Ten Most Frequently Cited Violations for Home and Community Support Services Agencies (HCSSAs)

Texas Health and Human Services Logo  

 

Welcome

Health and Human Services Commission (HHSC) is required to report survey and enforcement data every year. This data is captured in the Regulatory Services Annual Report. Part of this report includes the top 10 violations cited during the fiscal year. The top 10 violations for Home and Community Support Services Agencies (HCSSAs) in Fiscal Year 2022 are covered in this course.

The report may be accessed online using the following link:

HHSC Long-Term Care Regulation Annual Report for FY 2022 (texas.gov)

 

 

The Goal

The goal of the HCSSA survey is to determine if the HCSSA provider is in compliance with applicable Texas Administrative Code (TAC) chapters.

Surveyors determine whether or not to cite a program provider based on observations, interviews, and record review.

They also determine if the provider is ensuring individuals' dignity is respected and that their rights are being protected.

TAC Title 26, Chapter 558, Licensing Standards for Home and Community Support Services Agencies

 

Top 10 Rankings

FY 2022

Ranking

Citation

TAC Reference

FY 2021 Ranking

1

Quality Assessment and Performance Improvement - Level B

§558.287(a)(1)

1

2

Self-Reported Incidents of Abuse, Neglect and Exploitation - Level B

26 TAC §558.249(c)(1)-(2)

3

3

Verify Employability/Use Unlicensed Personnel - Level B

26 TAC §558.247(a)(5)(B)

4

4

Continuing Education in Agency Administrator - Level B

26 TAC §558.260(a)

6

5

Personal Assistance Services - Level A

26 TAC §558.404(f)(2)

Not Ranked

6

Quality Assessment and Performance Improvement - Level B

26 TAC §558.287(c)

7

7

Agency Cooperation with a Survey

26 TAC §558.507(a)

9

8 [TIED]

Staffing Policies - Level B

26 TAC §558.245(a)

8

8 [TIED]

Verify Employability/Use Unlicensed Personnel

26 TAC §558.247(a)(3)

Not Ranked

10

Infection Control - Level B

26 TAC §558.285(1)(B)

Not Ranked

Disclaimer:

All examples provided for this training are for illustrative purposes only. We acknowledge that examples may not contain all potential details but are meant to show basic non-compliance.

 

 

#1: Quality Assessment and Performance Improvement - Level B

26 TAC §558.287(a)(1)

Summary

The agency failed to have, implement, and review a Quality Assessment and Performance Improvement (QAPI) program consistent with state requirements.

Example

The agency failed to maintain a QAPI program in that the agency's total operation was not evaluated annually by the QAPI Committee for 2020, 2021 and 2022.  

This failure has the potential to place the agency's active clients receiving personal assistance services at risk of receiving inadequate care and services due to the agency's inability to trend patterns of negative client care outcomes; complaints and incidents of misconduct by unlicensed staff; infection control activities; and effectiveness and safety of all services provided, including: the competency of the agency's staff;   the promptness of service delivery; and the appropriateness of the agency's responses to client complaints and incidents; a determination that services have been performed as outlined in the individualized service plan, care plan, or plan of care; and an analysis of client complaint and satisfaction survey data.

 

 

#2: Self-Reported Incidents of Abuse, Neglect and Exploitation

26 TAC §558.249(c)(1)-(2)

Summary

The agency failed to immediately report within 24 hours, knowledge of an alleged act of abuse, neglect, or exploitation (ANE) of a client by an agency employee, contractor, or volunteer to the Department of Family and Protective Services (DFPS) and to HHSC.

Example

The agency learned of an incident on 12/31/2021 but did not report it to HHSC until 01/03/2022, three days later.

This failure has the potential to place the agency's clients at risk of further ANE and prevents HHSC from doing timely investigations.

 

 

#3: Verify Employability/Use Unlicensed Personnel - Level B

26 TAC §558.247(a)(5)(B)

Summary

The agency failed, after the initial verification of employability, to search the nurse aide and employee misconduct registries at least every 12 months for an unlicensed employee with face-to-face client contact who was most recently hired on or after September 1, 2009.

