Refuge House, Inc. · the one deep-including visit each calendar quarter · Quarter: ________ Year: ______
| 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.
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-CAP-01 26 TAC §749.2557(a) | Number of children living in the home (biological, adopted, foster, respite, day care) does not exceed the total capacity on the home's verification.[Medium-High] | |
| HM-CAP-02 26 TAC §749.2551 | Composition within limits: up to 6 children; if caring for infants — max 2 infants and 2 more children under 6 (sibling-group exception); PMN total-care limits (max 3 of 6, or 4 if all placements are PMN total-care); if capacity exceeds 6, exception requirements met.[Medium-High] | |
| HM-CAP-03 26 TAC §749.2931 | No child uses or possesses tobacco, e-cigarettes, or vaporizers; adults smoke/vape outside only; no one smokes in a vehicle while transporting children.[Medium-High] |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-MED-01 26 TAC §749.1463(b)(2) | Medications stored in original containers, or in an additional container bearing the same label and instructions. | |
| HM-MED-02 26 TAC §749.1521(1)–(2) | All medication stored in a locked container and inaccessible to anyone other than caregivers responsible for stored medication. | |
| HM-MED-03 26 TAC §749.1521(3) | Schedule II controlled substances stored under double lock in a separate container (e.g., locked box inside a locked closet/cabinet).[High] | |
| HM-MED-04 26 TAC §749.1521(4) | Provisions made for storing medication requiring refrigeration.[Medium-High] | |
| HM-MED-05 26 TAC §749.1521(5) | Medication storage area(s) clean and orderly.[Medium] | |
| HM-MED-06 26 TAC §749.1521(6)–(8) | Discontinued medication removed immediately; expired medication removed on/before expiration date; medication of a discharged or deceased child removed — all stored in a separate locked area until destroyed within 30 days. | |
| HM-MED-07 26 TAC §749.1543(a)–(b); FC-MED-01.1 §§4–5, 13 | Current month's medication records (MAR) maintained at the foster home — met digitally at Refuge House: doses are logged in the Pulse medication log at administration time, and the current month's MAR is accessible at the home on the caregiver's device at all times. Verify by having the caregiver open the Pulse MAR at the visit and display the current month for each child (agency copies are inherent in the system and filed to Radius monthly; paper MAR only where a documented exception applies). | |
| HM-MED-08 26 TAC §749.1541(a)–(c); FC-MED-01.1 §§4–5 | Cumulative medication record complete and updated within 24 hours of administration (medication name/strength/dosage, date/time, administrant name, refusals; reasons/symptoms for each PRN psychotropic dose and each OTC dose for a child under 5) — verify via the Pulse MAR view at the visit; confirm no unresolved overdue-log escalations for this home. | |
| HM-MED-09 26 TAC §749.1609; FC-MED-01.1 §8 | For any child on psychotropic medication: daily record maintained per §749.1541, including any noticeable behavior change in response to the medication — verify via the Pulse medication log entries and notes for the current month. | |
| HM-MED-10 26 TAC §749.1463(b)(3), (10), (11) | Medication administered per label/orders; labels match the child; no borrowed or other-person medication; never administered to more than one child from the same container. | |
| HM-MED-11 26 TAC §§749.1501–.1503 | Self-medication program: parent's written authorization on file, program in service plan, prescriber consulted, daily dosage recorded. | |
| HM-MED-12 DFPS 24-Hr RCC §5430 | Q·Deep Caregiver retains documentation of the DFPS Psychotropic Medication Training (pre-service and annual) for any psychotropic placement. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-SAF-01 26 TAC §749.2909(a) | Working smoke detectors in hallways or open areas outside sleeping rooms and on each level of the home. | |
| HM-SAF-02 26 TAC §749.2913(a) | Fire extinguisher present in each kitchen and on each level of the home. | |
| HM-SAF-03 26 TAC §749.2915 | Dangerous tools and equipment (hatchets, saws, axes) stored inaccessible to children (supervised use per age/maturity/treatment issues permitted). | |
