Regulatory Services Fiscal Year 2016

Annual Report February 2017

Texas Department of Aging and Disability Services

Contents

General Information 1 General Information 3 Texas Department of Aging and Disability Services (DADS) ...... 3 Long-Term Care Regulation: Regulatory Services ...... 4 Provider Descriptions ...... 5 Home and Community Support Services Agencies ...... 6. . Fiscal Year (FY) 2016 Information and Trends 10 DADS Regions in Texas ...... 10 DADS Waiver Contract Areas ...... 12. . . Regulated Facilities ...... 14 . . . Changes in Regulated Facilities ...... 16 . . Regulated Home and Community Support Services Agencies ...... 20. . . Changes in Regulated Home and Community Support Services Agencies ...... 23 Regulated Waiver Programs ...... 24 . . Changes in Waiver Programs ...... 26. . . Comparisons to Other States ...... 28 Credentialing Programs ...... 28 . . . Overview of Enforcement Activities ...... 31 Top 10 Rankings 34 Deficiencies ...... 34. . . Principles ...... 45

Assisted Living and Unlicensed Facilities 49 Assisted Living Facility and Unlicensed Facility Actions 51 Administrative Penalties ...... 51 . . . Injunctive/Other Relief and Civil Penalty Referrals ...... 52 . . Amelioration of Violations ...... 52 Trusteeships ...... 52. . . Emergency Suspension and Closing Orders ...... 53. . Denial of License ...... 53. . . Revocation of License ...... 53 Assisted Living Facility Actions by Region for FY 2016 ...... 54 Unlicensed Facility Actions by Region for FY 2016 ...... 55 . .

i Assisted Living and Unlicensed Facility Complaint and Incident Intakes 65 Complaints ...... 65 Incidents ...... 65. . . . Priority Assignment ...... 65 Assisted Living and Unlicensed Facility Actions Compared Over Multiple Fiscal Years 69

Day Activity and Health Services 73 Day Activity and Health Services Facility Actions 75 Administrative Penalties ...... 75 . . . Injunctive or Other Relief Referrals to the Office of the Attorney General ...... 76 . . Emergency Suspension and Closing Orders ...... 76. . Denial of License ...... 76. . . Revocation of License ...... 77 Day Activity and Health Services Facility Actions by Region for FY 2016 ...... 77 . . Day Activity and Health Services Facility Complaint and Incident Intakes 81 Complaints ...... 81 Incidents ...... 81. . . . Priority Assignment ...... 81 Day Activity and Health Services Facility Actions Compared Over Multiple Fiscal Years 84

Home and Community Support Services Agencies 87 Home and Community Support Services Agency Actions 89 Administrative Penalties ...... 89 . . . Civil Penalties ...... 89 . . . Denials of License Application ...... 90 Denials of License Renewal ...... 90 . . Expirations of License (in Lieu of Enforcement Actions) ...... 90 Immediate Suspensions ...... 90 Surrenders of License (in Lieu of Enforcement Actions) ...... 90. . License Revocations ...... 90 Home Health Agency Actions by Region for FY 2016 ...... 91 Hospice Agency Actions by Region for FY 2016 ...... 92

ii Home and Community Support Services Agency Complaint and Incident Intakes 134 Complaints ...... 134 Incidents ...... 134 . . . Priority Assignment ...... 134 Home and Community Support Services Agency Actions Compared Over Multiple Fiscal Years 139

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 145 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Actions 147 Administrative Penalties ...... 147 . . Injunctive/Other Relief and Civil Penalties ...... 148 Amelioration of Violations ...... 148 Trusteeships ...... 148 . . . Emergency Suspension and Closing Orders ...... 148 . . Denials of License ...... 149 Revocations of License ...... 149. . . Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition Actions by Region for FY 2016 . . . 150. Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Complaint and Incident Intakes 154 Complaints ...... 154 Incidents ...... 154 . . . Priority Assignment ...... 154 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Actions Compared Over Multiple Fiscal Years 158

Nursing Facilities 161 Nursing Facility Actions ...... 163 Administrative Penalties ...... 163 . . Injunctive/Other Relief and Civil Penalties ...... 164 Amelioration of Violations ...... 165 Trusteeships ...... 165 . . . Emergency Suspension and Closing Orders ...... 165 . . Suspension of Admissions ...... 165 . .

iii Denial of Payment for New Admissions ...... 165. . Denial of License ...... 166 . . . Revocation of License ...... 166 Civil Money Penalties ...... 167 Nursing Facility Actions by Region for FY 2016 ...... 168 . Nursing Facility Complaint and Incident Intakes 195 Complaints ...... 195 Incidents ...... 195 . . . Priority Assignment ...... 195 Nursing Facility Actions Compared Over Multiple Fiscal Years 199

Home and Community-based Services and Texas Home Living Contracts ...... 203 Home and Community-based Services and Texas Home Living Contracts 205 Vendor Hold ...... 205 . . . Denial of Certification ...... 205. . . Home and Community-based Services Actions by Contract Area for FY 2016 ...... 205 . . Texas Home Living Actions by Contract Area for FY 2016 ...... 205 Home and Community-based Services and Texas Home Living Complaints and Referrals 207 Complaints ...... 207 Waiver Contract Actions Compared Over Multiple Fiscal Years 208

Glossary 209

iv General Information

1 2 DADS Regulatory Services FY 2016 Annual Report General Information

Texas Department of Aging and Disability Services (DADS)

Vision

Aging Texans and individuals with disabilities will be supported by a comprehensive and cost-effective service delivery system that promotes and enhances individual well-being, dignity and choice .

Mission

To provide a comprehensive array of aging and disability services, supports and opportunities that are easily accessed in local communities .

Our key responsibilities to the residents of Texas include: • Working in partnership with consumers, caregivers, service providers and other stakeholders . • Developing and improving service options that are responsive to individual needs and preferences . • Ensuring and protecting self-determination, consumer rights and safety .

Goal 1: Long-term Services and Supports

To enable aging and disabled Texans to live dignified, independent, and productive lives in a safe living environment through an accessible, locally based, comprehensive and coordinated continuum of services and opportunities; to provide appropriate services and supports based on individual needs ranging from in-home and community based services for the aging and people with disabilities who request assistance in maintaining their independence and increasing their quality of life, to institutional services for those who require that level of support, seeking to ensure health and safety and to maintain maximum independence for the individual while providing the services and supports required .

Goal 2: Regulation, Certification and Outreach

Provide licensing, certification, contract enrollment services, financial monitoring and complaint investigation to ensure that residential facilities, home and community support services agencies and people providing services in facilities or home settings comply with state and federal standards, and that people receive high-quality services and are protected from abuse, neglect and exploitation .

General Information 3 Goal 3: Indirect Administration

Assure the efficient, quality, and effective administration of services provided to the aging and people with disabilities .

Long-Term Care Regulation: Regulatory Services

Regulatory Services Mission

Consumers of long-term care receive competent and compassionate care in a cooperative environment meeting their unique needs and preferences . DADS Regulatory Services regulates long-term care facilities, agencies, programs and individual providers of long-term care services through: • Inspections, surveys and plan reviews • Follow-up visits • Complaint and incident investigations • Other contacts required for carrying out state and federal licensure or certification responsibilities, such as telephone monitoring

The following long-term care facilities, agencies and programs must be licensed or, if exempt from licensure, certified by DADS and comply with licensure rules (or certification requirements) to operate in Texas: • Day activity and health services • Assisted living facilities • Home and community support services agencies • Intermediate care facilities for individuals with an intellectual disability or related conditions • Nursing facilities • Home and Community-based Services waiver providers [certified, exempt from licensure] • Texas Home Living waiver providers [certified, exempt from licensure]

Regulatory Services enrolls providers and manages the Medicaid provider contract agreements for the nursing facilities and intermediate care facilities for individuals with an intellectual disability or related conditions programs to ensure that provider applicants and providers meet the Medicaid provider participation requirements and are eligible to receive Medicaid reimbursement for long-term care services provided to residents of nursing facilities and intermediate care facilities for individuals with an intellectual disability or related conditions . These enrollment activities include initial provider contract enrollment, contract renewals, contract amendments, changes of ownership, facility relocations and contract monitoring .

4 DADS Regulatory Services FY 2016 Annual Report DADS also licenses, certifies, permits and/or monitors the following people and programs for the purpose of employability in facilities and agencies providing services to people with long-term care needs: • Direct care personnel • Medication aides • Nurse aides • Nursing facility administrators • The Nurse Aide Training and Competency Evaluation Program

Provider Descriptions

Day Activity and Health Services Facilities

Day activity and health services facilities (DAHS) provide regular services under a Day Activity and Health Services program, but not overnight, to four or more older people or people with disabilities who are not related to the owner of the facility by blood, marriage or adoption . A Day Activity and Health Services program is a structured, comprehensive program designed to meet the needs of adults with functional impairments through an individual plan of care by providing health, social and related support services in a protective setting . Residents of facilities that hold a Day Activity and Health Services contract receive services based on half-day (three to six hours) units of service; a resident may receive a maximum of 10 units of service per week, depending on the physician’s orders and related requirements .*

Assisted Living Facilities

Assisted living facilities (ALFs) provide individualized health and personal care assistance in a homelike setting with an emphasis on personal dignity, autonomy, independence and privacy . Facilities can be large apartment-like settings or private residences . Services include meals, bathing, dressing, toileting, and administering or supervising medication .

There are three types of assisted living facilities: • Type A Residents must be physically and mentally capable of evacuating unassisted during an emergency, must not require routine attendance during nighttime sleeping hours and must be capable of following directions during an emergency . • Type B Residents may require staff assistance to evacuate, be incapable of following directions during an emergency, require attendance during nighttime sleeping hours, and require assistance in transferring to and from a wheelchair but must not be permanently bedfast . • Type C A four-bed facility licensed by DADS as an adult foster care facility .

* Effective September 1, 2015, per Senate Bill 1999, 84th Legislature, Regular Session, 2015, the program title Adult Day Care (ADC) changes to Day Activity and Health Services (DAHS).

General Information 5 Home and Community Support Services Agencies Home and community support services agencies (HCSSAs) provide one or more home health, hospice or personal assistance services for people in a residence or independent living environment . These services include: • Home Health Services Nursing; physical, occupational, speech or respiratory therapy; medical or social services; intravenous therapies; dialysis; services by unlicensed personnel; medical equipment and supplies (excluding drugs); or nutritional counseling . • Hospice Services Intervention services that focus primarily on the reduction or abatement of physical, psychological and spiritual symptoms of the terminally ill consumer and support services for clients and their families . • Personal Assistance Services Routine ongoing care or services required by an individual in a residence or independent living environment that enable the recipient to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services .

The types of providers are: • Parent Agency The agency that develops and maintains administrative controls and supervises branch offices and alternate delivery sites . • Branch Office An agency or site in the parent agency’s service area that provides home health or personal assistance services or maintains active client records . • Alternate Delivery Site An agency or site in the parent agency’s service area that is not the agency’s principal place of business and from which the agency provides hospice services .

6 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions

Intermediate care facilities for individuals with an intellectual disability or related conditions (ICFs/IID) are residential facilities that provide services to four or more people, including active treatment services . Active treatment, the core requirement of certification as intermediate care facilities for individuals with an intellectual disability or related conditions, is the aggressive, consistent implementation of a program of specialized and generic training, treatment and health services . Intermediate care facilities for individuals with an intellectual disability or related conditions include both licensed (private) and non-licensed (governmental) providers .

Nursing Facilities

Nursing facilities (NFs) are residential facilities that provide care for people whose medical condition regularly requires the skills of licensed nurses . Nursing facilities provide for the medical, social and psychological needs of residents, including room and board, social services, over-the-counter drugs (prescription drugs may be covered through the Medicaid Vendor Drug program or Medicare Part D), medical supplies and equipment, rehabilitative services and personal needs items .

The nursing facility types are: • Non-Participating Nursing Facility A licensed nursing facility not certified to participate in Medicare or Medicaid . • Nursing Facility A licensed nursing facility certified to participate in Medicaid . • Skilled Nursing Facility A licensed nursing facility certified to participate in Medicare . • Skilled Nursing Facility/Nursing Facility A licensed nursing facility certified to participate in both Medicare and Medicaid . • Hospital-based Skilled Nursing Facility A nursing facility certified to participate in Medicare operating under the license of a hospital . • Swing Beds A nursing facility certified to participate in Medicare with contracted services located in a rural hospital .

General Information 7 Prescribed Pediatric Extended Care Centers

As of Jan . 1, 2015, providers are able to obtain a license to operate a prescribed pediatric extended care center (PPECC) in Texas . A prescribed pediatric extended care center functions as a non-residential facility operated for profit or on a nonprofit basis that provides physician prescribed basic services to seven or more medically- dependent or technologically-dependent minors age 21 or under . The maximum capacity for a prescribed pediatric extended care center may not exceed 60 minors . A minor can receive up to 12 hours of basic services per day including: • Medical • Nursing • Psychosocial • Therapeutic • Developmental

As of Aug . 31, 2016, DADS has not licensed any prescribed pediatric extended care centers .

Waiver Programs

The Home and Community-based Services and Texas Home Living programs are Medicaid waiver programs approved by the Centers for Medicare and Medicaid Services (CMS) pursuant to 1915(c) of the Social Security Act . They provide community-based services and supports to eligible recipients as an alternative to the Intermediate Care Facilities For Individuals With An Intellectual Disability Or Related Conditions program .

The waiver programs certified (not licensed) by Regulatory Services are:

• Home and Community-based Services Home and Community-based Services (HCS) provides community-based services and supports as an alternative to institutional placement . Program services supplement services and supports a person may receive from other programs, such as Texas Health Steps, or from natural supports, such as family, neighbors or community organizations . To qualify for services in Home and Community-based Services, a recipient must have a diagnosis of an intellectual or developmental disability and must be eligible for Medicaid . Home and Community-based Services serves people of any age . Participants live in the community in a variety of settings including their own home, their family’s home, a home with a foster care or a companion care provider or in a three- or four-person group home . Most Home and Community-based Services program participants receive Supplemental Security Income, Social Security or other benefits, which are used to pay their rent, utilities, food and living expenses . The Home and Community-based Services program waiver pays for supports such as residential or in-home and community supports,

8 DADS Regulatory Services FY 2016 Annual Report nursing, day habilitation, respite, behavioral supports, specialized therapies, dental, minor home modifications, adaptive aids and supported employment . The types and amounts of services received are based on the recipient’s needs . Medical services are typically provided by physicians or hospitals who accept Medicaid .

• Texas Home Living Texas Home Living (TxHmL) provides services and supports to Texans with intellectual or developmental disabilities who are eligible for Medicaid so they can continue to live with their families or in their own homes . Program services supplement services and supports a person may receive from other programs, such as Texas Health Steps, or from natural supports such as family, neighbors or community organizations . Texas Home Living does not offer residential services . Texas Home Living serves people of any age and pays for services such as in-home or community supports, nursing, day habilitation, respite, behavioral supports, specialized therapies, dental, minor home modifications, adaptive aids and employment assistance .

General Information 9 Fiscal Year (FY) 2016 Information and Trends

DADS Regions in Texas

Regions and the Counties They Serve

Region 1: High Plains Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum

Region 2: Northwest Texas Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan,

10 DADS Regulatory Services FY 2016 Annual Report Runnels, Scurry, Shackelford, Stonewall, Stephens, Taylor, Throckmorton, Wichita, Wilbarger, Young

Region 3: Metroplex Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise

Region 4: Upper East Texas Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood

Region 5: Southeast Texas Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler

Region 6: Gulf Coast Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton

Region 7: Central Texas Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson

Region 8: Upper South Texas Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala

Region 9: West Texas Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler

Region 10: Upper Rio Grande Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio

Region 11: Lower South Texas Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

General Information 11 DADS Waiver Contract Areas

Waiver Contract Areas and the Counties They Serve

Area 1 Armstrong, Bailey, Briscoe, Carson, Castro, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Donley, Floyd, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Wheeler

Area 2 Archer, Baylor, Brown, Callahan, Childress, Clay, Coleman, Comanche, Cottle, Dickens, Eastland, Erath, Foard, Hardeman, Haskell, Hood, Jack, Johnson, Jones, King, Knox, McCulloch, Mills, Montague, Palo Pinto, Parker, San Saba, Shackelford, Somervell, Stephens, Stonewall, Tarrant, Taylor, Throckmorton, Wichita, Wilbarger, Wise, Young

12 DADS Regulatory Services FY 2016 Annual Report Area 3 Collin, Cooke, Dallas, Denton, Fannin, Grayson

Area 4 Anderson, Angelina, Bowie, Camp, Cass, Chambers, Cherokee, Delta, Ellis, Franklin, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Hunt, Jasper, Jefferson, Kaufman, Lamar, Liberty, Marion, Montgomery, Morris, Nacogdoches, Nvarro, Newton, Orange, Panola, Polk, Rains, Red River, Rockwall, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Walker, Wood

Area 5 Austin, Brazoria, Colorado, Fort Bend, Galveston, Harris, Matagorda, Waller, Wharton

Area 6 Bastrop, Bell, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Gonzales, Grimes, Guadalupe, Hamilton, Hill, Lampasas, Lee, Leon, Limetone, Madison, McLennan, Milam, Robertson, Travis, Washington, Williamson

Area 7 Atascosa, Bandera, Bexar, Blanco, Calhoun, Comal, De Witt, Dimmit, Edwards, Frio, Gillespie, Goliad, Hays, Jackson, Karnes, Kendall, Kerr, Kimble, Kinney, La Salle, Lavaca, Llano, Mason, Maverick, McMullen, Medina, Menard, Real, Refugio, Schleicher, Sutton, Uvalde, Val Verde, Victoria, Wilson, Zavala

Area 8 Andrews, Borden, Brewster, Coke, Concho, Crane, Crockett, Culberson, Dawson, Ector, El Paso, Fisher, Gaines, Garza, Glasscock, Howard, Hudspeth, Irion, Jeff Davis, Kent, Loving, Martin, Midland, Mitchell, Nolan, Pecos, Presidio, Reagan, Reeves, Runnels, Scurry, Sterling, Terrell, Terry, Tom Green, Upton, Ward, Winkler, Yoakum

Area 9 Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, Nueces, San Patricio, Starr, Webb, Willacy, Zapata

General Information 13 Regulated Facilities The following tables and charts represent snapshots of regulated long-term care facility counts and occupancy numbers . Occupancy numbers reflect the facility census from the most recent visit and include all residents and occupants, whether they receive benefits from Medicare or Medicaid, or are private pay .

Facility and Occupancy Counts by Program Type

Program Count % of all Facilities Occupancy % of all Occupants

DAHS 466 10 .6% 22,443 13 .5% Assisted Living 1,864 42 .5% 42,782 25 .7% ICF/IID 828 18 .9% 8,132 4 .9% Nursing 1,228 28 .0% 92,943 55 .9% Total 4,386 NA 166,300 NA

Facilities in Texas by Program and Region

Asst. % of all DAHS % of all ICF/IID % of all Nursing % of all Total % of Region Living Asst. Count DAHS Count ICF/IID Count Nursing Count Total Count Living

01 6 1 .3% 87 4 .7% 32 3 .9% 73 5 .9% 198 4 .5% 02 1 0 .2% 48 2 .6% 41 5 .0% 74 6 .0% 164 3 .7% 03 36 7 .7% 569 30 .5% 210 25 .4% 278 22 .6% 1,093 24 .9% 04 8 1 .7% 94 5 .0% 71 8 .6% 97 7 .9% 270 6 .2% 05 9 1 .9% 46 2 .5% 48 5 .8% 84 6 .8% 187 4 .3% 06 50 10 .7% 467 25 .1% 123 14 .9% 167 13 .6% 807 18 .4% 07 5 1 .1% 179 9 .6% 107 12 .9% 148 12 .1% 439 10 .0% 08 56 12 .0% 271 14 .5% 118 14 .3% 173 14 .1% 618 14 .1% 09 2 0 .4% 23 1 .2% 33 4 .0% 42 3 .4% 100 2 .3% 10 30 6 .4% 39 2 .1% 13 1 .6% 17 1 .4% 99 2 .3% 11 263 56 .4% 41 2 .2% 32 3 .9% 75 6 .1% 411 9 .4% Total 466 NA 1,864 NA 828 NA 1,228 NA 4,386 NA (Note: Nursing count includes hospital-based facilities .)

14 DADS Regulatory Services FY2016 Annual Report Facility Visits/Contacts by DADS Surveyors by Region

Assisted Region DAHS ICF/IID Nursing Unlicensed Total Living

01 19 186 71 668 2 946 02 1 94 134 609 0 838 03 77 1,859 596 3,439 72 6,043 04 14 354 152 1,015 0 1,535 05 10 91 154 749 12 1,016 06 133 1,376 479 1,865 127 3,980 07 10 557 395 1,382 39 2,383 08 127 704 272 1,482 26 2,611 09 3 97 124 365 0 589 10 82 103 50 183 12 430 11 593 157 97 638 6 1,491 Total 1,069 5,578 2,524 12,395 296 21,862

Notes: 1 . Visits/contacts consist of all on-site, off-site and combination inspections and investigations done by Regulatory Services survey staff . 2 . The Unlicensed column includes visits to locations without a DADS license . During the visit, Regulatory Services staff will determine if the location is providing services in violation of state licensing rules, providing services that have no licensure requirements or not providing services

Facility Visits/Contacts Compared to the Number of Facilities

% of All Facility Visits/ % of All Visits/ Facility Type Facility Count Facilities Contacts Contacts

DAHS 466 10 .1% 1,069 4 .9% Assisted Living 1,864 40 .3% 5,578 25 .5% ICF/IID 828 17 .9% 2,524 11 .5% Nursing 1,228 26 .5% 12,395 56 .7% Unlicensed 242 5 .2% 296 1 .4% Total 4,628 NA 21,862 NA

Notes: 1 . Visits/contacts consist of all on-site, off-site and combination inspections and investigations done by Regulatory Services survey staff . 2 . The Unlicensed column includes visits to locations without a DADS license . During the visit, Regulatory Services staff will determine if the location is providing services in violation of state licensing rules, providing services that have no licensure requirements or not providing services .

General Information 15 Changes in Regulated Facilities

Facility and Occupancy Counts in FY 2012 and FY 2016

Program FY 2012 Count FY 2012 Occupancy FY 2016 Count FY 2016 Occupancy

DAHS 497 21,136 466 22,443 Assisted Living 1,664 33,182 1,864 42,782 ICF/IID 861 9,833 828 8,132 Nursing 1,211 87,533 1,228 92,943 Total 4,233 151,684 4,386 166,300

Facility and Occupancy by Percentage in FY 2012 and FY 2016

FY 2012 % of FY 2012 % of Total FY 2016 % of Total FY 2016 % of Total Program Total Facilities Occupancy Facilities Occupancy

DAHS 11 .7% 13 .9% 10 .6% 13 .5% Assisted Living 39 .3% 21 .9% 42 .5% 25 .7% ICF/IID 20 .3% 6 .5% 18 .9% 4 .9% Nursing 28 .6% 57 .7% 28 .0% 55 .9%

Day Activity and Health Services Facility Trends

Licensed Facilities: Occupants: Number of Spaces: Number of Percent Number of Percent Occupancy Fiscal Year Licensed Percent Facilities Growth/ Occupants Growth/ Rates Spaces Growth/ Loss Loss Loss

2012 498 +0 .2% 43,586 +1 .5% 21,826 +3 .3% 50 .1% 2013 479 -3 .8% 42,599 -2 .3% 21,943 +0 .5% 51 .1% 2014 478 -0 .2% 43,402 +1 .9% 22,174 +1 .1% 51 .1% 2015 481 +0 .6% 44,385 +2 .3% 22,493 +1 .4% 50 .7% 2016 466 -3 .1% 43,660 -1 .6% 22,443 -0 .2% 51 .4% Percent Change NA -6 4% NA +0 2% NA +2 8% NA FY2012 to 2016

16 DADS Regulatory Services FY 2016 Annual Report Assisted Living Facility Trends

Facilities: Number of Licensed Number Occupants: Percent Licensed or Certified Number of Occupancy Fiscal Year of Percent Growth/ or Certified Beds: Percent Occupants Rates Facilities Growth/Loss Loss Beds Growth/Loss

2012 1,723 +3 .5% 54,773 +3 .3% 35,017 +5 .5% 63 .9% 2013 1,792 +4 .0% 58,146 +6 .2% 37,546 +7 .2% 64 .6% 2014 1,771 -1 .2% 60,369 +3 .8% 39,435 +5 .0% 65 .3% 2015 1,829 +3 .3% 63,949 +5 .9% 40,845 +3 .6% 63 .9% 2016 1,864 +1 .9% 67,647 +5 .8% 42,782 +4 .7% 63 .2% Percent Change NA +8 2% NA +23 5% NA +22 2% NA FY2012 to 2016

All Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Trends

Facilities: Number of Licensed Number Occupants: Fiscal Percent Licensed or Certified Number of Occupancy of Percent Year Growth/ or Certified Beds: Percent Occupants Rates Facilities Growth/Loss Loss Beds Growth/Loss

2012 861 0 .0% 12,170 -0 .6% 9,570 -2 .7% 78 .6% 2013 862 +0 .1% 11,988 -1 .5% 9,160 -4 .3% 76 .4% 2014 863 +0 .1% 11,862 -1 .1% 8,803 -3 .9% 74 .2% 2015 847 -1 .9% 11,730 -1 .1% 8,401 -4 .6% 71 .6% 2016 828 -2 .2% 11,505 -1 .9% 8,132 -3 .2% 70 .7% Percent Change NA -3 8% NA -5 5% NA -15 0% NA FY2012 to 2016 Note: The number of certified beds reflects the number of intermediate care facilities for individuals with an intellectual disability or related conditions beds authorized by the Centers for Medicare and Medicaid Services for participation in the Medicaid program . Occupancy rates do not reflect funded capacity .

General Information 17 DADS-Operated Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Trends

Facilities: Number of Licensed Number Occupants: Fiscal Percent Licensed or Certified Number of Occupancy of Percent Year Growth/ or Certified Beds: Percent Occupants Rates Facilities Growth/Loss Loss Beds Growth/Loss

2012 15 0 .0% 5,995 0 .0% 3,787 -9 .7% 63 .2% 2013 15 0 .0% 5,995 0 .0% 3,557 -6 .1% 59 .3% 2014 15 0 .0% 5,995 0 .0% 3,372 -5 .2% 56 .2% 2015 15 0 .0% 5,995 0 .0% 3,195 -5 .2% 53 .3% 2016 15 0 .0% 5,995 0 .0% 3,112 -2 .6% 51 .9% Percent Change NA 0 0% NA 0 0% NA -17 8% NA FY2012 to 2016 Note: The number of certified beds reflects the number of intermediate care facilities for individuals with an intellectual disability or related conditions beds authorized by the Centers for Medicare and Medicaid Services for participation in the Medicaid program . Occupancy rates do not reflect funded capacity .

Private and Community-operated Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Trends

Facilities: Number of Licensed Number Occupants: Fiscal Percent Licensed or Certified Number of Occupancy of Percent Year Growth/ or Certified Beds: Percent Occupants Rates Facilities Growth/Loss Loss Beds Growth/Loss

2012 846 0 .0% 6,175 -1 .2% 5,783 +2 .5% 93 .7% 2013 847 +0 .1% 5,993 -2 .9% 5,603 -3 .1% 93 .5% 2014 848 +0 .1% 5,867 -2 .1% 5,431 -3 .1% 92 .6% 2015 832 -1 .9% 5,735 -2 .2% 5,206 -4 .1% 90 .8% 2016 813 -2 .3% 5,510 -3 .9% 5,020 -3 .6% 91 .1% Percent Change NA -3 9% NA -10 8% NA -13 2% NA FY2012 to 2016

18 DADS Regulatory Services FY 2016 Annual Report Nursing Facility Trends

Facilities: Number of Licensed Number Occupants: Fiscal Percent Licensed or Certified Number of Occupancy of Percent Year Growth/ or Certified Beds: Percent Occupants Rates Facilities Growth/Loss Loss Beds Growth/Loss

2012 1,215 +0 .3% 135,003 +0 .6% 92,844 +6 .1% 68 .8% 2013 1,218 +0 .2% 135,881 +0 .7% 93,764 +1 .0% 69 .0% 2014 1,224 +0 .5% 136,856 +0 .7% 94,591 +0 .9% 69 .1% 2015 1,223 -0 .1% 137,335 +0 .4% 93,588 -1 .1% 68 .1% 2016 1,228 +0 .4% 137,975 +0 .5% 92,943 -0 .7% 67 .4% Percent Change NA +1 1% NA +2 2% NA +0 1% NA FY2012 to 2016 Note: The number of licensed or certified beds includes all types — Medicare, Medicaid and private pay .

Facility Visits/Contacts by DADS Surveyors for FY 2012-16

Facility Type FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

DAHS 971 1,117 1,015 871 1,069 Assisted Living 4,502 4,447 4,946 4,883 5,578 ICF/IID 2,400 2,464 2,339 2,412 2,524 Nursing 10,611 10,916 11,683 12,228 12,395 Unlicensed 256 287 290 241 296 Totals 18,740 19,231 20,273` 20,635 21,862 Notes: 3 . Visits/contacts consist of all on-site, off-site and combination inspections and investigations done by Regulatory Services survey staff . 4 . The Unlicensed row counts visits to locations without a DADS license . During the visit, Regulatory Services staff will determine if the location is providing services in violation of state licensing rules, providing services that have no licensure requirements or not providing services .

Assisted Living Life Safety Code Initial Visit

In accordance with Texas Health and Safety Code, Title 4, Subtitle B, Chapter 247, Subchapter B, Section 247 .0262, Report on Life Safety Code Surveys, DADS is including information on the number of Life Safety Code surveys for an initial assisted living facility license when the department first visits the facility to conduct the survey more than 60 days after the date the applicant notifies the department that the applicant is ready for the initial survey .

General Information 19 During fiscal year 2016, DADS conducted 146 initial Life Safety Code visits for assisted living facilities . None of the visits exceeded the 60-day limit set by this statute .

Regulated Home and Community Support Services Agencies

Home and Community Support Services Agency Counts by Agency Type

Consumers for % of All % of All Agency Type Count FY2015 and Agencies Consumers FY2016

Home health and 5,402 85 .9% 1,201,770 98 .1% hospice parents Home health 701 11 .1% 12,471 1 .0% branches Alternate 189 3 .0% 11,381 0 .9% delivery sites Total 6,292 NA 1,225,622 NA Note: Senate Bill 1318, 80th Legislature, Regular Session, 2007, increased the licensure period for home and community support services agencies to two years . Consumer counts are the number of unduplicated consumers reported by each agency on its license renewal application .

Home and Community Support Services Agency Counts by DADS Region

% of % of % of Alternate Parent Branch Alternate Total % of Region Parent Branch Delivery Count Count Delivery Count Total Total Total Site Count Site Total

01 97 1 .8% 46 6 .6% 8 4 .2% 151 2 .4% 02 90 1 .7% 25 3 .6% 15 7 .9% 130 2 .1% 03 1,614 29 .9% 133 19 .0% 46 24 .3% 1,793 28 .5% 04 191 3 .5% 75 10 .7% 26 13 .8% 292 4 .6% 05 138 2 .6% 48 6 .8% 10 5 .3% 196 3 .1% 06 1,602 29 .7% 63 9 .0% 21 11 .1% 1,686 26 .8% 07 332 6 .1% 80 11 .4% 28 14 .8% 440 7 .0% 08 442 8 .2% 92 13 .1% 19 10 .1% 553 8 .8% 09 65 1 .2% 22 3 .1% 6 3 .2% 93 1 .5% 10 155 2 .9% 14 2 .0% 2 1 .1% 171 2 .7% 11 676 12 .5% 103 14 .7% 8 4 .2% 787 12 .5% Totals 5,402 NA 701 NA 189 NA 6,292 NA

20 DADS Regulatory Services FY 2016 Annual Report Home and Community Support Services Agency Visits/Contacts by DADS Surveyors by Region

Region HCSSA

01 72 02 57 03 685 04 156 05 86 06 773 07 250 08 313 09 34 10 97 11 362 Total 2,885 Note: Visits/contacts consist of all on-site, off-site and combination inspections and investigations done by Regulatory Services survey staff .

Home and Community Support Services Agency Counts by Category of Service

Alternate Category of Service Parent Branch Delivery Site

Licensed and certified home health 2,511 304 NA Licensed and certified home health w/ dialysis 1 0 NA Licensed home health services 3,234 562 NA Licensed home health w/ dialysis 30 1 NA Personal assistance services 3,703 415 NA Hospice 721 NA 189 Note: Home and community support services agencies can provide more than one category of service from the same parent or branch .

General Information 21 Home and Community Support Services Agency Counts by Category of Service by DADS Region

Category of Service 01 02 03 04 05 06 07 08 09 10 11 Total

Parent: licensed and 49 57 809 101 72 756 112 146 34 67 308 2,511 certified home health Parent: licensed 54 52 983 116 94 1,016 168 227 35 78 411 3,234 home health Parent: licensed home 0 0 8 2 0 16 2 1 0 0 1 30 health with dialysis Parent: personal assistance 44 43 1,146 94 71 1,231 199 244 32 106 493 3,703 Parent: hospice 24 14 210 36 29 160 60 89 14 17 68 721 Parent: licensed and 0 0 0 0 0 0 0 0 0 0 1 1 certified home health with dialysis Branch: licensed and 23 16 67 57 32 29 30 17 12 0 21 304 certified home health Branch: licensed 45 23 111 59 36 52 62 64 15 12 83 562 home health Branch: licensed home 0 0 1 0 0 0 0 0 0 0 0 1 health with dialysis Branch: personal assistance 25 14 73 39 26 31 40 69 13 8 77 415 Branch: licensed and 0 0 0 0 0 0 0 0 0 0 0 0 certified home health with dialysis Alternative delivery 8 15 46 26 10 21 28 19 6 2 8 189 site: hospice Note: Home and community support services agencies can provide more than one category of service from the same parent or branch .

