Home Monitoring Checklist — Quarterly Deep Check (Inline Supplement)

Refuge House, Inc. · served automatically within the Monthly Standard Review once per calendar quarter · first completed at initial verification

RH Staff Name
Foster Family Name
Total Capacity / Foster Care Capacity
Children placed (name / age / T3C package + add-ons)
Home credential(s) held	☐ T3C Basic ☐ TFFC ☐ MBH ☐ IDD/ASD ☐ SU ☐ STASS

Mark each cell: C = compliant · NC = non-compliant (describe in Notes for Follow-Up) · NA = not applicable (condition absent — e.g., no pool, no infants, package not in home). No blanks. Bracketed tags are HHSC enforcement weights.

Quarterly Deep Check — inline supplement to the Monthly Standard Review. Served automatically (in Pulse) whenever the home has no signed deep-including form in the current calendar quarter; first completed at initial verification (licensing). Completed during the same visit and walkthrough as that month's Monthly Standard Review — no separate signatures: the Monthly form's signature block covers these items. Structural, document-audit, and training/credential items live here. Structural, document-audit, and training/credential items live here. Mark C only when the document in front of you is current — no dates are written on this form; expirations are tracked in Pulse from the source records themselves.
Check type: ☐ Initial verification ☐ Quarterly Quarter/Year: ______________ Attached to Monthly Standard Review dated: ______________

Medication — applies when: Child on psychotropic medication placed in the home

How Refuge House meets the medication-records requirements: medication logs are DIGITAL. Caregivers log each dose in the Pulse medication log at the time of administration — so the current month's records are created at the foster home and remain accessible at the home at all times on the caregiver's device (26 TAC §749.1543(a)), updated within 24 hours (§749.1541(b)), with agency copies inherent in the system and filed to Radius monthly (§749.1543(b)). To verify at the walkthrough: have the caregiver open the Pulse medication log and display the current month's MAR for each child; print on demand if a physical copy is needed. A paper MAR is used only where a documented exception applies (see FC-MED-01.1).

Item / Citation	Standard	C/NC/NA
HM-MED-12 DFPS 24-Hr RCC §5430	Caregiver retains documentation of the DFPS Psychotropic Medication Training (pre-service and annual) for any psychotropic placement.

Health, Safety & Emergency Preparedness

Item / Citation	Standard	C/NC/NA
HM-SAF-14 26 TAC §749.2905	Fire and health inspection/evaluation current — authority inspection valid 2 years; CPA-staff evaluation (State Fire Marshal's checklist) valid 1 year. Record expiration dates.
HM-SAF-15 26 TAC §§749.2902–.2904(c)	Any deficiencies documented in an inspection/evaluation corrected; inspector/evaluator conditions and restrictions followed.[High]
HM-SAF-16 26 TAC §749.2911	Smoke detectors installed and maintained per manufacturer's or fire authority's instructions (additional detectors where those instructions require, §749.2909(b)).[Medium-High]
HM-SAF-17 26 TAC §749.2913(b)	Fire extinguishers serviced/replaced after each use; annual maintenance check by a qualified person (verify tag/date).
HM-SAF-18 26 TAC §749.2907	Written disaster/emergency plans at the home (fire, severe weather, transportation), including evacuation of children under 24 months / limited mobility / needing assistance, and availability of medications and equipment for children with special needs; caregivers can explain the procedures.[Medium-High]
HM-SAF-19 26 TAC §749.2908	Annual drills documented with date and time: plans discussed with children; fire drill showing children can safely exit within 3 minutes; severe-weather drill.[Medium-High]
HM-SAF-20 26 TAC §749.2917(c)	Vaccination documentation for dogs and cats (Health & Safety Code Ch. 826) available at the home.
HM-SAF-21 26 TAC §749.3043	Recalled children's products: the caregiver checks cribs, play equipment, and other children's products against the federal safety-recall list (cpsc.gov/recalls) and confirms none are in use. If something in the home has been recalled, it must be kept out of use and out of children's reach until the recall repair is done (or removed if it can't be fixed). An antique or collectible item may remain only if children never use it and cannot reach it. Ask: 'Have you checked your cribs and children's equipment against the recall list? Anything come up?'[Medium-High]
HM-SAF-22 26 TAC §749.2965	Foster home record documents weapon items present and required precautions; storage discussed and documented at each two-year evaluation (RH Weapons Inventory form current).[High]