| HM-SAF-04 26 TAC §749.2917(a)–(b) | Animals on premises free of disease, not a health risk, vaccinated and treated as recommended by a licensed veterinarian. | |
| HM-SAF-05 26 TAC §749.2961(a)(1), (d) | Weapons, firearms, explosive materials, and projectiles kept in locked storage when not in use; child use only with agency determination and direct adult supervision (ornamental/inoperable firearms exempt).[High] | |
| HM-SAF-06 26 TAC §749.2961(b) | Foster parent confirms whether there has been any change to or addition of weapons/firearms/explosives/projectiles on the property; any change reported to the agency (update RH Weapons, Firearms & Projectile Inventory and Acknowledgement).[High] | |
| HM-SAF-07 26 TAC §749.3041(1)–(2) | Indoor areas, equipment, and furniture safe for children, kept clean, and in good repair. | |
| HM-SAF-08 26 TAC §749.3041(3) | Exits in living areas not blocked by furniture. | |
| HM-SAF-09 26 TAC §749.3041(6) | Windows and doors used for ventilation are screened. | |
| HM-SAF-10 26 TAC §749.3041(7) | Flammable or poisonous substances stored out of reach of children (unless a child is evaluated as capable and likely to use such items responsibly). | |
| HM-SAF-11 26 TAC §749.3041(8) | Home free of rodents and insects.[High] | |
| HM-SAF-12 DFPS 24-Hr RCC (FY26) §1110 — Foster Care Ombudsman; 26 TAC §749.1003(b)(7)(B) (complaint right) | Foster Care Ombudsman poster displayed prominently in English and Spanish, easily accessible and legible to the children served; DFPS Statewide Intake hotline number readily available and displayed prominently; children may contact the Ombudsman privately and by phone free from observation. | |
| HM-SAF-13 26 TAC §749.1003(b)(7) | Children know and can access, without interference, the complaint numbers: DFPS Abuse Hotline 1-800-252-5400; HHSC Ombudsman 1-844-286-0769; DFPS Consumer Affairs 1-800-720-7777; Disability Rights Texas 1-800-252-9108.[High] | |
| HM-SAF-14 26 TAC §749.2905 | Q·Deep 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) | Q·Deep Any deficiencies documented in an inspection/evaluation corrected; inspector/evaluator conditions and restrictions followed.[High] | |
| HM-SAF-16 26 TAC §749.2911 | Q·Deep 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) | Q·Deep Fire extinguishers serviced/replaced after each use; annual maintenance check by a qualified person (verify tag/date). | |
| HM-SAF-18 26 TAC §749.2907 | Q·Deep 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 | Q·Deep 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) | Q·Deep Vaccination documentation for dogs and cats (Health & Safety Code Ch. 826) available at the home. | |
| HM-SAF-21 26 TAC §749.3043 | Q·Deep 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 | Q·Deep 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] | |
| HM-SAF-23 DFPS 24-Hr RCC §4900 | Runaway Prevention Plan present and current for any child at elevated runaway risk (completed within 48 hours of identification; evaluated within the last month); caregiver can describe the child's risk factors and de-escalation strategies; caseworker was provided a copy within 24 hours. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-BED-01 26 TAC §749.3021(a) | No more than 4 occupants per bedroom (occupants = any persons; PMN-treatment exception); current sleeping arrangements match approved arrangements.[Medium-High] | |
| HM-BED-02 26 TAC §749.3025(a)–(b) | Adult in care shares a bedroom with a child only if: siblings; adult is the child's parent; both non-ambulatory receiving PMN treatment; or child 16+ within 24 months of the adult's age (qualified under §§749.1103/.1105) — and (unless parent) the service planning team has assessed and documented dated approval in the child's service plan. | |
| HM-BED-03 26 TAC §749.3025(c) | Adult in care and child never sleep in the same bed unless the adult is the child's parent and the child is between 1 and 10 years old.[High] | |
| HM-BED-04 26 TAC §749.3027(a) | Child sleeps in a caregiver's bedroom only if: in the child's best interest, child is under 3, and the service planning team has documented dated approval in the service plan. | |
