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The Texas Health and Human Services Commission (HHSC) may recommend or take an enforcement action on a child care operation to help that operation come into compliance with state laws, rules and minimum standards while reducing risk to children in child care settings.
Types of Enforcement Actions
- Plan of Action
- Probation
- Adverse Actions (Adverse Amendment, Denial, Refuse to Renew, Revocation, Involuntary or Emergency Suspension)
- Judicial Actions
- Administrative Penalties
Enforcement actions are not progressive in nature. HHSC may recommend or impose any action if the risk to children at the operation warrants the recommended/imposed action.
Common Factors HHSC Considers
HHSC takes into account several factors which influence risk when recommending or imposing enforcement actions. The factors below are the most common, but other factors may be considered based on the specific case or circumstances.
Governing Body and Staffing
- Level of involvement the governing body has in the operation
- Ability to identify operation needs
- Knowledge behind intent of standards
- Knowledge of the operation’s policy and procedures
- Other history as a permit holder, governing body member, or a controlling person
Compliance History
- Scope and severity of deficiencies
- Patterns of deficiencies
- Repetition of deficiencies
- Investigation history
- Responsiveness to deficiencies
- Previous enforcement actions
Nature of the Risk
- Isolated serious incident caused or may have caused injury or death
- Systemic issues at the operation negatively impact the health and safety of children in care and caused or may have caused injury or death
Impact that Other Factors Have on Risk
- Operation capacity
- Type of permit
- Type of services provided
- Number of children impacted by enforcement action
- Impact to the community
- Involvement from other governmental agencies
How HHSC Determines What Type of Action to Recommend
Once HHSC has assessed the risk factors outlined above, a specific enforcement action is recommended or imposed according to the table below.
Recommended Action
| Enforcement Action | What is the capability of the governing body or permit holder? | Limitation on Using This Enforcement Action? | Can risk be mitigated while the operation continues to operate? |
|---|---|---|---|
| Plan of Action | The governing body or permit holder has demonstrated all of the following:
| Yes. Child Care Regulation may only offer a Plan of Action as an enforcement action if the operation does not have history of a POA within the previous 12 months for similar deficiencies. | Yes, by following the agreed upon plan to improve compliance. |
| Probation | The governing body or permit holder has repeatedly demonstrated the inability to:
In addition, the governing body or permit holder is willing and able to make necessary corrections, with intervention from HHSC. | No. The operation may or may not have had previous enforcement actions. | Yes, by following conditions HHSC has imposed. |
| Adverse Amendment | The governing body or permit holder is willing and able to abide by restrictions and conditions placed on the permit. | No. The operation may or may not have had previous enforcement actions. | Yes, if the operation abides by the restrictions or conditions placed on the permit. |
| Denial and Revocation | The governing body or permit holder has repeatedly demonstrated the inability to:
| No. The operation may or may not have had previous enforcement actions. | No. Children will be at risk of harm if the operation is allowed to operate or continue to operate. |
| Refuse to Renew | The governing body or permit holder has repeatedly demonstrated the inability to:
| No. The operation may or may not have had previous enforcement actions. | No. Children will be at risk of harm if the operation is allowed to operate or continue to operate. |
When HHSC Can Impose an Administrative Penalty
HHSC may impose an administrative penalty before imposing probation if the operation is out of compliance with background check requirements or if the operation has violated one of the following statutes or high risk rules.
Administrative Penalties
| Rule Category | Rule Number | Short Description |
|---|---|---|
| Human Resource Code | 42.048(b) | Restrictions on the permit (Age Range, Type of Children) |
| Human Resource Code | 42.052(c) | Listed Capacity* relative only homes |
| Listed Family Homes | 742.303(1)(B) | Abuse, neglect, or exploitation of a child. |
| Listed Family Homes | 742.307(3)(A) –(B) | Listed Capacity |
| Listed Family Homes | 742.407(a) – (c) | Failure to timely report to a parent of each child in care that the operation does not maintain the required liability insurance coverage. |
| Before or After School or School-Age Programs | 744.201(11) | Licensed Capacity |
| Before or After School or School-Age Programs | 744.207(a) – (b) | Failure to timely report to a parent of each child in care that the operation does not maintain the required liability insurance coverage. |
| Before or After School or School-Age Programs | 744.305(a)(2) | Failure to timely report to CCR that a child was injured and required medical treatment by a health-care professional or hospitalization. |
| Before or After School or School-Age Programs | 744.305(a)(3) | Failure to timely report to CCR that a child was ill and required hospitalization. |
| Before or After School or School-Age Programs | 744.307(b)(1) | Failure to timely report to a parent that a child was injured and required medical treatment by a health-care professional or hospitalization. |
| Before or After School or School-Age Programs | 744.307(b)(2) | Failure to timely report to a parent that a child that a child was ill and required hospitalization. |
| Before or After School or School-Age Programs | 744.311 | Failure to timely report to a parent of each child in care that a child in care was abused, neglected, or exploited. |
| Before or After School or School-Age Programs | 744.605(16)(A) - (B) | Failure to obtain required written admission information regarding a child’s swim competency and need for a PFD from a parent or guardian. |
| Before or After School or School-Age Programs | 744.1201(4) | Abuse, neglect, or exploitation of a child. |
