Reporting Abuse, Neglect, and Exploitation

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

This policy establishes how Sample Home Care Agency, LLC (the "Agency") recognizes, reports, and responds to abuse, neglect, and exploitation of a client. Texas requires every home and community support services agency to adopt and enforce a written policy relating to its procedures for reporting alleged acts of abuse, neglect, and exploitation of a client by an employee of the agency (26 TAC §558.249(b)). Separately, Texas Human Resources Code §48.051 requires every person who has cause to believe that an elderly person, a person with a disability, or an individual receiving services from a licensed home and community support services agency is in a state of abuse, neglect, or exploitation to report it immediately. For an individual receiving services from a licensed home and community support services agency, the statute sends the report to the Health and Human Services Commission (HHSC) (Tex. Hum. Res. Code §48.051(b-1)), and HHSC Provider Letter PL 2023-12 directs abuse, neglect, and exploitation by agency staff to HHSC and abuse by anyone else, and self-neglect, to the Department of Family and Protective Services (DFPS). Suspected abuse or neglect of a child is reported to DFPS under Texas Family Code §261.101. This policy satisfies each duty and makes clear that the duty to report is personal, immediate, and never delegated to a supervisor’s judgment.

This policy applies to every employee, contractor, volunteer, officer, and agent of the Agency, in every setting where Agency services are provided, and to every client regardless of age, diagnosis, or source of payment. It covers acts alleged against Agency personnel and acts alleged against any other person, including family members and other caregivers. No provision of this policy may be waived, shortened, or varied by any employee.

For the purposes of this policy the following meanings apply. The legal definitions of abuse, neglect, and exploitation are those adopted by 26 TAC §558.249(a)(1) (26 TAC Chapter 711, Subchapter A, and 40 TAC Chapter 705, Subchapter A); the descriptions below are for staff use and do not narrow them.

• Abuse means the negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment resulting in physical or emotional harm or pain, or any involuntary or nonconsensual sexual conduct.
• Neglect means the failure of a caretaker to provide the goods or services, including medical services, necessary to avoid physical or emotional harm or pain. Self-neglect is a client’s own failure, because of physical or mental limits, to provide for their basic needs.
• Exploitation means the illegal or improper use, or attempted use, of a client’s resources or identifying information for monetary or personal benefit without the client’s informed consent.
• Cause to believe means knowing, suspecting, or receiving an allegation regarding abuse, neglect, or exploitation (26 TAC §558.249(a)(4)). Certainty and proof are not required.
• Immediately means without delay. For the Agency’s own report of abuse, neglect, or exploitation by an Agency employee, 26 TAC §558.249(c) says "immediately, meaning within 24 hours". The 24 hours are the outer limit, not a target.
• Employee, for reporting purposes, means an officer, an individual directly employed by the Agency, or a contractor, volunteer, or agent working under the Agency’s auspices (26 TAC §558.249(a)(6)).
• Child means a client under 18 years of age who is not and has not been married and has not had the disabilities of minority removed; every other client is an adult (26 TAC §558.249(a)(2), (5)).

Every client has the right to be free from abuse, neglect, and exploitation by an Agency employee, volunteer, or contractor (26 TAC §558.282(f)(6)). The Agency does not tolerate abuse, neglect, or exploitation in any form, by any person, and treats every allegation as credible until a proper investigation shows otherwise.

Any member of Agency personnel who has cause to believe that a client has been or is being abused, neglected, or exploited tells the Administrator at once, and the report to the state is made immediately by the route below. Where an Agency employee, volunteer, contractor, or agent may be involved, the Administrator reports to HHSC Complaint and Incident Intake on 1-800-458-9858 immediately, and never later than 24 hours after the Agency has cause to believe (Tex. Hum. Res. Code §48.051(b-1); 26 TAC §558.249(c); HHSC PL 2023-12). Where anyone else may be involved, or the client is neglecting their own basic needs, the report goes to DFPS on 1-800-252-5400, or online at www.txabusehotline.org where no one is in immediate danger (Tex. Hum. Res. Code §48.051(a); HHSC PL 2023-12). Where the client is a child, the report goes to DFPS under Tex. Fam. Code §261.101, and also to HHSC if Agency staff may be involved. 26 TAC §558.249(c) still names both DFPS and HHSC for staff cases; the Agency follows the statute and HHSC’s provider letter, which send staff cases to HHSC.

