What Texas inspectors cite the most
The 15 licensing rules TX HHSC inspectors cite most often — in plain English, with what evidence inspectors look for. Free director's reference, from the official TX HHSC record.
Source: TX HHSC public inspection records · last reviewed 5/11/2026
#1 most cited
Staff must have a cleared, active, eligible background check before being present at the operation.
Evidence inspectors look for
- Program director without active background check on file in CLASS database
- New hire allowed to start before fingerprint clearance returned
- Returning seasonal staff not re-screened
#2 most cited
Caregivers must directly supervise each child with physical proximity and visual or auditory awareness.
Evidence inspectors look for
- Children left without direct supervision during transitions
- Caregiver out of sight of children during routine activities
- Lack of supervision during outdoor play
#3 most cited
Annual fire inspection required from local authority before initial permit and every 12 months thereafter.
Evidence inspectors look for
- Fire inspection expired more than 12 months ago
- No documentation of last fire inspection on file
- Fire inspection completed but not by authorized local authority
#4 most cited
Daily safety checks of building, grounds, and equipment to identify and address hazards.
Evidence inspectors look for
- Damaged or hazardous equipment in child-use areas
- Daily safety check log not maintained
- Hazards observed during inspection that were missed in daily checks
#5 most cited
Caregivers must demonstrate competency, good judgment, and self-control with children at all times.
Evidence inspectors look for
- Caregiver loss of temper observed during interaction with child
- Inappropriate response to behavioral incident
- Caregiver judgment failure during minor incident
#6 most cited
Maintain required child-to-caregiver ratio at all times — including during transitions and breaks.
Evidence inspectors look for
- Multiple classrooms out of ratio across consecutive days (per video review)
- Ratio exceeded during caregiver break periods
- Late-arriving caregiver caused start-of-day ratio violation
#7 most cited
Each child record must include current immunization documentation, with exemptions properly documented.
Evidence inspectors look for
- Child file with no immunizations on file
- Immunizations not up to date for age
- Immunization record present but not signed by health-care provider
#8 most cited
Annually report to CCR by January 15 the number of employees who left in the prior calendar year.
Evidence inspectors look for
- Annual employee-turnover report not submitted by January 15 deadline
- Report submitted but with incomplete data
- Report submitted but for wrong calendar year
#9 most cited
Caregivers must not leave children unattended at any time, including during transitions, naps, or routines.
Evidence inspectors look for
- Child left unattended in classroom during recess transition
- Caregiver stepped away while children were sleeping
- Children unattended in bathroom or hallway
#10 most cited
Indoor and outdoor areas must be safe and free from hazards, including damaged or unsafe equipment.
Evidence inspectors look for
- Damaged or cracked toys with sharp edges
- Hazardous equipment not removed from child areas
- Cleaning supplies stored within child reach
#11 most cited
Written feeding instructions for infants must be reviewed and updated by parents every 30 days.
Evidence inspectors look for
- Infant feeding instructions older than 30 days on file
- Multiple infant files with outdated instructions
- Feeding instructions present but not reviewed/initialed by parent
#12 most cited
Annual sanitation inspection required from local health authority.
Evidence inspectors look for
- Sanitation inspection expired more than 12 months ago
- Inspection requested after compliance deadline
- Sanitation inspector deficiencies not addressed
#13 most cited
Caregivers must complete required annual training on specific topics within mandated timeframes; documentation maintained.
Evidence inspectors look for
- Annual emergency-preparedness training not completed
- Communicable-disease training not on file
- Training completed but not documented in personnel records
#14 most cited
Food allergy emergency plan required; caregivers must be aware of each child individual allergies.
Evidence inspectors look for
- Caregiver provided child food containing known allergen
- Food allergy emergency plan not signed by parent and physician
- Allergy posting not current in food preparation area
#15 most cited
Each child record must include a current statement of health from a health-care professional.
Evidence inspectors look for
- Child file missing health professional statement
- Statement on file but expired
- Statement not signed by licensed practitioner
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