22 DADS Regulatory Services FY 2016 Annual Report Changes in Regulated Home and Community Support Services Agencies

Home and Community Support Services Agency Counts for FY 2012 and FY 2016

Agency Type FY 2012 Count FY 2016 Count

Home health and 5,115 5,402 hospice parents Home health branches 771 701 Alternate delivery sites 177 189 Total 6,063 6,292

Home and Community Support Services Agency Trends

Alternate Parents: Branches: Number of Total All: Number Number Delivery Fiscal Percent Percent Alternate Number Percent of of Sites: Year Growth/ Growth/ Delivery of Growth/ Parents Branches Percent Loss Loss Sites Agencies Loss Growth/Loss

2012 5,115 +4 .5% 771 -0 .4% 177 +7 .9% 6,063 +3 .9% 2013 5,339 +4 .4% 780 +1 .2% 177 +0 .0% 6,296 +3 .8% 2014 5,413 +1 .4% 769 -1 .4% 170 -4 .0% 6,352 +0 .9% 2015 5,426 +0 .2% 730 -5 .1% 187 +10 .0% 6,343 -0 .1% 2016 5,402 -0 .4% 701 -4 .0% 189 +1 .1% 6,292 -0 .8% Percent Change NA +5 6% NA -9 1% NA +6 8% NA +3 8% FY2012 to 2016

Home and Community Support Services Agency Visits/Contacts by DADS Surveyors for FY 2012-16

Agency Type FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

HCSSA 3,713 3,628 3,874 3,470 2,885 Note: Visits/contacts consist of all on-site, off-site and combination inspections and investigations done by Regulatory Services survey staff .

General Information 23 Regulated Waiver Programs

Waiver Program and Consumer Counts

Count of % of all % of All Program Type Waiver Consumers Contracts Consumers Contracts

Home and Community- 811 66 .8% 26,081 78 .9% based Services Texas Home Living 403 33 .2% 6,989 21 .1% Total 1,214 NA 33,070 NA

Contracts in Texas by Waiver Program and Contract Area

Waiver % of % of All HCS TxHmL Total % of All Contract All HCS TxHmL Contracts Contracts Contracts Contracts Area Contracts Contracts

1 15 1 .8% 10 2 .5% 25 2 .1% 2 99 12 .2% 58 14 .4% 157 12 .9% 3 147 18 .1% 78 19 .4% 225 18 .5% 4 110 13 .6% 45 11 .2% 155 12 .8% 5 229 28 .2% 107 26 .6% 336 27 .7% 6 70 8 .6% 30 7 .4% 100 8 .2% 7 74 9 .1% 29 7 .2% 103 8 .5% 8 22 2 .7% 18 4 .5% 40 3 .3% 9 45 5 .5% 28 6 .9% 73 6 .0% Total 811 NA 403 NA 1,214 NA

24 DADS Regulatory Services FY 2016 Annual Report Reviews of Waiver Programs by DADS Reviewers by Contract Area

Home and Waiver Texas Home Community-based Total Contract Area Living Services

1 29 12 41 2 150 64 214 3 201 92 293 4 160 53 213 5 320 129 449 6 128 41 169 7 110 38 148 8 35 21 56 9 69 27 96 Total 1,202 477 1,679 Note: Reviews consist of all certification, intermittent and follow-up reviews or drop-by visits done by Regulatory Services Waiver Survey and Certification staff .

Reviews of Waiver Programs Compared to the Number of Waiver Programs

Program Type Contract Count % of All Contracts % of All Reviews

Home and 811 66 .8% 71 .6% Community-based Services Texas Home Living 403 33 .2% 28 .4% Total 1,214 NA NA Note: Reviews consist of all certification, intermittent and follow-up reviews or visits by Regulatory Services Waiver Survey and Certification staff .

Home and Community-based Services Residential Category Consumer Counts

Residential Category Consumers % of Consumers

Own home or family home 4,378 17 .0% Foster care 13,156 51 .0% Three-person group home 3,840 14 .9% Four-person group home 4,425 17 .2% Total 25,799 NA

General Information 25 Home and Community-based Services Residential Reviews

Residential Category Reviews Completed % of All Reviews

Own home or family home NA NA Foster care 9,717 79 .9% Three-person group home 1,265 10 .4% Four-person group home 1,172 9 .6% Total 12,154 NA Note: Effective Sept . 1, 2009, Texas Human Resources Code, Title 11, Chapter 161, Subchapter D, Section 161 .076, On-site Surveys of Certain Providers, as amended by Senate Bill 643, 81st Legislature, Regular Session, 2009, requires DADS to conduct annual, unannounced inspections of all three- person and four-person Home and Community-based Services group homes . DADS also received appropriations to conduct annual inspections of all Home and Community-based Services foster/ companion care residences .

Changes in Waiver Programs

Waiver Program Contract and Consumer Counts for FY 2012–2016

FY 2012 FY 2012 FY 2016 FY 2016 Program Type Contracts Consumers Contracts Consumers

Home and 706 20,568 811 26,081 Community- based Services Texas Home 277 5,239 403 6,989 Living Total 983 25,807 1,214 33,070

Waiver Program Contract and Consumers by Percentage in FY 2012–2016

FY 2012 FY 2012 FY 2016 FY 2016 Program Type % of All % of All % of All % of All Contracts Consumers Contracts Consumers

Home and 71 .8% 79 .7% 66 .8% 78 .9% Community- based Services Texas Home 28 .2% 20 .3% 33 .2% 21 .1% Living

26 DADS Regulatory Services FY 2016 Annual Report Home and Community-based Services Trends

HCS Number of HCS: % HCS Consumers: Fiscal Year HCS Contracts Growth/Loss Consumers % Growth/ Loss

2012 706 +3 .7% 20,568 +0 .7% 2013 737 +4 .4% 20,781 +1 .0% 2014 767 +4 .1% 21,334 +2 .7% 2015 791 +3 .1% 24,608 +15 .3% 2016 811 +2 .5% 26,081 +6 .0% Percent Change NA +14 9% NA +26 8% FY2012 to 2016 Note: Home and Community-based Services contract counts include only contracts through which at least one consumer is provided services .

Texas Home Living Trends

Number TxHmL TxHmL: % TxHmL Fiscal Year of TxHmL Consumers: % Growth/Loss Consumers Contracts Growth/Loss

2012 277 +47 .3% 5,239 +128 .8% 2013 327 +18 .1% 5,755 +9 .8% 2014 374 +14 .4% 5,955 +3 .5% 2015 423 +13 .1% 7,358 +23 .6% 2016 403 -4 .7% 6,989 -5 .0% Percent Change NA +45 5% NA +33 4% FY2012 to 2016

Reviews of Waiver Programs by DADS Reviewers for FY 2012–16

Facility Type FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

Home and Community- 854 885 1,014 960 1,202 based Services Texas Home Living 319 316 425 396 477 Totals 1,173 1,201 1,439 1,356 1,679

General Information 27 Comparisons to Other States In Centers for Medicare and Medicaid Services Region VI (which includes Arkansas, Louisiana, New Mexico, Oklahoma and Texas):

In FY 2016, Texas accounts for: • 64 percent of all active certified facilities and agencies • 62 percent of all nursing federal enforcement cases • 63 percent of all immediate jeopardy situations • 68 percent of all past noncompliance cases

Nationwide, Texas accounts for: • 19 percent of all certified home and community support services agencies • 13 percent of all intermediate care facilities for individuals with an intellectual disability or related conditions • 8 percent of all certified nursing facilities • 15 percent of all state survey agency hours spent on investigations at nursing facilities • 8 percent of all nursing facility federal enforcement cases • 15 percent of all immediate jeopardy situations • 16 percent of all past noncompliance cases

Credentialing Programs DADS Regulatory Services is also responsible for the following activities and programs related to the administration and operation of long-term care facilities: • Nursing facility administrator licensing and investigation • Medication aide permits • Nurse Aide Training and Competency Evaluation • Nurse aide certification • Employee Misconduct Registry

28 DADS Regulatory Services FY 2016 Annual Report Credentialing Program Counts by Fiscal Year

Credentialing Program FY 2014 FY 2015 FY 2016

Licensed nursing facility administrators 2,057 2,127 2,210 Active medication aides 9,977 9,835 9,941 Approved Nurse Aide Training and Competency 216 252 310 Evaluation Programs (facility-based) Approved Nurse Aide Training and Competency 567 586 602 Evaluation Programs (non facility-based) Active certified nurse aides listed on the Nurse Aide 127,709 114,715 114,397 Registry

Nursing Facility Administrator Program

Activity Action FY 2014 FY 2015 FY 2016

New licenses Issued 194 181 167 License renewals (1) Renewed 928 882 1,030 Provisional licenses Issued 29 18 41 Referrals (2) Received 156 178 217 Complaints against nursing facility Received 1 1 0 administrators (3) New sanctions against administrator Imposed 40 62 61 license Nursing facility administrators required Fulfilled 40 27 45 sanctions Administrative penalties Assessed 0 3 2 National Association of Boards Administered 191 203 211 of Examiners of Long-term Care Administrators exams State exams Administered 210 196 211 Notes: 1 . Nursing facility administrators are licensed for two years . 2 . Nursing facility administrators are automatically referred to the Regulatory Services Professional Credentialing Enforcement unit for investigation when substandard quality of care or an immediate jeopardy is identified at a Medicaid- or Medicare-certified facility during their tenure . 3 . Complaints received from the general public .

General Information 29 Medication Aide Program

Activity Action FY 2014 FY 2015 FY 2016

New medication aide permits Issued 1,199 1,170 1,272 Testing dates at schools Scheduled 158 158 170 Initial exams Administered 1,443 1,309 1,387 Retest dates Scheduled 194 317 345 Permits Renewed 9,504 9,390 9,425 Complaints Received 3 8 10 Sanctions Imposed 6 6 15

Nurse Aide Training and Competency Evaluation Program

Activity Action FY 2014 FY 2015 FY 2016

New NATCEPs Approved 126 187 175 NATCEPs Renewed 194 236 221 NATCEPs withdrawn from participation Withdrew 123 151 104 Competency Evaluation Programs Approved 302 294 227

Nurse Aide Registry

Activity Action FY 2014 FY 2015 FY 2016

New nurse aides to program Added 12,866 15,717 15,944 Nurse aides removed from active status Removed 32,375 28,873 32,849 Nurse aides from expired status to Returned 83,495 69,929 76,689 active status New misconduct referrals received/ Processed 48 139 75 processed Employee misconduct cases Dismissed 0 7 18 Employee misconduct cases Revoked 44 98 81 Client contacts made by mail Contacted 42,777 48,335 47,066 Public inquiries Received 0 0 0 Client contacts made by telephone Contacted 109,134 132,652 130,156

30 DADS Regulatory Services FY 2016 Annual Report Employee Misconduct Registry

Activity Action FY 2014 FY 2015 FY 2016

New employee misconduct referrals Processed 30 59 60 New unlicensed facility employees to Added 25 61 59 the registry New unlicensed HCSSA, HCS or ICF/ Added 112 263 229 IID employees to the registry (1) Notes: 1 . Inclusion of unlicensed employees of home and community support services agency, home and community-based services or intermediate care facilities for individuals with an intellectual disability or related conditions onto the Employee Misconduct Registry result from investigations performed by the Texas Department of Family and Protective Services .

Overview of Enforcement Activities

Administrative Penalties

During FY 2016, DADS imposed 779 administrative penalties against facilities and agencies, including: • 659 against home and community support services agencies • 51 against nursing facilities • 44 against assisted living facilities • 20 against intermediate care facilities for individuals with an intellectual disability or related conditions • 5 against day activity and health services facilities

Facility Referrals to the Office of the Attorney General

During FY 2016, DADS referred the following facilities for injunctive/other relief and civil penalties: • 22 unlicensed facilities • 3 assisted living facilities • 2 nursing facilities

Facility Amelioration Requests

In certain situations, the commissioner of DADS may allow, in lieu of demanding payment of an administrative penalty, the use (under the supervision of DADS) of any portion of the penalty to ameliorate the violation . The amelioration plan must improve services (other than administrative services) or quality of care of residents in the nursing facility, intermediate care facilities for individuals with an intellectual disability or related conditions or assisted living facility affected by the violation .

General Information 31 DADS approved four amelioration requests for nursing facilities and two for intermediate care facilities for individuals with an intellectual disability or related conditions in FY 2016 . • $90,000 for expanded dining services . • $40,219 to implement the Music and Memory Program .

License Denials

During FY 2016, DADS denied 63 initial and renewal applications for licensure for facilities and agencies, including: • 30 home and community support services agencies • 24 assisted living facilities • 8 day activity and health services facilities • 1 nursing facility

License Revocations

During FY 2016, DADS revoked 48 facility and agency licenses, including: • 48 home and community support services agencies

Home and Community Support Services Agency Expiration of Licenses (in Lieu of Enforcement Actions)

Instead of pursuing additional enforcement actions, DADS may choose to allow an agency to let its license expire . During FY 2016, 11 home and community support services agency licenses were allowed to expire in lieu of further enforcement actions .

Home and Community Support Services Agency Surrender of Licenses (in Lieu of Enforcement Actions)

At DADS discretion, an agency may be offered the option to surrender its license, instead of receiving additional enforcement actions . In FY 2016, 36 home and community support services agencies surrendered their license in lieu of further enforcement actions .

Vendor Holds

During FY 2016, DADS placed 9 waiver contracts on vendor hold .

Denial of Certification

During FY 2016, DADS denied certification to 9 waiver contracts .

32 DADS Regulatory Services FY 2016 Annual Report Unlicensed Facilities

DADS Regulatory Services addresses violators of state licensing laws who operate facilities without a required license . DADS responds to complaints from the public and other entities alleging facilities are operating without a license and, if the agency finds a facility is in violation of licensure laws, it can refer a facility to the Office of the Attorney General or the local county or district attorney for relocation of residents, injunctive relief and/or civil penalties .

During FY 2016, DADS referred 22 unlicensed facilities for injunctive/other relief and civil penalties . Of those, all 22 referrals were to the Office of the Attorney General .

Nursing Facility Civil Money Penalties

Centers for Medicare and Medicaid Services or DADS may impose a civil money penalty (CMP) for the number of days that a skilled nursing or nursing facility is not in substantial compliance with one or more participation requirements, or for each instance that a facility is not in substantial compliance — regardless of whether the deficiencies constitute immediate jeopardy . Centers for Medicare and Medicaid Services or DADS may also impose a CMP for the number of days of past noncompliance since the last standard survey, including the number of days of immediate jeopardy .

In FY 2016, Centers for Medicare and Medicaid Services imposed 259 CMPs against facilities participating in the Medicare program; DADS imposed three CMPs against facilities that contracted for Medicaid only .

Regulatory Services Penalty Receipts for FY 2012–2016

Administrative Penalties Amount Civil Money Penalties Amount Fiscal Year Received (All Facility Types) Received (Nursing Facilities)

2012 $603,676 .16 $2,667,298 .49 2013 $394,675 .00 $2,979,482 .94 2014 $685,391 .00 $3,673,288 .69 2015 $489,417 .01 $4,252,411 .81 2016 $928,287 .99 $5,153,955 .58

General Information 33 Top 10 Rankings

Deficiencies

Top 10 Deficiencies (Licensure Violations) Cited During Inspections for FY 2016: Assisted Living Facilities

1 . [TIE] FA-SS: Fire Alarm and Sprinkler Systems: 40 TAC §92 62(f)(1) — The facility failed to ensure that the fire alarm and smoke detection system was in compliance with licensing standards for assisted living facilities . (Ranked No . 2 in FY 2015)

1 . [TIE] Sprinkler Systems: 40 TAC §92 62(f)(2) — The facility failed to ensure the required sprinkler system was inspected, tested, and maintained in compliance with National Fire Protection Association 25 . (Ranked No . 1 in FY 2015)

3. General Safety: Building in Good Repair: 40 TAC §92.62(i)(2) — The facility failed to ensure that the building was kept in good repair . (Ranked No . 3 in FY 2015)

4 . Operations: Fire Drills: 40 TAC §92 62(c)(2) — The facility failed to ensure fire drills were conducted and documented to be in compliance with licensing standards for assisted living facilities . (Ranked No . 4 in FY 2015)

5 . Requirements: Other Chapters, Sec etc of NFPA 101: 40 TAC §92 61(b)(4) (E) — The facility failed to ensure the building and structure complied with other applicable chapters of the Life Safety Code, NFPA 101 . (Ranked No . 6 in FY 2015)

6 . Resident Assessment: Service Plan: 40 TAC §92 41(c)(2) — The facility did not develop a service plan for a respite client . (Not ranked in FY 2015)

7 . Sanitation and Housekeeping: Facility Clean and in Good Repair: 40 TAC §92 62(h)(8) — The facility failed to maintain the building free of accumulations of dirt, rubbish, dust, and hazards . (Ranked No . 5 in FY 2015)

8 . FA-SS: Smoke Detector Sensitivity Checks: 40 TAC §92 62(f)(1)(F) — The facility failed to ensure the smoke detectors were to be tested for sensitivity as required . The facility failed to provide all required fire alarm documentation, including as-built installation drawings, operation and maintenance manuals, and a written sequence of operation, must be available for examination by DADS . (Not ranked in FY 2015)

9 . FA-SS: Contract to Maintain Alarm System: 40 TAC §92 62(f)(1)(E) — The facility failed to provide a written contract with a fire alarm firm to perform inspections, testing, and maintenance of the system at least every six months . (Ranked No . 10 in FY 2015)

34 DADS Regulatory Services FY 2016 Annual Report 10 . Requirement: Existing Type B Large Comply Chapter 19: 40 TAC §92 61(b)(4) (D) — The facility failed to ensure the building conformed to Chapters 21 and 18 (Option #2, requires a complete fire alarm system) of the Life Safety Code, NFPA 101 . (Not ranked in FY 2015)

Top 10 Deficiencies (Licensure Violations) Cited During Inspections for FY 2016: Day Activity and Health Services Facilities

1 . Sanitation/Kitchen-Food Service Sanitation: 40 TAC § 98 43(b)(1) — The facility failed to observe state requirements and local health ordinances relating to Texas food establishments . (Ranked No . 1 in FY 2015) 2 . Personal Safety/Fire-Smoking Regulations: 40 TAC §98 42(c)(1)(G)(iii) — The facility failed to provide the proper ashtrays in areas where smoking is permitted . (Ranked No . 3 in FY 2015)

3 . Sanitation/General-Odors/Refuse/Hazards: 40 TAC §98 43(a)(7) — The facility failed to keep the building clean and well maintained . (Ranked No . 5 in FY 2015) 4 . Personal Safety/Fire-Smoking Regulations: 40 TAC §98 42(c)(1)(G)(iv) — The facility failed to provide the proper containers to allow for the emptying of ashtrays in smoking areas . (Ranked No . 8 in FY 2015) 5 . Staff Responsibilities/Nurse: 40 TAC §98 62(d)(2)(A-H) — The facility failed to ensure the facility nurse fulfilled the responsibilities of the position . (Ranked No . 6 in FY 2015) 6 . Communicable Diseases/Staff Health: 40 TAC §98 62(c) — The facility failed to ensure that its employees were free of communicable diseases, through tuberculosis screening or through excluding them from work while communicable . (Ranked No . 4 in FY 2015) 7 . Staff Responsibilities/Director: 40 TAC §98 62(d)(1)(A-H) — The facility failed to ensure the director fulfilled the responsibilities of the position . (Ranked No . 2 in FY 2015) 8 . Staff Qualifications/Director: 40 TAC §98 62(a)(1)(A)(B) — The facility failed to assure that its director met the mandatory qualifications for a director . (Not ranked in FY 2015) 9 . Personal Safety/General-Outdoor Recreation Area: 40 TAC §98 42(c)(2)(L) — The facility failed to provide the required outdoor area directly from the facility, with a wall or fence enclosure, and suitably furnished . (Not ranked in FY 2015) 10 . Personal Safety/Fire Extinguishers-Monthly Inspection: 40 TAC §98 42(c) (1)(M)(i) — The facility staff did not inspect the portable fire extinguishers on a monthly basis or maintain them in proper condition and working order . (Not ranked in FY 2015)

General Information 35 Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Home Health Agencies

1 . Acceptance of Patients, Plan of Care, Medical Supervision: 42 CFR 484 18, TAG 0158 — The agency failed to ensure the care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine . (Ranked No . 1 in FY 2015)

2 . Administrator: 42 CFR 484 14(c), TAG 0133 — The administrator, who may also be the supervising physician or registered nurse required under paragraph (d) of this section, failed to organize and direct the agency's ongoing functions; maintains ongoing liaison among the governing body, the group of professional personnel, and the staff . (Ranked No . 2 in FY 2015)

3 . Clinical Records: 42 CFR 484 48, TAG 0236 — The agency failed to maintain a clinical record containing pertinent past and current findings in accordance with accepted professional standards is maintained for every patient receiving home health services . In addition to the plan of care, the record contains appropriate identifying information; name of physician; drug, dietary, treatment, and activity orders; signed and dated clinical and progress notes; copies of summary reports sent to the attending physician; and a discharge summary . (Ranked No . 4 in FY 2015)

4 . Plan of Care: 42 CFR 484 18(a), TAG 0159 — The agency failed to ensure the plan of care developed in consultation with the agency staff covers all pertinent diagnoses, including mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, any safety measures to protect against injury, instructions for timely discharge or referral, and any other appropriate items . (Ranked No . 3 in FY 2015)

5 . Coordination of Patient Services: 42 CFR 484 14(g), TAG 0143 — The agency failed to ensure all personnel furnishing services maintain liaison that their efforts are coordinated effectively and support the objectives outlined in the plan of care . (Ranked No . 6 in FY 2015)

6 . Encoding OASIS Data: 42 CFR 484 20(a), TAG 0321 — The agency failed to encode and be capable of transmitting OASIS data for each agency patient within 30 days of completing an OASIS data set . (Ranked No . 5 in FY 2015)

7 . Skilled Nursing Services: 42 CFR 484 30, TAG 0170 — The agency failed to furnish skilled nursing services in accordance with the plan of care . (Ranked No . 8 in FY 2015)

8 . Drug Regimen Review: 42 CFR 484 55(c), TAG 0337 — The agency failed to maintain a comprehensive assessment, which must include a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side

36 DADS Regulatory Services FY 2016 Annual Report effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy . (Ranked No . 9 in FY 2015)

9 . Patient Rights: 42 CFR 484 10, TAG 0101 — The agency failed to keep the patient informed of his or her rights . The HHA must protect and promote the exercise of those rights . (Not ranked in FY 2015)

10 . Coordination of Patient Services: 42 CFR 484 14(g), TAG 0144 — The agency failed to maintain clinical record or minutes of case conferences establish that effective interchange, reporting, and coordination of patient care does occur . (Ranked No . 7 in FY 2015)

Top 10 Deficiencies (Licensure Violations) Cited During Inspections for FY 2016: Home Health Agencies

1 . Management Responsibility Supervising Nurse – Level B: 40 TAC §97 243(c)(2) (A)(iii) — The supervising nurse or the alternate supervising nurse failed to make sure that care was provided according to a client's needs as written in the plan of care or care plan . (Ranked No . 1 in FY 2015)

2 . Management Responsibility Administrator – Level A and Level B: 40 TAC §97 243(b)(1)(B) — The agency administrator failed to carry out, organize, and supervise ongoing work under the agency's administrative policies . (Ranked No . 2 in FY 2015)

3 . Self-Reported Incidents of Abuse, Neglect and Exploitation – Level B: 40 TAC §97 249(c) — The agency failed to immediately report within 24 hours, knowledge of an alleged act of abuse, neglect or exploitation of a client by an agency employee, contractor or volunteer, to the Texas Department of Family and Protective Services and to DADS . (Ranked No . 3 in FY 2015)

4 . Quality Assess/Performance Improvement – Level B: 40 TAC §97 287(a)(1) — The agency failed to have, implement, and review a quality assessment and performance improvement program consistent with state requirements . (Ranked No . 5 in FY 2015)

5 . Management Responsibility Administrator – Level A and Level B: 40 TAC §97 243(b)(1)(A) — The agency administrator failed to manage the daily operations of the agency . (Ranked No . 4 in FY 2015)

6 . Continuing Education in Agency Administrator – Level B: 40 TAC §97 260(a) — The agency's administrator or alternate administrator failed to complete 12 hours of continuing education in the required topics within each 12 months in that job as required for the position of the administrator or alternate administrator of an agency . (Ranked No . 10 in FY 2015)

General Information 37 7 . Verify Employability/Use Unlicensed Personnel – Level B: 40 TAC §97 247(a) (3) — The agency employed an unlicensed person with face-to-face client contact before it searched the nurse aide and employee misconduct registries as required or employed an unlicensed person who was listed in either registry as unemployable . (Ranked No . 8 in FY 2015)

8 . Client Records – Level A: 40 TAC §97 301(a)(7) — The agency failed to keep client record entries current, accurate, signed, dated, and free of corrections or alterations made by any means other than strikethroughs properly identifying the person making each change . (Ranked No . 7 in FY 2015)

9 . Coordination of Services – Level B: 40 TAC §97 288(a)(2) — The agency failed to adopt and enforce a written policy regarding coordination of client services with other health services providers . (Not ranked in FY 2015)

10 . Emergency Preparedness Planning and Implementation – Level A and Level B: 40 TAC §97 256(k) — The agency failed to test the response phase of its emergency preparedness and response plan by conducting a planned drill consistent with state licensing rules as part of its annual review of the plan . (Ranked No . 9 in FY 2015)

Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Hospice Agencies

1 . Plan of Care: 42 CFR 418 56(b), TAG 0543 — The hospice failed to ensure all hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire . (Ranked No . 1 in FY 2015)

2 . Clinical Records: 42 CFR 418 104, TAG 0671 — The hospice failed to ensure a clinical record containing past and current findings is maintained for each hospice patient . The clinical record must contain correct clinical information that is available to the patient's attending physician and hospice staff . The clinical record may be maintained electronically . (Ranked No . 7 in FY 2015)

3 . Supervision of Hospice Aides: 42 CFR 418 76(h)(1)(i), TAG 0629 — The hospice failed to ensure that the registered nurse make an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs . The hospice aide does not have to be present during this visit . (Ranked No . 2 in FY 2015)

38 DADS Regulatory Services FY 2016 Annual Report 4 . Content of Plan of Care: 42 CFR 418 56(c)(2), TAG 0547 — The hospice failed to ensure that the plan of care include all services necessary for the palliation and management of the terminal illness and related conditions, including the following: a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs . (Ranked No . 8 in FY 2015)

5 . [TIE] Review of the Plan of Care: 42 CFR 418 56(d), TAG 0552 — The hospice interdisciplinary group (in collaboration with the individual's attending physician, (if any) failed to review, revise and document the individualized plan as frequently as the patient's condition requires, but no less frequently than every 15 calendar days . (Ranked No . 3 in FY 2015)

5 . [TIE] Level of Activity: 42 CFR 418 78(e), TAG 0647 — The hospice failed to ensure that volunteers provide day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract staff . The hospice must maintain records on the use of volunteers for patient care and administrative services, including the type of services and time worked . (Ranked No . 4 in FY 2015)

7 . [TIE] Counseling Services: 42 CFR 418 64(d)(1), TAG 0596 — The hospice failed to ensure counseling services include, but are not limited to, the following: bereavement counseling, have an organized program for the provision of bereavement services furnished under the supervision of a qualified professional with experience or education in grief or loss counseling, make bereavement services available to the family and other individuals in the bereavement plan of care up to one year following the death of the patient . Bereavement counseling also extends to residents of a SNF/NF or ICF/MR when appropriate and identified in the bereavement plan of care, ensure that bereavement services reflect the needs of the bereaved, develop a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery . A special coverage provision for bereavement counseling is specified in §418 .204(c) . (Not ranked in FY 2015)

7 . [TIE] Governing Body and Administrator: 42 CFR 418 100(b), TAG 0651 — The hospice failed to ensure a governing body (or designated persons so functioning) assumes full legal authority and responsibility for the management of the hospice, the provision of all hospice services, its fiscal operations, and continuous quality assessment and performance improvement . A qualified administrator appointed by and reporting to the governing body is responsible for the day-to-day operation of the hospice . The administrator must be a hospice employee and possess education and experience required by the hospice's governing body . (Not ranked in FY 2015)

General Information 39 9 . [TIE] Timeframe for Completion of Assessment: 42 CFR 418 54(b), TAG 0523 — The hospice failed to ensure that the interdisciplinary group, in consultation with the individual's attending physician (if any), must complete the comprehensive assessment no later than 5 calendar days after the election of hospice care in accordance with §418 .24 . (Ranked No . 9 in FY 2015)

9 . [TIE] Content of Comprehensive Assessments: 42 CFR 418 54(c)(6), TAG 0530 — The hospice failed to have comprehensive assessment take into consideration the following factors: drug profile . A review of all of the patient's prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy . This includes, but is not limited to, identification of the following: (i) Effectiveness of drug therapy (ii) Drug side effects (iii) Actual or potential drug interactions (iv) Duplicate drug therapy (v) Drug therapy currently associated with laboratory monitoring

(Not ranked in FY 2015)

Top 10 Deficiencies (Licensure Violations) Cited During Inspections for FY 2016: Hospice Agencies

1 . Hospice Plan of Care – Level B: 40 TAC §97 821(c) — The hospice failed to provide care and services according to the IDT's written plan of care . (Ranked No . 3 in FY 2015)

2 . Self-Reported Incidents of Abuse, Neglect and Exploitation — Level B: 40 TAC §97 249(c) - The hospice failed to immediately report within 24 hours, knowledge of an alleged act of abuse, neglect or exploitation of a client by an agency employee, contractor or volunteer, to the Texas Department of Family and Protective Services and to DADS . (Ranked No . 1 in FY 2015)

3 . Management Responsibility Supervisor Nurse – Level B: 40 TAC §97 243(c)(2) (A)(iii) — The supervising nurse or the alternate supervising nurse did not make sure that care was provided according to a client's needs as written in the plan of care or care plan . (Not ranked in FY 2015)

4 . Client Records – Level A: 40 TAC §97 301(a)(7) — The hospice failed to keep client record entries current, accurate, signed, dated, and free of corrections or alterations made by any means other than strikethroughs properly identifying the person making each change . (Ranked No . 4 in FY 2015)

40 DADS Regulatory Services FY 2016 Annual Report 5 . Verify Employability/Use Unlicensed Personnel — Level B: 40 TAC §97 247(a) (5)(B) — The hospice failed, after the initial verification of employability, to search the nurse aide and employee misconduct registries at least every 12 months for an unlicensed employee with face-to-face client contact who was most recently hired on or after September 1, 2009 . (Tied for No .2 in FY 2015)

6 . [TIE] Personal Records – Level A: 40 TAC §97 246(a)(3) — The hospice failed to include in its personnel records verification of license, permits, reference(s), job experience, or educational requirements to verify qualifications for each position a person accepted . (Not ranked in FY 2015)

6 . [TIE] Verify Employability/Use Unlicensed Personnel— Level B: 40 TAC §97 247(b)(3) — The hospice used an unlicensed volunteer for duties that included face-to-face client contact before it searched the nurse aide and employee misconduct registries as required or used an unlicensed volunteer who was listed in either registry as unemployable . (Not ranked in FY 2015)

8 . [TIE] Management Responsibility Administrator – Level B: 40 TAC §97 243(b) (1)(B) — The hospice administrator failed to carry out, organize, and supervise ongoing work under the hospice's administrative policies . (Ranked No . 5 in FY 2015)

8 . [TIE] Client Records – Level A: 40 TAC §97 301(a)(9)(D) — The hospice failed to have clinical and progress notes in each client record as applicable and/or to make sure staff wrote these notes on the day of service and that the agency placed these notes into the client records within 14 working days . (Not ranked in FY 2015)

8 . [TIE] Hospice Aide Services – Level B: 40 TAC §97 842(d)(1) — The hospice failed to make an on-site visit to a client's home to supervise the hospice aide services at least every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice IDT meet the client's needs . (Not ranked in FY 2015)

Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions — Program Deficiencies

1 . Governing Body: 42 CFR 483 410(a)(1), TAG 0104 — The governing body failed to provide administrative direction such as policies and procedures to the facility . (Ranked No . 1 in FY 2015)

2 . Physician Services: 42 CFR 483 460(a)(3), TAG 0322 — The facility failed to provide health care services . (Ranked No . 3 in FY 2015)

3 . Drug Administration: 42 CFR 483 460(k)(2), TAG 0369 — The facility failed to ensure that there were no medication errors . (Ranked No . 2 in FY 2015)

General Information 41 4 . Program Monitoring and Change: 42 CFR 483 440(f)(3)(ii), TAG 0263 — The committee specially constituted to address inappropriate client behaviors failed to ensure that written consents were secured from the correct person prior to the implementation of behavior programs . (Ranked No . 6 in FY 2015)

5 . Space and Equipment: 42 CFR 483 470(g)(2), TAG 0436 — The facility failed to provide, maintain, and teach clients to use corrective and adaptive equipment as determined by the interdisciplinary team . (Ranked No . 5 in FY 2015)

6 . [TIE] Program Implementation: 42 CFR 483 440(d)(1), TAG 0249 — The facility failed to immediately implement active treatment after the individual program plan was approved . (Ranked No . 9 in FY 2015)

6 . [TIE] Program Monitoring and Change: 42 CFR 483 440(f)(3)(i), TAG 0262 — The committee specially constituted to address inappropriate client behaviors failed to review, approve, or monitor plans that involve restrictive or intrusive procedures that pose risks to client protection and rights . (Ranked No . 8 in FY 2015)

8 . Qualified IID Professional: 42 CFR 483 430(a), TAG 0159 — The facility failed to have a qualified intellectual disability professional that coordinated and monitored clients' programming needs . (Ranked No . 4 in FY 2015)

9 . Evacuation Drills: 42 CFR 483 470(i)(1), TAG 0440 — The facility failed to ensure that each shift of personnel participated in an evacuation drill at least once in each 3-month period . (Ranked No . 7 in FY 2015)