| HM-BED-05 26 TAC §749.3027(c) | Children never sleep in the same bed with an adult caregiver.[High] | |
| HM-BED-06 26 TAC §749.3029 | A child 6 years old or older does not share a bedroom with a child of the opposite gender unless: siblings; the older child is the younger child's parent; or both are non-ambulatory receiving PMN treatment — and (unless the parent exception) the service planning team has assessed and documented dated approval in each child's service plan. | |
| HM-BED-07 26 TAC §749.3031 | Each child has their own bed and mattress (respite couch exception under 7 days), clean and comfortable; mattress off the floor with cover or protector; linens changed when soiled and at least weekly. | |
| HM-BED-08 26 TAC §749.3033 | Each child has accessible storage space for clothing and personal possessions.[Low] | |
| HM-BED-09 26 TAC §749.1003(b)(3)(F); DFPS 24-Hr RCC §4620 | Children have personal care, hygiene, and grooming equipment and supplies — meeting the child's ethnic hygiene and individual hair-care needs — and training in how to use them. | |
| HM-BED-10 26 TAC §749.1003(b)(3)(G), (H) | Comfortable clothing suitable to age and size, similar to other children in the community; teenagers have reasonable opportunity to select clothing; clothing protects against the weather. | |
| HM-BED-11 26 TAC §749.1003(b)(3)(E) | Privacy of communications honored: unopened mail, phone calls, personal journal, visitors — absent documented best-interest/professional/court restriction. | |
| HM-BED-12 26 TAC §749.1003(b)(3)(I)–(K) | Children have personal items at the home; personal bedroom space to store clothes/belongings; informed of search policies and free from unreasonable searches/removal of personal items. | |
| HM-BED-13 DFPS 24-Hr RCC (FY26) §§6700, 6840; FC09-01.1 | Educational Portfolio hard copy at the home and current (updated within 30 days of any educational event); comprehensive review with caregiver at least quarterly. | |
| HM-BED-14 26 TAC §749.1893(1) | Report cards and school information reviewed with the child; necessary information provided to agency staff. | |
| HM-BED-15 26 TAC §749.3021(a)–(c) | Q·Deep 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) | Q·Deep Each bedroom adequate for rest and has a door for privacy. | |
| HM-BED-17 26 TAC §749.3023(b) | Q·Deep 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) | Q·Deep 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) | Q·Deep 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) | Q·Deep Basement used as a bedroom only with a second fire-escape route.[Medium-High] | |
| HM-BED-21 DFPS 24-Hr RCC §4620 | Clothing and personal-item inventory completed at admission and kept current (monthly per FC-WCM-01.1); inventory signed and dated by the child (if able) and the provider; children are allowed to label their clothes and other items with their name or initials. Kinship homes: inventory at admission and at discharge. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-IND-01 26 TAC §749.2595 | Video cameras used to supervise only: infants/toddlers; or another child only with consent of the parent/person legally authorized AND the child is under 5, has primary medical needs, or has documented service-plan justification — and cameras do not record, with images accessible only to the home's caregivers. | |
| HM-IND-02 26 TAC §749.1893(4) | Quiet, well-lighted study space and regular homework/study times. | |
| HM-IND-03 26 TAC §749.3035(b); DFPS 24-Hr RCC §4620 | All lavatories, tubs, and showers have hot and cold running water, with sufficient hot water for daily baths or showers. | |
| HM-IND-04 26 TAC §749.3079(1)–(4) | Food covered, stored off the floor on clean surfaces, protected from contamination; storage containers protect from insects and rodents. | |
| HM-IND-05 26 TAC §749.3079(5)–(6) | Food refrigerated immediately after use/meals when required; covered when stored in the refrigerator. | |
| HM-IND-06 26 TAC §749.3081(a) | Furniture, equipment, food-contact surfaces, and food prep/eating/storage areas clean and well repaired. | |
| HM-IND-07 26 TAC §749.3081(b) | Single-use utensils and containers (paper/plastic dishes) not reused.[Medium] | |