Example

The agency failed to conduct a search of the Nurse Aide Registry (NAR)/Employee Misconduct Registry (EMR), using the HHSC Internet website, at least every 12 months for unlicensed employees hired after 09/01/2009 and whose duties include direct client contact in five of five unlicensed employee personnel records reviewed whose employment exceeded one year for years 2021 and 2022.

 

This failure could potentially place agency clients at risk of ANE in the event the employees were listed on either registry as unemployable during the 12 months the searches were not conducted.

 

#4: Continuing Education in Agency Administrator - Level B

26 TAC §558.260(a)

Summary

The agency's administrator or alternate administrator failed to complete 12 hours of continuing education in the required topics within each 12 months in that job as required for the position of the administrator or alternate administrator of an agency.

Example:

The agency's Administrator failed to complete 12 clock hours of continuing education in 2020 and 2021.  

This failure could place the agency's active clients at risk of having care and services directed by individuals that did not have the required educational training in administration to supervise and direct the day-to-day functioning of the agency.

 

#5: Personal Assistance Services - Level A

26 TAC §558.404(f)(2)

Summary

The agency failed to make sure the files of clients receiving personal assistance services (PAS) included a properly developed individualized service plan that had all the required elements.

Example

The agency failed to include a properly developed Individual Service Plan which included the planned date of service initiation that was agreed upon and signed by the client or the client's family and the agency in four of six client records reviewed.

This failure could place clients at risk of receiving inadequate service or inappropriate care.

 

#6: Quality Assessment and Performance Improvement - Level B

26 TAC §558.287(c)

Summary

The agency failed to make sure its Quality Assessment and Performance Improvement (QAPI) committee met at least twice a year to address identified problems and concerns in service delivery.

Example

There was no documentation that the agency's QAPI committee had met twice a year for the 2021 and 2022 review periods.

 

#7: Agency Cooperation with a Survey

26 TAC §558.507(a)

Summary

The agency failed to consent to entry and survey by an HHSC surveyor to verify compliance with the statue or this chapter.

Example:

The administrator and alternate administrator were not available to allow an HHSC surveyor to conduct a re-licensure survey to determine the agency's compliance with the licensing standards, laws and state statute.

This failure places all clients at risk of poor outcomes from the agency's inability to direct agency services.  

 

#8 [TIED]: Staffing Policies - Level B

26 TAC § 558.245(a)

Summary

The agency failed to enforce staffing policies that governed all staff used by the agency, including employees, volunteers and contractors.

Example

The agency did not have documentation of annual performance evaluations for volunteers.

 

 

#8 [TIED]: Verify Employability/Use Unlicensed Personnel - Level B

26 TAC §558.247(a)(3)

Summary

The agency employed an unlicensed person with face-to-face client contact before it searched the nurse aide and employee misconduct registries or employed an unlicensed person who was listed in either registry as unemployable.

Example

Review of one home health attendant's personnel record contained an HHSC NAR/EMR search result, dated 08/19/20, one day after the home health attendant's first face to face contact with a client.

 

#10: Infection Control - Level B

26 TAC §558.285(1)(B)

Summary

The agency failed to have written policies to control infections and communicable diseases to ensure staff met certain Occupational Safety and Health Administration (OSHA) requirements.

Example

The Staff Nurse had a hire date of 11/09/20 and the personnel record failed to include initial or annual bloodborne pathogens (BBP) training since date of hire.

This failure has potential to put staff at greater risk of exposure to bloodborne pathogens.

 

Conclusion

Many violations reoccur from year to year. Knowing the most commonly cited violations may help you anticipate issues and resolve them to maintain compliance and avoid a citation.

QAPI was the top cited violation for Fiscal Year 2022. What can agencies do to avoid being cited for QAPI?

Reviewing and updating or revising the QAPI plan of implementation at least once within a calendar year, or more if needed, is the foundation for accomplishing strategic objectives and goals. The QAPI Committee must meet twice a year or more if needed and document it. This ensures identified areas of improvement have been addressed.

In preparation of future surveys, agencies should review and implement their QAPI plan to make self-determination of compliance, particularly in accordance with the most-frequently cited violations.

 

Contact

HHSC Long-Term Care Regulation

LTCRPolicy@hhs.texas.gov

https://hhs.texas.gov/