10 . Infection Control: 42 CFR 483 470(l)(1), TAG 0454 — The facility failed to provide a sanitary environment to avoid sources and transmissions of infections . (Not ranked in FY 2015)

Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions— Life Safety Code

1 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S018 — The facility failed to meet applicable Life Safety Code requirements for the fire safety of doors including their locations, construction, design, and closers . (Ranked No . 4 in FY 2015)

2 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S051 — The facility failed to provide a working manual fire alarm as required . (Ranked No . 1 in FY 2015)

3 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i) TAG S056 — The facility failed to meet applicable requirements for sprinkler system coverage . (Ranked No . 2 in FY 2015)

42 DADS Regulatory Services FY 2016 Annual Report 4 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S046 — The facility failed to provide utilities that met the requirements of the Life Safety Code . (Ranked No . 3 in FY 2015)

5 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S053 — The facility failed to provide approved smoke detectors in all the required areas, or failed to ensure that they met requirements for power, or failed to ensure that they were audible in all sleeping areas . (Ranked No . 8 in FY 2015)

6 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S152 — The facility failed to ensure that evacuation drills were held in the manner and with the frequency required . (Ranked No . 5 in FY 2015)

7 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S041 — The facility failed to provide an acceptable primary means of escape for every sleeping room as required for fire safety . (Ranked No . 10 in FY 2015)

8 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S149 — The facility failed to provide appropriate receptacles for smoking materials in all areas where smoking is permitted . (Ranked No . 9 in FY 2015)

9 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S147 — The facility failed to have a written fire safety plan that was updated, readily available, understood by all employees, and the subject of required periodic staff instruction . (Ranked No . 6 in FY 2015)

10 . Life Safety Code Standard: 42 CFR 483 470(j)(1)(i), TAG S043 — The facility failed to ensure that no door providing escape from the facility in the event of fire should ever be locked . (Not ranked in FY 2015)

Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Nursing Facilities — Program Deficiencies

1 . Infection Control, Prevent Spread, Linens: 42 CFR 483 65, TAG 0441 — The facility did not have a program to keep infection from spreading . (Ranked No . 1 in FY 2015)

2 . Food Procure, Store/Prepare/Serve – Sanitary: 42 CFR 483 35(i), TAG 0371 — The facility did not get food from approved places and store, cook and give out food in a safe and clean way . (Ranked No . 2 in FY 2015)

3 . Pharmaceutical Services – Accurate Procedures, RPH: 42 CFR 483 60(a),(b), TAG 0425 — The facility failed to obtain and provide drugs as needed or use the services of a licensed pharmacist . (Ranked No . 3 in FY 2015)

General Information 43 4 . Develop Comprehensive Care Plans: 42 CFR 483 20(d), 483 20(k)(1), TAG 0279 — The facility did not develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured . (Ranked No . 5 in FY 2015)

5 . Provide Care/Services for Highest Well Being: 42 CFR 483 25, TAG 0309 — The facility did not give each resident care and services to get or keep the highest quality of life possible . (Ranked No . 9 in FY 2015)

6 . Safe/Functional/Sanitary/Comfortable Environment: 42 CFR 483 70(h), TAG 0465 — The facility did not make sure that the nursing home area is safe, easy to use, clean and comfortable . (Ranked No . 7 in FY 2015)

7 . Nurse Aide Demonstrate Competency/Care Needs: 42 CFR 483 75(f), TAG 0498 — The facility did not make sure that nurse aides show they have the skills to be able to care for residents . (Ranked No . 8 in FY 2015)

8 . Develop/Implement Abuse/Neglect, Policies: 42 CFR 483 13(c), TAG 0226 — The facility did not write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property . (Ranked No . 4 in FY 2015)

9 . Free of Accident Hazards/Supervision/Devices: 42 CFR 483 25(h), TAG 0323 — The facility did not make sure that the nursing home area is free of dangers that cause accidents . (Ranked No . 6 in FY 2015)

10 . Drug Records, Label/Store Drugs and Biologicals: 42 CFR 483 60(b), (d), (e), TAG 0431 — The facility failed to properly store and label drugs . (Not ranked in FY 2015)

Top 10 Deficiencies (Certification) Cited During Inspections for FY 2016: Nursing Facilities — Life Safety Code

1 . Life Safety Code Standard: National Fire Protection Association 101, TAG 0067 — The facility failed to meet requirements for air conditioning and ventilating equipment . (Ranked No . 1 in FY 2015)

2 . Life Safety Code Standard: NFPA 101, TAG 0062 — The facility failed to ensure that the required sprinkler systems are continuously maintained in reliable operating condition and are inspected and tested periodically . (Ranked No . 3 in FY 2015)

3 . Life Safety Code Standard: NFPA 101, TAG 0025 — The facility failed to provide smoke walls that are constructed to provide the required fire resistance rating . (Ranked No . 4 in FY 2015)

4 . Life Safety Code Standard: NFPA 101, TAG 0038 — The facility failed to ensure that arrangements of exits are provided and/or maintained such that exits are readily accessible at all times . (Ranked No . 2 in FY 2015)

44 DADS Regulatory Services FY 2016 Annual Report 5 . Life Safety Code Standard: NFPA 101, TAG 0147 — The facility failed to ensure that electrical wiring and equipment is in accordance with NFPA standards and national electrical codes . (Ranked No . 6 in FY 2015)

6 . Life Safety Code Standard: NFPA 101, TAG 0029 — The facility failed to separate hazardous areas by construction that provides at least a one-hour fire resistance rating, and/or a sprinkler system as specified by the Life Safety Code . (Ranked No . 5 in FY 2015)

7 . Life Safety Code Standard: NFPA 101, TAG 0018 — The facility failed to ensure that doors protecting corridor openings are substantial doors that will resist fire for at least 20 minutes . (Ranked No . 9 in FY 2015)

8 . Life Safety Code Standard: NFPA 101, TAG 0069 — The facility failed to provide commercial cooking equipment that meets the requirements of the NFPA . (Ranked No . 8 in FY 2015)

9 . Life Safety Code Standard: NFPA 101, TAG 0144 — The facility failed to inspect and test its generators as required by NFPA 99 . (Ranked No . 7 in FY 2015)

10 . Life Safety Code Standard: NFPA 101, TAG 0051 — The facility failed to ensure that the fire alarm system meets the functional requirements of the Life Safety Code . (Not ranked in FY 2015)

Principles

Top 10 Principles Cited During Reviews for FY 2016: Home and Community-based Services

1 . Nursing Services: 40 TAC §9 174(A)(31) — The program provider failed toen sure nursing services were provided in accordance with state rules . (Ranked No . 1 in FY 2015)

2 . Critical Incident in Data System: 40 TAC §9 178(Y) — The program provider failed to enter critical incident data in the DADS data system no later than 30 calendar days after the last day of the month being reported . (Ranked No . 2 in FY 2015)

3 . Background Checks: 40 TAC §9 177(N) — The program provider failed to complete the required background checks for employees . (Not ranked in FY 2015)

4 . Staff Training on Current Needs: 40 TAC §9 177(D)(01) — The program provider failed to implement and maintain a plan for training of personnel to ensure they were qualified to meet the needs and characteristics of the individuals to whom they delivered services, including the use of restraint . (Ranked No . 4 in FY 2015)

General Information 45 5 . Share with Service Coordinator:40 TAC §9 178(C)(02) – The program provider failed to ensure that the service coordinator was provided with a copy of the results of the on-site inspection within five calendar days after completing the inspection . (Not ranked in FY 2015)

6 . Training on Reporting Abuse/Neglect: 40 TAC §9 177(D)(02) — The program provider failed to implement and maintain a plan for training of personnel that ensured that personnel were knowledgeable of prevention and the requirement to report abuse, neglect and exploitation . (Ranked No . 7 in FY 2015)

7 . Reporting to DFPS: 40 TAC §9 178(M)(02) – The program provider failed to report the provider's response to findings of all DFPS investigations of abuse, neglect, or exploitation to DADS within 14 calendar days of the provider's receipt of the investigation findings . (Not ranked in FY 2015)

8 . Notify Individual/Service Coordinator In 24 Hours: 40 TAC §9 178(K)(03) — The program provider failed to notify the Legally Authorized Representative and the Service Coordinator of allegation and actions taken by program provider within 24 hours of an allegation of abuse, neglect or exploitation . (Ranked No . 8 in FY 2015)

9 . Notification of DFPS Findings: 40 TAC §9 178(M)(01) – The program provider failed to promptly, but not later than five calendar days after the program provider's receipt of a DFPS investigation report make notifications to the individual, LAR, and SC . (Not ranked in FY 2015)

10 . Provide Services without Delay: 40 TAC §9 174(A)(03) — The program provider failed to provide or obtain as needed and without delay all program services . (Ranked No . 5 in FY 2015)

Top 10 Principles Cited During Reviews for FY 2016: Texas Home Living

1 . Report Critical Incident Data: 40 TAC §9 580(R) — The program provider failed to enter critical incident data in the DADS data system no later than 30 calendar days after the last calendar day of the month being reported . (Ranked No . 1 in FY 2015)

2 . Back Ground Checks: 40 TAC §9 579(R) — The program provider failed to complete the required background checks for employees . (Ranked No . 7 in FY 2015)

3 . Inform Individual of Provider Obligations: 40 TAC §9 580(A)(20) — The program provider failed to inform the individual or legal representative of the provider obligations orally and in writing . (Ranked No . 3 in FY 2015)

46 DADS Regulatory Services FY 2016 Annual Report 4 . Develop Methods for Outcomes: 40 TAC §9 578(C)(02) — The program provider failed to develop, in conjunction with individual, the family or legally authorized representative, a written implementation plan . (Ranked No . 2 in FY 2015)

5 . Review/Prevent Abuse Quarterly: 40 TAC §9 580(K) — The program provider failed to review, at least quarterly, incidents of confirmed abuse, neglect or exploitation, complaints, temporary and permanent discharges, transfers, and unusual incidents . (Ranked No . 6 in FY 2015)

6 . Staff Know/Report Abuse/Neglect: 40 TAC §9 579(D)(02) — The program provider failed to implement and maintain a plan for training of personnel that ensured personnel were knowledgeable of how to recognize, prevent and report abuse, neglect and exploitation . (Ranked No . 10 in FY 2015)

7 . No Nursing Assessment on Individual Plan of Care: 40 TAC §9 578(R)(01) — The program provider failed to determine that an individual did not require a nursing assessment when nursing services were not on the individual’s individual plan of care and the program provider determined that no nursing task would be performed by unlicensed service providers . (Ranked No . 5 in FY 2015)

8 . Provide Services According to Definition: 40 TAC §9 578(N)(02) — The program provider failed to provide all program service components in accordance with the applicable service component definition . (Ranked No . 8 in FY 2015)

9 . Obtain Signed Acknowledgement: 40 TAC §9 580(A)(21) – The program provider failed to obtain a signed acknowledgment of that the provider obligations were shared with the individual or LAR . (Not ranked in FY 2015)

10 . Train Staff on Needs: 40 TAC §9 579(D)(01) — The program provider failed to implement and maintain a plan for training of personnel to ensure they were qualified to meet the needs and characteristics of the individuals to whom they deliver services . (Ranked No . 10 in FY 2015)

General Information 47 48 DADS Regulatory Services FY 2016 Annual Report Assisted Living and Unlicensed Facilities

49 50 Assisted Living Facility (ALF) and Unlicensed Facility Actions The tables on pages 54 and 55 contain information relating to Texas Health and Safety Code, Title 4, Subtitle B, Chapter 247, Assisted Living Facilities, facility actions and unlicensed facility actions, by category, for fiscal year (FY) 2016 .

Administrative Penalties

Basis for Imposing

DADS may assess an administrative penalty against a person who: • Violates this chapter or a rule, standard or order adopted under this chapter or a term of a license issued under this chapter . • Makes a false statement, that the person knows or should know is false, of a material fact: ° On an application for issuance or renewal of a license or in an attachment to the application . ° With respect to a matter under investigation by the department . • Refuses to allow a representative of the department to inspect: ° A book, record or file required to be maintained by a day activity and health services facility . ° Any portion of the premises of an assisted living facility . • Willfully interferes with the work of a representative of the department or the enforcement of this chapter . • Willfully interferes with a representative of the department preserving evidence of a violation of this chapter or a rule, standard or order adopted under this chapter or a term of a license issued under this chapter . • Fails to pay a penalty assessed under this chapter before the 30th day after the date the assessment of the penalty becomes final . • Fails to notify the department of a change of ownership before the effective date of the change of ownership .

Imposed

An action can be recommended by: • The regional survey or investigation team and supported during enforcement review . • The regional or state office Regulatory Services staff, considering the survey or investigation findings or evaluating the facility’s past history or performance .

DADS imposes the action when the administrative penalty recommendation has been reviewed and confirmed by state office staff . The facility is formally notified of the administrative penalty citation and the penalty amount . Additionally, the notice includes information about the appeal process available to the facility .

Assisted Living and Unlicensed Facilities 51 Assessed

Penalties assessed are the final actions after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or if the person charged consents to the penalty or does not respond in a timely manner to the notice of the penalty . The facility is notified of the amount to be paid and the date payment is due . A lump sum payment or a monthly payment plan may be agreed upon during the appeal or settlement process .

Injunctive/Other Relief and Civil Penalty Referrals DADS may refer a licensed or unlicensed facility to the Office of the Attorney General (OAG) or district attorney or county attorney under Texas Health and Safety Code Chapter 247 . When a case is resolved through settlement, a portion of the payment is designated a civil penalty and normally deposited to general revenue . The Office of the Attorney General receives the portion designated as attorney fees and costs .

Although there may be several survey or investigative visits to the same facility resulting in civil penalty recommendations, the recommendations are generally consolidated into one case when referred to the Office of the Attorney General .

A civil penalty may be awarded if a facility violates a licensing rule and DADS determines the violation threatens resident health and safety, or if the facility is operating without a license .

Amelioration of Violations In certain situations, DADS commissioner may allow, in lieu of demanding payment of an administrative penalty, the use (under the supervision of DADS) of any portion of the penalty to ameliorate the violation or to improve services (other than administrative services) in the facility affected by the violation .

Trusteeships DADS, through the Office of the Attorney General, may petition a court of competent jurisdiction for the involuntary appointment or appointment by agreement of a trustee to operate a facility if one or more of the following conditions exist: • The facility is operating without a license . • The facility’s license has been suspended or revoked . • License suspension or revocation procedures against a facility are pending and an imminent threat to the health and safety of the residents exists . • An emergency presents an immediate threat to the health and safety of the residents . • The facility is closing (whether voluntarily or through an emergency closing order),

52 DADS Regulatory Services FY 2016 Annual Report and arrangements for relocation of the residents to other licensed institutions have not been made before closure .

Emergency Suspension and Closing Orders DADS will suspend a facility’s license or order an immediate closing of all or part of the facility if: • DADS finds that the facility is operating in violation of the licensure rules . • The violation creates an immediate threat to the health and safety of a resident .

The order suspending a license or closing a part of a facility is either immediately effective on the date the license holder receives written notice, or on a later date specified in the order . This suspension may occur simultaneously with any other enforcement provision available to DADS . The order is effective for 10 days .

Denial of License DADS may deny a facility’s license when the facility does not meet licensure rules .

DADS may deny a facility’s license if a facility: • Violates Texas Health and Safety Code Chapter 247 or the rules adopted under it in a repeated or substantial manner . • Aids, abets or permits a substantial violation of the rules . • Fails to submit required information and documents needed to complete the application process or provides false or fraudulent information . • Fails to pay certain fees . • Applicant has had a license revoked, has been debarred or excluded from the Medicare or Medicaid program, has a court injunction prohibiting the applicant or manager from operating a facility, has been subject to certain enforcement actions, has a criminal conviction, has an unsatisfied judgment, has been evicted or has had a license suspended . • Committed any act described by Texas Health and Safety Code §247 .0451(a)(2)–(6) . • Has violated Texas Health and Safety Code §247 021. . • Any controlling person subject to refusal or denial as described in Texas Administrative Code, Title 40, Part 1, Chapter 99, Denial or Refusal of License .

Revocation of License DADS may revoke a facility’s license for a violation of Texas Health and Safety Code Chapter 247 or a rule adopted under this chapter . DADS may revoke a license when the license holder:

Assisted Living and Unlicensed Facilities 53 • Violates Texas Health and Safety Code §247 .0451(a)(2)–(6) . • Violates Texas Health and Safety Code Chapter 247 or the rules adopted under it in a repeated or substantial manner . • Submits false or misleading statements on an application . • Uses subterfuge or other evasive means to obtain a license . • Conceals a material fact or fails to disclose a material fact on a license application . • Violates Texas Health and Safety Code §247 .021 .

The revocation of a license may occur simultaneously with any other enforcement provision available to DADS .

Assisted Living Facility Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative penalties Imposed 0 1 5 3 2 23 4 5 1 0 0 44 Administrative penalties 1 Assessed 0 0 2 0 0 1 1 3 0 0 0 7 OAG injunctive/ other Referred 1 0 2 0 0 0 0 0 0 0 0 3 relief and civil penalties 2 CA/DA injunctive/ other Referred 0 0 0 0 0 0 0 0 0 0 0 0 relief and civil penalties 2 Amelioration Approved 0 0 0 0 0 0 0 0 0 0 0 0 of violations Amelioration Denied 0 0 0 0 0 1 0 1 0 0 0 2 of violations Trusteeships Ordered 0 0 0 0 0 0 0 0 0 0 0 0 Emergency suspension Ordered 0 0 0 0 0 0 0 0 0 0 0 0 and closing orders Denials of License 3 Proposed 0 0 8 2 1 19 4 5 1 5 4 49 Denials of License 3 Denied 0 0 4 0 1 11 2 1 0 2 3 24 Revocations Proposed 0 0 0 0 0 0 0 0 0 0 2 2 of license 4 Revocations Revoked 0 0 0 0 0 0 0 0 0 0 0 0 of license 4 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 2 . DADS refers injunctive/other relief and civil penalties to the county or district attorney if DADS as an existing agreement to do so; otherwise, they are referred to the Office of the Attorney General . 3 . DADS may propose to deny renewal of a license for many reasons . However, if a facility has been cited for one or more violations of the licensing rules and those violations have not been determined to have been corrected by the date the facility’s license is due for renewal, DADS may propose to deny the application . If the facility subsequently corrects the violation(s), DADS may withdraw its proposal to deny the application for license renewal . Denied actions may also include final actions on cases proposed in a previous fiscal year . 4 . Revoked actions can include final actions on cases proposed in a previous fiscal year .

54 DADS Regulatory Services FY 2016 Annual Report Unlicensed Facility Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

OAG injunctive/ Referred 0 0 8 0 0 11 2 1 0 0 0 22 other relief and civil penalties 1 CA/DA Referred 0 0 0 0 0 0 0 0 0 0 0 0 injunctive/ other relief and civil penalties 1 Notes: 1 . DADS refers injunctive/other relief and civil penalties to the county or district attorney if DADS has an existing agreement to do so; otherwise, they are referred to the Office of the Attorney General .

Assisted Living and Unlicensed Facilities 55 Assisted Living Facility Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

02 - Abilene Abilene 000665 Highland Assisted Living LLC 05/18/2015 $900 $900 $0 N 03 - Arlington Dallas 103515 Morning Starr New Beginnings 09/30/2015 $1,200 $1,200 $0 N 03 - Arlington Desoto 103650 Rising Sun Residential Care Facility 08/26/2015 $350 $350 $0 Y Inc #2 03 - Arlington Desoto 103650 Rising Sun Residential Care Facility 10/21/2015 $100 $100 $0 Y Inc #2 03 - Arlington Grand Prairie 030399 The Estates at Grand Prairie 09/02/2015 $350 $350 $0 N 03 - Arlington Plano 105554 Arbor Hills Memory Care 10/11/2015 $1,800 $1,800 $0 N Community 04 - Tyler Hawkins 010397 The Gardens at Hawkins ALC 02/19/2016 $1,050 $0 $0 Y 04 - Tyler Henderson 104191 Arbor Place Assisted Living 11/12/2015 $500 $500 $0 N 04 - Tyler Tyler 103676 East Texas ALF Waterton Inn LLC 01/22/2016 $1,300 $1,300 $0 N 05 - Beaumont Lufkin 000424 Pinecrest Retirement Community 06/22/2015 $800 $800 $0 N Assisted Living Unit 05 - Beaumont Port Arthur 000480 Rose Place 11/18/2015 $500 $500 $0 N 06 - Houston Conroe 030252 Loving Kindness Assisted Living 04/27/2016 $1,400 $0 $1,400 N Home 06 - Houston Houston 102199 Bed of Roses Assisted Living LLC 10/15/2013 $1,100 $1,100 $0 N 06 - Houston Houston 000835 Briardale Treatment Center 01/21/2015 $4,350 $4,350 $0 N 06 - Houston Houston 105438 Comfort Care Assisted Living LLC 01/28/2016 $500 $500 $0 N 06 - Houston Houston 030099 Elmcroft of Cy-Fair 06/29/2016 $1,350 $1,350 $0 N 06 - Houston Houston 100115 Good Living Community Care Inc 12/04/2015 $450 $450 $0 N #4 06 - Houston Houston 106303 Graystone Life Care LLC 09/03/2015 $1,850 $0 $1,850 N

06 - Houston Houston 103025 Joyful Homes IV 06/22/2016 $650 $0 $650 N Assisted Living Facility Administrative Penalties for FY 2016 Assisted Living Facility Administrative Penalties for FY 2016

Facility Visit Exit Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H Region City Facility Imposed Assessed Collected Balance H ID Date ID Date

02 - Abilene Abilene 000665 Highland Assisted Living LLC 05/18/2015 $900 $900 $0 N 06 - Houston Houston 000809 Liberty Island Personal Care Homes 07/26/2016 $350 $0 $350 N 03 - Arlington Dallas 103515 Morning Starr New Beginnings 09/30/2015 $1,200 $1,200 $0 N Inc 03 - Arlington Desoto 103650 Rising Sun Residential Care Facility 08/26/2015 $350 $350 $0 Y 06 - Houston Houston 104616 Texas Community Care $1,000 $250 $750 N Inc #2 Compartments # 1 03 - Arlington Desoto 103650 Rising Sun Residential Care Facility 10/21/2015 $100 $100 $0 Y 06 - Houston Houston 105447 Universal Assisted Living Homes 05/21/2015 $1,200 $1,200 $0 N Inc #2 06 - Houston Houston 105872 Us Memory Care - Vintage 02/11/2016 $2,700 $2,700 $0 N 03 - Arlington Grand Prairie 030399 The Estates at Grand Prairie 09/02/2015 $350 $350 $0 N 06 - Houston Houston 105872 Us Memory Care - Vintage 04/13/2016 $2,700 $2,700 $0 N 03 - Arlington Plano 105554 Arbor Hills Memory Care 10/11/2015 $1,800 $1,800 $0 N Community 06 - Houston Houston 030257 Wildwood Terrace Assisted Living 07/27/2016 $200 $400 ($200) N Facility 04 - Tyler Hawkins 010397 The Gardens at Hawkins ALC 02/19/2016 $1,050 $0 $0 Y 06 - Houston Katy 104047 The Solana at Cinco Ranch 03/11/2015 $900 $900 $0 N 04 - Tyler Henderson 104191 Arbor Place Assisted Living 11/12/2015 $500 $500 $0 N 06 - Houston Katy 105724 Veranda House 10/30/2015 $500 $500 $0 N 04 - Tyler Tyler 103676 East Texas ALF Waterton Inn LLC 01/22/2016 $1,300 $1,300 $0 N 06 - Houston Missouri City 104587 Autumn Leaves of Riverstone 08/25/2015 $1,800 $1,800 $0 N 05 - Beaumont Lufkin 000424 Pinecrest Retirement Community 06/22/2015 $800 $800 $0 N Assisted Living Unit 06 - Houston New Caney 000456 J and D Personal Care Home 05/13/2015 $450 $0 $450 Y 05 - Beaumont Port Arthur 000480 Rose Place 11/18/2015 $500 $500 $0 N 06 - Houston New Caney 000456 J and D Personal Care Home 05/05/2016 $1,350 $0 $1,350 Y 06 - Houston Conroe 030252 Loving Kindness Assisted Living 04/27/2016 $1,400 $0 $1,400 N 06 - Houston Pasadena 000563 Pine Tree Assisted Living LP 10/10/2014 $550 $350 $350 $0 Y Home 06 - Houston Spring 104657 Autumn Leaves of Cypresswood 08/05/2014 $300 $300 $0 N 06 - Houston Houston 102199 Bed of Roses Assisted Living LLC 10/15/2013 $1,100 $1,100 $0 N 06 - Houston The 104849 The Village at the 11/13/2015 $650 $650 $0 N 06 - Houston Houston 000835 Briardale Treatment Center 01/21/2015 $4,350 $4,350 $0 N Woodlands Woodlands Waterway 06 - Houston Houston 105438 Comfort Care Assisted Living LLC 01/28/2016 $500 $500 $0 N 06 - Houston Tomball 102096 Inwood Crossing 05/01/2015 $900 $900 $0 N 06 - Houston Houston 030099 Elmcroft of Cy-Fair 06/29/2016 $1,350 $1,350 $0 N 07 - Austin Austin 030303 Ashwood Assisted Living 01/22/2016 $300 $300 $0 N 06 - Houston Houston 100115 Good Living Community Care Inc 12/04/2015 $450 $450 $0 N 07 - Austin Bryan 102654 Hudson Creek Alzheimer's Special 06/09/2015 $350 $350 $0 N #4 Care Center 06 - Houston Houston 106303 Graystone Life Care LLC 09/03/2015 $1,850 $0 $1,850 N 07 - Austin Marlin 000877 Marlin Personal Care 12/01/2015 $200 $0 $200 N 07 - Austin Temple 000365 Elmcroft of Cottonwood 06/02/2015 $550 $550 $0 N 06 - Houston Houston 103025 Joyful Homes IV 06/22/2016 $650 $0 $650 N 08 - San Antonio Devine 050639 Brendas Residential Assisted Living 11/03/2015 $500 $500 $0 N 08 - San Antonio San Antonio 050192 IHCS Residential 05/21/2015 $1,200 $1,200 $0 N 08 - San Antonio San Antonio 050192 IHCS Residential 04/15/2016 $900 $0 $900 Y 08 - San Antonio San Antonio 102902 Superlative Senior Care Inc 07/02/2015 $300 $300 $0 N Assisted Living Facility Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

08 - San Antonio San Antonio 102941 Thera Med Rehabilitation Clinic Inc 06/21/2016 $1,650 $0 $1,650 Y 09 - Abilene Midland 000699 Helen Greathouse Manor 05/07/2015 $650 $650 $0 N Totals $42,650 $350 $32,050

44 Total assisted living facility administrative penalties imposed Notes: 1 . The Imposed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if there is no alternative amount resulting from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount of penalty due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or if the person charged consents to the penalty or does not respond timely to the notice of the penalty . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, there is no total for this column . An administrative penalty with a negative balance may indicate an overpayment or that the penalty was rescinded after payment . 5 . The H column stands for Hearing, and a “Y” in this column indicates the facility requested a hearing on the violation . Once a facility requests and meets the criteria for a hearing on the violation, the case results will be pending until the appeal process is complete . An “N” indicates the facility did not request a hearing . Assisted Living Facility Injunctive/Other Relief and Civil Penalty Referrals to the Office of the Attorney General for FY 2016

Date Region City Facility ID Facility Referred

01 - Lubbock Dalhart 102470 Legacy Assisted Living 03/23/2016 Community 03 - Arlington Cedar Hill 102594 Crescent Place Assisted 10/22/2015 Living & Memory Care 03 - Arlington Fort Worth 000669 Heritage Square 09/15/2015 3 Total assisted living facility injunctive/other relief and civil penalty referrals to the Office of the Attorney General

Assisted Living Facility Injunctive/Other Relief and Civil Penalty Referrals to the County or District Attorney for FY 2016

DADS did not refer any assisted living facilities to the county or district attorney for injunctive/other relief and civil penalties in FY 2016 .

Assisted Living and Unlicensed Facilities 59 Unlicensed Facility Injunctive/Other Relief and Civil Penalty Referrals to the Office of the Attorney General for FY 2016

Facility Date Region City Facility ID Referred

03 - Arlington Dallas 103516 7206 Claymont Drive 06/23/2016 03 - Arlington Dallas 106493 7539 Rice Lane 05/16/2016 03 - Arlington Dallas 106470 7706 Los Alimitos Drive 08/12/2016 03 - Arlington Fort Worth 105686 1204 Cameo Drive 10/16/2015 03 - Arlington Fort Worth 105686 1204 Cameo Drive 06/03/2016 03 - Arlington Fort Worth 105922 1329 Andante Drive 10/16/2015 03 - Arlington Fort Worth 105922 1329 Andante Drive 06/03/2016 03 - Arlington McKinney 106596 2412 Castleridge Drive 08/05/2016 06 - Houston Conroe 106624 11526 Coon Hollow Road 05/24/2016 06 - Houston Conroe 106296 1406 N . Thompson St . 10/02/2015 06 - Houston Conroe 106215 1820 South 3rd St . 09/28/2015 06 - Houston Friendswood 106528 16639 Townes Road 02/26/2016 06 - Houston Houston 102689 11615 Dover Street 11/24/2015 06 - Houston Houston 101134 5620 N . Freeway 02/25/2016 06 - Houston Houston 106304 6802 Crestridge St . 04/01/2016 06 - Houston Houston 100778 Dusty Dawn Care Home 02/24/2016 06 - Houston Missouri City 105613 6646 Briargate Drive 11/25/2015 06 - Houston Spring 103824 23626 Sawmill Pass 11/25/2015 06 - Houston West Texas City 106209 228 Blanchard St . 02/11/2016 07 - Austin Austin 105702 11005 Anderson Mill Road 05/31/2016 07 - Austin Leander 106673 407 Mesa Grande Drive 08/09/2016 08 - San Antonio Windcrest 103895 Sunny Spirits at 08/23/2016 Hickory Hollow 22 Total unlicensed facility injunctive/other relief and civil penalty referrals to the Office of the Attorney General

Unlicensed Facility Injunctive/Other Relief and Civil Penalty Referrals to the County or District Attorney for FY 2016

DADS did not refer any unlicensed facilities to the county or district attorney for injunctive/other relief and civil penalties in FY 2016 .

60 DADS Regulatory Services FY 2016 Annual Report Assisted Living Facility Amelioration of Violations for FY 2016

Decision Region City Facility ID Facility Decision Date Inwood 06 - Houston Tomball 102096 05/20/2016 Denied Crossing 08 - San IHCS San Antonio 050192 03/23/2016 Denied Antonio Residential 2 Total assisted living facility ameliorations processed

Assisted Living Facility Trusteeships Ordered for FY 2016

DADS did not order any trustees placed in assisted living facilities in FY 2016 .

Assisted Living Facility Emergency Suspension and Closing Orders for FY 2016

DADS did not issue any emergency suspension and closing orders in assisted living facilities in FY 2016 .

Assisted Living and Unlicensed Facilities 61 Assisted Living Facility License Denials and Revocations Proposed for FY 2016

Facility Proposed Revoked Denied Region City Facility Status ID Action Date Date

03 - Arlington Allen 106350 Texas Star Deny Rescinded Assisted Living 03 - Arlington Dallas 106244 Morningstar Deny Rescinded 03 - Arlington Dallas 102921 Trinity Residential Care Deny Rescinded 03 - Arlington Grand 105721 2904 Olympia Dr . Deny Rescinded Prairie 03 - Arlington Lewisville 106000 477 W . Main St . Deny Action Propose 03 - Arlington Mansfield 106137 Echelon Place Deny 11/22/2015 License Denied 03 - Arlington Melissa 106307 Humane Residential Deny 02/29/2016 License Care Home Denied 03 - Arlington Sanger 106342 The Home Place Deny Withdrawn 04 - Tyler Gladewater 106456 Sentinel Gardens Deny Hearing Assisted Living Center 04 - Tyler Walton 106524 CP 02 (TX) LLC Deny Rescinded 05 - Beaumont Oakhurst 104903 1910 Highway 190 Deny 12/19/2015 License Denied 06 - Houston Houston 106551 Avalon Memory Care- Deny Rescinded Tuckerton 06 - Houston Houston 105438 Comfort Care Assisted Deny Rescinded Living LLC 06 - Houston Houston 105897 Distinctive Differences, Deny 08/15/2016 License LLC Denied 06 - Houston Houston 030093 Goodness and Mercy Deny Hearing Health Care 06 - Houston Houston 106262 Greenwood Village Deny 04/18/2016 License Assistance & Living Denied Care 06 - Houston Houston 102328 Jumer House Deny 10/12/2016 License Denied 06 - Houston Houston 106206 Regal Cottage of Deny 01/13/2016 License Southland Acres Denied 06 - Houston Houston 000425 Spiller Personal Care Deny Rescinded Home 06 - Houston Houston 103470 The Word Heals Deny Formal Springbrook Personal Hearing Care Facility Letter

62 DADS Regulatory Services FY 2016 Annual Report Assisted Living Facility License Denials and Revocations Proposed for FY 2016

Facility Proposed Revoked Denied Region City Facility Status ID Action Date Date

06 - Houston Houston 101707 Vintage Place Deny 08/15/2016 License Denied 06 - Houston Katy 106069 Legacy at Falcon Point Deny Rescinded 06 - Houston Kingwood 104679 Heritage Retreat Deny 03/17/2016 License Kingwood Denied 06 - Houston League City 106261 MRC The Crossings Deny Rescinded 06 - Houston Magnolia 105586 31805 Nichols Deny 08/10/2016 License Sawmill Rd Denied 06 - Houston Magnolia 103637 Assisted Living of Deny Rescinded Sendera Ranch 06 - Houston Pasadena 000563 Pine Tree Assisted Deny Hearing Living LP 06 - Houston Pearland 100756 Trinity Oaks of Deny 01/20/2016 License Pearland Denied 06 - Houston Sharpstown 106462 Ethel's House Deny 04/18/2016 License Denied 06 - Houston Tamina 106427 Assisted Living of Deny Hearing Montgomery County 07 - Austin Austin 105702 11005 Anderson Mill Rd Deny 10/14/2015 License Denied 07 - Austin Austin 000455 Harper House Personal Deny Formal Care Facility, Inc Hearing Letter 07 - Austin Austin 105464 Moore's Personal Care Deny Hearing Assisted Living 07 - Austin Marlin 000877 Marlin Personal Care Deny 05/17/2016 License Denied 08 - San Kerrville 102640 Mountain Villa Deny Rescinded Antonio at Kerrville 08 - San San Antonio 106556 Avalon Memory Care- Deny Rescinded Antonio Mystic Park 08 - San San Antonio 030088 Country Living in the Deny Rescinded Antonio City 08 - San San Antonio 000562 Guzmans Personal Care Deny Hearing Antonio 08 - San San Antonio 000740 South Texas Assisted Deny Rescinded Antonio Living LLC 09 - Abilene Lamesa 104153 Beehive Homes of Deny Rescinded Lamesa 2

Assisted Living and Unlicensed Facilities 63 Assisted Living Facility License Denials and Revocations Proposed for FY 2016

Facility Proposed Revoked Denied Region City Facility Status ID Action Date Date

10 - El Paso El Paso 106010 2725 Fillmore Deny 02/24/2016 License Denied 10 - El Paso El Paso 106359 Hogar Esperanza Deny Hearing 10 - El Paso El Paso 106475 Maximus Matthew Deny Rescinded Loving Care Home 10 - El Paso El Paso 106475 Maximus Matthew Deny 08/29/2016 License Loving Care Home Denied 10 - El Paso Horizon 106057 Salubris Assisted Living Deny Hearing City Facility 11 - Corpus Brownsville 103703 #1 Medford Place Revoke Rescinded Christi 11 - Corpus Brownsville 103703 #1 Medford Place Deny 03/02/2016 License Christi Denied 11 - Corpus Brownsville 103704 #2 Medford Place Deny Rescinded Christi 11 - Corpus Brownsville 103704 #2 Medford Place Deny 03/02/2016 License Christi Denied 11 - Corpus Laguna Vista 102326 Assisted Living at Revoke Rescinded Christi Laguna Vista 11 - Corpus Laguna Vista 102326 Assisted Living at Deny 03/02/2016 License Christi Laguna Vista Denied 51 Total assisted living facility license denials and revocations proposed Notes: Status column values: 1 . Action Propose – DADS is proposing to take this action . 2 . Formal Hearing Letter – a letter has been sent to the facility offering the opportunity to appeal the action . 3 . Hearing – the facility has requested a hearing . 4 . License Denied – the application for a license was denied . 5 . Rescinded – DADS withdrew the proposed action . 6 . Withdrawn – the facility withdrew the application .