| HM-IND-08 26 TAC §749.3063(c); §749.3067 | Drinking water always available and served safely; food never used as punishment and never withheld.[Medium-High] | |
| HM-IND-09 26 TAC §749.3037 | Q·Deep 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) | Q·Deep 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) | Q·Deep Bathrooms allow for privacy.[Medium-High] | |
| HM-IND-12 26 TAC §749.3035(c) | Q·Deep Primary-medical-needs child's bedroom and bathroom on the same floor.[Medium] |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-OUT-01 26 TAC §749.3041(4)–(5) | Outdoor areas safe for children, clean, in good repair, and well drained. | |
| HM-OUT-02 26 TAC §749.3039(d) | Outdoor equipment appropriate, cleaned, maintained, repaired. | |
| HM-OUT-03 26 TAC §749.3039(e); RH agency policy | Trampoline: occupancy per manufacturer's instructions; shock-absorbing pads cover springs, hooks, frame; ladder removed when not in use; supervision — under 12: caregiver immediately present, watching at all times; 12+: caregiver on premises with frequent visual checks. Agency policy: prior RH management approval required.[Medium-High] | |
| HM-OUT-04 26 TAC §749.3039(a) | Q·Deep Outdoor equipment free of openings, angles, protrusions that can entangle clothing or entrap body parts. | |
| HM-OUT-05 26 TAC §749.3039(b) | Q·Deep Outdoor equipment securely anchored per manufacturer's specifications against collapsing, tipping, sliding, moving, overturning. | |
| HM-OUT-06 26 TAC §749.3039(c) | Q·Deep Climbing equipment, swings, slides not installed over asphalt or concrete. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-VEH-01 26 TAC §749.3103 | Driver and passengers follow all laws when driving, including child passenger safety seat systems, seat belts, and liability insurance; appropriate child safety seats present for the ages in care. | |
| HM-VEH-02 26 TAC §749.3111 | Children always inside the vehicle — never in a pickup bed, on runners, or on the hood/trunk.[High] | |
| HM-VEH-03 26 TAC §749.2967 | Firearms (other than handguns), weapons, explosives, projectiles in a vehicle transporting a child: unloaded, inaccessible to the child, and legally possessed. Handguns: in the possession and control of the caregiver, who is not legally prohibited from carrying.[High] | |
| HM-VEH-04 26 TAC §749.3101(1)–(2) | Q·Deep 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 | Q·Deep 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. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-WTR-01 26 TAC §749.3133(e) | Fence gates self-closing and self-latching; locked when pool not in use; keys/locks inaccessible to children under 12, children of any age who are not competent swimmers, and any children receiving treatment services.[High] | |
| HM-WTR-02 26 TAC §749.3133(g) | Furniture, equipment, or large materials not close enough to the pool area to scale the fence or release a lock. | |
| HM-WTR-03 26 TAC §749.3133(h) | At least 2 life-saving devices (reach pole, backboard, buoy, safety throw bag); one more per 2,000 sq ft of water surface. | |
| HM-WTR-04 26 TAC §749.3133(k)–(l) | Bottom of pool visible at all times; pool covers completely removed prior to use. | |
| HM-WTR-05 26 TAC §749.3133(n)–(o) | Pool chemicals and pumps inaccessible to all children; machinery rooms locked. | |
| HM-WTR-06 26 TAC §749.3145 | Wading pools stored out of children's reach when not in use, drained at least daily, stored so they don't hold water. | |
| HM-WTR-07 26 TAC §749.3147 | Hot tub enclosed per §749.3133 or covered with a locking cover when not in use.[High] | |
| HM-WTR-08 26 TAC §749.3135(a) | Children under 12, non-competent swimmers, and children receiving treatment services protected from unsupervised access to any body of water — pool, hot tub, fountain, pond, lake, creek.[High] | |
