Residential Child Care Regulation Standards FAQs


Can a foster parent or facility caregiver post something about a child in care on Twitter, Facebook or any other Internet or social networking site?

No. Rules 748.1101 and 749.1003 require that you ensure the child's right to confidential care and treatment. Confidential care and treatment includes refraining from identifying a foster child or child in residential care as such in any internet communications with others, including social networking sites. Pictures or information identifying a child as a foster child or child in residential care on the Internet, including social networking sites, violates the child's right to confidential care.

How are tuberculosis screening results required to be documented?

Some health care professionals will document the results as "positive" or "negative," while others may measure a person's reaction to the screening as "no induration" or in millimeters. Recently, more health care professionals have been documenting tuberculosis screening results based on the millimeters of the induration (palpable, raised, hardened area or swelling). Minimum standards do not require the results to be documented using specific terminology. You are only required to maintain documentation of the screening results, and to seek further medical treatment as required.

Am I required to make a serious incident report if a child chokes himself or if a child is choked by another person?

Choking must be reported to Texas Health and Human Services Child Care Licensing and the child's parent if the incident meets serious incident reporting requirements related to attempted suicide, critical injury, physical abuse or child-on-child physical abuse.

Serious Incidents
Serious Incident (i) To Licensing?
(ii) If so, when?
S(i) To Parents?
(ii) If so, when?
(2) A critical injury or illness that warrants treatment by a medical professional or hospitalization, including dislocated, fractured, or broken bones; concussions; lacerations requiring stitches; second and third degree burns; and damage to internal organs. (A)(i) YES
(A)(ii) Report as soon as possible, but no later than 24 hours after the incident or occurrence.
(B)(i) YES
(B)(ii) Report as soon as possible, but no later than 24 hours after the incident or occurrence.
(3) Allegations of abuse, neglect, or exploitation of a child; or any incident where there are indications that a child in care may have been abused, neglected, or exploited. (A)(i) YES
(A)(ii) As soon as you become aware of it.
(B)(i) YES
(B)(ii) As soon as you become aware of it.
(4) Physical abuse committed by a child against another child. For the purpose of this subsection, physical abuse is:
physical injury that results in substantial bodily harm and requiring emergency medical treatment, excluding any accident; or failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial bodily harm to a child.
(A)(i) YES
(A)(ii) As soon as possible, but no later than 24 hours after the occurrence or incident.
(B)(i) YES
(B)(ii) As soon as possible, but no later than 24 hours after the occurrence or incident.
(11) A suicide attempt by a child. (A)(i) YES
(A)(ii) As soon as you become aware of the incident.
(B)(i) YES
(B)(ii) As soon as you become aware of the incident.

If a caregiver spanks a child, is this reportable as a serious incident?

Minimum Standards do not allow spanking or hitting of children in any way. However, spankings are not reportable to CCL as serious incidents unless the child is hit in the head/face or other vital area OR unless the spanking leaves marks or results in an injury requiring medical attention. Otherwise, the incident would be addressed internally by the facility or child-placing agency by helping the caregiver learn and use appropriate discipline and guidance techniques.

In what circumstances during an inspection or investigation will CCL document technical assistance related to compliance with a minimum standard?

Technical assistance may be documented with or without a citation of the minimum standard. In order to encourage future compliance with a standard, we may provide technical assistance regarding correction of a citation and document accordingly. Regardless of whether we provide and document technical assistance, the operation remains responsible for compliance with minimum standards.

If we do not cite a standard, we may still document a discussion regarding compliance with a standard that includes technical assistance. For example, there could be a discussion between Licensing staff and the permit holder or someone else at the operation during the inspection or investigation concerning compliance with a minimum standard in relation to a possible expansion of the operation or another change in the operation.

If I admit children in the conservatorship of Child Protective Services, can I be cited for an incomplete Placement Authorization Form 2085?

You are not in compliance if the form is not signed by any CPS personnel, or does not include the reason for placement and the estimated length of time in care. You are in compliance even if the CPS supervisor does not co-sign with the CPS caseworker.

Which children are allowed to go on hunting trips or participate in other activities that involve firearms, weapons, explosives, projectiles or toys that explode or shoot (such as BB guns)?

Answer: There are two requirements in CCL Minimum Standards:

  1. For facilities, children receiving emergency care services or treatment services are not permitted to use firearms, weapons, explosives, projectiles or toys that explode or shoot.All children in Residential Treatment Centers are considered to be receiving treatment services, so this requirement applies to all children residing in RTCs.
  2. For all other children residing in facilities and foster homes, the operation must determine that it is appropriate for a specific child to use firearms, weapons, explosives, projectiles or toys that explode or shoot.

If a child is in the conservatorship of Child Protective Services, additional contractual requirements apply.

Before CPS approves the use of firearms for hunting:

  • The child must be at least 12 years old.
  • The child must complete the Texas Hunter Education course facilitated by the Texas Parks and Wildlife Department.
  • The child must purchase a hunting license.
  • The CPS caseworker, supervisor, and program director must grant permission for the activity.
  • The adult accompanying the child must sign Form 1704, Acknowledgement of Hunting Supervision Responsibility for Youth in DFPS Conservatorship, which is a statement acknowledging his or her responsibility in supervising the child. Contact the CPS caseworker for form. The signed Form 1704 must be filed in the child’s record.