64 DADS Regulatory Services FY 2016 Annual Report Assisted Living and Unlicensed Facility Complaint and Incident Intakes

Complaints A complaint allegation is an assertion that a requirement of state licensure has been violated and can come directly from individuals or residents, family members, health care providers, advocates, law enforcement and other state agencies . Report sources may be oral or written .

Incidents An incident is an official notification to the state survey agency from an assisted living facility provider that the physical or mental health or welfare of a resident has been or may be adversely affected by mistreatment, neglect or abuse . These reports also include injuries of unknown source and exploitation or misappropriation of consumer or resident property .

Priority Assignment DADS evaluates each complaint based on its own unique circumstances and assigns priorities accordingly . When timeliness is crucial to the health and safety of a resident(s), such as in a situation of heating or air conditioner equipment failure, alleged staff walkout, etc ., an investigation may be initiated immediately by telephone, regardless of the priority code assignment . After the initial contact, each complaint is assigned a priority . The priorities available are: • On or before 24 hours • On or before 14 calendar days • On or before 30 calendar days • On or before 45 calendar days • Professional review • Withdrawn • Not required

On or Before 24 Hours

Immediate response by Regulatory Services is warranted because a provider allegedly created or allowed a present and ongoing situation in which the provider’s noncompliance with one or more requirements of licensure or certification has failed to protect residents from abuse, neglect or mistreatment or has caused, or is likely to cause, serious injury, harm, impairment or death to a resident .

Assisted Living and Unlicensed Facilities 65 On or Before 14 Calendar Days

The present or ongoing threat of continued abuse, neglect or mistreatment has been removed . The resident is no longer in imminent danger; however, the provider’s alleged noncompliance with one or more requirements of licensure or certification may have or has a high potential to cause harm that impacts a resident’s mental, physical or psychosocial status and is of such consequence that a rapid response by Regulatory Services is indicated . There is evidence or suspicion that system(s) failure contributed to or brought on the threat . Usually, specific rather than general information (e .g . descriptive identifiers, individual names, date, time, location of occurrence, description of harm) will factor into the assignment of this level of priority .

On or Before 30 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has caused or may cause harm that is of limited consequence and does not significantly impair the resident’s mental, physical or psychosocial status .

On or Before 45 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has a low potential for more than minimal harm or resulted in physical, mental or psychosocial harm that did not directly affect resident health and safety and functional status . This priority may also be assigned for alleged violations of regulations that do not directly affect resident health and safety .

Professional Review

A provider who has cause to believe the physical or mental health or welfare of a resident has been or may be adversely affected by mistreatment, neglect or abuse must self-report to the state survey agency immediately upon learning of the alleged conduct or conditions . This notice could include injuries of unknown source and exploitation or misappropriation of resident property .

Complaint Intake Call Center staff assign a professional review priority when a provider self-reports an incident to Regulatory Services and the provider’s oral report indicates that the provider’s immediate corrective action is reasonably likely to ensure that abuse, neglect, mistreatment or injury to the resident will not occur again, or at least not while the provider conducts its investigation and a Professional Quality Assurance staff reviews the provider’s written investigation report .

Based on review of the facility investigation report, if further investigation is warranted to assess whether the provider’s abuse prohibition policies ensure compliance with regulatory requirements, the Professional Review unit will send notification to the Regulatory Services regional staff to schedule an on-site investigation .

66 DADS Regulatory Services FY 2016 Annual Report Withdrawn

A complaint report filed with DADS is withdrawn at the request of the complainant, except when abuse, neglect or exploitation is alleged . Please refer to Survey and Certification Clarification 03-08 (www.dads.state.tx.us/providers/ communications/2003/scc/SCC2003-08.pdf) .

Not Required

DADS determines it has no jurisdiction to investigate a complaint or a referral, or a report to another agency, board or entity is required .

Assisted Living Facility All Intakes by Priority and Region for FY 2016

Intake priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 14 4 69 11 4 62 28 33 9 5 7 246 On or before 14 days 46 23 455 112 24 388 135 206 24 28 51 1,492 On or before 30 days 20 7 309 70 13 220 101 136 19 22 29 946 On or before 45 days 17 11 253 71 10 138 93 81 12 16 31 733 Professional review 20 8 150 61 15 65 45 50 14 4 17 449 Withdrawn 1 0 11 4 2 5 2 7 0 0 3 35 Not required 0 0 8 6 1 6 1 5 0 0 2 29 Total 118 53 1,255 335 69 884 405 518 78 75 140 3,930

Assisted Living Facility Complaints by Priority and Region for FY 2016

Complaint priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 11 3 65 10 4 58 26 30 9 3 7 226 On or before 14 days 33 14 327 83 15 258 92 155 12 26 41 1,056 On or before 30 days 15 5 192 47 8 131 56 104 8 15 17 598 On or before 45 days 8 7 118 23 3 80 49 51 3 10 16 368 Withdrawn 1 0 11 4 2 5 2 7 0 0 3 35 Not required 0 0 4 3 0 2 1 3 0 0 1 14 Total 68 29 717 170 32 534 226 350 32 54 85 2,297 Note: The intake priority “professional review” does not apply to assisted living facility complaint intakes .

Assisted Living and Unlicensed Facilities 67 Assisted Living Facility Incidents by Priority and Region for FY 2016

Incident priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 3 1 4 1 0 4 2 3 0 2 0 20 On or before 14 days 13 9 128 29 9 130 43 51 12 2 10 436 On or before 30 days 5 2 117 23 5 89 45 32 11 7 12 348 On or before 45 days 9 4 135 48 7 58 44 30 9 6 15 365 Professional review 20 8 150 61 15 65 45 50 14 4 17 449 Not required 0 0 4 3 1 4 0 2 0 0 1 15 Total 50 24 538 165 37 350 179 168 46 21 55 1,633 Note: The intake priority “Withdrawn” does not apply to assisted living facility incident intakes .

Unlicensed Facility Complaint Intakes by Priority and Region for FY 2016

Complaint priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 0 0 1 0 1 11 4 0 0 0 0 17 On or before 14 days 0 0 18 0 3 29 9 5 0 5 4 73 On or before 30 days 0 0 6 0 3 25 11 6 0 1 1 53 On or before 45 days 2 0 26 0 4 35 15 15 0 5 1 103 Withdrawn 0 0 2 0 0 1 0 0 0 0 0 3 Not required 0 0 7 0 0 1 0 0 0 1 1 10 Total 2 0 60 0 11 102 39 26 0 12 7 259 Note: Incident intakes do not apply to unlicensed facilities .

68 DADS Regulatory Services FY 2016 Annual Report Assisted Living and Unlicensed Facility Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Assisted Living Facility Administrative Penalties Imposed and Assessed for FY 2012–2016 . • Assisted Living Facility Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016 . • Unlicensed Facility Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General or the county/district attorney for FY 2012–2016 . • Assisted Living Facility Emergency Suspension and Closing Orders for Fiscal Years 2012–2016 . • Assisted Living Facility License Denials and Revocations Proposed for Fiscal Years 2012–2016 . • Assisted Living Facility Complaint and Incident Intakes for FY 2012–2016 . • Unlicensed Facility Complaint Intakes for FY 2012–2016 .

Assisted Living Facility Administrative Penalties Imposed and Assessed for FY 2012–2016

50 47 45 44 40 35 36 33 34 30 25 20 15 14 10 9 7 7 5 6 0 FY12 FY13 FY14 FY15 FY16

Imposed Assessed

Assisted Living and Unlicensed Facilities 69 Assisted Living Facility Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016

10 9 6 6 6 5 3 0 FY12 FY13 FY14 FY15 FY16

Unlicensed Facility Injuctive/Other Relief and Civil Penalty Referrals to the Attorney General or the County/District Attorney for FY 2012–2016

25 23 22 20 19

15 15 13 10

5

0 FY12 FY13 FY14 FY15 FY16

70 DADS Regulatory Services FY 2016 Annual Report Assisted Living Facility Emergency Suspension and Closing Orders for FY 2012–2016 2

1 1 1

0 0 0 0 FY12 FY13 FY14 FY15 FY16

Assisted Living Facility License Denials and Revocations Proposed for FY 2012–2016

80 70 60 61 58 50 51 49 40 39 30 20 10 0 2 2 2 2 2 FY12 FY13 FY14 FY15 FY16 Denials Revocations

Assisted Living and Unlicensed Facilities 71 Assisted Living Facility Complaint and Incident Intakes for FY 2012–2016

2,297 2,200 2,169 2,116 2,015 2,000 1,956 1,800 1,633 1,600

1,400 1,379

1,200 1,180 1,096 1,000 1,012

800

600 FY12 FY13 FY14 FY15 FY16

Complaints Incidents

Unlicensed Facility Complaint Intakes for FY 2012–2016

500

400 347 306 300 286 289 259 200

100

0 FY12 FY13 FY14 FY15 FY16

72 DADS Regulatory Services FY 2016 Annual Report Day Activity and Health Services

73 74 DADS Regulatory Services FY 2016 Annual Report Day Activity and Health Services (DAHS) Facility Actions The table on page 77 contains information relating to Texas Human Resources Code, Title 6, Chapter 103, Day Activity and Health Services, facility actions, by category, for fiscal year (FY) 2016 .

Administrative Penalties

Basis for Imposing

DADS may assess an administrative penalty against a person who: • Violates this chapter; a rule, standard or order adopted under this chapter; or a term of a license issued under this chapter . • Makes a false statement, that the person knows or should know is false, of a material fact: ° On an application for issuance or renewal of a license or in an attachment to the application . ° With respect to a matter under investigation by the department . • Refuses to allow a representative of the department to inspect: ° A book, record or file required to be maintained by a day activity and health services facility . ° Any portion of the premises of an assisted living facility . • Willfully interferes with the work of a representative of the department or the enforcement of this chapter . • Willfully interferes with a representative of the department preserving evidence of a violation of this chapter or a rule, standard or order adopted under this chapter or a term of a license issued under this chapter . • Fails to pay a penalty assessed under this chapter before the 30th day after the date the assessment of the penalty becomes final . • Fails to notify the department of a change of ownership before the effective date of the change of ownership .

Imposed

An action can be recommended by: • The regional survey or investigation team and supported during enforcement review . • The regional or state office Regulatory Services staff, considering the survey or investigation findings or evaluating the facility’s past history and performance .

DADS imposes the action when the administrative penalty recommendation has been reviewed and confirmed by state office staff . The facility is formally notified of the administrative penalty citation and the penalty amount . Additionally, the notice includes information about the appeal process available to the facility .

Day Activity and Health Services 75 Assessed

Penalties assessed are the final actions after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or if the person charged consents to the penalty or does not respond in a timely manner to the notice of the penalty . The facility is notified of the amount to be paid and the date payment is due . A lump sum payment or a monthly payment plan may be agreed upon during the appeal or settlement process .

Injunctive or Other Relief Referrals to the Office of the Attorney General Injunctive or other relief cases are referred to the Office of the Attorney General for action if DADS finds a violation that creates an immediate threat to resident health and safety or the facility is operating without a license .

Emergency Suspension and Closing Orders DADS will suspend a facility’s license or order an immediate closing of all or part of the facility if: • DADS finds that the facility is operating in violation of the licensure rules . • The violation creates an immediate threat to the health and safety of a resident .

The order suspending a license or closing a part of a facility is immediately effective on the date the license holder receives written notice or on a later date specified in the order . This suspension of a license may occur simultaneously with any other enforcement provision available to DADS . The order is valid for 10 days .

Denial of License DADS may deny a facility’s license when the facility substantially fails to comply with certain rule requirements or the license holder aids, abets or permits substantial violation of the rules; fails to provide required information or provides false or fraudulent information; fails to pay certain fees; the license holder has operated a facility that has been decertified or had its contract terminated, has been subject to sanctions, has a criminal conviction, has an unsatisfied final judgment, or has been evicted or had its license suspended; or any controlling person is subject to denial or refusal of a license as described in Texas Administrative Code, Title 40, Part 1, Chapter 99, Denial or Refusal of License .

76 DADS Regulatory Services FY 2016 Annual Report Revocation of License DADS may revoke the license of a license holder who violates the rules or standards for licensing required by Texas Human Resources Code Chapter 103 .

DADS may also revoke a license if the licensee submitted false or misleading statements in the application for license, used subterfuge or other evasive means to obtain a license, or concealed a material fact or failed to disclose information that would have been the basis to deny a license .

The revocation of a license may occur simultaneously with any other enforcement provision available to DADS .

Day Activity and Health Services Facility Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative Imposed 0 0 0 0 0 1 0 0 0 1 3 5 penalties Administrative Assessed 0 0 0 0 0 0 0 0 0 0 0 0 penalties 1 Injunctive or Referred 0 0 0 0 0 0 0 0 0 0 0 0 other relief 2 Emergency Ordered 0 0 0 0 0 0 0 0 0 0 0 0 suspension and closing orders Denials of license 3 Proposed 0 0 2 1 0 3 1 2 0 0 2 11 Denials of license 3 Denied 0 0 0 0 0 3 1 2 0 0 2 8 Revocations of Proposed 0 0 0 0 0 0 0 0 0 0 0 0 license 4 Revocations of Revoked 0 0 0 0 0 0 0 0 0 0 0 0 license 4 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 1 . Injunctive or other relief cases are referred to the Office of the Attorney General . 1 . DADS may propose to deny renewal of a license for many reasons . However, if a facility has been cited for one or more violations of the licensing rules and those violations have not been determined to have been corrected by the date the facility’s license is due for renewal, DADS may propose to deny the application . If the facility subsequently corrects the violation(s), DADS may withdraw its proposal to deny the application for license renewal . Denied actions may also include final actions on cases proposed in a previous fiscal year . 1 . Revoked actions can include final actions on cases proposed in a previous fiscal year .

Day Activity and Health Services 77 78 Day Activity and Health Services Facility Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

06 - Houston Houston 003345 The Center Serving Persons with 10/07/2015 $12,800 $12,800 $0 N DADS RegulatoryFY 2016 Annual Services Report Mental Retardation 10 - El Paso El Paso 104264 Desert Heaven Assisted Living 02/01/2016 $15,600 $15,600 $0 N Community Center 11 - Corpus Christi Brownsville 102547 Ministry Adult Day Care 01/07/2016 $500 $500 $0 N 11 - Corpus Christi Laredo 100098 Casa De Nuestra Gente Inc 06/01/2016 $1,400 $1,400 $0 N 11 - Corpus Christi Pharr 003326 Centro D Amistad 06/15/2016 $1,500 $1,500 $0 N Totals $31,800 $31,800 $0 5 Total day activity and health services facility administrative penalties imposed Notes: 1 . The Imposed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if there is no alternative amount resulting from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount of penalty due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or if the person charged consents to the penalty or does not respond timely to the notice of the penalty . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe .The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, there is no total for this column . An administrative penalty with a negative balance may indicate an overpayment or that the penalty was rescinded after payment . 5 . The H column stands for Hearing, and a “Y” in this column indicates the facility requested a hearing on the violation . Once a facility requests and meets the criteria for a hearing on the violation, the case results will be pending until the appeal process is complete . An “N” indicates the facility did not request a hearing . Day Activity and Health Services Facility Injunctive or Other Relief Referrals to the Office of the Attorney General for FY 2016

DADS did not refer any day activity and health services facilities to the Office of the Attorney General for injunctive/other relief in FY 2016 .

Day Activity and Health Services Facility Emergency Closing Orders for FY 2016

DADS did not issue any emergency closing orders for day activity and health services facilities in FY 2016 .

Day Activity and Health Services 79 Status Rescinded License Denied Formal Letter Hearing License Denied Hearing License Denied License Denied License Denied License Denied License Denied Rescinded Denied Date

02/19/2016

09/30/2016

09/08/2015 02/12/2016 08/22/2016 05/29/2016 04/18/2016

Revoked Revoked Date

Deny Proposed Proposed Action Deny Deny Deny Deny Deny Deny Deny Deny Deny Deny Healthy Joy Adult Care Services Care Adult Joy Healthy Facility Young at Heart Adult Day Care, Inc . Inc Care, Day Adult Heart at Young The Harmony Place Harmony The Galveston Transitions Community Community Transitions Galveston Inc Center Care Best Friends Adult Activity Center Activity Adult Best Friends ADCCTX - Adult Daycare Center of TX of Center ADCCTX Daycare - Adult Quality Activity Center LLC Center Quality Activity Jean's Adult Daycare Adult Jean's Jean's Adult Daycare Adult Jean's Strawberry Patch Adult Day Care Day Adult Strawberry Patch Mi Casita Adult Day Care Day Casita Adult Mi 106399 Facility Facility ID 105611 106562 001526 106022 106158 106552 106124 106476 003464 102104 Garland City Mesquite West Texas City Texas West Longview Austin Houston San Antonio San Houston San Antonio San McAllen Pharr es: t 03 - Arlington Region 03 - Arlington 06 - Houston 04 - Tyler 07 - Austin 06 - Houston 08 - San Antonio 08 - San 06 - Houston 08 - San Antonio 08 - San 11 - Corpus Christi11 - Corpus 11 - Corpus Christi11 - Corpus 11 Total day activity and health activity and services day denials facility revocations licensure and proposed 11 Total Day Activity and Health Services Facility License Denial and Revocation Proposals for FY 2016 for Proposals and Revocation Denial License Activity Services and Health Day Facility No Status column values: column Status appeal the action to opportunity the offering to facility has the been — a letter sent Hearing Letter Formal 1 . . hearing a requested has — facility Hearing the 2 . denied a license was for 3 . application License Denied — the action proposed the DADS withdrew 4 . Rescinded —

80 DADS Regulatory Services FY 2016 Annual Report Day Activity and Health Services Facility Complaint and Incident Intakes

Complaints A complaint allegation is an assertion that a requirement of state licensure has been violated and can come directly from individuals or residents, family members, health care providers, advocates, law enforcement and other state agencies . Report sources may be oral or written .

Incidents An incident is an official notification to the state survey agency from a day activity and health services provider that the physical or mental health or welfare of a consumer has been or may be adversely affected by mistreatment, neglect or abuse . These reports also include injuries of unknown source and exploitation or misappropriation of consumer or resident property .

Priority Assignment DADS evaluates each complaint based on its own unique circumstances and assigns priorities accordingly . When timeliness is crucial to consumer health and safety, such as in a situation of heating or air conditioner equipment failure, alleged staff walkout, etc ., an investigation may be initiated immediately by telephone, regardless of the priority code assignment . After the initial contact, each complaint is assigned a priority . The priorities are: • On or before 24 hours • On or before 14 calendar days • On or before 30 calendar days • Professional review • Withdrawn • Not required

On or Before 24 Hours

Immediate response by Regulatory Services is warranted because a provider allegedly created or allowed a present and ongoing situation in which the provider’s noncompliance with one or more requirements of licensure or certification has failed to protect consumers from abuse, neglect or mistreatment or has caused, or is likely to cause, serious injury, harm, impairment or death to a consumer .

Day Activity and Health Services 81 On or Before 14 Calendar Days

The present or ongoing threat of continued abuse, neglect or mistreatment has been removed . The consumer(s) is no longer in imminent danger; however, the provider’s alleged noncompliance with one or more requirements of licensure or certification may have or has a high potential to cause harm that impacts a consumer’s mental, physical or psychosocial status and is of such consequence that a rapid response by Regulatory Services is indicated . There is evidence or suspicion that system(s) failure contributed to or brought on the threat . Usually, specific rather than general information (e .g . descriptive identifiers, individual names, date, time, location of occurrence, description of harm) will factor into the assignment of this level of priority .

On or Before 30 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has caused or may cause harm that is of limited consequence and does not significantly impair the consumer’s mental, physical or psychosocial status .

Professional Review

A provider who has cause to believe the physical or mental health or welfare of a consumer(s) has been or may be adversely affected by mistreatment, neglect or abuse must self-report to the state survey agency immediately upon learning of the alleged conduct or conditions . This notice could include injuries of unknown source and exploitation or misappropriation of consumer property .

Complaint Intake Call Center staff assign a professional review priority when a provider self-reports an incident to Regulatory Services and the provider’s oral report indicates that the provider’s immediate corrective action is reasonably likely to ensure that abuse, neglect, mistreatment or injury to the consumer(s) will not occur again, or at least not while the provider conducts its investigation and a Professional Quality Assurance staff reviews the provider’s written investigation report .

Based on review of the facility investigation report, if further investigation is warranted to assess whether the provider’s abuse prohibition policies ensure compliance with regulatory requirements, the Professional Review unit will send notification to the Regulatory Services regional staff to schedule an on-site investigation .

Withdrawn

A complaint report filed with DADS is withdrawn at the request of the complainant, except when abuse, neglect or exploitation is alleged . Please refer to Survey and Certification Clarification 03-08 (www.dads.state.tx.us/providers/ communications/2003/scc/SCC2003-08.pdf) .

82 DADS Regulatory Services FY 2016 Annual Report Not Required

DADS determines it has no jurisdiction to investigate a complaint or a referral, or a report to another agency, board or entity is required .

Day Activity and Health Services Facility All Intakes by Priority and Region for FY 2016

Intake Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 0 0 1 2 0 3 1 4 0 1 8 20 On or before 14 days 11 0 5 6 0 30 2 39 0 22 102 217 On or before 30 days 5 0 11 1 1 18 5 60 0 32 233 366 Professional review 5 0 3 0 0 2 0 1 1 15 36 63 Withdrawn 0 0 0 0 0 0 0 0 0 0 5 5 Not required 2 0 6 0 0 0 0 0 0 1 13 22 Total 23 0 26 9 1 53 8 104 1 71 397 693

Day Activity and Health Services Facility Complaints by Priority and Region for FY 2016

Complaint Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 0 0 1 2 0 3 1 3 0 1 8 19 On or before 14 days 7 0 3 4 0 20 2 35 0 15 88 174 On or before 30 days 4 0 8 0 1 17 4 54 0 20 195 303 Withdrawn 0 0 0 0 0 0 0 0 0 0 5 5 Not required 1 0 6 0 0 0 0 0 0 1 11 19 Total 12 0 18 6 1 40 7 92 0 37 307 520 Note: The intake priority “Professional review” does not apply to day activity and health services facility complaint intakes .

Day Activity and Health Services Facility Incidents by Priority and Region for FY 2016

Incident Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 0 0 0 0 0 0 0 1 0 0 0 1 On or before 14 days 4 0 2 2 0 10 0 4 0 7 14 43 On or before 30 days 1 0 3 1 0 1 1 6 0 12 38 63 Professional review 5 0 3 0 0 2 0 1 1 15 36 63 Not required 1 0 0 0 0 0 0 0 0 0 2 3 Total 11 0 8 3 0 13 1 12 1 34 90 173

Day Activity and Health Services 83 Day Activity and Health Services Facility Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Day Activity and Health Services Facility License Denials and Revocations Proposed for FY 2012–2016 • Day Activity and Health Services Facility Complaint and Incident Intakes for FY 2012–2016

Day Activity and Health Services Facility License Denials and Revocations Proposed for FY 2012-2016

25 20 20 20 16 15 16

10 11 5 2 0 1 0 0 0 FY12 FY13 FY14 FY15 FY16

Denials Revocations

84 DADS Regulatory Services FY 2016 Annual Report Day Activity and Health Services Facility Complaint and Incident Intakes for FY 2012-2016

700

632 600

533 495 520 500 479

400

300 221 200 197 165 178 173

200

0 FY12 FY13 FY14 FY15 FY16

Complaints Incidents

Day Activity and Health Services 85 86 Home and Community Support Services Agencies

87 88 Home and Community Support Services Agency (HCSSA) Actions The table on pages 91 and 92 contain information relating to Texas Health and Safety Code, Title 2, Subtitle G, Chapter 142, Home and Community Support Services, agency actions, by category for fiscal year (FY) 2016 .

Administrative Penalties

Basis for Imposing

An administrative penalty may be assessed against a person who violates requirements of Texas Health and Safety Code Chapter 142 or Texas Administrative Code, Title 40, Part 1, Chapter 97, Licensing Standards for Home and Community Support Service Agencies, or Texas Occupations Code, Title 3, Subtitle A, Chapter 102, Solicitation of Patients .

Imposed

DADS imposes the action when the administrative penalty recommendation has been reviewed and confirmed by state office staff . The agency is formally notified of the administrative penalty citation and the penalty amount . Additionally, the notice includes information about the appeal process available to the agency .

Assessed

Penalties assessed are the final actions after the appeal process has been completed (or an agreement to settle has been reached) and a final amount and due date have been decided, or the person accepts the determination by DADS or fails to respond to the notice letter in a timely manner . The agency is notified of the amount to be paid and the date payment is due . A lump sum payment or a monthly payment plan may be agreed upon during the appeal or settlement process .

Civil Penalties A person is liable for a civil penalty, of not less than $1,000 or more than $2,500 for each day of the violation, if he or she: • Engages in the business of providing home health, hospice or personal assistance services for pay without a license issued under Texas Health and Safety Code Chapter 142 and Texas Administrative Code Title 40 Chapter 97 . • Represents to the public that he or she is a provider of home health, hospice or personal assistance services for pay without a license issued under Texas Health and Safety Code Chapter 142 and Texas Administrative Code Title 40 Chapter 97 .

Home and Community Support Services Agencies 89 An action to recover a civil penalty is in addition to an action brought for injunctive relief under Texas Health and Safety Code §142 .013 or any other remedy provided by law . The Office of the Attorney General pursues this action on behalf of the state to collect the civil penalty .

Denials of License Application DADS may deny a license for any of the reasons specified in Texas Administrative Code Title 40 §97 .21 (relating to denial of an application for a license), such as: • Failure to comply with the statute . • Failure to comply with the licensure requirements . • Knowingly aiding, abetting or permitting another person to violate the statute or licensure requirements . • Failure to meet the criteria for a license established in Texas Administrative Code Title 40 §97 .11 (relating to criteria and eligibility for licensing) .

Denials of License Renewal DADS may deny the application to renew a license of an existing home and community support services agency .

Expirations of License (in Lieu of Enforcement Actions) Instead of pursuing additional enforcement actions, DADS may choose to allow an agency to let its license expire .

Immediate Suspensions The suspension of a home and community support services agency license may be on an emergency basis . The suspension is effective immediately and is in effect until lifted .The home and community support services agency is provided an opportunity for a hearing no later than seven days after the effective date of the suspension .

Surrenders of License (in Lieu of Enforcement Actions) DADS may offer an agency the option to surrender its license, instead of receiving additional enforcement actions .

License Revocations DADS may revoke a license issued to an applicant or agency if the applicant or agency: • Fails to comply with any provision of Texas Health and Safety Code Chapter 142 . • Fails to comply with any provision of Texas Administrative Code Title 40 Chapter 97 . • Engages in conduct that violates Texas Occupations Code Chapter 102 .

90 DADS Regulatory Services FY 2016 Annual Report Home Health Agency Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative penalties Imposed 10 10 85 15 9 206 100 77 6 21 54 593 Administrative penalties 1 Assessed 0 0 4 0 0 14 9 5 0 1 5 38 Injunctive/other relief Referred 0 0 0 0 0 0 0 0 0 0 0 0 and civil penalties 2 Denials of initial Proposed 0 0 10 0 0 14 2 4 1 0 4 35 license application 3 Denials of initial Denied 0 0 7 0 0 9 1 2 0 0 0 19 license application 3 Denials of license renewal 4 Proposed 0 0 8 1 1 5 0 0 0 0 0 15 Denials of license renewal 4 Denied 0 0 5 0 1 1 0 0 0 0 1 8 Expirations of license 5 Completed 0 0 3 0 0 6 0 0 0 0 2 11 Immediate suspensions Suspended 0 0 0 0 0 0 0 0 0 0 0 0 Surrenders of license 6 Completed 0 0 7 2 0 17 2 2 0 2 2 34 Revocations of license 7 Proposed 3 2 15 3 0 83 3 14 0 0 15 138 Revocations of license 7 Revoked 0 1 3 0 0 27 2 7 0 1 4 45 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 2 . DADS refers injunctive/other relief and civil penalties to the Office of the Attorney General . 3 . Proposed actions may not result in denials if the agency comes into compliance with the licensing requirements before a proposal becomes final . 4 . Denial of license renewal proposals may not result in a denial action if the agency comes into compliance with the licensure requirements before a proposal becomes final . Denied actions may include actions proposed in previous fiscal years . 5 . When the home and community support services agency license is allowed to expire in lieu of further enforcement action . 6 . When the home and community support services agency license is surrendered in lieu of further enforcement action . 7 . Revocation of license proposals may end up as other licensure actions, such as expiration of license in lieu of further enforcement action or surrender of license in lieu of further enforcement action, without having to revoke the license .

Home and Community Support Services Agencies 91 Hospice Agency Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative Imposed 4 2 14 0 4 12 17 7 2 2 2 66 penalties 1 Administrative Assessed 0 0 0 0 0 2 0 0 0 0 0 2 penalties 1 Injunctive/other relief Referred 0 0 0 0 0 0 0 0 0 0 0 0 and civil penalties 2 Denials of initial Proposed 0 0 3 0 0 1 1 2 0 0 1 8 license application 3 Denials of initial Denied 0 0 2 0 0 1 0 0 0 0 0 3 license application 3 Denials of Proposed 0 0 0 0 0 0 0 0 0 0 0 0 license renewal 4 Denials of Denied 0 0 0 0 0 0 0 0 0 0 0 0 license renewal 4 Expirations of license 5 Completed 0 0 0 0 0 0 0 0 0 0 0 0 Immediate suspensions Suspended 0 0 0 0 0 0 0 0 0 0 0 0 Surrenders of license 6 Completed 0 0 0 0 0 0 0 2 0 0 0 2 Revocations of license 7 Proposed 0 0 0 0 0 20 1 7 0 1 1 30 Revocations of license 7 Revoked 0 0 0 0 0 3 0 0 0 0 0 3 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 2 . DADS refers injunctive/other relief and civil penalties to the Office of the Attorney General . 3 . Proposed actions may not result in denials if the agency comes into compliance with the licensing requirements before a proposal becomes final . 4 . Denial of license renewal proposals may not result in a denial action if the agency comes into compliance with the licensure requirements before a proposal becomes final . Denied actions may include actions proposed in previous fiscal years . 5 . When the home and community support services agency license is allowed to expire in lieu of further enforcement action . 6 . When the home and community support services agency license is surrendered in lieu of further enforcement action . 7 . Revocation of license proposals may end up as other licensure actions, such as expiration of license in lieu of further enforcement action or surrender of license in lieu of further enforcement action, without having to revoke the license .