| HM-WTR-09 26 TAC §749.3133(a) | Q·Deep 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) | Q·Deep 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) | Q·Deep 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) | Q·Deep 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) | Q·Deep 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) | Q·Deep 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 | Q·Deep 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 | Q·Deep 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) | Q·Deep If children swim in a natural body of water, supervising adult clearly designates swimming areas.[High] |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-INF-01 26 TAC §749.1803(c); §749.1841 | Environment safe for infants and toddlers: free of choking hazards and electric-shock risk; no unstable/broken furniture; no unsupervised access to water; toddler supervision per §749.1841. | |
| HM-INF-02 26 TAC §749.1803(d)–(e) | Diapering supplies out of children's reach (locked storage not required); infants never unsupervised (eyesight/hearing/monitor rules). | |
| HM-INF-03 26 TAC §749.1805(1) | Individual crib for each infant. | |
| HM-INF-04 26 TAC §749.1805(2) | Sufficient toys to keep each child engaged. | |
| HM-INF-05 26 TAC §749.1807(a)(1)–(4) | Crib condition: firm flat mattress fitting snugly (no foam supplements); snug sheets with no entanglement hazard; waterproof/washable mattress; secure mattress support hangers with no loose or damaged hardware. | |
| HM-INF-06 26 TAC §749.1813(b)–(d) | Crib bare for an infant under 12 months except a tight-fitting sheet and a tight, thin, size-specific mattress cover that doesn't soften the sleep surface; special safe-sleep items only for a primary-medical-needs infant with a written health-care-professional recommendation kept in the child's record. | |
| HM-INF-07 26 TAC §749.1813(a) | Not used: baby walker, baby bungee jumper, accordion safety gate, toys small enough to swallow/choke; infants don't sleep on bean bags, waterbeds, or foam pads. | |
| HM-INF-08 26 TAC §749.1815 | Infant not yet able to turn over is placed face-up to sleep unless a health-care professional's order (kept in the child's record) directs otherwise; infant's head, face, or crib never covered; infant never sleeps prone with a sleeping adult (adult's bed, couch, etc.). | |
| HM-INF-09 26 TAC §749.1817 | Infants do not sleep in restrictive devices (car seats, swings, bouncy seats, high chairs); an infant asleep in one is moved to a crib as soon as possible. | |
| HM-INF-10 26 TAC §749.1821 | No swaddled sleep/rest on any surface at any time, absent a signed health-care-professional order kept in the child's record. | |
| HM-INF-11 26 TAC §749.1819(b)–(d) | Infants 6 months or younger (or unable to sit unassisted) held during bottle feeding; bottles never propped; shared bottles/training cups sterilized between infants; high-chair trays cleaned before each use. | |
| HM-INF-12 26 TAC §749.1811(a)–(b) | High chair, swing, stroller, infant carrier, rocker, bouncer seat (or similar equipment) has safety straps, and straps are fastened whenever the infant uses the equipment. | |
| HM-INF-13 26 TAC §749.1807(b)–(c) | Crib sanitized when soiled and before use by a different child; child never left in crib with the side down. | |
| HM-INF-14 26 TAC §749.1807(a)(5)–(8) | Q·Deep 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) | Q·Deep No stackable cribs in the home. | |
| HM-INF-16 26 TAC §749.1809 | Q·Deep 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. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-DLY-01 DFPS 24-Hr RCC §4500 | Evidence of two or more Basic Life Skills activities this month (in home or community), documented in the caregiver's log / child's plan of service; age-appropriate financial-literacy content included over time (banking, credit, taxes; vehicle financing and voter registration at 17+). | |
| HM-DLY-02 DFPS 24-Hr RCC §4510 | Q·Deep 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 | Q·Deep Children have input into meal planning (verify by child/caregiver interview). |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-T3C-01 T3C Blueprint (Apr 2026), package §Service Package Expectations | Awake-night supervision in place if 7 or more children in the home; HHSC-CCR variance on file for more than 6 children in foster care. | |
| HM-T3C-02 T3C Blueprint (Apr 2026), package §Service Package Expectations | Caregiver maintains and can produce in-home documentation/records of the child's services, appointments, and transportation per court orders and the Service Plan. | |