Bedrooms, Belongings & Rights

Item / Citation	Standard	C/NC/NA
HM-BED-15 26 TAC §749.3021(a)–(c)	Bedroom floor space: at least 40 sq ft per occupant; single-occupant bedroom at least 80 sq ft; closets/alcoves excluded; rooms usable for daily activities.[Medium-High]
HM-BED-16 26 TAC §749.3023(a), (c)(3)	Each bedroom adequate for rest and has a door for privacy.
HM-BED-17 26 TAC §749.3023(b)	Each bedroom has at least one source of natural light (pre-2007 verification grandfather, subsection (f)).
HM-BED-18 26 TAC §749.3023(c)(1)–(2)	No dining room, living room, hallway, porch, other common-use room, or passageway used as a bedroom for anyone.
HM-BED-19 26 TAC §749.3023(d)	Detached-structure bedroom only if: child is 16+, service planning team approves, and the structure is included in required fire and health inspections.[High]
HM-BED-20 26 TAC §749.3023(e)	Basement used as a bedroom only with a second fire-escape route.[Medium-High]

Other Indoor Space & Food

Item / Citation	Standard	C/NC/NA
HM-IND-09 26 TAC §749.3037	At least 40 sq ft indoor activity space per child (excluding bedrooms, kitchens, bathrooms, utility rooms, unfinished attics, hallways).
HM-IND-10 26 TAC §749.3035(a)	One lavatory (sink), one tub or shower, and one toilet per eight household members (pre-2007 verification grandfather).
HM-IND-11 26 TAC §749.3035(d)	Bathrooms allow for privacy.[Medium-High]
HM-IND-12 26 TAC §749.3035(c)	Primary-medical-needs child's bedroom and bathroom on the same floor.[Medium]

Outdoor Space

Item / Citation	Standard	C/NC/NA
HM-OUT-04 26 TAC §749.3039(a)	Outdoor equipment free of openings, angles, protrusions that can entangle clothing or entrap body parts.
HM-OUT-05 26 TAC §749.3039(b)	Outdoor equipment securely anchored per manufacturer's specifications against collapsing, tipping, sliding, moving, overturning.
HM-OUT-06 26 TAC §749.3039(c)	Climbing equipment, swings, slides not installed over asphalt or concrete.

Vehicles & Transportation

Item / Citation	Standard	C/NC/NA
HM-VEH-04 26 TAC §749.3101(1)–(2)	Vehicles used to transport children maintained in safe operating condition; inspected and registered per federal, state, and local law (verify current registration/inspection and liability insurance documents).
HM-VEH-05 26 TAC §749.3109	Child requiring increased supervision or non-ambulatory/non-mobile: sufficient caregivers accompany the child; special provisions made, including locks for wheelchairs and hydraulic lifts when necessary.

Swimming Areas & Bodies of Water

Item / Citation	Standard	C/NC/NA
HM-WTR-09 26 TAC §749.3133(a)	Caregivers have informed children of pool house rules and safety precautions; supervision and safety-feature monitoring adequate to protect children under 12 and non-competent swimmers.[High]
HM-WTR-10 26 TAC §749.3133(c)	Pool has a barrier (fence/wall) preventing unauthorized access; a pool cover qualifies only if it is a power safety cover meeting ASTM specifications.[High]
HM-WTR-11 26 TAC §749.3133(d)	Fence/wall at least 4 ft high completely around pool area (house back wall may serve as one side if subsection (f) is met).
HM-WTR-12 26 TAC §749.3133(f)	If the home is one side of the barrier, each door to the pool area has (1) a door alarm and (2) a lock reachable only by adults or children over 12 (fire-code exception documented in the foster home record).[High]
HM-WTR-13 26 TAC §749.3133(i)–(j), (m)	Drain grates in place, in good repair, removable only with tools; caregivers can see all parts of the swimming area when supervising; an adult present who can immediately turn off pump and filter when any child is in the pool.
HM-WTR-14 26 TAC §749.3133(p)	Aboveground pool: inaccessible when not in use to children under 12, non-competent swimmers of any age, and children receiving treatment services (incl. stairs); meets all other division requirements.
HM-WTR-15 26 TAC §749.3149	Bodies of water on or adjacent to the premises documented (type, location, size) with barriers between home and water verified.[Medium]
HM-WTR-16 26 TAC §749.3137(e); §749.3141	Coast Guard-approved life jackets available and used: natural bodies of water (children under 12 or unable to swim); boating; water over 2 ft for a child unable to swim; or per physician order.[High]
HM-WTR-17 26 TAC §749.3135(b)	If children swim in a natural body of water, supervising adult clearly designates swimming areas.[High]

Infants & Toddlers — applies when: Infant placed in the home (includes an infant of a PPY youth)

Item / Citation	Standard	C/NC/NA
HM-INF-14 26 TAC §749.1807(a)(5)–(8)	Crib construction: max 2-3/8 inches between slats/poles; no corner posts over 1/16 inch above end panels; no entrapping cutouts in headboard/footboard; drop rails (if present) fasten securely and cannot be opened by a child.
HM-INF-15 26 TAC §749.1807(d)	No stackable cribs in the home.
HM-INF-16 26 TAC §749.1809	Mesh crib: used per manufacturer's instructions; mesh securely attached to top rail, side rail, floor plate; folded sides latch securely when raised; child never left with a side folded down; use discontinued upon recall.