If the Administrator and the Alternate Administrator cannot be reached at once, the staff member makes the report personally. The duty to report under Tex. Hum. Res. Code §48.051 belongs to each person, applies to every person whose knowledge comes from their employment (Tex. Hum. Res. Code §48.051(c)), and is never met by telling a coworker. A staff member who is a professional under Tex. Fam. Code §261.101(b), for example a licensed nurse or an employee of the Agency with direct contact with children, reports suspected child abuse or neglect "not later than the 24th hour after the hour the professional first has reasonable cause to believe" and may not delegate the report.

No member of staff, including the Administrator, may decide that an allegation is unfounded and therefore need not be reported. Screening, filtering, or delaying a report pending an internal review is a violation of this policy. Knowingly failing to report is a criminal offense under Tex. Hum. Res. Code §48.052, and a person who reports in good faith is immune from civil and criminal liability under §48.054.

The Agency does not retaliate against any client, family member, employee, or other person for making a report or cooperating with an investigation (26 TAC §558.250(e)), and does not reduce, reschedule, or discontinue services because a report was made.

The following steps apply in order. Steps 1 to 3 are completed immediately; the report to HHSC of abuse, neglect, or exploitation by Agency staff is never later than 24 hours after the Agency has cause to believe (26 TAC §558.249(c)); step 6 is completed no later than the 10th day after the report (26 TAC §558.250(b)(3)).

1. Protect the client (any staff member, at once). Ensure the client is safe, call 911 if the client is in immediate danger or needs medical attention, and do not leave a client alone with a suspected perpetrator. Do not confront the suspected perpetrator and do not disturb physical evidence.
2. Notify the Administrator (the staff member with cause to believe, at once). Give the client’s name, what was seen or heard, when, and who was involved. If the Administrator is unavailable, notify Jo Sample; if neither can be reached at once, the staff member makes the report in step 3 personally.
3. Report to the state (Administrator, or the staff member under step 2, immediately). Where an Agency employee, volunteer, contractor, or agent may be involved, report to HHSC Complaint and Incident Intake on 1-800-458-9858, immediately and never later than 24 hours (Tex. Hum. Res. Code §48.051(b-1); 26 TAC §558.249(c)). Where someone else may be involved, or the client is neglecting their own needs, report to DFPS on 1-800-252-5400 or, where no one is in immediate danger, at www.txabusehotline.org (Tex. Hum. Res. Code §48.051(a)). Where the client is a child, report to DFPS under Tex. Fam. Code §261.101, and also to HHSC if Agency staff may be involved. Give the information Tex. Hum. Res. Code §48.051(d) lists: the client’s name, age, and address; the name and address of any person responsible for the client’s care; the nature and extent of the client’s condition; the basis of the reporter’s knowledge; and any other relevant information. Record the date, time, the name of each intake worker, and each intake or case number in the incident file. Where a crime may have been committed, also notify local law enforcement.
4. Begin the internal investigation immediately (Administrator, on witnessing the act or receiving the allegation) (26 TAC §558.250(b)(1)). Open a confidential incident file, secure any records, and where the alleged perpetrator is an employee, contractor, or volunteer, remove that person from all client contact pending the outcome, as the Agency’s own protective standard. The investigation follows Policy TX-QA-02.
5. Preserve and document (Administrator, throughout). Record the allegation as close to verbatim as possible, interview the client, the reporter, and any witness separately, and keep contemporaneous notes signed and dated.
6. Submit HHSC Form 3613, Provider Investigation Report (Administrator, no later than the 10th day after the report to HHSC). Complete every item 26 TAC §558.250(b)(2) lists: incident date; the alleged victim’s name and age at the time of the incident; the alleged perpetrator’s name; any witnesses; the allegation; any injury or adverse effect; any assessments made; any treatment required; the investigation summary; and any action taken. Send the completed form to HHSC Complaint and Incident Intake at ciiprovider@hhs.texas.gov or fax 1-877-438-5827 (26 TAC §558.250(b)(3)) and keep the transmission confirmation in the incident file.
7. Cooperate with HHSC and DFPS (all staff, as requested). Make records and staff available, and never contact the client or family in a way that could influence their account.
8. Close and learn (Administrator, at the end of the investigation). Complete the investigation and its documentation within 30 days after receiving the report unless the Agency has and documents reasonable cause for a delay (26 TAC §558.250(d)). Record the finding and the corrective and personnel action, notify the client or representative of the outcome as permitted by law, and report the case to the QAPI Committee under Policy TX-QA-01.