92 DADS Regulatory Services FY 2016 Annual Report Home Health Agency Administrative Penalties for FY 2016 93 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

01-Lubbock Amarillo 016005 Ama Ruby Slippers Care Inc 09/01/2015 $1,500 $1,500 $0 01-Lubbock Lubbock 000750 South Plains Community 11/04/2015 $750 $750 $0 Action Association Inc - Class Program 01-Lubbock Lubbock 001401 457548 Caprock Home Health 03/01/2016 $1,500 $1,500 $0 Services Inc 01-Lubbock Lubbock 001401 457548 Caprock Home Health 06/01/2016 $750 $750 $0 Services Inc 01-Lubbock Lubbock 004822 457822 Essential Home Health 04/07/2016 $750 $750 $0 01-Lubbock Lubbock 013599 458232 Phoenix Home Care Service Inc 04/21/2016 $750 $750 $0 01-Lubbock Lubbock 015024 Epic Pediatric Therapy 09/18/2015 $3,000 $3,000 $0 01-Lubbock Lubbock 015236 Best in Home Care LLC 08/04/2016 $1,500 $1,500 $0 01-Lubbock Lubbock 015691 Educare Community Living 03/08/2016 $6,350 $0 $6,350 Corporation Texas 01-Lubbock Lubbock 015691 Educare Community Living 03/31/2016 $800 $0 $800 Corporation Texas 02-Abilene Abilene 002242 457383 Caprock Home Health 10/06/2015 $1,500 $1,500 $0

Services Inc Services Support Agencies Community and Home 02-Abilene Abilene 010716 679184 Encompass Home Health 08/02/2016 $750 $750 $0 of West Texas 02-Abilene Bowie 001710 677028 Bowie Memorial Hospital 02/22/2016 $0 $0 $0 Home Health 02-Abilene Bowie 001710 677028 Bowie Memorial Hospital 04/07/2016 $0 $0 $0 Home Health 02-Abilene Henrietta 002151 677277 Clay County Home Health Care 04/15/2016 $750 $750 $0 02-Abilene Snyder 015458 Comfort Keepers #500 07/13/2016 $1,250 $0 $1,250 02-Abilene Vernon 003251 458423 Hospital Home Health of 03/10/2016 $1,000 $1,000 $0 Wilbarger General Hospital 02-Abilene Wichita Falls 003390 Rolling Meadows Home 07/13/2016 $750 $0 $750 Health Agency 94 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

02-Abilene Wichita Falls 015461 Home Instead Senior Care 07/12/2016 $750 $750 $0 02-Abilene Wichita Falls 015831 678008 Encompass Home Health 09/11/2015 $750 $750 $0 of Wichita Falls

DADS RegulatoryFY 2016 Annual Services Report 03-Arlington Addison 007678 679144 Home Medical Care Inc 05/13/2016 $0 $1,000 ($1,000) 03-Arlington Addison 014770 679407 Theracare Home Health 09/18/2015 $3,000 $3,000 $0 03-Arlington Aledo 017116 678001 5 Star Home Health 02/24/2016 $500 $0 $500 03-Arlington Aledo 017116 678001 5 Star Home Health 02/25/2016 $500 $0 $500 03-Arlington Aledo 017116 678001 5 Star Home Health 03/15/2016 $500 $0 $500 03-Arlington Arlington 010407 679638 St Nicholas Healthcare Agency 03/16/2016 $500 $0 $500 03-Arlington Arlington 010407 679638 St Nicholas Healthcare Agency 04/19/2016 $1,250 $0 $1,250 03-Arlington Arlington 011105 743193 KM Home Health Services 08/13/2015 $5,250 $3,750 $3,750 $0 03-Arlington Arlington 011835 747106 Calvary Hill Health 05/24/2016 $500 $500 $0 Services LLC 03-Arlington Arlington 012642 747292 Guidance Healthcare Services 05/19/2016 $3,750 $0 $3,750 03-Arlington Arlington 013583 747689 Caretrends Health Service 06/06/2016 $1,750 $1,750 $0 03-Arlington Carrollton 013638 747634 Hice Healthcare Services Inc 07/14/2015 $500 $500 $0 03-Arlington Carrollton 013921 747781 K S Home Healthcare Inc 11/24/2015 $4,500 $3,750 $750 03-Arlington Carrollton 016474 Texas TLC Home Health Care 12/29/2015 $2,250 $0 $0 $0 Providers Inc 03-Arlington Cedar Hill 010556 679616 VCM Healthcare LLC 08/17/2015 $2,250 $2,250 $0 03-Arlington Dallas 005184 459445 Johnson Home Health Care 08/27/2015 $500 $2,750 ($2,250) Nursing Inc 03-Arlington Dallas 006717 459370 Aria Home Health Inc 10/26/2015 $3,250 $3,250 $0 03-Arlington Dallas 007146 Affordable Elder Care Inc 04/08/2016 $500 $0 $500 03-Arlington Dallas 008757 453131 New Era Home Healthcare 02/12/2016 $2,250 $0 $2,250 Services Inc 03-Arlington Dallas 009365 Caregiver Support Systems LLC 08/24/2015 $7,500 $7,500 $0 03-Arlington Dallas 011137 747271 Imperial Professional 04/26/2016 $4,750 $4,750 $0 Healthcare Services Inc Home Health Agency Administrative Penalties for FY 2016 95 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

03-Arlington Dallas 012116 747326 Ultimate Caring Home 09/08/2015 $2,250 $2,250 $0 Health LLC 03-Arlington Dallas 012412 747452 AAA Home Healthcare Inc 09/09/2015 $2,750 $2,750 $0 03-Arlington Dallas 012467 747267 Higher Standards Home Health 06/01/2016 $500 $500 $0 03-Arlington Dallas 012548 747471 Quality Concept Inc 01/12/2016 $2,750 $1,375 $1,375 03-Arlington Dallas 012796 458496 Geryn Home Health Care Inc 05/05/2016 $2,750 $2,750 $0 03-Arlington Dallas 012816 747004 Peculiar Care Home Health Inc 09/18/2015 $1,500 $1,500 $0 03-Arlington Dallas 012982 747470 Altruist Home Health Care Inc 06/21/2016 $1,250 $250 $1,000 03-Arlington Dallas 013506 678062 North Star Home 10/23/2015 $3,250 $2,800 $2,800 $0 Health Services 03-Arlington Dallas 013895 747672 Sunshine Home Health 03/16/2016 $1,250 $1,250 $0 03-Arlington Dallas 013996 459373 Sure Home Health Services 04/25/2016 $2,000 $0 $2,000 03-Arlington Dallas 015223 458444 DFW Home Health 08/27/2015 $750 $750 $0 03-Arlington Dallas 015518 Little Dove Pediatric 08/05/2015 $1,750 $0 $1,750 Home Health 03-Arlington Dallas 015626 Axel Healthcare Inc . 09/28/2015 $1,500 $1,500 $0

03-Arlington Dallas 015840 Hope Pediatrics LLC 04/13/2016 $3,000 $0 $3,000 Services Support Agencies Community and Home 03-Arlington Dallas 015993 Ever Dynamic Home Health 03/02/2016 $2,500 $2,000 $2,000 $0 Services LLC 03-Arlington Dallas 016190 459472 Aline Home Health Care 03/07/2016 $1,250 $1,250 $0 of Texas Inc 03-Arlington Dallas 016348 1st Choice Resources 03/14/2016 $900 $900 $0 (In-Home Care) 03-Arlington Desoto 012065 747073 Metroplex Home Health 04/14/2016 $250 $250 $0 Services PLLC 03-Arlington Duncanville 015852 Whitewaters Healthcare 08/26/2015 $1,500 $0 $1,500 Services 03-Arlington Flower Mound 015510 Extol Healthcare Services LLC 10/15/2015 $11,250 $0 $11,250 03-Arlington Fort Worth 007277 679011 Divine Care Health Services 01/04/2016 $5,250 $3,500 $1,750 96 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

03-Arlington Fort Worth 009989 Comfort Keepers 12/17/2015 $750 $750 $0 03-Arlington Fort Worth 011801 747160 First Response Home Health 09/21/2015 $500 $500 $0 Services LLC

DADS RegulatoryFY 2016 Annual Services Report 03-Arlington Fort Worth 014989 458178 Bridgeway Health Services Inc 08/05/2015 $1,250 $1,250 $0 03-Arlington Garland 005253 459317 Ada Light Home Health LLC 12/15/2015 $5,250 $5,250 $0 03-Arlington Garland 005847 679023 Vision Home Health Care Inc 10/06/2015 $1,000 $1,000 $0 03-Arlington Garland 010372 453113 E N Tender Care Home 01/05/2016 $500 $500 $0 Health Inc 03-Arlington Garland 010902 747331 Everest Home Health Agency 12/10/2015 $2,250 $2,250 $0 03-Arlington Garland 011542 677820 Prelude Health Care 07/19/2016 $1,500 $0 $1,500 Services LLC 03-Arlington Garland 011681 747131 Silverline Healthcare 06/15/2016 $3,000 $3,000 $0 Network Inc 03-Arlington Garland 012049 747322 Praise Home Health Agency 02/22/2016 $3,250 $1,450 $1,800 03-Arlington Glen Rose 015872 Kamisa Home Health 10/15/2015 $3,000 $0 $3,000 Services Inc 03-Arlington Granbury 016078 The Help 06/16/2016 $2,000 $0 $2,000 03-Arlington Grand Prairie 011340 677801 Good Hands Care Home 06/20/2016 $1,500 $0 $1,500 Health Services Inc 03-Arlington Heartland 011887 747354 Yetkin Advanced Healthcare 01/07/2016 $750 $750 $0 Incorporated 03-Arlington Hurst 011903 679151 Premier Health Care Services II 12/09/2015 $750 $750 $0 03-Arlington Irving 008474 679453 Devine Home Health Agency 12/07/2015 $1,500 $1,500 $0 03-Arlington Irving 014670 679114 Good Shepherd Health 06/21/2016 $3,050 $0 $3,050 Care Services 03-Arlington Kaufman 008905 679496 Your Health Team 11/19/2015 $1,000 $1,000 $0 03-Arlington Lancaster 008812 453103 Angels of Hands Home 09/14/2015 $3,500 $0 $3,500 Health Agency Corp 03-Arlington Lancaster 012349 747693 Care Pro Pediatrics 03/02/2016 $5,200 $5,200 $0 03-Arlington Lewisville 013848 747732 Enable Home Healthcare 03/08/2016 $500 $0 $500 Home Health Agency Administrative Penalties for FY 2016 97 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

03-Arlington Little Elm 016020 Zubic Home Health 05/02/2016 $1,000 $0 $1,000 Services Inc 03-Arlington Little Elm 016020 Zubic Home Health 05/09/2016 $1,250 $0 $1,250 Services Inc 03-Arlington Mansfield 012711 453126 Medical Case Management 02/26/2016 $5,500 $5,500 $0 Home Health Services 03-Arlington McKinney 012791 747410 Home Health & Beyond 01/07/2016 $2,250 $2,250 $0 Services LLC 03-Arlington McKinney 012791 747410 Home Health & Beyond 07/28/2016 $1,500 $0 $1,500 Services LLC 03-Arlington Mesquite 007740 673189 Chemana Home Health 12/21/2015 $1,500 $1,500 $0 Services Inc 03-Arlington Mesquite 008832 453118 Med Global Home Health 12/28/2015 $3,500 $4,250 ($750) Care Inc 03-Arlington Mesquite 009304 679105 Heartbeat Home Health 01/25/2016 $3,500 $3,500 $0 Agency LTD LLP 03-Arlington Mesquite 012652 747557 SAS Home Health Services Inc 06/29/2016 $1,500 $0 $1,500 03-Arlington Mesquite 013011 673183 Osgood Home Care 06/13/2016 $5,250 $1,750 $3,500 Home and Community Support Services Support Agencies Community and Home 03-Arlington Plano 016282 679709 Integrity Home Health 03/01/2016 $2,250 $563 $1,688 Care LLC 03-Arlington Richardson 004828 459021 Americansenior 03/15/2016 $4,250 $4,250 $0 03-Arlington Richardson 009686 677817 Good Shepherd Home 07/30/2015 $500 $0 $500 Healthcare Agency 03-Arlington Richardson 009686 677817 Good Shepherd Home 06/24/2016 $2,250 $0 $2,250 Healthcare Agency 03-Arlington Richardson 012221 747327 WeLLCare Group Home 10/07/2015 $4,500 $4,500 $0 Health Inc 03-Arlington Richardson 015696 Companion Residential 08/13/2015 $750 $750 $0 Care LLC 03-Arlington Rowlett 016056 Auxiegoldie Home Health 04/19/2016 $1,500 $1,500 $0 Services Inc 98 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

03-Arlington Stephenville 004548 677624 Stephens Health Care Inc 05/04/2016 $6,250 $6,250 $0 03-Arlington Terrell 011476 747330 Risesun Care Home Health 08/19/2015 $5,250 $5,250 $0 03-Arlington Whitesboro 016869 458193 First Texas Home Health 04/05/2016 $750 $750 $0 DADS RegulatoryFY 2016 Annual Services Report 03-Arlington Wylie 008562 679401 Divine Home Health 09/25/2015 $900 $900 $0 Agency LLC 03-Arlington Wylie 008958 673184 Albert Home Health 07/29/2016 $2,250 $2,250 $0 Agency Inc 04-Tyler Henderson 016464 677275 Happy at Home Healthcare 03/16/2016 $1,500 $0 $1,500 04-Tyler Henderson 016464 677275 Happy at Home Healthcare 03/16/2016 $0 $1,500 ($1,500) 04-Tyler Jefferson 016140 Amazing Hearts Homecare 03/01/2016 $3,000 $0 $3,000 and Staffing LLC 04-Tyler Longview 007572 Disability Services of the 04/13/2016 $750 $750 $0 Southwest Inc 04-Tyler Longview 016314 679138 Onesource Home Care Inc 08/12/2015 $750 $750 $0 04-Tyler Longview 016656 Elite Private Care 04/27/2016 $0 $3,750 ($3,750) 04-Tyler Longview 016855 Then Theres Cheerful Givers 04/27/2016 $2,250 $750 $1,500 HHA Inc 04-Tyler Mount Pleasant 003819 678093 Texas Helping Hands Inc 09/17/2015 $750 $750 $0 04-Tyler Mount Vernon 008275 Jordan Health Services 09/01/2015 $750 $0 $750 04-Tyler Mount Vernon 008275 Jordan Health Services 03/23/2016 $750 $750 $0 04-Tyler Sulphur 015017 747844 Exceptional Home 04/20/2016 $8,750 $0 $8,750 Springs Health Care 04-Tyler Tyler 008374 679290 Allegiance Home 01/14/2016 $750 $750 $0 Health Services 04-Tyler Tyler 012918 Maxim Healthcare Services Inc 12/02/2015 $750 $750 $0 04-Tyler Tyler 012918 Maxim Healthcare Services Inc 02/09/2016 $750 $0 $750 04-Tyler Tyler 016648 Innovations Health Services 05/10/2016 $4,000 $4,000 $0 05-Beaumont Beaumont 007608 Texas Home Health 04/13/2016 $750 $750 $0 of America 05-Beaumont Beaumont 014890 Epic Pediatric Therapy 08/11/2015 $750 $750 $0 Home Health Agency Administrative Penalties for FY 2016 99 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

05-Beaumont Beaumont 016801 Educare Community Living 03/25/2016 $750 $0 $750 Corporation Texas 05-Beaumont Jasper 007991 679159 Advantage Plus Homecare 02/10/2016 $0 $750 ($750) 05-Beaumont Nacogdoches 007846 679139 Bethany Home Health Services 08/31/2015 $500 $500 $0 05-Beaumont Nacogdoches 007846 679139 Bethany Home Health Services 05/19/2016 $3,750 $3,750 $0 05-Beaumont Nacogdoches 009689 457899 Motherwell Home 04/13/2016 $1,700 $1,700 $0 Health Professionals 05-Beaumont Onalaska 013616 747664 A Compassionate Care Home 01/13/2016 $3,000 $3,000 $0 Health Services of Onalaska 05-Beaumont Silsbee 009110 673196 MDS Choice Home Health Inc 08/31/2015 $750 $750 $0 06-Houston Bay City 008427 679345 Angels Care Home Health 08/17/2015 $2,000 $2,000 $0 06-Houston Baytown 004433 678499 Signature Health Services 07/16/2015 $1,700 $1,700 $0 06-Houston Baytown 014078 679010 Bay View Home Health Services 05/26/2016 $1,500 $1,500 $0 06-Houston Baytown 014865 673157 Nursing and Beyond 03/21/2016 $5,650 $0 $5,650 Home Health 06-Houston Bellaire 011738 457222 Kindred at Home 06/21/2016 $1,500 $1,500 $0 06-Houston Bellville 017110 Unistar Healthcare 04/28/2016 $3,000 $3,000 $0 Services LLC Services Support Agencies Community and Home 06-Houston Cleveland 008776 Texas Home Health 09/02/2015 $1,000 $1,000 $0 of America 06-Houston Conroe 011784 Cynthias Touch Senior 10/15/2015 $1,500 $1,500 $0 Services Inc 06-Houston Crosby 012688 743167 Omnix Health Care Services Inc 08/04/2016 $750 $0 $750 06-Houston Cypress 010111 Home Dialysis 01/14/2016 $7,300 $0 $7,300 06-Houston Cypress 013126 747551 Prana Health Solutions Inc 10/15/2015 $1,350 $0 $1,350 06-Houston Friendswood 009424 457915 Apostle Home Health 05/12/2016 $1,450 $0 $1,450 Care PLLC 06-Houston Friendswood 011667 City Crown Home Health 08/20/2015 $1,300 $1,300 $0 Agency Inc 100 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Galveston 007750 679104 Texas Home Health 03/18/2016 $850 $850 $0 Skilled Services 06-Houston Galveston 012753 747414 Absolute Kheir Services Inc 07/14/2016 $1,550 $1,550 $1,550 $0

DADS RegulatoryFY 2016 Annual Services Report 06-Houston Hempstead 012532 457903 Faith and Care Home Health 01/29/2016 $4,700 $4,700 $0 Agency Inc 06-Houston Houston 001663 Independent Home Health 09/18/2015 $4,200 $3,500 $3,500 $0 Care Inc 06-Houston Houston 001793 677006 Nurses Night and Day Inc 08/13/2015 $700 $700 $0 06-Houston Houston 001995 American Home Health 11/13/2015 $500 $400 $400 $0 Care Inc 06-Houston Houston 004350 678322 Emmanuel Health 08/06/2015 $4,250 $0 $4,250 Homecare Inc 06-Houston Houston 004622 458479 Nurses Home Services Inc 07/09/2015 $4,350 $4,350 $0 06-Houston Houston 005445 678086 Coastal Medical Services Inc 06/08/2016 $1,500 $0 $1,500 06-Houston Houston 006197 678474 Nursing Resource Home 03/17/2016 $4,400 $4,400 $0 Health Services 06-Houston Houston 006605 F K Bold Healthcare Inc . 06/22/2016 $750 $0 $750 06-Houston Houston 006980 459479 Promed Home Care 08/18/2015 $3,000 $3,000 $0 06-Houston Houston 007087 Loyal Home Health 08/26/2015 $2,099 $2,099 $0 Care Agency 06-Houston Houston 007241 679098 Resource Home 03/09/2016 $700 $700 $0 Health Services 06-Houston Houston 007453 459442 St Marys Home Health Inc 01/28/2016 $1,500 $1,500 $0 06-Houston Houston 007711 679098 Resource Home Health Services 07/22/2016 $750 $0 $750 06-Houston Houston 007872 677901 Metro Health Services 05/24/2016 $1,430 $0 $1,430 06-Houston Houston 008157 679363 The Four Group Homecare LLC 08/17/2015 $600 $600 $0 06-Houston Houston 008250 679257 Exceptional Home Health 08/13/2015 $1,300 $1,300 $0 06-Houston Houston 008301 673138 Resource Health Care Inc 01/29/2016 $1,750 $1,750 $0 06-Houston Houston 008400 459431 AP Care Unlimited Inc 02/24/2016 $1,850 $1,850 $0 06-Houston Houston 008421 679397 Diversified Health Care Inc 01/14/2016 $5,250 $0 $5,250 Home Health Agency Administrative Penalties for FY 2016 101 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 008421 679397 Diversified Health Care Inc 02/23/2016 $1,550 $0 $1,550 06-Houston Houston 008577 679434 St Francis Health 09/29/2015 $2,000 $2,000 $0 Care Services Inc 06-Houston Houston 008593 453101 Bestin Medical Group Inc 01/15/2016 $1,500 $1,250 $250 06-Houston Houston 008593 453101 Bestin Medical Group Inc 06/03/2016 $1,200 $0 $1,200 06-Houston Houston 008594 Victory Home Health 09/02/2015 $750 $750 $0 06-Houston Houston 008668 679480 Emason Healthcare Services 09/30/2015 $750 $0 $750 06-Houston Houston 008679 679107 Kingspoint Health 12/16/2015 $1,000 $1,000 $0 Care Services Inc 06-Houston Houston 008679 679107 Kingspoint Health Care 03/31/2016 $2,250 $2,250 $0 Services Inc 06-Houston Houston 008821 Crystal Healthcare Services Inc 10/26/2015 $500 $0 $500 06-Houston Houston 008913 453170 Fidelity Care Home Health 02/22/2016 $1,500 $1,000 $0 $1,000 06-Houston Houston 008919 673147 Empathy Home Health 04/08/2016 $1,950 $1,950 $0 Services Inc 06-Houston Houston 008967 At Your Side Home Care 03/07/2016 $1,500 $0 $1,500 06-Houston Houston 009030 673198 C N G Home Health Inc 03/14/2016 $1,500 $1,500 $0 Home and Community Support Services Support Agencies Community and Home 06-Houston Houston 009032 Hope Health Care Inc 09/17/2015 $1,500 $1,500 $0 06-Houston Houston 009112 457816 Trinity Home Health Services 03/03/2016 $2,950 $1,800 $900 $900 06-Houston Houston 009242 679451 A & C Health Services 03/23/2016 $800 $800 $0 06-Houston Houston 009281 Touch of Class 12/16/2015 $750 $750 $0 06-Houston Houston 009372 457828 Nurturing Home Healthcare 04/08/2016 $2,350 $0 $2,350 Agency Inc 06-Houston Houston 009419 677873 Newchannel Healthcare 06/30/2016 $750 $0 $750 Services 06-Houston Houston 009475 Ambassadors LLC 06/22/2016 $1,500 $1,500 $0 06-Houston Houston 009503 Precious Healthcare 10/15/2015 $2,099 $1,500 $1,500 $0 Services Inc 06-Houston Houston 009517 457898 New Creation Care Inc 05/02/2016 $3,800 $3,800 $0 102 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 009546 Noel Home Health Agency Inc 03/07/2016 $2,250 $2,250 $0 06-Houston Houston 009575 457954 ABL Homehealth Services Inc 05/27/2016 $2,450 $2,450 $0 06-Houston Houston 009673 679321 Reliable Health Services Inc 06/08/2016 $4,400 $0 $4,400 DADS RegulatoryFY 2016 Annual Services Report 06-Houston Houston 009792 679449 Destiny Care Services Inc 07/14/2016 $5,200 $0 $5,200 06-Houston Houston 009854 Luvic Health Services 09/11/2015 $3,699 $1,800 $1,350 $450 06-Houston Houston 009910 Encompass Home Health 12/21/2015 $2,350 $2,350 $0 Pediatric Services 06-Houston Houston 009977 453154 St Agnes Healthcare 06/08/2016 $750 $0 $750 Professionals Inc 06-Houston Houston 010010 747193 Inland Home Health LLC 08/09/2016 $750 $0 $750 06-Houston Houston 010097 A & R Healthcare Services Inc 03/31/2016 $1,500 $1,500 $0 06-Houston Houston 010117 Careworks 10/22/2015 $2,049 $2,049 $0 06-Houston Houston 010158 Victory Personal Care Inc . 09/22/2015 $3,000 $1,700 $1,700 $0 06-Houston Houston 010308 679748 Ventex Home Health 10/13/2015 $1,450 $1,450 $0 Agency Inc 06-Houston Houston 010331 679756 Timeless Home Health Inc 06/23/2016 $2,250 $0 $2,250 06-Houston Houston 010511 679607 Deross Health Care Inc 07/23/2015 $2,600 $2,600 $0 06-Houston Houston 010549 679601 Lifecare Health Services LLC 07/24/2015 $800 $0 $800 06-Houston Houston 010872 453186 St Jude Visiting Nurses 07/30/2015 $2,000 $2,000 $0 Homehealth Inc 06-Houston Houston 011063 747066 Bridge Solutions 06/17/2016 $650 $650 $0 06-Houston Houston 011101 747076 Deligent Health Services Inc 02/11/2016 $1,650 $1,650 $0 06-Houston Houston 011101 747076 Deligent Health Services Inc 06/24/2016 $2,450 $0 $2,450 06-Houston Houston 011114 679771 Forever Homehealth Inc 10/27/2015 $2,000 $2,000 $0 06-Houston Houston 011157 747100 Gracefaith Healthcare 02/11/2016 $3,000 $2,500 $500 Services Inc 06-Houston Houston 011336 679135 Carocare Healthcare 06/24/2016 $1,500 $1,500 $0 Services Inc 06-Houston Houston 011353 Care Innovations LLC 06/07/2016 $1,500 $0 $1,500 06-Houston Houston 011356 679731 A Better Homecare 11/17/2015 $3,750 $3,750 $0 Home Health Agency Administrative Penalties for FY 2016 103 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 011752 743170 Texas Premier Care Services Inc 12/22/2015 $1,500 $1,500 $0 06-Houston Houston 012025 747345 Crescent Home Health Inc 03/11/2016 $1,500 $1,500 $0 06-Houston Houston 012039 743198 Jaimel Health Care 03/09/2016 $1,500 $1,500 $0 Services LLC 06-Houston Houston 012241 673134 Encompass Home Health 02/26/2016 $2,700 $2,700 $0 of Houston 06-Houston Houston 012316 679728 Xtra-Care Home Health Inc 07/13/2016 $2,250 $2,250 $0 06-Houston Houston 012387 747721 Alpha One Healthcare LTD 02/25/2016 $6,600 $0 $6,600 06-Houston Houston 012555 Beneficient Healthcare 06/23/2016 $1,500 $1,500 $0 06-Houston Houston 012634 Kis Med Concepts Inc 05/20/2016 $11,200 $0 $11,200 06-Houston Houston 012815 747179 Sonica Healthcare Group Inc 04/28/2016 $2,800 $0 $2,800 06-Houston Houston 012876 Brookdale at Home Houston 11/19/2015 $700 $0 $700 06-Houston Houston 013037 Visiting Angels 09/23/2015 $4,445 $4,445 $0 06-Houston Houston 013064 Homewatch Caregivers of SW 09/23/2015 $1,500 $1,500 $0 Houston 06-Houston Houston 013155 673129 National Home Health 01/14/2016 $4,900 $3,600 $2,400 $1,200 Services Inc Home and Community Support Services Support Agencies Community and Home 06-Houston Houston 013285 673193 Megacare Home Health 01/14/2016 $3,000 $3,000 $0 Services Inc . 06-Houston Houston 013352 747037 Angel Wings Home 03/21/2016 $2,250 $1,125 $1,125 Healthcare Agency 06-Houston Houston 013372 747645 Paradigm Home Health 10/14/2015 $750 $750 $0 Solutions PLLC 06-Houston Houston 013372 747645 Paradigm Home Health 12/23/2015 $1,500 $1,500 $0 Solutions PLLC 06-Houston Houston 013512 Mount Sinai Home Care 11/04/2015 $2,150 $1,800 $1,200 $600 06-Houston Houston 013779 Guji Health Care Inc 12/09/2015 $1,500 $0 $1,500 06-Houston Houston 013824 Silverado at Home 04/12/2016 $1,350 $1,350 $0 104 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 013851 Caring Senior Service 08/07/2015 $1,500 $1,500 $0 of Houston 06-Houston Houston 013954 Alexis Health Care Inc 07/30/2015 $2,000 $2,000 $0

DADS RegulatoryFY 2016 Annual Services Report 06-Houston Houston 013977 Destiny Health Care Inc 10/01/2015 $5,750 $5,750 $0 06-Houston Houston 014219 747698 Just Absolute Health Care 04/11/2016 $3,250 $0 $3,250 Services LLC 06-Houston Houston 014238 677938 C & C Ultra Healthcare 01/21/2015 $1,350 $0 $1,350 Providers Inc 06-Houston Houston 014509 I .J . Healthcare Services Inc . 09/15/2015 $1,499 $1,500 ($1) 06-Houston Houston 014649 679785 M & M Advanced 05/06/2016 $1,610 $1,610 $0 Healthcare Inc 06-Houston Houston 014655 At Your Side Home Care - 12/11/2015 $1,500 $1,500 $0 Northwest Metro Houston 06-Houston Houston 014679 Volga Home Care LLC 06/14/2016 $1,500 $1,500 $0 06-Houston Houston 014835 Kellies Sitting Services Inc 06/20/2016 $1,450 $1,450 $0 06-Houston Houston 014855 747083 Golden Acres Home Health 01/28/2016 $5,250 $5,250 $0 06-Houston Houston 014955 459008 Prestige Health Services Inc . 06/16/2016 $750 $750 $0 06-Houston Houston 014985 Epic Pediatric Therapy 09/28/2015 $8,350 $0 $8,350 06-Houston Houston 014985 Epic Pediatric Therapy 11/10/2015 $4,550 $4,550 $0 06-Houston Houston 015026 Epic Pediatric Therapy 08/20/2015 $2,247 $2,247 $0 06-Houston Houston 015100 747847 St Michael Healthcare 01/21/2016 $1,250 $0 $1,250 Services Inc . 06-Houston Houston 015159 Astro Medical Services LLC 03/09/2015 $0 $0 $0 06-Houston Houston 015455 Garden Healthcare Services 04/28/2016 $0 $0 $0 Corporation 06-Houston Houston 015554 Sheilas Angels In-Home 09/02/2015 $749 $749 $0 Care LLC 06-Houston Houston 015614 Churchgate Health Care Inc . 08/24/2015 $1,250 $0 $1,250 06-Houston Houston 015631 Home for Texas 10/02/2015 $7,000 $7,000 $0 Home Health Agency Administrative Penalties for FY 2016 105 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 015657 Our Care Senior Solutions 09/24/2015 $2,850 $2,850 $0 06-Houston Houston 015673 679619 Universal Health Care 10/02/2015 $3,000 $3,000 $0 06-Houston Houston 015714 One Step Homecare 12/11/2015 $3,750 $0 $3,750 06-Houston Houston 015785 679195 Houston Total Home Care Inc . 10/16/2015 $850 $850 $0 06-Houston Houston 015806 Houston Homecare LLC 09/24/2015 $725 $725 $0 06-Houston Houston 015853 Home Stay Senior Care Inc . 10/14/2015 $2,175 $2,175 $0 06-Houston Houston 015855 Nazareth Home Healthcare Inc 04/14/2016 $2,105 $2,105 $0 06-Houston Houston 015893 747146 Adora Healthcare Services Inc . 10/15/2015 $4,450 $4,450 $0 06-Houston Houston 015893 747146 Adora Healthcare Services Inc . 02/08/2016 $750 $750 $0 06-Houston Houston 015944 Favor Home Care Inc . 03/25/2016 $1,500 $1,500 $0 06-Houston Houston 015961 Cobarm Healthcare Services Inc 10/27/2015 $3,450 $3,450 $0 06-Houston Houston 015995 Blazing Healthcare Services Inc . 04/05/2016 $4,650 $0 $4,650 06-Houston Houston 016006 458398 Stat Home Health Houston LLC 02/04/2016 $600 $600 $0 06-Houston Houston 016063 Americare Home 04/13/2016 $1,500 $0 $1,500 Health Solutions 06-Houston Houston 016063 Americare Home 04/13/2016 $1,500 $0 $1,500

Health Solutions Services Support Agencies Community and Home 06-Houston Houston 016185 Serenity Home Providers Inc . 06/15/2016 $3,600 $3,600 $0 06-Houston Houston 016196 Medrelief Staffing 06/08/2016 $1,500 $1,500 $0 06-Houston Houston 016240 Cautious Providers 04/08/2016 $2,050 $0 $2,050 06-Houston Houston 016304 Edition Health Services Inc 04/06/2016 $1,500 $0 $1,500 06-Houston Houston 016400 679030 Direct Home Care Services 06/10/2016 $2,250 $2,250 $0 06-Houston Houston 016619 747400 County Home Healthcare 06/29/2016 $2,400 $0 $2,400 06-Houston Houston 016674 Houston Therapy Consult PLLC 07/28/2015 $3,750 $3,750 $0 06-Houston Houston 016848 673153 Prudent Health 10/15/2015 $1,400 $1,400 $0 Management Inc 06-Houston Houston 016884 458221 Supreme Health Care Inc 02/18/2016 $1,500 $1,500 $0 06-Houston Houston 016885 747364 Nurse2u LLC 03/02/2016 $1,250 $0 $1,250 106 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Houston 016941 747616 Sugarland Trinity Home 04/29/2016 $0 $1,250 ($1,250) Health Care Inc . 06-Houston Houston 017022 Advanced Healthcare 12/15/2015 $1,500 $1,500 $0

