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
745.641 High severity

Staff must have a cleared, active, eligible background check before being present at the operation.

Evidence inspectors look for
#2 most cited
746.1205(a)(4) High severity

Caregivers must directly supervise each child with physical proximity and visual or auditory awareness.

Evidence inspectors look for
#3 most cited
746.5101(a) High severity

Annual fire inspection required from local authority before initial permit and every 12 months thereafter.

Evidence inspectors look for
#4 most cited
746.3407 Med-High severity

Daily safety checks of building, grounds, and equipment to identify and address hazards.

Evidence inspectors look for
#5 most cited
746.1201(1) High severity

Caregivers must demonstrate competency, good judgment, and self-control with children at all times.

Evidence inspectors look for
#6 most cited
746.1601 Med-High severity

Maintain required child-to-caregiver ratio at all times — including during transitions and breaks.

Evidence inspectors look for
#7 most cited
746.603(a)(4) Medium severity

Each child record must include current immunization documentation, with exemptions properly documented.

Evidence inspectors look for
#8 most cited
746.303(b) Med-Low severity

Annually report to CCR by January 15 the number of employees who left in the prior calendar year.

Evidence inspectors look for
#9 most cited
746.1203(4) High severity

Caregivers must not leave children unattended at any time, including during transitions, naps, or routines.

Evidence inspectors look for
#10 most cited
746.3701 Med-High severity

Indoor and outdoor areas must be safe and free from hazards, including damaged or unsafe equipment.

Evidence inspectors look for
#11 most cited
746.2421(b) Medium severity

Written feeding instructions for infants must be reviewed and updated by parents every 30 days.

Evidence inspectors look for
#12 most cited
746.3401(a) Med-High severity

Annual sanitation inspection required from local health authority.

Evidence inspectors look for
#13 most cited
746.1309(e) Medium severity

Caregivers must complete required annual training on specific topics within mandated timeframes; documentation maintained.

Evidence inspectors look for
#14 most cited
746.3819 Med-High severity

Food allergy emergency plan required; caregivers must be aware of each child individual allergies.

Evidence inspectors look for
#15 most cited
746.603(a)(3) Medium severity

Each child record must include a current statement of health from a health-care professional.

Evidence inspectors look for

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