The CPS caseworker grants permission for the activity based on the child’s history and behaviors as well as the recommendations of the caregiver. The child’s biological parents are consulted, if parental rights have not been terminated and the parents can be located with reasonable efforts. Others may also be consulted, such as the child’s attorney ad litem or Court Appointed Special Advocate worker.

While using firearms, the youth must be accompanied and supervised at all times by a responsible adult who:

  • Holds a hunting license
  • Has gun safety knowledge
  • Has experience handling guns
  • Complies with the Texas Parks and Wildlife regulations

Is constant eyesight supervision required for infants and toddlers?

No. Supervision requirements include “auditory and/or visual awareness of each child’s ongoing activity as appropriate” and prohibits infants and toddlers from being “left unsupervised.” Each child must receive the level of supervision that is appropriate based on that child’s age, behaviors and any special needs. Infants and toddlers must never be left unsupervised, but this does not mean they must be in constant eyesight. It does mean that they should not be left outdoors or indoors without an adult. A sleeping infant or toddler is considered supervised if the caregiver is within eyesight or hearing range of the child and can intervene as needed, or if the caregiver uses a video camera or audio monitoring device to monitor the child and is close enough to the child to intervene as needed.

  • Example: An infant, who was playing with pots and pans in a corner of the kitchen, crawls into the living room while the foster mother is cooking dinner. The living room is child proof and the foster mother can hear the infant. There are no other known hazards. She finishes chopping an onion and then goes to carry the infant back into the kitchen. This is appropriate supervision.
  • Example: A toddler is napping. The foster father is in the next room paying bills. The foster father can clearly hear the toddler when he awakens and begins to make any noise. This is appropriate supervision.
  • Example: A foster father is helping one toddler with toileting when another toddler wanders out of the bathroom into his foster sister’s bedroom. The foster sister is eight years old and plays with the toddler for 10 minutes while the foster father gets the other toddler ready for bed. This is appropriate supervision.

Can I continue to care for a resident who turns 18 years old? Can I admit someone who has already turned 18 years old?

Licensing rules allow you to maintain a resident after they turn 18 years old if the resident is remaining in your care under one of the following circumstances (748.1931 or 749.1103):

(a)A young adult may remain in your care until his 23rd birthday in order to:

  1. Transition to independence, including attending college or vocational or technical training.
  2. Attend high school, a program leading to a high school diploma, or GED classes;.
  3. Complete your program.
  4. Stay with a minor sibling.

(b)A young adult who turns 18 in your care may remain in your care indefinitely if the person:

  1. Continues to need the same level of care.
  2. Is unlikely to physically and/or intellectually progress over time.

Licensing rules (748.1933 or 749.1105) allow you to admit a resident after they have turned 18 years old if the resident is being admitted into a transitional living program, is in the care of DFPS, or is coming from another licensed residential child care operation and is being admitted for the reasons noted above. Any young adult in the CPS Extended Care Program may be admitted or maintained in care under these licensing rules, as long as the young adult meets your admission criteria and can be appropriately cared for in your program/setting.

An adult in care at your operation does not affect the age range on your license or a foster home’s verification, as CCL does not regulate the care of adults. However, the care of these adults must comply with relevant minimum standards as outlined below.

General residential operations and residential treatment centers:

  • Admission policies must address admission of adults into your program.
  • Serious incidents for adult residents are not reported to CCL, but are documented and reported to law enforcement as required by minimum standards. Serious incidents are reported to parents as required by minimum standards if the adult resident is not capable of making decision about his/her own care.
  • Child/caregiver ratio must include all residents in care, or caregivers must be assigned to work exclusively with the children or exclusively with the adults.
  • All persons living at the facility, including adults, must be screened for tuberculosis; this applies regardless of whether or not the person is in care.
  • You are not required to conduct a background check on adults in care.
  • An adult in care can share a bedroom with a child in care if the conditions in 748.1937 are met; square footage requirements must be met as if the adult were a child in care.
  • Square footage requirements for general living space must be met as if the adult were a child in care.

Child-placing agencies:

  • Admission policies must address admission of adults into your program.
  • Serious incidents for adult residents are not reported to CCL, but are documented and reported to law enforcement as required by minimum standards. Serious incidents are reported to parents as required by minimum standards if the adult resident is not capable of making decision about his/her own care.
  • Child/caregiver ratio does NOT include adults in care, but adults in care are counted in the capacity of the home. Care and supervision provided to foster children must not be adversely impacted (see 749.103(10) regarding conflict of care) .
  • Adults in care must be screened for tuberculosis, just as any other person living in the home.
  • You are NOT required to conduct a background check on adults in care.

Can I offer respite child-care? How do you determine if a child is in respite child-care, not just on a visit?