DADS RegulatoryFY 2016 Annual Services Report Professionals Inc 06-Houston Houston 017085 457820 Class Home Health 02/26/2016 $1,500 $1,500 $0 06-Houston Houston 017215 457743 Southern Touch Home Health 07/21/2016 $5,950 $0 $5,950 06-Houston Humble 013059 Community of Care 10/14/2015 $1,420 $1,420 $0 06-Houston Katy 009130 457897 D Life Healthcare Services Inc 07/14/2016 $750 $750 $0 06-Houston Katy 013078 Katy Dreamweaver Home 09/30/2015 $725 $725 $0 Health Services LLC 06-Houston Katy 013231 Ft Bend Home Health Care Inc 04/12/2016 $2,250 $2,250 $0 06-Houston Katy 015773 Compassionate Care 10/15/2015 $1,400 $1,400 $0 Providers Plus LLC 06-Houston Kingwood 015446 Rapid Home Health Care 02/23/2016 $2,250 $900 $1,350 Agency LLC 06-Houston Lake Jackson 016095 Genesis Geriatriccare & 04/21/2016 $750 $750 $0 Consulting Services LLC 06-Houston League City 015295 Carebuilders at Home 07/26/2016 $1,500 $1,500 $0 Houston 1 06-Houston League City 015653 Home Health Experts 09/22/2015 $4,950 $0 $4,950 of Texas Inc 06-Houston Missouri City 010229 673186 Lifetime Healthcare Inc 02/11/2016 $1,450 $1,450 $0 06-Houston Missouri City 010567 679590 Unity Care Home Health Inc 04/15/2016 $3,000 $500 $2,500 06-Houston Missouri City 013202 Fame Health Care Services Inc 04/19/2016 $1,500 $0 $1,500 06-Houston Missouri City 015774 Comfort Keepers 04/08/2016 $740 $740 $0 06-Houston Missouri City 016398 747057 CJ Healthcare Inc . 07/22/2016 $3,700 $3,700 $0 06-Houston Montgomery 008846 679014 Alpha Omega Home Health 06/08/2016 $3,600 $3,600 $0 Services Inc 06-Houston Pasadena 017251 458116 Angel Home Health Care 07/01/2016 $1,500 $0 $1,500 06-Houston Pearland 011234 743112 Mynurse Home Care Inc 07/20/2016 $750 $750 $0 Home Health Agency Administrative Penalties for FY 2016 107 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Pearland 016206 Yestohomecare 04/13/2016 $750 $750 $0 06-Houston Richmond 009221 673191 Ameuro Home Health Inc 03/04/2016 $1,450 $1,450 $0 06-Houston Richmond 011066 747690 Felvin Health Care 02/19/2016 $4,450 $2,967 $1,483 Services Inc 06-Houston Richmond 011131 743190 Mercyfull Home Health Inc 03/03/2016 $3,000 $0 $3,000 06-Houston Richmond 014026 Amazing Caregivers Home 12/04/2015 $2,239 $2,239 $0 Health Inc 06-Houston Richmond 014069 KC Healthcare Services Inc 03/07/2016 $750 $750 $0 06-Houston Richmond 016113 673121 Ivory Healthcare Agency 08/18/2015 $750 $0 $750 06-Houston Rosenberg 010105 679574 Siercam Healthcare 06/03/2016 $5,090 $5,090 $0 Services LLC 06-Houston Spring 016695 Right at Home 06/15/2016 $2,200 $0 $2,200 06-Houston Spring 016695 678232 Right at Home 06/24/2016 $1,250 $0 $1,250 06-Houston Stafford 004976 459155 Nationsmed Healthcare 06/09/2016 $1,500 $1,500 $0 06-Houston Stafford 009181 457826 Blessed Healthcare Inc 04/01/2016 $2,250 $2,250 $0 06-Houston Stafford 009975 679560 Nissi Home Health Care and 03/03/2016 $1,500 $1,500 $0 Personal Assistance Care Services Agency Services Support Agencies Community and Home 06-Houston Stafford 011085 677866 Bio Home Health Services Inc 06/16/2016 $1,500 $1,500 $0 06-Houston Stafford 011219 743111 Midland Health Care 07/22/2015 $1,500 $1,500 $0 Services Inc 06-Houston Stafford 011806 747585 LFA Health Care Services Inc 02/10/2016 $4,000 $4,000 $0 06-Houston Stafford 011843 Global Dialysis Plus Inc 02/05/2016 $7,500 $7,500 $0 06-Houston Stafford 012016 677884 Triple O Health Services Inc 07/01/2016 $1,750 $0 $1,750 06-Houston Stafford 013579 747709 Diversity Care Providers Inc 03/14/2016 $2,000 $2,000 $0 06-Houston Stafford 015164 457888 Chrysolyte Health Services 07/28/2016 $750 $0 $750 06-Houston Stafford 015261 Universal Home Therapy 05/19/2016 $0 $7,400 $0 $7,400 108 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

06-Houston Sugar Land 007654 679073 Assured Care Health 01/28/2016 $1,250 $1,250 $0 Services LLC 06-Houston Sugar Land 008482 679447 Axis Care Group Home 02/19/2016 $3,000 $3,000 $0

DADS RegulatoryFY 2016 Annual Services Report Health Services Inc 06-Houston Sugar Land 010003 679565 Psalm 23 Health Services 07/14/2016 $3,050 $0 $3,050 06-Houston Sugar Land 010375 679595 Healthlinks Services Inc 10/21/2015 $2,120 $2,120 $0 06-Houston Sugar Land 013441 Healthcare Masters Inc 04/19/2016 $745 $250 $495 06-Houston Sugar Land 015884 Unick Angels Home Health 10/23/2015 $2,950 $2,950 $0 Services Inc . 06-Houston Sugar Land 015925 Divine Caregivers Inc . 12/11/2015 $2,200 $0 $2,200 06-Houston Sugar Land 016146 Amazement Home Care 04/20/2016 $8,750 $1,458 $7,292 06-Houston Texas City 016046 Home Instead Senior Care 10/27/2015 $2,200 $1,500 $1,500 $0 06-Houston The Woodlands 014182 679483 Maxim Healthcare 04/01/2016 $1,500 $1,000 $1,000 $0 Services Inc 06-Houston Tomball 013171 453145 Sienna Home Health Care 01/29/2016 $600 $600 $0 06-Houston Webster 012756 Visiting Angels Living 03/31/2016 $2,400 $2,000 $2,000 $0 Assistance Services 06-Houston Wharton 012662 Denali Healthcare Inc 09/15/2015 $1,950 $1,950 $0 06-Houston Wharton 014676 Agape Services Incorporated 06/16/2016 $3,150 $0 $3,150 06-Houston Wharton 014898 Carissa Health Care 12/03/2014 $0 $1,500 ($1,500) Services Inc 06-Houston Wharton 016204 Delmar Health Services 05/03/2016 $2,220 $2,220 $0 Incorporated 06-Houston Wharton 016332 Rubies Healthcare Inc 07/12/2016 $2,140 $357 $1,783 07-Austin Austin 003114 New Hope Health Care Inc 07/22/2015 $500 $500 $0 07-Austin Austin 003605 Helping the Aging Needy 11/02/2015 $500 $500 $0 and Disabled Inc 07-Austin Austin 003605 Helping the Aging Needy 05/16/2016 $500 $500 $0 and Disabled Inc 07-Austin Austin 006537 677661 PSA Healthcare Inc 08/07/2015 $1,000 $1,000 $0 Home Health Agency Administrative Penalties for FY 2016 109 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Austin 006793 458129 C C Home Health Central Inc 06/06/2016 $1,500 $0 $1,500 07-Austin Austin 007439 Angel Healthcare LP 01/20/2016 $1,750 $0 $1,750 07-Austin Austin 007439 Angel Healthcare LP 06/09/2016 $2,500 $0 $2,500 07-Austin Austin 007439 Angel Healthcare LP 07/07/2016 $4,500 $0 $4,500 07-Austin Austin 007502 I V Specialty LTD 06/29/2016 $4,750 $0 $4,750 07-Austin Austin 007556 Disability Services of the 03/18/2016 $1,000 $1,000 $0 Southwest Inc 07-Austin Austin 007742 679120 Texas Home Health Skilled 02/11/2016 $2,250 $2,250 $0 Services 07-Austin Austin 007742 679120 Texas Home Health Skilled 03/01/2016 $800 $800 $0 Services 07-Austin Austin 007838 The Medical Team Personal 03/31/2016 $2,750 $2,750 $0 Care Services 07-Austin Austin 008312 457174 Interim Healthcare of Austin 11/06/2015 $1,000 $1,000 $0 07-Austin Austin 008700 Matties Homecare Services LLC 10/07/2015 $3,750 $3,000 $3,000 $0 07-Austin Austin 009478 Encompass Home Health 08/06/2015 $4,000 $4,000 $0 Pediatric Services 07-Austin Austin 009478 Encompass Home Health 06/15/2016 $1,500 $1,500 $0 Services Support Agencies Community and Home Pediatric Services 07-Austin Austin 009538 Heavenly Caregiver Services Inc 10/28/2015 $750 $500 $500 $0 07-Austin Austin 010617 679734 K and J Sunshine Home 05/18/2016 $2,100 $2,100 $0 Health Care Inc 07-Austin Austin 011732 Girling Community Care 10/22/2015 $500 $500 $0 Texas by Harden Healthcare 07-Austin Austin 011732 Girling Community Care 02/19/2016 $1,000 $1,000 $0 Texas by Harden Healthcare 07-Austin Austin 011732 Girling Community Care 06/28/2016 $750 $750 $0 Texas By Harden Healthcare 07-Austin Austin 011739 457050 Kindred at Home 01/15/2016 $4,500 $4,500 $0 07-Austin Austin 011739 457050 Kindred at Home 03/09/2016 $2,000 $2,000 $0 110 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Austin 013520 Longhorn Village 12/30/2015 $3,000 $3,000 $0 07-Austin Austin 013546 678267 Encompass Home Health 11/23/2015 $750 $750 $0 of Austin

DADS RegulatoryFY 2016 Annual Services Report 07-Austin Austin 013546 678267 Encompass Home Health 06/08/2016 $2,000 $2,000 $0 of Austin 07-Austin Austin 014052 Elder Homecare Inc 09/16/2015 $500 $500 $0 07-Austin Austin 014052 Elder Homecare Inc 10/21/2015 $750 $750 $0 07-Austin Austin 014052 Elder Homecare Inc 11/04/2015 $750 $750 $0 07-Austin Austin 014433 Halo Senior Care 06/27/2016 $1,000 $0 $1,000 07-Austin Austin 014927 Epic Pediatric Therapy 08/19/2015 $1,000 $1,000 $0 07-Austin Austin 014927 Epic Pediatric Therapy 05/02/2016 $750 $750 $0 07-Austin Austin 014927 Epic Pediatric Therapy 07/06/2016 $2,000 $0 $2,000 07-Austin Austin 015057 747789 Edward's Home Health 08/03/2015 $750 $750 $0 & Hospice 07-Austin Austin 015235 Viva Pediatrics 05/11/2016 $1,800 $1,800 $0 07-Austin Austin 015325 Austin Elite Home 06/07/2016 $2,850 $2,850 $0 Healthcare Solutions 07-Austin Austin 015865 Nurses Case Management LLC 04/06/2016 $1,950 $1,950 $0 07-Austin Austin 016039 Capitol Senior Care 03/31/2016 $3,500 $3,500 $0 07-Austin Austin 016148 Synergy Homecare 05/17/2016 $1,000 $1,000 $0 07-Austin Austin 016178 Synergy Homecare 05/19/2016 $500 $500 $0 07-Austin Austin 016318 Synergy Homecare 08/05/2015 $2,750 $2,000 $2,000 $0 07-Austin Austin 016412 Elder Care Resource LLC . 03/14/2016 $7,500 $0 $7,500 07-Austin Austin 016414 Texas County Home Care 04/07/2016 $9,000 $0 $9,000 Services LLC 07-Austin Austin 016422 458114 A*Med Home Health 10/19/2015 $750 $750 $0 07-Austin Austin 016422 458114 A*Med Home Health 12/30/2015 $1,700 $0 $1,700 07-Austin Austin 016424 Total Care Provider LLC 08/27/2015 $6,750 $4,500 $4,500 $0 Home Health Agency Administrative Penalties for FY 2016 111 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Austin 016425 Acti-Kare Responsive 08/18/2015 $11,000 $5,500 $5,500 $0 In-Home Care 07-Austin Austin 016529 Elder Home Healthcare 04/14/2016 $8,750 $0 $8,750 07-Austin Austin 016574 Health at Home 04/22/2016 $2,050 $2,050 $0 07-Austin Austin 016600 MGA Healthcare Texas Inc 04/20/2016 $1,200 $1,200 $0 07-Austin Austin 016857 Homewatch Caregivers of 04/18/2016 $500 $0 $500 South West Austin 07-Austin Austin 017027 457871 Bellcoa Home Health 06/22/2016 $5,000 $5,000 $0 Service Inc 07-Austin Bastrop 005899 Bluebonnet Home Health 05/11/2016 $500 $500 $0 Care of Texas Inc 07-Austin Bastrop 010520 457506 Standards Home Health 04/29/2016 $750 $0 $750 07-Austin Brenham 015752 Pek's Legacy Healthcare 07/29/2015 $2,000 $2,000 $0 Incorporated 07-Austin Brenham 016121 ACV Healthcare Incorporated 07/29/2015 $750 $750 $0 07-Austin Brenham 017370 Omega Divine Healthcare Inc 07/14/2016 $750 $750 $0 $750 07-Austin Bryan 011573 677153 Guardian Healthcare 06/02/2016 $750 $750 $0 07-Austin Buda 016868 Nellie's Heart Caregiving 05/11/2016 $4,500 $0 $4,500 Services Support Agencies Community and Home Incorporated 07-Austin Cedar Park 016597 457986 Abiding Home Health 10/07/2015 $1,000 $1,000 $0 of Cedar Park 07-Austin Cedar Park 016597 457986 Abiding Home Health 02/12/2016 $750 $750 $0 of Cedar Park 07-Austin Cedar Park 016616 Heaven Sent Care Givers LLC 04/20/2016 $500 $0 $500 07-Austin Cedar Park 016731 B . C . Collins Home 06/21/2016 $750 $750 $0 Health Care 07-Austin College Station 007951 679189 Texas Home Health 02/19/2016 $1,250 $1,250 $0 Skilled Services 07-Austin College Station 011108 673123 Brazos Valley Home 12/17/2015 $1,250 $1,250 $0 Health Services LLC 112 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Georgetown 007220 Caring Home Health 03/04/2016 $750 $750 $0 07-Austin Georgetown 014003 Visiting Angels 06/09/2016 $1,250 $1,250 $0 07-Austin Hewitt 011520 Home Instead Senior Care 10/02/2015 $1,500 $1,200 $1,200 $0

DADS RegulatoryFY 2016 Annual Services Report Franchise #664 07-Austin Hillsboro 016221 679573 Family and Health First 08/13/2015 $1,500 $1,500 $0 of Hillsboro 07-Austin Killeen 009578 457922 Texmed Home Health Inc . 01/28/2016 $3,250 $0 $3,250 07-Austin Killeen 015594 Grace Therapeutic 01/25/2016 $750 $0 $750 Homes LLC 07-Austin Kyle 015699 747926 Your Home Health Care 06/01/2016 $1,900 $1,900 $0 07-Austin La Grange 015578 Compassionate Provider 07/29/2016 $500 $500 $0 Services of Texas 07-Austin Lockhart 015923 747423 Quality Providers Home 08/04/2015 $1,000 $1,000 $0 Care Inc 07-Austin Navasota 016269 DMD Home & Companion 06/15/2016 $2,750 $0 $2,750 Care Services LLC 07-Austin Navasota 016467 Smith & Williams 06/02/2016 $3,500 $0 $3,500 Community Healthcare 07-Austin Pflugerville 008324 PN Home Health Services 04/05/2016 $1,000 $0 $1,000 07-Austin Round Rock 010381 457661 Hill Country Home Health 05/26/2016 $2,000 $2,000 $0 07-Austin Round Rock 013554 Right at Home Austin North 04/14/2016 $4,000 $2,667 $1,333 07-Austin Round Rock 015984 Home Instead Senior Care 04/20/2016 $750 $0 $750 07-Austin Round Rock 016224 747022 Royalty Care Home Health 04/05/2016 $1,750 $1,750 $0 Services Inc 07-Austin Round Rock 017038 Guiding Angels 07/21/2016 $8,000 $8,000 $0 $8,000 07-Austin San Marcos 014439 Hutchison Place South 12/15/2015 $3,250 $3,250 $0 07-Austin San Marcos 015571 Corridor Caregivers 09/02/2015 $750 $750 $0 07-Austin Spicewood 016555 My Savior Home 06/20/2016 $500 $500 $0 Healthcare LLC 07-Austin Temple 012292 458194 Standards Home Health 11/05/2015 $1,500 $1,500 $0 Home Health Agency Administrative Penalties for FY 2016 113 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Temple 012601 459300 Lakeway Home Health 09/10/2015 $3,000 $3,000 $0 07-Austin Temple 013943 Epic Health Services 09/24/2015 $1,750 $1,750 $0 07-Austin Temple 013943 Epic Health Services 04/14/2016 $1,800 $1,800 $0 07-Austin Temple 015387 Lifespan Home Health 08/25/2015 $750 $750 $0 07-Austin Temple 016485 PSA Healthcare 04/26/2016 $1,350 $1,350 $0 07-Austin Troy 016477 R Kidz Rock Rediatrics PLLC 04/28/2016 $700 $700 $0 07-Austin Waco 007382 ABC Health Care Inc 12/16/2015 $500 $500 $0 07-Austin Waco 007587 Texas Home Health 09/01/2015 $1,500 $1,500 $0 of America 07-Austin Waco 007587 Texas Home Health 09/18/2015 $750 $750 $0 of America 07-Austin Waco 007587 Texas Home Health 06/15/2016 $750 $750 $0 of America 07-Austin Waco 007950 679200 Texas Home Health 05/25/2016 $1,000 $1,000 $0 Skilled Services 07-Austin Waco 008089 Visiting Angels 08/06/2015 $4,400 $3,500 $3,500 $0 07-Austin Waco 016737 457377 Providence Home Care 02/26/2016 $600 $600 $0 Home and Community Support Services Support Agencies Community and Home 08-San Antonio Boerne 015920 Home Instead Senior 08/27/2015 $650 $650 $0 Care Franchise 577 08-San Antonio Boerne 016564 Ohana Pediatric Home 05/13/2016 $700 $700 $0 Health LLC 08-San Antonio Crystal City 002170 677290 Lopez Health Systems Inc 06/09/2016 $1,500 $0 $1,500 08-San Antonio Del Rio 008855 Care ETC 04/27/2016 $1,300 $1,300 $0 08-San Antonio Edna 016215 Gig Healthcare Services Inc 10/14/2015 $650 $650 $0 08-San Antonio Fair Oaks 004287 678333 Basic Nursing Services Inc 02/08/2016 $1,550 $0 $1,550 Ranch 08-San Antonio Fredericksburg 016622 Fredericksburg Home 10/14/2015 $10,350 $2,587 $2,587 $0 Care LLC 08-San Antonio Hondo 016337 God's Country PHC Services 08/14/2015 $5,000 $3,400 $3,400 $0 114 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

08-San Antonio Hondo 016337 God's Country PHC Services 11/04/2015 $650 $650 $0 08-San Antonio New Braunfels 016590 Equality Homecare Inc 04/28/2016 $1,900 $0 $1,900 08-San Antonio Poteet 016578 1 Stop Senior Services 06/14/2016 $3,950 $0 $3,950 DADS RegulatoryFY 2016 Annual Services Report 08-San Antonio San Antonio 001327 457491 The Medical Team Inc 12/28/2015 $650 $650 $0 08-San Antonio San Antonio 001327 457491 The Medical Team Inc 06/16/2016 $750 $750 $0 08-San Antonio San Antonio 002798 458001 Caprock Home Health 01/29/2016 $1,400 $1,400 $0 Services Inc 08-San Antonio San Antonio 004137 Med Team Inc 10/23/2015 $650 $650 $0 08-San Antonio San Antonio 004137 Med Team Inc 02/26/2016 $550 $550 $0 08-San Antonio San Antonio 005415 458441 Casa Linda Homecare Inc 11/13/2015 $600 $0 $600 08-San Antonio San Antonio 007919 Caring Senior Service of 08/06/2015 $650 $400 $400 $0 San Antonio 08-San Antonio San Antonio 007949 679174 Texas Home Health 03/08/2016 $700 $0 $700 Skilled Services 08-San Antonio San Antonio 008178 678191 Homecare Dimensions Inc 06/07/2016 $750 $750 $0 08-San Antonio San Antonio 008293 Best Care Home Health 08/14/2015 $750 $750 $0 08-San Antonio San Antonio 008486 Brookdale Therapy 07/23/2015 $6,350 $6,350 $0 Parklane West 08-San Antonio San Antonio 008652 453158 Associates Home 02/19/2016 $550 $550 $0 Health Agency 08-San Antonio San Antonio 009956 679298 San Antonio Home 03/04/2016 $2,050 $2,050 $0 Health Care 08-San Antonio San Antonio 010535 Aim Care Home Health Inc 10/09/2015 $3,250 $3,250 $0 08-San Antonio San Antonio 011018 679775 Inhome Care 12/31/2015 $1,500 $1,500 $0 08-San Antonio San Antonio 011260 Jordan Health Services 08/20/2015 $1,500 $1,500 $0 08-San Antonio San Antonio 011260 Jordan Health Services 01/27/2016 $750 $750 $0 08-San Antonio San Antonio 011553 In Home Senior Care 05/03/2016 $750 $750 $0 08-San Antonio San Antonio 011575 677504 Interim Healthcare 07/22/2016 $750 $750 $0 Home Health Agency Administrative Penalties for FY 2016 115 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

08-San Antonio San Antonio 011757 Girling Community Care 03/07/2016 $550 $550 $0 Texas by Harden Healthcare 08-San Antonio San Antonio 012963 747435 Alpha Care Home Health 01/11/2016 $4,650 $4,650 $0 08-San Antonio San Antonio 013551 747595 Generations Health Care Inc 02/12/2016 $3,900 $3,900 $0 08-San Antonio San Antonio 013799 Bethesda Texas Home Health 10/20/2015 $2,250 $0 $2,250 Limited Liability Company 08-San Antonio San Antonio 013870 747821 A + Abundant Care Home 04/13/2016 $2,600 $2,600 $0 Health LLC 08-San Antonio San Antonio 013877 Santana Primary 08/07/2015 $600 $600 $0 Home Care Inc 08-San Antonio San Antonio 013878 Epic Health Services 01/29/2016 $550 $550 $0 08-San Antonio San Antonio 013878 Epic Health Services 03/24/2016 $3,350 $3,350 $0 08-San Antonio San Antonio 014111 Senior Buddies LLC 09/03/2015 $2,150 $0 $2,150 08-San Antonio San Antonio 014204 Home Helpers of San Antonio 10/29/2015 $2,950 $2,950 $0 08-San Antonio San Antonio 015175 Lighthouse Primary 08/12/2015 $600 $0 $600 Home Care LLC 08-San Antonio San Antonio 015222 Home Care Assistance of 09/03/2015 $7,900 $5,900 $5,900 $0

San Antonio Services Support Agencies Community and Home 08-San Antonio San Antonio 015302 Helping Our Seniors LLC 06/07/2016 $600 $0 $600 08-San Antonio San Antonio 015570 Texas Heartfelt Personal 04/15/2016 $1,400 $1,400 $0 Care LLC 08-San Antonio San Antonio 015644 679395 National Nursing & 12/18/2015 $1,300 $1,300 $0 Rehab Adult LLC 08-San Antonio San Antonio 015675 Brightstar Care 10/28/2015 $700 $700 $0 08-San Antonio San Antonio 015675 Brightstar Care 02/19/2016 $2,000 $2,000 $0 08-San Antonio San Antonio 015756 673146 Health Care Partners 05/26/2016 $750 $750 $0 of San Antonio 08-San Antonio San Antonio 015847 San Rafael Healthcare Inc 11/24/2015 $600 $600 $0 116 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

08-San Antonio San Antonio 015897 Absolute Care 09/01/2015 $500 $0 $500 08-San Antonio San Antonio 015902 Sweet Pea's Pedi Care Inc 08/21/2015 $4,500 $2,600 $2,600 $0 08-San Antonio San Antonio 015916 Clips Primary Home Care 08/19/2015 $700 $700 $0 DADS RegulatoryFY 2016 Annual Services Report 08-San Antonio San Antonio 015918 Disability Services of 06/16/2016 $700 $700 $0 the Southwest Inc . 08-San Antonio San Antonio 015955 Alamo Pediatric Therapy 08/12/2015 $700 $700 $0 08-San Antonio San Antonio 015979 679002 Baptist Home Health 10/16/2015 $800 $800 $0 08-San Antonio San Antonio 016050 Fidelity Home Care Agency 09/16/2015 $2,750 $3,250 ($500) 08-San Antonio San Antonio 016216 Pediatric Health Therapy Inc 09/30/2015 $2,800 $2,800 $0 08-San Antonio San Antonio 016251 Adept Home Health Care Inc 02/26/2016 $750 $750 $0 08-San Antonio San Antonio 016288 San Antonio Visiting Angels 10/16/2015 $2,150 $2,150 $0 08-San Antonio San Antonio 016295 Guardian Angels Healthcare 11/12/2015 $1,400 $1,400 $0 08-San Antonio San Antonio 016311 JPR Quality Home Health 06/09/2016 $650 $0 $650 Care Inc 08-San Antonio San Antonio 016350 Alamo Rehab Specialists 03/31/2016 $2,500 $2,500 $0 08-San Antonio San Antonio 016457 Authentic Home Care Inc 05/16/2016 $1,000 $0 $1,000 08-San Antonio San Antonio 016470 Simply the Best Home 10/21/2015 $650 $650 $0 Therapy LLC . 08-San Antonio San Antonio 016527 Aramis Health Services 06/16/2016 $3,500 $0 $3,500 08-San Antonio San Antonio 016567 679145 Abiding Home Health LLC 11/13/2015 $2,850 $2,850 $0 08-San Antonio San Antonio 016598 Castle Homecare 4 Kids LLC 06/27/2016 $1,500 $0 $1,500 08-San Antonio San Antonio 016723 Triage Home Care 06/03/2016 $2,100 $2,100 $0 08-San Antonio San Antonio 016807 Scarlet Medical Home Health 07/08/2016 $3,450 $0 $3,450 08-San Antonio Selma 015189 679667 Southern Assured Home 11/06/2015 $5,300 $5,300 $0 Health LLC 08-San Antonio Spring Branch 013997 Mkare Management Inc 07/08/2016 $250 $250 $0 08-San Antonio Universal City 016254 Golden Heart Senior Care 09/24/2015 $2,000 $2,000 $0 Home Health Agency Administrative Penalties for FY 2016 117 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

08-San Antonio Victoria 008990 673133 Texas Home Health 05/27/2016 $1,500 $1,500 $0 Skilled Services 08-San Antonio Victoria 010635 679615 Victorian Healthcare 09/04/2015 $1,950 $1,950 $0 Services Inc 08-San Antonio Victoria 010635 679615 Victorian Healthcare 05/13/2016 $550 $550 $0 Services Inc 08-San Antonio Victoria 011735 457126 Girling Home Health 09/08/2014 $4,250 $4,250 $0 08-San Antonio Victoria 016298 Brookdale At Home Victoria 05/13/2016 $1,200 $1,200 $0 09-Abilene Fort Stockton 009326 673107 Pecos County Memorial 08/07/2015 $750 $750 $0 Hospital Home Health and Hospice 09-Abilene Lamesa 010265 677129 Medical Arts Hospital 04/29/2016 $1,500 $1,500 $0 Home Care 09-Abilene Midland 011597 Comfort Keepers 208 07/07/2016 $1,500 $1,500 $0 09-Abilene Midland 012859 747447 Tripple C Health Systems Inc 07/05/2016 $3,750 $0 $3,750 09-Abilene Midland 015730 HCA West Texas 09/03/2015 $750 $750 $0 09-Abilene Odessa 008527 679327 Express Nursing 07/28/2016 $3,750 $3,750 $0

10-El Paso El Paso 002026 677207 Sun City Home Care Inc 07/14/2016 $1,000 $1,000 $0 Services Support Agencies Community and Home 10-El Paso El Paso 002251 457384 Caprock Home Health 09/18/2015 $1,250 $1,250 $0 Services Inc 10-El Paso El Paso 004250 Bienvivir All-Inclusive 08/31/2015 $1,000 $1,000 $0 Senior Health 10-El Paso El Paso 004455 678341 Pasos Home Health Inc 02/29/2016 $500 $500 $0 10-El Paso El Paso 007056 Inhome Care 03/01/2016 $800 $800 $0 10-El Paso El Paso 007987 679180 Alpha Home Nurses 03/24/2016 $1,000 $0 $1,000 10-El Paso El Paso 009593 457948 Good Shepard Home 09/17/2015 $1,498 $1,498 $0 Health Agency 10-El Paso El Paso 011414 Vida Bella 08/11/2015 $1,000 $1,000 $0 10-El Paso El Paso 012385 747099 Urgent Care Home Health Inc 05/06/2016 $1,000 $1,000 $0 118 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

10-El Paso El Paso 013522 Grace Personal Assistance 03/04/2016 $500 $500 $0 Services Inc 10-El Paso El Paso 013815 457894 Nurses Care Home Services 03/17/2016 $5,250 $5,250 $0

DADS RegulatoryFY 2016 Annual Services Report 10-El Paso El Paso 014695 747872 Angels 2 You Home Health 04/06/2016 $2,500 $0 $2,500 10-El Paso El Paso 016371 San Lorenzo Adult Provider 04/25/2016 $750 $750 $0 And Pediatrics 10-El Paso El Paso 016448 American Arch Homehealth 11/02/2015 $500 $500 $0 & Personal Assistance Care Agency LLC 10-El Paso El Paso 016456 Celestial Personal Assistance 03/09/2016 $500 $500 $0 Services LLC 10-El Paso El Paso 016471 Home Helpers of El Paso 07/13/2015 $7,500 $0 $0 $0 10-El Paso El Paso 016478 El Paso Prime Home 04/20/2016 $750 $750 $0 Health LLC 10-El Paso El Paso 016500 Aliante Personal 03/29/2016 $1,500 $0 $1,500 Assistance Services 10-El Paso El Paso 016593 Open Arms Private 05/19/2016 $600 $0 $600 Duty Services 10-El Paso El Paso 016631 JMJ Home Health Care 05/20/2016 $750 $750 $0 10-El Paso El Paso 016653 Comfort Keepers El Paso 08/21/2015 $500 $500 $0 11-Corpus Christi Alice 003825 678094 Carestat Provider Services 05/19/2016 $2,750 $2,750 $0 11-Corpus Christi Alice 005343 459319 Del Cielo Home Care Services 06/16/2016 $2,450 $2,450 $0 11-Corpus Christi Alice 013683 747607 Mi Casa Home Health Agency 03/25/2016 $600 $600 $0 11-Corpus Christi Aransas Pass 012297 679129 Guardian Healthcare 05/10/2016 $2,200 $2,200 $0 11-Corpus Christi Benavides 008750 453121 Santa Fe Health Care Inc 01/12/2016 $650 $650 $0 11-Corpus Christi Brownsville 003165 677594 Caring for You Home 07/27/2015 $6,700 $6,700 $0 Health Inc 11-Corpus Christi Brownsville 007958 679166 Med Team Inc 10/07/2015 $1,000 $1,000 $0 11-Corpus Christi Corpus Christi 002352 677513 Bayside Home Health Care Inc 04/01/2016 $4,300 $4,300 $0 11-Corpus Christi Corpus Christi 003814 678236 Corpus Christi Home Care Inc 09/04/2015 $1,000 $1,000 $0 Home Health Agency Administrative Penalties for FY 2016 119 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

11-Corpus Christi Corpus Christi 005407 459015 Save Home Health Care Inc 04/15/2016 $1,750 $1750 $1,750 $0 11-Corpus Christi Corpus Christi 007471 Save Home Care Inc 08/13/2015 $1,500 $1,500 $0 11-Corpus Christi Corpus Christi 007510 678464 National Nursing & Rehab Inc 09/23/2015 $1,200 $1,200 $0 11-Corpus Christi Corpus Christi 007577 Rising Star Home Care 11/13/2015 $1,800 $1,800 $0 Services Inc 11-Corpus Christi Corpus Christi 008442 459433 Legacy Home Health 03/18/2016 $1,950 $1,950 $0 Agency Inc 11-Corpus Christi Corpus Christi 011587 Interim Healthcare 10/01/2015 $1,700 $1,700 $0 11-Corpus Christi Corpus Christi 014828 Epic Pediatric Therapy 11/23/2015 $3,300 $3,300 $0 11-Corpus Christi Corpus Christi 015681 Educare Community Living 05/20/2016 $6,450 $0 $6,450 Corp Texas 11-Corpus Christi Corpus Christi 015982 747673 Community Health 09/18/2015 $600 $0 $600 11-Corpus Christi Corpus Christi 016002 679463 Community Rehab 10/06/2015 $500 $0 $500 11-Corpus Christi Corpus Christi 017029 679354 Hosanna Health Care 04/14/2016 $500 $500 $0 11-Corpus Christi Donna 011548 747340 Spectrum Health 12/22/2015 $650 $0 $650 Care Services 11-Corpus Christi Donna 014081 First Choice In-Home 01/28/2016 $1,700 $1,700 $0 Home and Community Support Services Support Agencies Community and Home Care LLC 11-Corpus Christi Edinburg 008694 679390 Ninos Home Care Inc 07/01/2016 $5,300 $0 $5,300 11-Corpus Christi Edinburg 008933 453139 Vida Home Health Inc 09/21/2015 $4,000 $4,000 $0 11-Corpus Christi Edinburg 010933 679738 Fountain of Life Home 06/06/2016 $2,000 $2,000 $0 Health LP 11-Corpus Christi Harlingen 005782 Bee First Primary Home Care 08/07/2015 $2,850 $2,850 $0 11-Corpus Christi Harlingen 009479 677922 Merida Health Care Group 12/16/2015 $2,500 $3,000 ($500) 11-Corpus Christi Harlingen 009479 677922 Merida Health Care Group 03/02/2016 $0 $2,300 ($2,300) 11-Corpus Christi Harlingen 009479 677922 Merida Health Care Group 05/05/2016 $1,400 $1,400 $0 11-Corpus Christi Harlingen 009479 677922 Merida Health Care Group 07/08/2016 $3,000 $3,000 $0 120 Home Health Agency Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

11-Corpus Christi Kingsville 015546 Angels of God Home 10/23/2015 $2,000 $1,500 $1,500 $0 Health LLC 11-Corpus Christi La Feria 016664 Amable Home Care LLC 07/12/2016 $2,500 $2,500 $2,500 $0