At admission the Agency gives each client and, where applicable, the client’s legal representative a written statement of this policy that explains how to report abuse, neglect, or exploitation directly to HHSC and DFPS, and files the client’s acknowledgment of receipt in the client record (26 TAC §558.301(a)(9)(K)). The statement is issued as Form TX-ANE-01-A and is available in Spanish. The Agency also posts the HHSC and DFPS numbers in the Agency office.

Every new employee, contractor, and volunteer receives this policy during orientation, before first client contact, and signs an acknowledgment for the personnel record. The Agency has set an annual refresher; that frequency is the Agency’s own, not a rule requirement.

Accountability under this policy is allocated as follows.

Every employee, contractor, and volunteer is trained on Sections 4 and 5 at orientation, before first client contact, and signs an acknowledgment, and receives an annual refresher, which is the Agency’s own frequency. Training covers recognizing signs of abuse, neglect, and exploitation, the routes in Section 4, and what to say to the intake worker.

The Administrator keeps a confidential incident file for every allegation, separate from the client record and the personnel record, containing: the internal report; the date, time, and intake numbers of each HHSC and DFPS report; interview notes; Form 3613 and its transmission confirmation; the finding; corrective and personnel action; and any correspondence with DFPS, HHSC, or law enforcement. The client’s signed acknowledgment of Form TX-ANE-01-A is filed in the client record and retained for the period required by 26 TAC §558.301(b). Staff acknowledgments are filed in the personnel record (26 TAC §558.246). A log of all allegations is kept for the QAPI Committee.

Each quarter, as the Agency’s own standard, the Administrator reviews every allegation in the log and confirms the time from cause to believe to the state report, the date Form 3613 was sent, and the date the investigation closed, against Section 5. Every late report is treated as a finding. Findings are reported to the QAPI Committee under Policy TX-QA-01.

• 26 Texas Administrative Code §558.249, Self-Reported Incidents of Abuse, Neglect, and Exploitation
• 26 Texas Administrative Code §558.250, Agency Investigations
• 26 Texas Administrative Code §558.282, Client Conduct and Responsibility and Client Rights
• 26 Texas Administrative Code §558.301, Client Records
• Texas Human Resources Code, Chapter 48, Investigations and Protective Services for Elderly Persons and Persons with Disabilities
• Texas Human Resources Code §48.051, Report, including subsection (b-1); §48.052, Failure to Report; Penalty; §48.054, Immunity
• Texas Family Code, Chapter 261, Investigation of Report of Child Abuse or Neglect, including §261.101, Persons Required to Report; Time to Report
• Texas Health and Safety Code, Chapter 142, Home and Community Support Services
• HHSC Provider Letter PL 2023-12, reporting of abuse, neglect, and exploitation by home and community support services agencies (revised May 22, 2023)
• HHSC Form 3613, Provider Investigation Report

This policy is adopted by the governing body of Sample Home Care Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 9 is amended, the amendment is recorded in this table and a new version of this policy is issued.