CCR Enforcement Actions

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

Recommended Action
Enforcement ActionWhat 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:

  • the ability to identify risk;
  • accepts responsibility for correcting deficiencies;
  • willingness to comply; and
  • a history of maintaining corrections for ongoing compliance.
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:

  • identify risk; and/or
  • make the necessary changes to address underlying issues to reduce risk.

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 AmendmentThe 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:

  • identify risk; and/or
  • make the necessary changes to address underlying issues to reduce risk.
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:

  • identify risk; and/or
  • make the necessary changes to address underlying issues to reduce risk.
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

Administrative Penalties
Rule CategoryRule NumberShort Description
Human Resource Code42.048(b)Restrictions on the permit (Age Range, Type of Children)
Human Resource Code42.052(c)Listed Capacity* relative only homes
Health and Safety Code341.0646(c)(2)Failure to ensure that a child is wearing an approved, properly fitted and fastened life jacket when required.
Listed Family Homes742.303(1)(B)Abuse, neglect, or exploitation of a child.
Listed Family Homes742.307(3)(A) –(B)Listed Capacity
Listed Family Homes742.407(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 Programs744.201(11)Licensed Capacity
Before or After School or School-Age Programs744.207(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 Programs744.305(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 Programs744.305(a)(3)Failure to timely report to CCR that a child was ill and required hospitalization.
Before or After School or School-Age Programs744.307(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 Programs744.307(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 Programs744.311Failure 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 Programs744.1201(4)Abuse, neglect, or exploitation of a child.
Before or After School or School-Age Programs744.3805(4)Safety precautions for loading and unloading children - no child unattended.
Background Checks, Licensing745.621(a)(2)-(7)Initial Background Check
Background Checks, Licensing745.621(b)(1)(A)Renewal Background Check within Five Years
Background Checks, Licensing745.621(b)(1)(B)Renewal Background Check within Two Years
Background Checks, Licensing745.641Operation’s Compliance with Background Check Determination
Background Checks, Licensing745.635(2)A Person with an Ineligible Status is Present at Operation
Background Checks, Licensing745.635(3)Violation of Any Condition Placed on Background Check Determination
Licensed Child Care Center746.201(11)Licensed Capacity
Licensed Child Care Center746.207(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 Center746.305(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 Center746.305(a)(3)Failure to timely report to CCR that a child was ill and required hospitalization.
Licensed Child Care Center746.307(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 Center746.307(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:

  • a child in care was abused, neglected, or exploited; or
  • the operation had a deficiency in a safe sleeping standard.
Licensed Child Care Center746.1201(4)Abuse, neglect, or exploitation of a child.
Licensed Child Care Center746.2415(b)Cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age
Licensed Child Care Center746.2427Infants sleep on backs
Licensed Child Care Center746.5605(4)Safety precautions for loading and unloading children - no child unattended
Licensed and Registered Child Care Homes747.207(10)Licensed/Registered Capacity
Licensed and Registered Child Care Homes747.2315(b)Cribs - only snug fitting sheet and crib mattress cover allowed if infant younger than 12 months of age.
Licensed and Registered Child Care Homes747.2327Infants sleep on backs
Licensed and Registered Child Care Homes747.5405(4)Safety precautions for loading and unloading children - no child unattended
General Residential Operations748.155(a)Licensed Capacity
General Residential Operations748.160(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 Operations748.303(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 Operations748.303(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 Operations748.319(a)

Failure to timely report to a parent of each child in care that:

  • a child in care was abused, neglected, or exploited; or
  • the operation had a deficiency in a safe sleeping standard.
General Residential Operations748.535(2)Administrator fails to ensure the residential care operation complies with current Heightened Monitoring plan.
General Residential Operations748.1757(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 Operations748.1763(a)Infants sleep on backs
General Residential Operations748.2003(b)(3)Administration of medication-administer medications according to label instructions or a prescribing health-care professional's subsequent orders.
General Residential Operations748.4011(3)Safety precautions for loading and unloading children - no child unattended.
Child-Placing Agencies749.159(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 Agencies749.503(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 Agencies749.503(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 Agencies749.519(a)

Failure to timely report to a parent of each child in care that:

  • a child in care was abused, neglected, or exploited; or
  • the operation had a deficiency in a safe sleeping standard.
Child-Placing Agencies749.635(2)Administrator fails to ensure the CPA complies with current Heightened Monitoring plan.
Child-Placing Agencies749.1463(b)(3)Administration of medication-administer medications according to label instructions or a prescribing health-care professional's subsequent orders.
Child-Placing Agencies749.1813(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 Agencies749.1815(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 Agencies749.2557(a)Licensed Capacity