DADS RegulatoryFY 2016 Annual Services Report 11-Corpus Christi Laredo 008692 679490 Torres Home Health 01/08/2016 $2,400 $4,800 ($2,400) Service L C 11-Corpus Christi Laredo 010954 747257 Laredo Skilled Services Inc 07/30/2015 $750 $750 $0 11-Corpus Christi Laredo 012028 747254 Superior Nursing Care 01/28/2016 $600 $600 $0 11-Corpus Christi Laredo 012249 747311 ABC Home Health LLC 09/23/2015 $4,050 $4,050 $0 11-Corpus Christi Laredo 012799 GDM Primary Home Care Inc 02/25/2016 $2,250 $2,250 $0 11-Corpus Christi Laredo 013907 Palomitas R Us Inc 11/09/2015 $3,950 $3,950 $0 11-Corpus Christi Mathis 003523 458490 Lakeview Home Care Inc 03/24/2016 $2,150 $2,150 $0 11-Corpus Christi McAllen 002164 677285 Health Care Unlimited Inc 01/29/2016 $550 $550 $0 11-Corpus Christi McAllen 008177 459199 First Choice Healthcare 10/02/2015 $1,900 $1,900 $0 11-Corpus Christi McAllen 012454 747218 Te Cuido Home 09/25/2015 $2,000 $2,000 $0 Health Services 11-Corpus Christi McAllen 013571 747669 Southern Valley Home 11/13/2015 $1,500 $0 $1,500 Health LLC 11-Corpus Christi McAllen 013925 Los Reyes Home Care 09/01/2015 $750 $750 $0 11-Corpus Christi McAllen 015428 Prosperity Health Care LLC 08/19/2015 $1,800 $1,800 $0 11-Corpus Christi McAllen 015504 Sunshine Home Health Care 08/27/2015 $1,200 $1,200 $0 11-Corpus Christi Mission 004067 678155 Arise Home Health Care Inc 08/07/2015 $750 $750 $0 11-Corpus Christi Mission 010819 Helping Hands 10/30/2015 $500 $400 $400 $0 Provider Service 11-Corpus Christi Pharr 007171 All Valley Primary Home 07/10/2015 $600 $600 $0 Care Inc 11-Corpus Christi Pharr 014807 Epic Pediatric Therapy 06/13/2016 $1,350 $1,350 $0 11-Corpus Christi Rio Grande 015140 Familia Primary Home 09/17/2015 $2,000 $2,000 $0 City Care Inc 11-Corpus Christi San Benito 002790 458108 Eldercare Home Health II 03/18/2016 $4,000 $3,300 $1,100 $2,200 Home Health Agency Administrative Penalties for FY 2016 121 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

11-Corpus Christi Weslaco 011859 747255 Care Plus Home Health 11/09/2015 $2,900 $2,900 $0 11-Corpus Christi Weslaco 013385 457985 Maximum Home Health LLC 04/29/2016 $1,500 $1,500 $0 Totals $1,218,918 $92,387 $806,704 593 Total home health agency administrative penalties imposed Notes: 1 . Them I posed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if no alternative amount results from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount and due date have been decided, or the person accepts the determination by DADS or fails to respond to the notice letter in a timely manner . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, this column is not totaled . Home and Community Support Services Support Agencies Community and Home 122 Hospice Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

01-Lubbock Canadian 003016 451603 Hemphill County Hospice 04/20/2016 $1,000 $1,000 $0 01-Lubbock Dalhart 005693 671531 Coon Memorial Hospital 10/22/2015 $2,250 $2,250 $0 Home Care

DADS RegulatoryFY 2016 Annual Services Report 01-Lubbock Lubbock 010522 671561 Interim Hospice of West Texas 01/26/2016 $750 $750 $0 01-Lubbock Lubbock 010522 671561 Interim Hospice of West Texas 07/13/2016 $4,000 $4,000 $0 02-Abilene Abilene 007488 451558 Hospice of the Big Country 01/13/2016 $1,500 $1,500 $0 02-Abilene Ballinger 015166 671570 Hospice of Ballinger 02/04/2016 $4,500 $4,500 $0 03-Arlington Arlington 009440 451797 Tender Heart Hospice Care 02/18/2016 $0 $750 ($750) 03-Arlington Dallas 003140 451790 CC Young Home Health 01/29/2016 $750 $750 $0 and Hospice 03-Arlington Dallas 006983 451504 Vitas Healthcare of Texas LP 05/12/2016 $500 $500 $0 03-Arlington Dallas 010273 671544 Bluebonnet Hospice of East 01/15/2016 $1,000 $0 $1,000 Texas Inc 03-Arlington Dallas 015111 671710 Novus Health Services 10/29/2015 $2,000 $0 $2,000 03-Arlington Dallas 015929 671632 Optim Health Services 10/26/2015 $1,000 $0 $1,000 03-Arlington Decatur 007938 451688 Solaris Hospice Inc 11/10/2015 $0 $500 ($500) 03-Arlington Denton 007693 451571 Kindred at Home-Hospice 06/27/2016 $1,500 $1,500 $0 03-Arlington Fort Worth 013919 671718 Bear Creek Hospice 01/21/2016 $2,250 $0 $2,250 03-Arlington Mesquite 010526 671563 Magnolia Hospice 04/04/2016 $750 $0 $750 03-Arlington Mesquite 010526 671563 Magnolia Hospice 04/04/2016 $0 $750 ($750) 03-Arlington Richardson 007562 451752 Advance Hospice Care 07/15/2016 $750 $750 $0 of America Inc 03-Arlington Terrell 015142 671766 Alinea Family 09/01/2015 $750 $750 $0 Hospice Care LLC 03-Arlington Waxahachie 015998 451743 Bristol Hospice - 03/16/2016 $500 $500 $0 Pathways LLC 05-Beaumont Beaumont 017041 Three M Hospice Care LLC 06/24/2016 $2,250 $0 $2,250 05-Beaumont Beaumont 017157 G & V Hospice Inc 01/13/2016 $1,500 $1,500 $0 Hospice Administrative Penalties for FY 2016 123 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

05-Beaumont Lufkin 013942 671690 Affinity Health Care 06/01/2016 $4,000 $4,000 $0 05-Beaumont Lufkin 015266 741518 Harbor Hospice 26 LP 10/07/2015 $1,000 $1,000 $0 06-Houston Bellaire 007698 451647 Kindred Hospice 01/14/2016 $3,600 $3,600 $0 06-Houston Bellaire 016502 451612 Cima Hospice 06/03/2016 $2,400 $2,400 $0 06-Houston Conroe 009029 451568 Kindred Hospice 02/12/2016 $2,550 $2,550 $0 06-Houston Conroe 014816 671772 Traditions Hospice 07/14/2016 $2,250 $2,200 $2,200 $0 06-Houston Houston 009895 671537 Hospice Compassus - The 07/10/2015 $750 $750 $0 Woodlands 06-Houston Houston 010227 671565 Foundation Careplus 01/27/2016 $2,250 $2,250 $0 Group Inc 06-Houston Houston 010477 671568 Evangel Hospice Care Services 02/09/2016 $1,499 $1,000 $1,000 $0 06-Houston Houston 015693 671703 Encompass Hospice 02/01/2016 $2,250 $2,250 $0 of Houston 06-Houston Kingwood 013770 671693 Tricare Hospice LLC 05/17/2016 $2,140 $2,140 $0 06-Houston Sugar Land 014263 671763 The Providence Hospice Inc 11/16/2015 $700 $700 $0 06-Houston Sugar Land 017459 New Century Hospice 07/18/2016 $1,500 $1,500 $0 of Houston Home and Community Support Services Support Agencies Community and Home 06-Houston Tomball 008722 451762 Sunset Hospice Inc 03/16/2016 $900 $900 $0 07-Austin Austin 001791 451515 Hospice Austin 12/01/2015 $900 $900 $0 07-Austin Austin 005101 451570 Aseracare Hospice 09/22/2015 $2,000 $2,000 $0 07-Austin Austin 007845 451715 Kindred Hospice 06/24/2016 $1,750 $1,750 $0 07-Austin Austin 011306 671630 Harbor Hospice of Austin LP 05/19/2016 $2,100 $2,100 $0 07-Austin Austin 013782 671538 Austin's Grace Hospice LLC 07/15/2015 $1,750 $1,750 $0 07-Austin Austin 015952 671529 Heart to Heart Hospice 07/21/2016 $750 $0 $750 of Austin LTD 07-Austin Austin 016776 741607 Capitol Hospice 02/24/2016 $0 $2,750 ($2,750) 07-Austin Bryan 015951 Harbor Hospice of Bryan- 07/27/2015 $3,250 $3,250 $0 College Station LP 124 Hospice Administrative Penalties for FY 2016 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

07-Austin Clifton 010595 671557 Hospice Sunset 10/28/2015 $1,000 $1,000 $0 07-Austin Georgetown 014240 671546 Wesleyan Hospice 07/22/2015 $500 $500 $0 07-Austin Harker Heights 013890 671555 New Century Hospice 09/08/2015 $1,000 $1,000 $0

DADS RegulatoryFY 2016 Annual Services Report of Central Texas 07-Austin Harker Heights 013890 671555 New Century Hospice 10/14/2015 $3,000 $3,000 $0 of Central Texas 07-Austin Harker Heights 013890 671555 New Century Hospice 05/26/2016 $500 $500 $0 of Central Texas 07-Austin Hewitt 016436 451759 Southerncare Waco 03/03/2016 $2,700 $2,700 $0 07-Austin Round Rock 013855 671628 Hospice Compassus 04/21/2016 $1,500 $1,500 $0 07-Austin San Marcos 004098 451640 Kindred Hospice 10/15/2015 $1,250 $1,250 $0 07-Austin Waco 007477 451713 Providence Hospice 05/04/2016 $750 $750 $0 08-San Antonio Del Rio 014458 671748 Superior Hospice of 12/18/2015 $750 $750 $0 Del Rio LLC 08-San Antonio San Antonio 010026 671520 Hospice Compassus – 11/02/2015 $5,800 $5,800 $0 San Antonio 08-San Antonio San Antonio 011557 671593 Harbour Hospice 05/18/2016 $1,000 $1,000 $0 08-San Antonio San Antonio 013328 671655 River City Hospice 03/17/2016 $600 $600 $0 08-San Antonio San Antonio 013949 671612 New Century Hospice 10/29/2015 $2,950 $2,950 $0 of San Antonio 08-San Antonio San Antonio 015794 Harbor Hospice of Central 10/22/2015 $2,000 $2,000 $0 San Antonio LP 08-San Antonio San Antonio 015981 671746 Encompass Hospice 03/08/2016 $1,450 $1,450 $0 of Central Texas 09-Abilene Midland 002022 451531 Hospice of Midland Inc 08/05/2016 $1,750 $1,750 $0 09-Abilene Midland 015049 451696 Compass Hospice LLC 03/18/2016 $10,250 $10,250 $0 10-El Paso El Paso 016787 671666 Choice Hospice of Texas 08/12/2015 $1,000 $1,000 $0 10-El Paso El Paso 016787 671666 Choice Hospice of Texas 10/01/2015 $1,000 $1,000 $0 Hospice Administrative Penalties for FY 2016 125 License CMS Visit Exit Region City Agency Imposed Assessed Collected Balance Number Number Date

11-Corpus Christi Corpus Christi 013874 671607 New Century Hospice 09/14/2015 $3,050 $3,050 $0 of South Texas 11-Corpus Christi Corpus Christi 014981 671621 Altus Hospice of 02/23/2016 $1,950 $1,950 $0 Corpus Christi LP Totals $115,539 $3,200 $109,740 66 Total hospice agency administrative penalties imposed

Notes: 1 . The Imposed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if no alternative amount results from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount and due date have been decided, or the person accepts the determination by DADS or fails to respond to the notice letter in a timely manner . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, this column is not totaled . Home and Community Support Services Support Agencies Community and Home Home and Community Support Services Agency Injunctive/Other Relief and Civil Penalty Referrals to the Office of the Attorney General for FY 2016

DADS did not refer any home and community support services agency to the Office of the Attorney General for injunctive/other relief in FY 2016 .

Home Health Agency Denials of License Application for FY 2016

License CMS Denial Region City Agency Number Number Date

03-Arlington Allen Pend Priceless Care Home Health 12/09/2015 03-Arlington Arlington Pend Central Point Home and 06/30/2016 Personal Care Agency LLC 03-Arlington Cedar Hill Pend True Providence 04/05/2016 Healthcare Services 03-Arlington Denton Pend Mt Zion Home Health 08/12/2016 Agency LLC 03-Arlington Fort Worth Pend 1st Choice Homecare 06/29/2016 03-Arlington McKinney Pend Always Use Wisdom LLC 06/14/2016 03-Arlington Rockwall Pend Texas Care Services LLC 06/22/2016 06-Houston Houston Pend All for Love Inc 07/13/2016 06-Houston Houston Pend Eaglesys Health Care 08/27/2016 Services Inc 06-Houston Houston Pend God be Willing Home 10/23/2015 Health LLC 06-Houston Houston Pend Lifecare Resources Inc 02/01/2016 06-Houston Houston Pend Vital Care of North Houston 05/15/2016 06-Houston Kingwood Pend Convenient Care Home 05/26/2016 Therapies PLLC 06-Houston Richmond Pend Marvic Home Healthcare 08/03/2016 Agency Inc 06-Houston Sealy Pend 1accurate Healthcare 10/17/2015 Services Inc 06-Houston Stafford Pend Versatile Home 03/24/2016 Healthcare LLC 07-Austin Austin Pend Fresenius Medical Care 09/13/2015 Austin North 08-San Antonio San Antonio Pend Faith and Hope Home 10/30/2015 Health Care Inc 08-San Antonio San Antonio Pend Ma Medical Services LLC 01/26/2016 19 Total home health agency denials of license application

126 DADS Regulatory Services FY 2016 Annual Report Hospice Agency Denials of License Application for FY 2016

License CMS Denial Region City Agency Number Number Date

03-Arlington Carrollton Pend MDM Hospice Care 09/24/2015 03-Arlington Irving Pend I Care Hospice Inc 12/11/2015 06-Houston Stafford Pend Hilltop Hospice 08/24/2016 for Kids 3 Total hospice agency denials of license application

Home Health Agency Denials of License Renewal for FY 2016

License CMS Denial Region City Agency Number Number Date

03-Arlington Dallas 012690 677903 Dallas Metro 05/25/2016 Professional Healthcare Agency 03-Arlington Dallas 011436 743179 Everwell Health 04/04/2016 Agency LLC 03-Arlington Dallas 015609 Gallant Healthcare 08/23/2016 Services Inc 03-Arlington Granbury 015491 Healing Arms Home 10/13/2015 Health Agency Inc 03-Arlington Grand Prairie 015645 Review Home 03/04/2016 Health Agency Inc 05-Beaumont Beaumont 016233 A Plus Awesome 07/03/2016 Care Home Health Service 06-Houston Richmond 015716 CC Healthcare 01/23/2016 Services 11-Corpus Christi Corpus Christi 016002 679463 Community Rehab 02/01/2016 8 Total home health agency denials of license renewal

Hospice Agency Denials of License Renewal for FY 2016

DADS did not deny renewal of any licenses for a hospice agency in FY 2016 .

Home and Community Support Services Agencies 127 Home Health Agency Expirations of License (in Lieu of Further Enforcement Action) for FY 2016

License CMS Denial Region City Agency Number Number Date

03-Arlington Arlington 010407 679638 St Nicholas 07/08/2016 Healthcare Agency 03-Arlington Duncanville 015852 Whitewaters 02/11/2016 Healthcare Services 03-Arlington Glen Rose 015872 Kamisa Home Health 11/30/2015 Services Inc 06-Houston Brookshire 013062 Tri-Care Health Services 02/16/2016 06-Houston Houston 009521 747178 ACM Home Health 04/07/2016 Care Inc 06-Houston Houston 013030 AFS Health Services Inc 08/24/2016 06-Houston Houston 008821 Crystal Healthcare 01/13/2016 Services Inc 06-Houston Houston 016304 Edition Health 08/11/2016 Services Inc 06-Houston Richmond 016150 Excel Healthcare 06/29/2016 Services 11-Corpus Christi Corpus 015982 747673 Community Health 10/31/2015 Christi 11-Corpus Christi Corpus 015846 Cowboy Healthcare 10/31/2015 Christi PLLC 11 Total home health agency expirations of license

Hospice Agency Expirations of License (in Lieu of Further Enforcement Action) for FY 2016

DADS did not accept any expirations of license (in lieu of further enforcement action) for a hospice agency in FY 2016 . Home Health Agency Immediate Suspension Orders for FY 2016

DADS did not issue any immediate suspension orders for a home health agency in FY 2016 . Hospice Agency Immediate Suspension Orders for FY 2016

DADS did not issue any immediate suspension orders for a hospice agency in FY 2016 .

128 DADS Regulatory Services FY 2016 Annual Report Home Health Agency Surrenders of License (in Lieu of Further Enforcement Action) for FY 2016

License CMS Surrender Region City Agency Number Number Date

03-Arlington Arlington 016911 679791 Solaris Home Health 12/07/2015 03-Arlington Carrollton 016474 Texas TLC 02/23/2016 Home Health Care Providers Inc 03-Arlington Dallas 014342 Genix Home 10/09/2015 Healthcare LLC 03-Arlington Dallas 014117 747899 Salvation Home 09/18/2015 Care Inc 03-Arlington Flower 015510 Extol Healthcare 03/02/2016 Mound Services LLC 03-Arlington Garland 015748 ADE Home Health 01/15/2016 Services Inc 03-Arlington Mineral Wells 001728 677036 Palo Pinto General 06/16/2016 Hospital Home Health 04-Tyler Palestine 017135 Bethany Home Health 06/14/2016 Services 04-Tyler Palestine 015738 Personalized Living at 04/22/2016 Palestine 06-Houston Fresno 016237 Angelica Healthcare 06/28/2016 Services 06-Houston Fresno 016943 S & L PCA 08/16/2016 Services, LLC 06-Houston Houston 011427 Avalon Healthcare 10/06/2015 Services 06-Houston Houston 016821 Beausejour 05/31/2016 Personal Care 06-Houston Houston 016182 Excellence In Home 05/24/2016 Healthcare, Inc 06-Houston Houston 013861 Harris County Home 01/25/2016 Health Services 06-Houston Houston 016679 Home Caregiver 03/24/2016 Solutions 06-Houston Houston 012634 KIS Med Concepts Inc 08/11/2016 06-Houston Houston 015076 MDTJ Caregivers, LLC 09/29/2015 06-Houston Houston 013415 Texas Pillar Home 09/29/2015 Health Group 06-Houston Humble 015384 453148 Healing Hearts Home 11/03/2015 Health Agency of Atascocita, LLC

Home and Community Support Services Agencies 129 Home Health Agency Surrenders of License (in Lieu of Further Enforcement Action) for FY 2016

License CMS Surrender Region City Agency Number Number Date

06-Houston Katy 014475 Home Helpers 1025 11/03/2015 06-Houston Katy 016435 Wings of Angels Adult 11/03/2015 Day Services 06-Houston Kingwood 016468 Golden Partners LLC 04/01/2016 06-Houston Pearland 016198 Affordable Senior Care 03/18/2016 06-Houston Stafford 011806 747585 LFA Health Care 06/27/2016 Services Inc 06-Houston Sugar Land 016146 Amazement Home Care 07/07/2016 07-Austin Austin 016412 Elder Care 04/20/2016 Resource, LLC 07-Austin Waco 016402 Solstice Homecare 12/03/2015 08-San Antonio San Antonio 013799 Bethesda Texas 01/08/2016 Home Health Limited Liability Company 08-San Antonio San Antonio 014762 Deystar Home 01/22/2016 Health Care 10-El Paso El Paso 009328 678381 A Plus Home 10/15/2015 Health Services 10-El Paso El Paso 016471 Home Helpers of 09/24/2015 El Paso 11-Corpus Christi Harlingen 009269 679192 Magic Valley Health 01/11/2016 Services Inc 11-Corpus Christi Laredo 016961 Palomitas De Amor 08/11/2016 34 Total home health agency surrenders of license

Hospice Agency Surrenders of License (in Lieu of Further Enforcement Action) for FY 2016

License CMS Surrender Region City Agency Number Number Date

08-San Antonio San 017123 Celestine Hospice 07/22/2016 Antonio Care Inc 08-San Antonio San 016228 Lenity Hospice Care 01/01/2016 Antonio 2 Total hospice agency surrender of license

130 DADS Regulatory Services FY 2016 Annual Report Home Health Agency Revocations of License for FY 2016

License CMS Date Region City Agency Number Number Revoked

02-Abilene Bowie 001710 677028 Bowie Memorial Hospital 06/08/2016 Home Health 03-Arlington Aledo 017116 678001 5 Star Home Health 06/26/2016 03-Arlington Hurst 008235 457819 Osolife Home Health 09/29/2015 Services Inc 03-Arlington Rowlett 012497 679240 Cador Home Health 11/02/2015 Services Inc 06-Houston Cypress 016672 Star Texas Personal 06/01/2016 Assistance Services 06-Houston Fresno 016122 Care Central 05/18/2016 06-Houston Houston 016738 Always at Hand Care 06/01/2016 06-Houston Houston 016953 Always Best Care – 05/05/2016 Houston 06-Houston Houston 016163 Angel Care Enterprise 09/05/2015 Home Health 06-Houston Houston 016451 Capline Healthcare 05/07/2016 06-Houston Houston 008668 679480 Emason Healthcare Services 03/27/2016 06-Houston Houston 016410 Home Care Helpers 05/28/2016 06-Houston Houston 012035 Juliet Healthcare Inc 05/23/2016 06-Houston Houston 016761 Medco Plus Health 06/23/2016 06-Houston Houston 016537 National Provider Services 05/19/2016 06-Houston Houston 016885 747364 Nurse2u LLC 06/05/2016 06-Houston Houston 015100 747847 St Michael Healthcare 06/29/2016 Services, Inc 06-Houston Houston 016976 Terra-Boson Home 05/10/2016 Dialysis, LLC 06-Houston Houston 017030 TLC Nursing & 07/17/2016 Companionship Services 06-Houston Katy 016671 Margaret Care Home Health 05/18/2016 06-Houston Katy 016896 Precise Healthcare Services 06/23/2016 06-Houston Katy 014563 743131 Special Healthcare, Inc 09/10/2015 06-Houston Missouri 013202 Fame Health Care 08/13/2016 City Services Inc 06-Houston Richmond 016806 Arcadius Health Care LLC 05/10/2016 06-Houston Richmond 016962 Caring by Nature Home 05/30/2016 Healthcare Services

Home and Community Support Services Agencies 131 Home Health Agency Revocations of License for FY 2016

License CMS Date Region City Agency Number Number Revoked

06-Houston Richmond 013614 Gemini Home Health 03/16/2016 Services Inc 06-Houston Richmond 016907 House of Isaiah, LLC 05/18/2016 06-Houston Richmond 012223 747274 Obycris Healthcare Inc 07/12/2016 06-Houston Richmond 016760 Sweet Solutions Home 05/06/2016 Health Agency 06-Houston Sealy 016682 Aamanar Healthcare Inc 05/04/2016 06-Houston Sealy 016079 Just Serenity, Incorporated 05/06/2016 07-Austin Brenham 015752 Pek's Legacy Healthcare, 12/08/2015 Incorporated 07-Austin Hutto 015869 Angel Hearts Home Care 10/03/2015 08-San Antonio New 016615 Texan Home Care 10/30/2015 Braunfels 08-San Antonio San 015897 Absolute Care 11/11/2015 Antonio 08-San Antonio San 016457 Authentic Home Care Inc 08/14/2016 Antonio 08-San Antonio San 017122 Celestine Home Health Inc 07/30/2016 Antonio 08-San Antonio San 015175 Lighthouse Primary Home 11/13/2015 Antonio Care LLC 08-San Antonio San 010883 Monarca Home Health Inc 10/18/2015 Antonio 08-San Antonio San 016610 Regal Life Home Health 10/03/2015 Antonio Care Service Providers LLC 10-El Paso El Paso 016595 By Your Side 09/30/2015 Home Care Services 11-Corpus Corpus 016762 Santa Fe Provider Services 04/05/2016 Christi Christi 11-Corpus Los 016666 Lovely Angels Home 12/02/2015 Christi Fresnos Health Care LLC 11-Corpus McAllen 013571 747669 Southern Valley Home 02/11/2016 Christi Health LLC Corpus Christi Weslaco 008816 453167 Milagros II Home Care Inc 03/26/2016 45 Total home health agency revocations of license

132 DADS Regulatory Services FY 2016 Annual Report Hospice Agency Revocations of License for FY 2016

License CMS Date Region City Agency Number Number Revoked

06-Houston Cleveland 016708 A Serena Care 05/31/2016 Hospice, LLC 06-Houston Pearland 017086 My Nurse Hospice and 07/21/2016 Private Sitters Corp 06-Houston Richmond 016659 Amstar Hospice 05/10/2016 3 Total hospice agency revocations of license

Home and Community Support Services Agencies 133 Home and Community Support Services Agency Complaint and Incident Intakes

Complaints A complaint allegation is an assertion that a requirement of state licensure or federal certification has been violated and can come directly from individuals or residents, family members, health care providers, advocates, law enforcement and other state agencies . Report sources may be oral or written .

Incidents An incident is an allegation of abuse, neglect or misappropriation of property; an allegation of conduct or a condition resulting in the exploitation of consumers; or any act allegedly perpetrated by agency staff and reported by agency management or other agency staff .

Priority Assignment DADS evaluates each intake based on its own unique circumstances and assigns priorities accordingly . When timeliness is crucial to the health and safety of a consumer(s), such as in a situation of heating or air conditioner equipment failure (if the consumer is in an inpatient hospice unit), alleged staff walkout, etc ., an investigation may be initiated immediately by telephone, regardless of the priority code assignment . After the initial telephone contact, an on-site visit is conducted according to the time frame specified by the priority assignment . The priorities that can be assigned to a home and community support services agency are: • On or before two working days • On or before 10 working days • On or before 45 calendar days • On or before 45 working days • On or before 90 working days • Next on-site • Desk review • Withdrawn • Not applicable

On or Before Two Working Days

Immediate response by Regulatory Services is warranted because a home and community support services agency provider allegedly created or allowed a present

134 DADS Regulatory Services FY 2016 Annual Report and ongoing situation in which the provider’s noncompliance with one or more requirements of licensure or certification has failed to protect consumers or has caused, or is likely to cause, serious injury, harm, impairment or death to a consumer

On or Before 10 Working Days

Alleged provider noncompliance may have or has a high potential to cause harm that affects a consumer’s mental, physical or psychosocial well-being and is of such consequence that a rapid response by Regulatory Services is indicated . The complaint allegation(s) asserts that one or more of the following exist: • Nursing care was not delivered as planned to a consumer with present and ongoing need for nursing care . • There was a break in service for skilled services for Community Care for the Aged and Disabled - Community Based Alternatives, Community Living Assistance and Support Services, or Deaf Blind/Multiple Disability waiver consumers . • Agency personnel were not available to the consumers during normal operating hours . • The consumer sustained harm from improper or inadequate care and service provision . • Immediate threat to health and safety has been removed, but the situation poses a continued threat to consumers .

On or Before 45 Calendar Days

This priority applies only to Home and Community Support Services Agency Joint Commission, Community Health Accreditation Program or Accreditation Commission for Health Care deemed agencies with Centers for Medicare and Medicaid Services regional office authorization .

A provider’s alleged noncompliance with one or more requirements of licensure or certification has a low potential for more than minimal harm or physical, mental or psychosocial harm that did not directly impact consumer or resident health and safety and functional status; this priority may also be assigned for alleged violations of regulations that do not directly impact consumer or resident health and safety .

On or Before 45 Working Days

The allegation(s) asserts that one or more of the following exist: • Noncompliance with one or more requirements of licensure or certification that has a low potential for more than minimal harm or resulted in physical, mental or psychosocial harm that did not directly impact consumer health and safety • Financial insolvency without alleged impact on consumers • Inaccurate clinical records

Home and Community Support Services Agencies 135 On or Before 90 Working Days

The complaint allegation(s) asserts that an agency is providing home health services (hiring and sending out nurses to provide skilled nursing services or hiring and sending out aides to provide personal assistance services) without a license .

Next On-site

This priority replaced “on or before 120 working days” during FY 2008 . The complaint allegation(s) asserts that one or more of the following exist: • Discharge without proper notice • Illegal remuneration (i .e ., solicitation or kickbacks) • Personal assistance services not being provided when the situation does not pose a serious threat to the consumer’s health and safety • Consumer rights violations • Billing irregularities

Desk Review

DADS uses desk reviews for off-site investigation of home and community support services agency self-reported incidents . If further investigation is warranted to ensure compliance with federal, state or local laws, regional staff schedule an on-site investigation . Whether investigation is by desk review or on-site, it must be completed on or before 120 working days .

Withdrawn

A complaint report filed with DADS is withdrawn at the request of the complainant, except when abuse, neglect or exploitation is alleged . Please refer to Survey and Certification Clarification 03-08 (www.dads.state.tx.us/business/ltc-policy/ communications/SCC/2003/scc03_08.pdf) .

Not Applicable

DADS determines it has no jurisdiction to investigate a complaint or a referral, or when a report to another agency, board or entity is required .

136 DADS Regulatory Services FY 2016 Annual Report Home and Community Support Services Agency All Intakes by Priority and Region for FY 2016

Intake Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 0 0 24 7 2 13 13 8 0 1 11 79 2 working days On or before 5 1 63 11 14 64 29 32 2 6 41 268 10 working days On or before 26 13 241 51 23 258 101 134 11 42 159 1,059 45 working days On or before 1 0 5 2 3 6 5 0 2 1 5 30 90 working days Next on site 11 9 300 30 17 143 53 67 10 27 164 831 Desk review 139 255 1,074 532 204 678 524 571 113 122 1,258 5,470 Withdrawn 0 1 16 2 0 3 1 2 0 0 1 26 Not applicable 24 35 241 36 31 145 68 89 26 18 123 836 Total 206 314 1,964 671 294 1,310 794 903 164 217 1,762 8,599

Home and Community Support Services Agency Complaints by Priority and Region for FY 2016

Complaint Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 0 0 24 7 2 13 10 8 0 1 10 75 2 working days On or before 5 1 59 11 13 63 27 29 2 5 38 253 10 working days On or before 22 11 226 45 21 234 92 119 9 36 137 952 45 working days On or before 1 0 5 2 3 6 5 0 2 1 5 30 90 working days Next on site 11 9 144 29 16 118 53 67 9 27 162 645 Withdrawn 0 1 16 2 0 3 1 2 0 0 1 26 Not applicable 7 3 104 4 7 34 22 27 2 3 18 231 Total 46 25 578 100 62 471 210 252 24 73 371 2,212 Note: The intake priority “Desk review” does not apply to home and community support services agency complaint intakes .

Home and Community Support Services Agencies 137 Home and Community Support Services Agency Incidents by Priority and Region for FY 2016

Incident Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 0 0 0 0 0 0 3 0 0 0 1 4 2 working days On or before 0 0 4 0 1 1 2 3 0 1 3 15 10 working days On or before 4 2 15 6 2 24 9 15 2 6 22 107 45 working days Next on site 0 0 156 1 1 25 0 0 1 0 2 186 Desk review 139 255 1,074 532 204 678 524 571 113 122 1,258 5,470 Not applicable 17 32 137 32 24 111 46 62 24 15 105 605 Total 160 289 1,386 571 232 839 584 651 140 144 1,391 6,387 Note: The intake priorities “On or before 90 working days” and “Withdrawn” do not apply to home and community support services agency incident intakes .

138 DADS Regulatory Services FY 2016 Annual Report Home and Community Support Services Agency Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Home Health Agency Administrative Penalties Imposed and Assessed for FY 2012–2016 • Hospice Agency Administrative Penalties Imposed and Assessed for FY 2012–2016 • Home Health Agency License Application Denials Proposed and Denials for FY 2012–2016 • Home Health Agency License Renewal Denials Proposed and Denials for FY 2012–2016 • Home and Community Support Services Agency Expirations of License In Lieu of Further Enforcement Action for FY 2012–2016 • Home and Community Support Services Agency Surrenders of License In Lieu of Further Enforcement Action for FY 2012–2016 • Home Health Agency License Revocations Proposed and Revocations for FY 2012–2016 • Hospice Agency License Revocations Proposed and Revocations for FY 2012–2016 • Home and Community Support Services Agency Complaint and Incident Intakes for FY 2012–2016

Home Health Agency Administrative Penalties Imposed and Assessed for FY 2012–2016

800 700 663 593 600 507 500 397 400 254 300 200 100 82 38 0 30 30 43 FY12 FY13 FY14 FY15 FY16

Imposed Assessed

Home and Community Support Services Agencies 139 Hospice Agency Administrative Penalties Imposed and Assessed for FY 2012–2016

90 80 78 70 66 60 50 40 38 30 29 20 12 10 6 5 0 0 1 2 FY12 FY13 FY14 FY15 FY16

Imposed Assessed

Home Health Agency License Application Denials Proposed and Denials for FY 2012–2016

45

40 39 35 35 30 30 25 22 21 20 19 17 16 15 14 12 10 5 0 FY12 FY13 FY14 FY15 FY16

Proposed Denied

140 DADS Regulatory Services FY 2016 Annual Report Home Health Agency License Renewal Denials Proposed and Denials for FY 2012–2016

16 15 14 13 12

10 10

8 8

6

4 4 3 3 3 3 3 2

0 FY12 FY13 FY14 FY15 FY16

Proposed Denied

Home and Community Support Services Agency Expirations of License (in Lieu of Further Enforcement Action) for FY 2012–2016

30 18 20 11 11 8 10 10 0 1 0 0 0 0 FY12 FY13 FY14 FY15 FY16

Home Health Hospice

Home and Community Support Services Agencies 141 Home and Community Support Services Agency Surrenders of License (in Lieu of Further Enforcement Action) for FY 2012–2016

35 34 30 28 28 26 25 25

20

15

10

5 3 2 2 2 1 0 FY12 FY13 FY14 FY15 FY16

Home Health Hospice

Home Health Agency License Revocations Proposed and Revocations for FY 2012–2016

250 219

200 173 138 120 150 109 100 67 50 39 45 30 37 0 FY12 FY13 FY14 FY15 FY16

Proposed Revoked

142 DADS Regulatory Services FY 2016 Annual Report Hospice Agency License Revocations Proposed and Revocations for FY 2012–2016

35 30 29 30 25 20 15 15 14 10 10 8 5 4 4 2 3 0 FY12 FY13 FY14 FY15 FY16 Proposed Revoked

Home and Community Support Services Agency Complaint and Incident Intakes for FY 2012–2016

6,000 6,387 5,025 5,123 4,694 5,000 4,184

4,000

3,000

2,212 2,055 2,194 2,159 2,000 1,834

1,000

0 FY12 FY13 FY14 FY15 FY16

Complaints Incidents

Home and Community Support Services Agencies 143 144 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions

145 146 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID)Actions The table on page 150 contains information relating to Texas Health and Safety Code, Title 4, Subtitle B, Chapter 252, Intermediate Care Facilities, for licensed intermediate care facility for individuals with an intellectual disability or related conditions actions, by category, for fiscal year (FY) 2016 .

