CCR Enforcement Actions | Texas Health and Human Services

Child Care Regulation 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

Voluntary 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. CCR may recommend or impose any action if the risk to children at the operation warrants the recommended/imposed action.

Common Factors We Consider

Child Care Regulation 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 We Determine What Type of Action to Recommend

Once CCR 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 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: the ability to identify risk; accepts responsibility for correcting deficiencies; willingness to comply; and a history of maintaining corrections for ongoing compliance.	Yes. CCR 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 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: 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 We Can Impose an Administrative Penalty

CCR 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 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	744.1201(4)	Abuse, neglect, or exploitation of a child.
Before or After School or School-Age Programs	744.3805(4)	Safety precautions for loading and unloading children - no child unattended.
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	746.307(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 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	746.5605(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	747.2315(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	747.5405(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: a child in care was abused, neglected, or exploited; or the operation had a deficiency in a safe sleeping standard.
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: a child in care was abused, neglected, or exploited; or the operation had a deficiency in a safe sleeping standard.
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