| HM-T3C-03 T3C Blueprint (Apr 2026), package §Service Package Expectations; DFPS 24-Hr RCC §4400 (universal — 'no exception for participation in Normalcy activities') | Normalcy supports observable: age-appropriate clothing, hygiene and hair-care products suited to the child, participation in birthdays/holidays/activities per the Service Plan. | |
| HM-T3C-04 T3C Blueprint (Apr 2026), package §Quality Assurance / Continued Stay | Q·Deep Home's credential(s) current for every package being delivered. | |
| HM-T3C-05 T3C Blueprint (Apr 2026), package §Service Package Expectations | Q·Deep 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 | Q·Deep Universal Human Trafficking Prevention Training completed (verify record); child has received trafficking-prevention information per the agency's documented method. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-TFFC-01 T3C Blueprint (Apr 2026), TFFC §Service Package Description, pp. 137–148 | No more than 2 children in foster care placed in the home at the same time. | |
| HM-TFFC-02 T3C Blueprint (Apr 2026), TFFC §Service Package Expectations | Home's night-safety plan producible and aligned with what's needed to keep all children safe (awake-night supervision per plan; mandatory at 7+ children). | |
| HM-TFFC-03 T3C Blueprint (Apr 2026), TFFC §Service Package Expectations | Caregiver can state how to reach 24/7 case-manager crisis response and the on-call Licensed Therapist; contacts accessible in the home. | |
| HM-TFFC-04 T3C Blueprint (Apr 2026), TFFC §Service Package Expectations | Caregiver participates in the child's therapy; available for multiple meetings weekly and immediate crisis response. | |
| HM-TFFC-05 T3C Blueprint (Apr 2026), TFFC §Length of Service | Q·Deep Placement date cross-checked against the 274-day limit (one 91-day extension; 365 max). |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-MBH-01 T3C Blueprint (Apr 2026), MBH §Service Package Expectations, pp. 79–89 | Caregiver can state how to reach 24/7 case-manager-or-above crisis response; contact accessible in home. | |
| HM-MBH-02 T3C Blueprint (Apr 2026), MBH §Service Package Expectations | Caregiver participates in therapy as needed; able to attend multiple meetings and respond immediately to the child's MH/BH needs. | |
| HM-MBH-03 T3C Blueprint (Apr 2026), MBH §Service Package Expectations | Q·Deep Dual credential verified: home holds current MBH credential AND T3C Basic credential; MBH-specific training current. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-IDD-01 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations, pp. 125–136 | Custom care plan present/accessible in the home, incorporating RN guidance on the child's medical needs, including medication administration and use of medically necessary equipment; caregiver can explain it. | |
| HM-IDD-02 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations | Medically necessary / adaptive equipment identified in the care plan is present, in working order, and caregiver demonstrates correct use per RN guidance. | |
| HM-IDD-03 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations | Caregiver can state how to reach the agency RN (24/7) and the 24/7 crisis line; contacts accessible in home. | |
| HM-IDD-04 T3C Blueprint (Apr 2026), IDD/ASD §Admission Guidelines | All services and supports called for by the child's plan are in place in the home (environmental accommodations, sensory supports, therapy equipment, communication/AAC as applicable). | |
| HM-IDD-05 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations | Normalcy items both age-appropriate and developmentally appropriate; if Intermittent Alternative Care is planned, child has been introduced to the alternate caregiver. | |
| HM-IDD-06 T3C Blueprint (Apr 2026), IDD/ASD §Service Package Expectations | Q·Deep Dual credential verified (IDD/ASD + T3C Basic); IDD/ASD-specific training current. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-SU-01 T3C Blueprint (Apr 2026), SU §Service Package Expectations, pp. 59–69 | Caregiver can state how to reach 24/7 crisis response and the on-call LCDC/QCC; contacts accessible in home. | |