Daily Living, Life Skills & Income

Item / Citation	Standard	C/NC/NA
HM-DLY-02 DFPS 24-Hr RCC §4510	Youth 14+ with a source of income has been offered help establishing a savings plan and, if available, a savings account they manage independently (18–22: savings or checking account with a financial institution).
HM-DLY-03 DFPS 24-Hr RCC §4610	Children have input into meal planning (verify by child/caregiver interview).

T3C — All Packages — applies when: Any T3C placement in the home

Item / Citation	Standard	C/NC/NA
HM-T3C-04 T3C Blueprint (Apr 2026), package §Quality Assurance / Continued Stay	Home's credential(s) current for every package being delivered.
HM-T3C-05 T3C Blueprint (Apr 2026), package §Service Package Expectations	Caregiver trained, practicing, and current in the agency's Treatment Model for each package delivered (verify training record).
HM-T3C-06 T3C Blueprint (Apr 2026), package §Service Package Expectations	Universal Human Trafficking Prevention Training completed (verify record); child has received trafficking-prevention information per the agency's documented method.

T3C — Treatment Foster Family Care — applies when: TFFC placement

Item / Citation	Standard	C/NC/NA
HM-TFFC-05 T3C Blueprint (Apr 2026), TFFC §Length of Service	Placement date cross-checked against the 274-day limit (one 91-day extension; 365 max).

T3C — Mental & Behavioral Health — applies when: MBH placement

Item / Citation	Standard	C/NC/NA
HM-MBH-03 T3C Blueprint (Apr 2026), MBH §Service Package Expectations	Dual credential verified: home holds current MBH credential AND T3C Basic credential; MBH-specific training current.

T3C — IDD / Autism Spectrum Disorder — applies when: IDD/ASD placement

Item / Citation	Standard	C/NC/NA
HM-IDD-06 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations	Dual credential verified (IDD/ASD + T3C Basic); IDD/ASD-specific training current.

T3C — Substance Use — applies when: Substance Use placement

Item / Citation	Standard	C/NC/NA
HM-SU-03 T3C Blueprint (Apr 2026), SU §Service Package Expectations	Dual credential verified (SU + T3C Basic); SU-specific training current.

T3C — Short-Term Assessment — applies when: STASS placement

Item / Citation	Standard	C/NC/NA
HM-STASS-04 T3C Blueprint (Apr 2026), STASS §Service Package Expectations; §Length of Service	STASS observation/assessment training current; placement date cross-checked against 30-day (≤5) / 45-day (>5) limits plus one 15-day extension.

T3C Add-On — Transition Support (14–22) — applies when: Transition Support add-on

Item / Citation	Standard	C/NC/NA
HM-YTSS-04 T3C Blueprint (Apr 2026), Transition Add-On §Expectations	Caregiver PAL-program expertise demonstrated; Transition Add-On training current.

T3C Add-On — Kinship Caregiver Support — applies when: Kinship add-on

Item / Citation	Standard	C/NC/NA
HM-KIN-02 T3C Blueprint (Apr 2026), Kinship Add-On §Expectations	Support delivery adapted to this household and residence (incl. weekend/after-hours availability); any physical-residence support needs from verification tracked to closure.

T3C Add-On — Pregnant & Parenting Youth — applies when: Pregnant & Parenting add-on

Item / Citation	Standard	C/NC/NA
HM-PPY-06 T3C Blueprint (Apr 2026), P&P Add-On §Expectations	Pregnant & Parenting Add-On training current.

Notes for Follow-Up (required for every NC — item ID, finding, corrective action, due date)

Additional Comments

Signatures: this supplement is completed within — and covered by the signature block of — the Monthly Standard Review it accompanies (one visit, one signature set).

DRAFT v2026.6-DRAFT · 2026-07-13 · Replaces Home Visit Monitoring Checklist Rev. 10.2022 · Verified against 26 TAC Ch. 749 (Nov 2025) and T3C System Blueprint (Apr 2026). Store the completed form in Radius/Pulse; attach to the Quarterly Agency Home Evaluation.