| Before or After School or School-Age Programs | 744.3409(a) - (b) | Failure to ensure that a child is wearing an approved, properly fitted and fastened life jacket in good repair when required. |
| Before or After School or School-Age Programs | 744.3805(4) | Safety precautions for loading and unloading children - no child unattended. |
| Background Checks, Licensing | 745.621(a)(2)-(7) | Initial Background Check |
| Background Checks, Licensing | 745.621(b)(1)(A) | Renewal Background Check within Five Years |
| Background Checks, Licensing | 745.621(b)(1)(B) | Renewal Background Check within Two Years |
| Background Checks, Licensing | 745.641 | Operation’s Compliance with Background Check Determination |
| Background Checks, Licensing | 745.635(2) | A Person with an Ineligible Status is Present at Operation |
| Background Checks, Licensing | 745.635(3) | Violation of Any Condition Placed on Background Check Determination |
| Licensed Child Care Center | 746.201(11) | Licensed Capacity |
| Licensed Child Care Center | 746.207(a) – (b) | Failure to timely report to a parent of each child in care that the operation does not maintain the required liability insurance coverage. |
| Licensed Child Care Center | 746.305(a)(2) | Failure to timely report to CCR that a child was injured and required medical treatment by a health-care professional or hospitalization. |
| Licensed Child Care Center | 746.305(a)(3) | Failure to timely report to CCR that a child was ill and required hospitalization. |
| Licensed Child Care Center | 746.307(b)(1) | Failure to timely report to a parent that a child was injured and required medical treatment by a health-care professional or hospitalization. |
| Licensed Child Care Center | 746.605(16)(A) - (B) | Failure to obtain required written admission information regarding a child’s swim competency and need for a PFD from a parent or guardian. |
| Licensed Child Care Center | 746.307(b)(2) | Failure to timely report to a parent that a child that a child was ill and required hospitalization. Licensed Child Care Center 746.311(a) Failure to timely report to a parent of each child in care that:
|
| Licensed Child Care Center | 746.1201(4) | Abuse, neglect, or exploitation of a child. |
| Licensed Child Care Center | 746.2415(b) | Cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age |
| Licensed Child Care Center | 746.2427 | Infants sleep on backs |
| Licensed Child Care Center | 746.5009(a) - (b) | Failure to ensure that a child is wearing an approved, properly fitted and fastened life jacket in good repair when required. |
| Licensed Child Care Center | 746.5605(4) | Safety precautions for loading and unloading children - no child unattended |
| Licensed and Registered Child Care Homes | 747.207(10) | Licensed/Registered Capacity |
| Licensed and Registered Child Care Homes | 747.605(16)(A) - (B) | Failure to obtain required written admission information regarding a child’s swim competency and need for a PFD from a parent or guardian. |
| Licensed and Registered Child Care Homes | 747.2315(b) | Cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age. |
| Licensed and Registered Child Care Homes | 747.2327 | Infants sleep on backs |
| Licensed and Registered Child Care Homes | 747.4811(a) - (b) | Failure to ensure that a child is wearing an approved, properly fitted and fastened life jacket in good repair when required. |
| Licensed and Registered Child Care Homes | 747.5405(4) | Safety precautions for loading and unloading children - no child unattended |
| General Residential Operations | 748.155(a) | Licensed Capacity |
| General Residential Operations | 748.160(a) – (b) | Failure to timely report to a parent of each child in care that the operation does not maintain the required liability insurance coverage. |
| General Residential Operations | 748.303(a)(2)(A) | Failure to report to CCR a critical illness that a reasonable person would conclude needs treatment by a medical professional or hospitalization. |
| General Residential Operations | 748.303(a)(2)(B) | Failure to report to a parent a critical illness that a reasonable person would conclude needs treatment by a medical professional or hospitalization. |
| General Residential Operations | 748.319(a) | Failure to timely report to a parent of each child in care that:
|
| General Residential Operations | 748.535(2) | Administrator fails to ensure the residential care operation complies with current Heightened Monitoring plan. |
| General Residential Operations | 748.1757(b) | Prohibited equipment for infants-cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age. |
| General Residential Operations | 748.1763(a) | Infants sleep on backs |
| General Residential Operations | 748.2003(b)(3) | Administration of medication-administer medications according to label instructions or a prescribing health-care professional's subsequent orders. |
| General Residential Operations | 748.4011(3) | Safety precautions for loading and unloading children - no child unattended. |
| Child-Placing Agencies | 749.159(a) – (b) | Failure to timely report to a parent of each child in care that the operation does not maintain the required liability insurance coverage. |
| Child-Placing Agencies | 749.503(a)(2)(A) | Failure to report to CCR a critical illness that a reasonable person would conclude needs treatment by a medical professional or hospitalization. |
| Child-Placing Agencies | 749.503(a)(2)(B) | Failure to report to a parent a critical illness that a reasonable person would conclude needs treatment by a medical professional or hospitalization. |
| Child-Placing Agencies | 749.519(a) | Failure to timely report to a parent of each child in care that:
|
| Child-Placing Agencies | 749.635(2) | Administrator fails to ensure the CPA complies with current Heightened Monitoring plan. |
| Child-Placing Agencies | 749.1463(b)(3) | Administration of medication-administer medications according to label instructions or a prescribing health-care professional's subsequent orders. |
| Child-Placing Agencies | 749.1813(b) | Prohibited equip for infants-Cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age. |
| Child-Placing Agencies | 749.1815(a) | Infant sleep requirements-must place an infant not able to turn over in face-up sleeping position unless health-care professional orders otherwise. |
| Child-Placing Agencies | 749.2557(a) | Licensed Capacity |