| HM-SU-02 Agency practice (no Blueprint/TAC mandate); cf. 26 TAC §749.3041(7) | Household alcohol and other intoxicants secured consistent with the child's evaluated needs. | |
| HM-SU-03 T3C Blueprint (Apr 2026), SU §Service Package Expectations | Q·Deep Dual credential verified (SU + T3C Basic); SU-specific training current. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-STASS-01 T3C Blueprint (Apr 2026), STASS §Service Package Description, pp. 70–78 | No more than 4 children in foster care placed in the home at the same time, unless accommodating a sibling group (verify exception). | |
| HM-STASS-02 T3C Blueprint (Apr 2026), STASS §Service Package Expectations | Enhanced in-home records of assessments/evaluations producible; appointments on track for the 21-day (age 5 and under) / 30-day (age 6+) completion deadlines from admission. | |
| HM-STASS-03 T3C Blueprint (Apr 2026), STASS §Service Package Summary | No Add-On Services delivered for STASS placements. | |
| HM-STASS-04 T3C Blueprint (Apr 2026), STASS §Service Package Expectations; §Length of Service | Q·Deep STASS observation/assessment training current; placement date cross-checked against 30-day (≤5) / 45-day (>5) limits plus one 15-day extension. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-YTSS-01 T3C Blueprint (Apr 2026), Transition Add-On §Expectations, pp. 149–154 | In-home records producible: Casey Life Skills Assessment, PAL events/Life Skills Training attendance, transition-planning participation. | |
| HM-YTSS-02 T3C Blueprint (Apr 2026), Transition Add-On §Expectations | Funded Normalcy items actually available to the youth (e.g., cell phone, part-time-job logistics, driving/driver's-ed access, activities) as directed by the youth. | |
| HM-YTSS-03 T3C Blueprint (Apr 2026), Transition Add-On §Expectations | Youth aware of Extended Foster Care, Transitional Living, and Supervised Independent Living options; Workforce Solutions/Transition Center connection as available; ID/driver's-license and benefit-application progress per plan. | |
| HM-YTSS-04 T3C Blueprint (Apr 2026), Transition Add-On §Expectations | Q·Deep Caregiver PAL-program expertise demonstrated; Transition Add-On training current. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-KIN-01 T3C Blueprint (Apr 2026), Kinship Add-On §Expectations, pp. 155–158 | Kinship caregiver can state how to reach the agency's 24/7 immediate-response support line; contact accessible in home. | |
| HM-KIN-02 T3C Blueprint (Apr 2026), Kinship Add-On §Expectations | Q·Deep Support delivery adapted to this household and residence (incl. weekend/after-hours availability); any physical-residence support needs from verification tracked to closure. |
| Item / Citation | Standard | C/NC/NA |
|---|---|---|
| HM-PPY-01 T3C Blueprint (Apr 2026), P&P Add-On §Expectations, pp. 159–164 | Custom parenting plan present/accessible (may be part of the Service Plan); caregiver and youth can describe it. | |
| HM-PPY-02 T3C Blueprint (Apr 2026), P&P Add-On §Expectations | Infant safe sleep and childproofing observable per the parenting plan — complete the Infants & Toddlers section for the youth's child; childproofing in areas the infant/toddler can access. | |
| HM-PPY-03 T3C Blueprint (Apr 2026), P&P Add-On §Expectations | Youth can identify approved substitute caregiver(s) for the infant per the parenting plan. | |
| HM-PPY-04 T3C Blueprint (Apr 2026), P&P Add-On §Description | Infant/child's basic-needs items present (food/formula, clothing, equipment — funded via Foster Care Maintenance Payments). | |
| HM-PPY-05 T3C Blueprint (Apr 2026), P&P Add-On §Expectations | In-home documentation/records for both youth and child(ren): prenatal/postpartum, pediatric/Texas Health Steps, ECI, WIC/benefits; caregiver engagement efforts with the minor parent documented. | |
| HM-PPY-06 T3C Blueprint (Apr 2026), P&P Add-On §Expectations | Q·Deep Pregnant & Parenting Add-On training current. |
| Date of visit | Agency Staff Signature | Foster Parent Signature | Foster Parent Signature |
|---|---|---|---|
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.