Both facilities and child-placing agencies can offer respite child-care.    For facilities, children in respite child-care must be physically separated from other children except those receiving emergency care services. Respite child-care is defined as care lasting longer than 72 hours. Therefore, shorter periods of care are not regulated as respite child-care. Please refer to the minimum standards for more detailed requirements regarding respite care.

If I need help interpreting a minimum standard, what should I do?

If you have discussed your question with your CCL representative and still need additional information, you should contact the CCL representative's supervisor or send an email to the RCCL Standards mailbox. The email box is checked each business day and each email receives an individual response from the standards specialist in State Office.

Chapter 748 Only (General Residential Operations)

Do emergency care services have to meet the same requirements for treatment services as other types of care?

Only an emergency care services program that plans to admit a specific child population requiring treatment services, for example emergency care specifically for children with intellectual disabilities, will be required to meet treatment service standards. Emergency care service programs which do not limit their admissions with regard to treatment service needs are not expected to meet requirements related to treatment services. However, all admissions must meet the program's admission policies, and the program must be able to meet the needs of each child admitted for emergency care.

How is successive restraint use documented and counted?

748.2751(b) requires that successive restraint use comply with time limits in the minimum standards based on the time spent in the personal restraints being cumulative. Each restraint must be documented separately, including de-escalation attempted before each separate restraint. Each restraint also must be counted separately for the purposes of quarterly data reporting and the evaluation of data as part of the required annual emergency behavior intervention review (see 748.2953).

Chapter 749 Only (Child-Placing Agencies)

What verifying documentation do I need to accompany a home screening?

§749.2447 and §749.3623 list what must be included in the home screening. Select items must be verified through documentation: Ages of the prospective foster or adoptive parents

  • Information on the family’s income.
  • Required background checks.
  • Medical insurance coverage plans for the child (adoptive home only).
  • You must review and document the marriage license or declaration of marriage record (adoptive home only).

Do law enforcement or military personnel have different requirements related to weapons storage?

No. All foster parents must comply with the requirements related to weapons storage and weapons in vehicles. 

How does my CPA comply with the requirements to submit quarterly emergency behavior intervention data to HHSC and conduct an annual evaluation of emergency behavior interventions?

The CPA may choose to have the main office and each branch office comply with these requirements independently, or choose to comply with these requirements with one report and one evaluation for the CPA as a whole. However, the CPA's choice must be implemented consistently throughout the CPA. Please inform each of your assigned Licensing Representatives of how you intend to comply with these requirements.

Who can I contact at the Texas Department of State Health Services to do a health inspection for a foster home?

DSHS has informed HHSC that they are no longer able to conduct health inspections in foster homes. If the local authorities cannot conduct a health inspection for a foster home, document your attempts to schedule a health inspection with the local authority and use the Form 4004, Residential Child Care Licensing Environmental Health Checklist.

Is the child-to-caregiver ratio for a foster home based on the services that the home is verified to provide or on the children actually placed in the home?

The child-to-caregiver ratio for a foster home is based on the children in care at the time.

For example, if a foster home is verified to provide child-care services and treatment services for children with intellectual disabilities from birth to 10 years old, the required child to caregiver ratio would depend on the ages and needs of the children in care at any given time.

Child-to-caregiver Ratio
Children under 5 years old Children 5 years old and older Children Receiving Child-Care Services Children Receiving Treatment Services Total Number of Children Child to Caregiver Ratio
0 7 5 2 7 1:8
2 5 5 2 7 1:5
0 7 4 3 7 1:4
2 5 4 3 7 1:4

How does a child-placing agency distinguish between a babysitter, a respite care provider and a caregiver?

A person is considered a babysitter if they are not affiliated with the agency (not an employee, verified foster parent, or official volunteer) and only provide occasional care for short periods. If a person regularly provides care in the home (every day, or every evening, or every week day, etc.), then they are a caregiver and must meet all caregiver requirements in the minimum standards. Care provided outside of the foster home for more than 72 hours by a person who is not a regular caregiver in the home is respite care.

Can I obtain information from the Attorney General’s office regarding whether or not a potential foster or adoptive parent owes child support?

This information is not available to the general public unless the person is listed as a “child support evader.” See the Attorney General’s website for information on individuals listed as child support evaders. You can ask the potential foster or adoptive parent to request Form 1A004, Release of Information, from the Attorney General’s office, and have the person complete the form so that the Attorney General’s office can release specific information to you about that person. The individual in question must request the form and fill it out, not the child-placing agency.

In a foster home caring for children with primary medical needs, can the home health agency nurses count in the child-to-caregiver ratio for the home?

The nurse may be counted in the child-to-caregiver ratio if they meet all minimum standard requirements for a caregiver, including training requirements, and is not on duty for the home health agency. Medicaid rules require that a home health nurse may only provide care to the child(ren) to whom the nurse is assigned while on duty for the home health agency, and may not be left alone in the home while on duty for the home health agency. A foster parent or responsible adult must be in the home to provide care or implement a contingency plan in the event a home health nurse does not arrive for a scheduled shift or must leave the home unexpectedly.