Administrative Penalties

Basis for imposing

DADS may assess an administrative penalty against a facility that violates Texas Health and Safety Code Chapter 252, or a rule, standard or order adopted, or license issued, under Texas Health and Safety Code Chapter 252 .

Imposed

An action can be recommended by: • The regional survey or investigation team and supported during enforcement review, • The regional or state office Regulatory Services staff, considering the survey or investigation findings or evaluating the facility’s past history or performance .

DADS imposes the action when the administrative penalty recommendation has been reviewed and confirmed by state office staff . The facility is formally notified of the administrative penalty citation and the penalty amount . Additionally, the notice includes information about the appeal process available to the facility .

Assessed

Penalties assessed are the final actions after the appeal process has been completed (or an agreement to settle has been reached) and a final amount and due date have been decided, or the person accepts the determination by DADS or fails to respond to the notice letter in a timely manner . The facility is notified of the amount to be paid and the date payment is due . A lump sum payment or a monthly payment plan may be agreed upon during the appeal or settlement process .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 147 Injunctive/Other Relief and Civil Penalties Injunctive/other relief and civil penalty cases are referred to the Office of the Attorney General for action . When a case is resolved through settlement, a portion of the payment is designated a civil penalty and normally deposited to general revenue . The Office of the Attorney General receives the portion designated as attorney fees and costs .

One or more survey or investigative visits may result in a recommendation for civil penalties for a facility depending on the findings . These visits are generally consolidated into one case per facility for referral .

A civil penalty may be awarded if the facility violates a licensing rule and DADS determines that the violation creates a threat to the health and safety of a resident .

Amelioration of Violations In certain situations, the commissioner of DADS may allow, in lieu of demanding payment of an administrative penalty, the use (under the supervision of DADS) of any portion of the penalty to ameliorate the violation or to improve services (other than administrative services) in the facility affected by the violation .

Trusteeships DADS, through the Office of the Attorney General, may petition a court of competent jurisdiction for the involuntary appointment or appointment by agreement of a trustee to operate a facility if one or more of the following conditions exist: • The facility is operating without a license . • The facility’s license has been suspended or revoked . • License suspension or revocation procedures against a facility are pending and an imminent threat to the health and safety of the residents exists . • An emergency exists that presents an immediate threat to the health and safety of the residents . • The facility is closing (whether voluntarily or through an emergency closing order), and arrangements for relocation of the residents to other licensed/certified intermediate care facilities for individuals with an intellectual disability or related conditions or into Intermediate Care Facilities For Individuals With An Intellectual Disability Or Related Conditions waiver programs have not been made before closure .

Emergency Suspension and Closing Orders DADS will suspend a facility’s license or order an immediate closing of all or part of the facility if: • DADS finds that the facility is operating in violation of licensure rules . • The violation creates an immediate threat to the health and safety of a resident .

148 DADS Regulatory Services FY 2016 Annual Report The order suspending a license or closing a part of a facility is immediately effective on the date the license holder receives written notice or on a later date specified in the order . This suspension of a license may occur simultaneously with any other enforcement provision available to DADS . The order is effective for 10 days .

Denials of License DADS may deny a facility’s license when the facility does not meet licensure rules or when the facility fails to maintain compliance with these rules on a continuous basis .

DADS may deny a facility’s license if an applicant, manager or affiliate: • Substantially fails to comply with licensure requirements or has violations that posed or pose a serious threat to health and safety, or fails to maintain compliance on a continuous basis . • Aids, abets or permits a substantial violation of Texas Health and Safety Code Chapter 252 . • Fails to submit required information and documents needed to complete the application process or provides false or fraudulent information . • Fails to pay certain fees . • Has had a license revoked, has been debarred or excluded, has an unsatisfied final judgment, has been decertified or evicted, has a license suspended or has a criminal conviction . • Is subject to denial or refusal as described in Texas Administrative Code, Title 40, Part 1, Chapter 99, Denial or Refund of License .

Revocations of License DADS may revoke a facility’s license if the department finds that the license holder has violated the requirements established under Texas Health and Safety Code Chapter 252 and that violation either jeopardizes the health and safety of residents, is repeated or is a substantial violation of Texas Health and Safety Code Chapter 252 .

DADS may also revoke a facility’s license if the license holder submitted false or misleading statements in the application for license, used subterfuge or other evasive means to obtain a license, concealed a material fact or failed to disclose information that would have been the basis for denial, or received monetary or other remuneration from a person or agency that furnishes services or materials to the facility for a fee .

The revocation of a license may occur simultaneously with any other enforcement provision available to DADS .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 149 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative Imposed 0 3 0 0 4 6 4 1 0 0 2 20 penalties Administrative Assessed 0 0 0 0 0 0 0 0 0 0 0 0 penalties 1 Injunctive/other Referred 0 0 0 0 0 0 0 0 0 0 0 0 relief and civil penalties 2 Amelioration Approved 0 0 0 0 0 0 0 0 0 0 0 0 of violations Amelioration Denied 0 0 0 0 0 0 0 0 0 0 0 0 of violations Trusteeships Ordered 0 0 0 0 0 0 0 0 0 0 0 0 Emergency Ordered 0 0 0 0 0 0 0 0 0 0 0 0 suspension and closing orders Denials of license 3 Proposed 0 0 1 0 0 0 0 0 0 0 0 1 Denials of license 3 Denied 0 0 0 0 0 0 0 0 0 0 0 0 Revocations of Proposed 0 0 0 0 0 0 1 0 0 0 0 1 license 3 Revocations of Revoked 0 0 0 0 0 0 0 0 0 0 0 0 license 3 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 2 . DADS refers injunctive/other relief and civil penalty requests to the Office of the Attorney General . 3 . Denied and revoked actions can include final actions on cases proposed in a previous fiscal year .

150 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

02 - Abilene Abilene 007578 Woodridge 09/04/2015 $5,000 $5,000 $0 N 02 - Abilene Burkburnett 007392 Meadowview 02/05/2016 $5,000 $5,000 $0 N Group Home 02 - Abilene Iowa Park 007390 Clara Cottage 08/25/2015 $5,000 $5,000 $0 N Community Home 05 - Beaumont Beaumont 003964 Cambridge $5,000 $5,000 $0 N Group Home 05 - Beaumont Beaumont 003673 Carnation Living 05/26/2016 $5,000 $10,000 ($5,000) N Center 05 - Beaumont Beaumont 003690 Nottingham 04/21/2016 $5,000 $5,000 $0 N Living Center 05 - Beaumont Beaumont 003693 Sams Way Living 09/24/2015 $5,000 $5,000 $0 N Center 06 - Houston Houston 007548 April Wind 01/14/2016 $5,000 $0 $5,000 Y House 06 - Houston Houston 003915 Briar Grove Park 01/29/2016 $5,000 $5,000 $0 N 06 - Houston Houston 003911 Candlelight 01/20/2016 $5,000 $5,000 $0 N Forest 06 - Houston Houston 003828 Rose House 09/11/2015 $5,000 $5,000 $0 N 06 - Houston Houston 003971 Spring Shadows 02/04/2016 $5,000 $5,000 $0 N 06 - Houston Pasadena 007346 Judy Living 07/17/2015 $5,000 $5,000 $0 N Center 07 - Austin Austin 007249 Austin House $1,000 $0 $1,000 Y 07 - Austin Austin 007320 Red Oak 05/06/2015 $5,000 $5,000 $0 N 07 - Austin San Marcos 003919 Mockingbird 01/16/2015 $5,000 $0 $5,000 Y Villa 07 - Austin Temple 007219 Taylor 07/08/2015 $5,000 $10,000 ($5,000) N Community Home 08 - San San Antonio 007287 Sage Trail 11/23/2015 $5,000 $5,000 $0 N Antonio 11 - Corpus Brownsville 003744 Caring Palms 02/09/2016 $5,000 $5,000 $0 N Christi Health Care Center

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 151 Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

11 - Corpus Corpus 003664 Educare 11/02/2015 $5,000 $0 $0 Y Christi Christi Community Living Corporation – Texas Total $96,000 $90,000 20 Total intermediate care facilities for individuals with an intellectual disability or related conditions administrative penalties imposed Notes: 1 . The Imposed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if there is no alternative amount resulting from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount of penalty due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or if the person charged consents to the penalty or does not respond timely to the notice of the penalty . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, there is no total for this column . An administrative penalty with a negative balance may indicate an overpayment or that the penalty was rescinded after payment . 5 . The H column stands for Hearing, and a “Y” in this column indicates the facility requested a hearing on the violation . Once a facility requests and meets the criteria for a hearing on the violation, the case results will be pending until the appeal process is complete . An “N” indicates the facility did not request a hearing .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Injunctive/Other Relief and Civil Penalty Referrals to the Office of the Attorney General for FY 2016

DADS did not refer any intermediate care facilities for individuals with an intellectual disability or related conditions to the Office of the Attorney General for injunctive/other relief in FY 2016 .

152 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Amelioration of Violations for FY 2016

DADS did not review any amelioration requests for intermediate care facilities for individuals with an intellectual disability or related conditions in FY 2016 .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Trusteeships for FY 2016

DADS did not place a trustee in an intermediate care facilities for individuals with an intellectual disability or related conditions in FY 2016 .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Emergency Suspension and Closing Orders for FY 2016

DADS did not issue an emergency suspension and closing order in an intermediate care facilities for individuals with an intellectual disability or related conditions in FY 2016 .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions License Denials and Revocations Proposed for FY 2016 Facility Proposed Revoked Denied Region City Facility Status ID Action Date Date

03 - Arlington Mesquite 003987 Harman Deny Rescinded House 07 - Austin Austin 007210 Brantley Revoke Rescinded Cove 2 Total intermediate care facilities for individuals with an intellectual disability or related conditions license denials and revocations processed

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 153 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Complaint and Incident Intakes

Complaints A complaint allegation is an assertion that a requirement of state licensure or federal certification has been violated and can come directly from individuals or residents, family members, health care providers, advocates, law enforcement and other state agencies. Report sources may be oral or written.

Incidents An incident is an official notification to the state survey agency by the facility owner, administrator, designee or any employee of the facility who has cause to believe that the physical or mental health of an individual has been or may be adversely affected by abuse, neglect, exploitation, or other unusual events or occurrences in accordance with Texas Health and Safety Code Chapter 252; 40 Texas Administrative Code §90.212(b) (1) or the Memorandum of Understanding between DADS and the Texas Department of Family and Protective Services.

Priority Assignment DADS evaluates each complaint based on its own unique circumstances and assigns priorities accordingly. When timeliness is crucial to the health and safety of a consumer(s), such as imminent transfer or discharge, heating or air conditioner equipment failure, alleged staff walkout, etc., an investigation may be initiated immediately by telephone, regardless of the priority code assignment. After the initial telephone contact, an on-site visit is conducted according to the time frame specified by the priority assignment. The priorities available for an intermediate care facilities for individuals with an intellectual disability or related conditions facility are: • On or before 24 hours • On or before 14 calendar days • On or before 45 calendar days • Professional review • Financial • Withdrawn • Not required

154 DADS Regulatory Services FY 2016 Annual Report On or Before 24 Hours

Immediate response by Regulatory Services is warranted because a provider allegedly created or allowed a present and ongoing situation in which the provider’s noncompliance with one or more requirements of licensure or certification has failed to protect consumers from abuse, neglect or mistreatment or has caused, or is likely to cause, serious injury, harm, impairment or death to a consumer.

On or Before 14 Calendar Days

The present or ongoing threat of continued abuse, neglect or mistreatment has been removed. The consumer(s) is no longer in imminent danger; however, the provider’s alleged noncompliance with one or more requirements of licensure or certification may have or has a high potential to cause harm that impacts a consumer’s mental, physical or psychosocial status and is of such consequence that a rapid response by Regulatory Services is indicated. There is evidence or suspicion that system(s) failure contributed to or brought on the threat. Usually, specific rather than general information (e.g., descriptive identifiers, individual names, date, time, location of occurrence, description of harm) will factor into the assignment of this level of priority.

On or Before 45 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has a low potential for more than minimal harm or resulted in physical, mental or psychosocial harm that did not directly impact consumer health and safety and functional status. This priority may also be assigned for alleged violations of regulations that do not directly impact consumer health and safety.

Professional Review

A professional review priority is assigned by Complaint Intake Call Center staff when a provider self-reports an incident to DADS in accordance with Texas Health and Safety Code Chapter 252, 40 Texas Administrative Code §90.213 or 40 Texas Administrative Code §90.225 when the provider’s incident report indicates the provider’s immediate corrective action is reasonably likely to ensure the safety of individuals while the provider conducts its investigation and a Professional Quality Assurance staff reviews the provider’s written investigation report.

Based on review of the facility investigation report, if further investigation is warranted to assess whether the provider complies with regulatory requirements, the Professional Review staff will change the priority and send notification to Regulatory Services regional staff to schedule an on-site investigation.

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 155 Financial

These investigations involve complaint allegations related to a consumer not having access to their trust funds, failure to maintain trust funds for consumers or failure to transfer or release trust funds when a consumer is discharged or deceased .

Withdrawn

A complaint report filed with DADS is withdrawn at the request of the complainant, except when harm to a resident alleged . Please refer to Survey and Certification Clarification 03-08 (www.dads.state.tx.us/providers/communications/2003/scc/ SCC2003-08.pdf) .

Not Required

DADS determines it has no jurisdiction to investigate a complaint or a referral, or a report to another agency, board or entity is required .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions All Intakes by Priority and Region for FY 2016

Intake Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 1 1 6 1 1 6 6 7 10 0 3 42 On or before 14 days 31 25 70 8 38 71 86 58 65 15 47 514 On or before 45 days 20 27 64 10 26 35 82 32 56 13 47 412 Professional review 11 15 24 3 8 15 30 10 21 4 13 154 Financial 0 0 2 0 0 0 2 3 2 1 0 10 Withdrawn 0 0 1 0 0 1 0 0 1 0 1 4 Not required 8 4 15 2 4 6 14 5 0 2 3 63 Total 71 72 182 24 77 134 220 115 155 35 114 1,199

156 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Complaints by Priority and Region for FY 2016

Complaint Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 0 1 5 0 0 4 3 3 8 0 3 27 On or before 14 days 3 12 36 1 12 24 28 19 17 3 13 168 On or before 45 days 3 10 31 6 13 23 33 18 15 3 15 170 Financial 0 0 2 0 0 0 2 3 2 1 0 10 Withdrawn 0 0 1 0 0 1 0 0 1 0 1 4 Not required 0 0 6 0 0 1 2 0 0 0 2 11 Total 6 23 81 7 25 53 68 43 43 7 34 390 Note: The intake priority “Professional review” does not apply to intermediate care facilities for individuals with an intellectual disability or related conditions complaint intakes .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Incidents by Priority and Region for FY 2016

Incident Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 24 hours 1 0 1 1 1 2 3 4 2 0 0 15 On or before 14 days 28 13 34 7 26 47 58 39 48 12 34 346 On or before 45 days 17 17 33 4 13 12 49 14 41 10 32 242 Professional review 11 15 24 3 8 15 30 10 21 4 13 154 Not required 8 4 9 2 4 5 12 5 0 2 1 52 Total 65 49 101 17 52 81 152 72 112 28 80 809 Note: The intake priorities “Financial” and “Withdrawn” do not apply to intermediate care facilities for individuals with an intellectual disability or related conditions incident intakes .

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 157 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Administrative Penalties Imposed and Assessed for FY 2012–2016 • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016 • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions License Denials and Revocations Proposed for FY 2012–2016 • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Complaint and Incident Intakes for FY 2012–2016

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Facility Administrative Penalties Imposed and Assessed for FY 2012–2016

30 25 26

20 20 15 15 10 6 5 5 3 2 1 2 0 0 FY12 FY13 FY14 FY15 FY16

Imposed Assessed

158 DADS Regulatory Services FY 2016 Annual Report Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016

3

2

1 1 1

0 0 0 0 FY12 FY13 FY14 FY15 FY16

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Facility License Denials and Revocations Proposed for FY 2012-2016

4 3 3 2 1 1 1 1 1 1 0 0 0 0 0 FY12 FY13 FY14 FY15 FY16

Denials Revocations

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions 159 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Facility Complaint and Incident Intakes for FY 2012-2016

1200 1000 900 895 800 843 792 809 600 423 400 391 364 386 390 200 0 FY12 FY13 FY14 FY15 FY16

Complaints Incidents

160 DADS Regulatory Services FY 2016 Annual Report Nursing Facilities

161 162 DADS Regulatory Services FY 2016 Annual Report Nursing Facility (NF)Actions The table on page 168 contains information relating to Texas Health and Safety Code, Title 4, Subtitle B, Chapter 242, Convalescent and Nursing Homes and Related Institutions, nursing facility actions, by category, for fiscal year (FY) 2016 .

Administrative Penalties DADS may assess administrative penalties for each violation of the statutes or rules, including each violation found in a single survey . A violation that is the subject of a penalty is presumed to continue on each successive day until it is corrected . The date of correction alleged by the facility in its written plan of correction will be presumed to be the actual date of correction unless it is later determined by DADS that the correction was not made by that day or was not satisfactory . DADS may impose an administrative penalty against: • An applicant for a license • A license holder • A partner, officer, director or managing employee of an applicant or a license holder • A person who controls a nursing facility

Basis for Imposing

DADS may impose an administrative penalty when a facility licensed under Texas Health and Safety Code Chapter 242, fails to meet specified rules and requirements found in Texas Administrative Code, Title 40, Part 1, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification . DADS may assess an administrative penalty against a person who: • Violates Texas Health and Safety Code Chapter 242 or a rule, standard or order adopted, or license issued, under Texas Health and Safety Code Chapter 242 . • Makes a false statement, that the person knows or should know is false, of a material fact: ° On an application for issuance or renewal of a license or in an attachment to the application . ° With respect to a matter under investigation by DADS . • Refuses to allow a representative of DADS to inspect: ° A book, record or file required to be maintained by a facility . ° Any portion of the premises of a facility . • Willfully interferes with the work of a representative of DADS or the enforcement of this chapter . • Willfully interferes with a representative of DADS preserving evidence of a violation of a rule, standard or order adopted, or license issued, under Texas Health and Safety Code Chapter 242 .

Nursing Facility Actions 163 • Fails to pay a penalty assessed by DADS under Texas Health and Safety Code Chapter 242, by the 10th day after the date the assessment of the penalty becomes final . • Fails to notify DADS of a change of ownership before the effective date of the change of ownership .

No facility will be penalized because of a physician’s or consultant’s nonperformance beyond the facility’s control or if documentation clearly indicates the violation is beyond the facility’s control .

Imposed

An action can be recommended by: • The regional survey or investigation team and supported during enforcement review . • The regional or state office Regulatory Services staff, considering the survey or investigation findings or evaluating the facility’s past history and performance .

DADS imposes the action when the administrative penalty recommendation has been reviewed and confirmed by state office staff . The facility is formally notified of the administrative penalty citation, the penalty amount and the due date . Additionally, the notice includes information about the appeal process available to the facility .

Assessed

Penalties assessed are the final actions after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or the facility consents to the administrative penalty, fails to respond to the department’s notice letter in a timely manner, or fails to correct the violation to the department’s satisfaction . The facility is notified of the amount to be paid and the date payment is due . A lump sum payment or a monthly payment plan may be agreed upon during the appeal or settlement process .

Injunctive/Other Relief and Civil Penalties DADS refers injunctive/other relief and civil penalty cases to the Office of the Attorney General for action . A civil penalty may be awarded if a facility violates a licensing rule and DADS determines the violation threatens the health and safety of a resident . When a case is resolved through settlement, a portion of the payment is designated a civil penalty and normally deposited to general revenue . The Office of the Attorney General collects attorney fees and costs for civil penalty cases .

One or more survey or investigative visits for a facility may be referred for civil penalty . These multiple visits are generally consolidated into one case per facility for referral .

164 DADS Regulatory Services FY 2016 Annual Report Amelioration of Violations In certain situations, the commissioner of DADS may allow, in lieu of demanding payment of an administrative penalty, the use (under the supervision of DADS) of any portion of the penalty to ameliorate the violation or to improve services (other than administrative services) in the facility affected by the violation .

Trusteeships DADS, through the Office of the Attorney General, may petition a court of competent jurisdiction for the involuntary appointment of a trustee to operate a facility if one or more of the following conditions exist: • The facility is operating without a license . • The facility’s license has been suspended or revoked . • License suspension or revocation procedures against a facility are pending and an imminent threat to the health and safety of the residents exists . • An emergency exists that presents an immediate threat to the health and safety of the residents . • The facility is closing and arrangements for relocation of the residents to other licensed institutions have not been made before closure .

Emergency Suspension and Closing Orders DADS may suspend a facility’s license or order an immediate closing of all or part of the facility if: • DADS finds that the facility is operating in violation of the licensure rules . • The violation creates an immediate threat to the health and safety of a resident . The order suspending a license or closing a part of a facility is immediately effective on the date the license holder receives a written notice or on a later date specified in the order . This suspension of a license may occur simultaneously with any other enforcement provision available to DADS . The order is valid for 10 days .

Suspension of Admissions If DADS finds that a facility has committed an act for which a civil penalty may be imposed under Texas Health and Safety Code §242 .065, the commissioner may order the facility to immediately suspend admissions .

Denial of Payment for New Admissions To participate in the Medicare or Medicaid program, or both, long-term care facilities must be certified as meeting federal participation requirements . Long-term care facilities include skilled nursing facilities for Medicare and nursing facilities for

Nursing Facility Actions 165 Medicaid . Among the remedies available to the secretary of the Centers for Medicare and Medicaid Services and the state under the Social Security Act to address facility noncompliance is denial of payment for all new Medicare and Medicaid admissions . This remedy may — and in certain instances, must — be imposed by Centers for Medicare and Medicaid Services or the state Medicaid agency . Denial of payment for new admissions may be imposed alone or in combination with other remedies to encourage quick compliance .

Denial of License DADS may deny a facility’s license when the facility does not meet licensure rules or when the facility does not have a satisfactory history of compliance with state and federal nursing facility regulations .

DADS may deny a facility’s license if the applicant or controlling party: • Does not have a satisfactory history of compliance . • Fails to submit required information and documents needed to complete the application process . • Has had a license revoked, has allowed a license to expire or surrendered a license when revocation action was pending, has been debarred or excluded, has an unsatisfied final judgment, has been decertified or evicted, has had a license suspended or has a criminal conviction . • Violated Texas Health and Safety Code Chapter 242 or a rule, standard or order adopted, or license issued, under Texas Health and Safety Code Chapter 242, in either a repeated or substantial manner, or aids, abets or permits a substantial violation of Texas Health and Safety Code Chapter 242 . • Fails to pay certain fees . • Committed any act described by Texas Health and Safety Code §242 .066(a)(2)-(6) . • Fails to comply with Texas Health and Safety Code §242 .074 . • Fails to meet the minimum standards of financial condition . • Fails to notify DADS of a significant adverse change in financial condition . • Is subject to denial or refusal as described in Texas Administrative Code, Title 40, Part 1, Chapter 99, Denial or Refusal of License .

Revocation of License DADS may revoke a license if the license holder (or other person described in Texas Health and Safety Code §242 .032(d)): • Violated Texas Health and Safety Code Chapter 242 or a rule, standard or order adopted, or license issued, under Texas Health and Safety Code Chapter 242, in either a repeated or substantial manner . • Committed any act described by Texas Health and Safety Code §242 .066(a)(2)-(6) . • Failed to comply with Texas Health and Safety Code §242 .074 .

166 DADS Regulatory Services FY 2016 Annual Report The revocation of a license may occur simultaneously with any other enforcement provision available to DADS .

Civil Money Penalties To participate in the Medicare or Medicaid program, or both, long-term care facilities must be certified as meeting federal participation requirements . Long-term care facilities include skilled nursing facilities for Medicare and nursing facilities for Medicaid . Among the remedies available to the secretary of the Centers for Medicare and Medicaid Services (CMS) and the state under the Social Security Act to address facility noncompliance is a civil money penalty (CMP) . CMPs may be imposed to remedy noncompliance at amounts not to exceed $10,000 per day . The statute additionally permits the secretary and the state to impose a CMP for past instances of noncompliance even if a facility is in compliance at the time of a current survey . In accordance with Code of Federal Regulations, Title 42, Chapter IV, Subchapter G, Part 488, Subpart F, Section 488 .436, Civil money penalties: waiver of hearing, reduction of penalty amount, if the facility waives the right to a hearing, in writing, within 60 days from the date of the notice imposing the civil money penalty, Centers for Medicare and Medicaid Services or the state reduces the civil money penalty amount by 35 percent .

Federal regulations allow for penalties to be imposed, in $50 increments, in the following amounts: • $3,050 to $10,000 per day for deficiencies constituting immediate jeopardy • $50 to $3,000 per day when immediate jeopardy does not exist, but the violation either caused actual harm or caused no actual harm but has the potential for more than minimal harm

Centers for Medicare and Medicaid Services and DADS can also impose penalties on a “per-instance” basis of noncompliance; the penalties range between $1,000 to $10,000 per instance .

In determining the amount of penalty, Centers for Medicare and Medicaid Services or the state must take into account: • The facility’s history of noncompliance, including repeated deficiencies • The facility’s financial condition • The factors specified in 42 CFR §488 .404 (regarding the seriousness of the deficiency) • The facility’s degree of culpability

Centers for Medicare and Medicaid Services may impose CMPs against Medicare or Medicare/Medicaid-certified nursing facilities . DADS may impose CMPs only against Medicaid-certified nursing facilities .

Nursing Facility Actions 167 Nursing Facility Actions by Region for FY 2016

Type of Remedy Actions 01 02 03 04 05 06 07 08 09 10 11 Totals

Administrative Imposed 7 1 2 1 0 19 6 10 0 0 5 51 penalties Administrative Assessed 0 1 0 1 0 2 0 3 0 0 1 8 penalties 1 Injunctive/other relief Referred 1 0 1 0 0 0 0 0 0 0 0 2 and civil penalties 2 Amelioration of Approved 1 0 0 0 0 0 0 1 0 0 1 3 violations Amelioration of Denied 0 0 0 0 0 0 0 0 0 0 0 0 violations Trusteeships Ordered 0 0 0 0 0 0 0 0 0 0 0 0 Closures under Accomplished 0 0 0 0 0 0 0 0 0 0 0 0 trusteeship Emergency suspension Ordered 0 0 0 0 0 0 0 0 0 0 0 0 and closing orders Suspensions of Ordered 0 0 0 0 0 0 0 0 0 0 0 0 admission Denial of Payment for Imposed 2 2 6 4 1 15 4 3 0 1 1 39 New Admissions Denials of license 3 Proposed 0 0 0 0 1 1 0 0 0 0 0 2 Denials of license 3 Denied 0 0 0 0 0 0 1 0 0 0 0 1 Revocations of license 4 Proposed 0 0 0 1 0 0 0 0 0 0 0 1 Revocations of license 4 Revoked 0 0 0 0 0 0 0 0 0 0 0 0 Civil money penalties Imposed 16 17 42 31 12 63 32 14 14 9 12 262 Civil money penalties 5 Assessed 0 1 6 4 0 3 5 3 1 1 2 26 Notes: 1 . Assessed administrative penalties can include final actions on penalties imposed in a previous fiscal year . 2 . DADS refers injunctive/other relief and civil penalties to the Office of the Attorney General . 3 . DADS may propose to deny renewal of a license for many reasons . However, if a facility has been cited for one or more violations of the licensing rules and those violations have not been determined to have been corrected by the date the facility’s license is due for renewal, DADS may propose to deny the application . If the facility subsequently corrects the violation(s), DADS may withdraw its proposal to deny the application for license renewal . Denied actions may also include final actions on cases proposed in a previous fiscal year . 4 . Revoked actions may include final actions on cases proposed in a previous fiscal year . 5 . Assessed civil money penalties can include final actions on penalties imposed in a previous fiscal year .

168 DADS Regulatory Services FY 2016 Annual Report Nursing Facility Administrative Penalties for FY 2016 169

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

01 - Lubbock Amarillo 005231 Plum Creek Healthcare Residence 05/27/2016 $2,100 $4,200 ($2,100) N 01 - Lubbock Brownfield 004283 Brownfield Rehabilitation and 04/13/2016 $10,500 $10,500 $0 N Care Center 01 - Lubbock Hale Center 004882 Hale Center Health and 06/02/2016 $44,100 $0 $44,100 N Rehabilitation 01 - Lubbock Levelland 005279 Lynwood Nursing and 05/25/2016 $48,300 $48,300 $0 N Rehabilitation LP 01 - Lubbock Littlefield 004520 Littlefield Hospitality 12/03/2015 $102,200 $0 $102,200 Y 01 - Lubbock Littlefield 004520 Littlefield Hospitality 12/18/2015 $119,700 $0 $119,700 Y

01 - Lubbock Lubbock 004929 Whisperwood Nursing & $44,100 $3,881 $0 Y Actions Facility Nursing Rehabilitation Center 02 - Abilene Sweetwater 004645 Sweetwater Healthcare Center 12/04/2015 $4,000 $4,000 $0 N 03 - Arlington Fort Worth 104379 Fort Worth Center 08/14/2015 $36,000 $36,000 $0 N of Rehabilitation 03 - Arlington Stephenville 004962 Mulberry Manor 06/11/2015 $34,300 $0 $0 N 04 - Tyler New Boston 004185 New Boston Healthcare Center 09/14/2015 $616,100 $0 $0 $0 Y 06 - Houston Brookshire 004501 Brookshire Residence and 10/15/2015 $4,800 $0 $4,800 Y Rehabilitation Center 06 - Houston Conroe 100790 Park Manor of Conroe $3,600 $3,600 $0 N 06 - Houston Eagle Lake 105688 Eagle Lake Nursing and 05/28/2015 $15,600 $15,600 $0 N Rehabilitation, LP 06 - Houston Houston 105594 Bridgecrest Rehabilitation Suites 03/11/2016 $1,400 $1,400 $0 N 06 - Houston Houston 005177 Cypresswood Health and 02/05/2015 $87,600 $87,600 $0 N Rehabilitation Center 06 - Houston Houston 005177 Cypresswood Health and 07/22/2015 $9,000 $9,000 $0 N Rehabilitation Center 170 Nursing Facility Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

06 - Houston Houston 104360 Fallbrook Nursing 11/10/2015 $1,250 $0 $1,250 N & Rehabilitation 06 - Houston Houston 000122 Hallmark Anderson Health 04/16/2016 $18,000 $18,000 $0 N DADS RegulatoryFY 2016 Annual Services Report Care Center 06 - Houston Houston 004456 Park Manor of Cyfair 03/25/2015 $5,400 $5,400 $0 N 06 - Houston Houston 102294 Park Manor of Westchase 05/20/2015 $900 $900 $0 N 06 - Houston Houston 105006 Solera at West Houston $8,700 $8,700 $0 N 06 - Houston Houston 005174 St Dominic Village Nursing Home 02/24/2015 $4,200 $4,200 $0 N 06 - Houston Houston 000184 The Vosswood Nursing Center 12/01/2015 $1,500 $1,500 $0 N 06 - Houston Houston 005056 Westchase Health and $13,800 $13,800 $0 N Rehabilitation Center 06 - Houston Humble 005208 Oakmont Healthcare and 08/27/2015 $3,000 $3,000 $0 N Rehabilitation Center of Humble 06 - Houston Richmond 005333 Cambridge Health and $2,400 $2,400 $0 N Rehabilitation Center 06 - Houston Rosenberg 005112 Rosenberg Health & 01/13/2016 $12,400 $0 $12,400 Y Rehabilitation Center 06 - Houston Rosenberg 005112 Rosenberg Health & 02/18/2016 $700 $1,400 ($700) Y Rehabilitation Center 06 - Houston Wharton 004115 Wharton Nursing and 07/23/2015 $2,400 $2,400 $0 N Rehabilitation Center 07 - Austin Austin 104663 Senior Care of Onion Creek 05/26/2016 $54,600 $0 $0 N 07 - Austin Bremond 005161 Bremond Nursing and 12/17/2015 $1,250 $1,250 $0 N Rehabilitation Center 07 - Austin Caldwell 103889 Copperas Hollow Nursing & $2,100 $0 $2,100 Y Rehabilitation Center 07 - Austin Granger 004871 Granger Villa 07/03/2015 $72,800 $0 $72,800 Y Nursing Facility Administrative Penalties for FY2016 Region 11 -C 11 -C 11 -C 07 -Austin 07 -Austin 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 08 -San Antonio 11 -C 08 -San Antonio orpus Christi orpus Christi orpus Christi orpus Christi City Christi Corpus Brownsville Brownsville Navasota Waco Floresville Karnes City Braunfels New San Antonio San Antonio San Antonio San Antonio San Antonio San Antonio Brownsville Stockdale ID Facility 005006 005282 005282 102540 004029 005344 005331 004533 004721 005304 004353 000195 004944 005076 005259 004277 Facility Trisun Care Center-Westwood Spanish Meadows Spanish Meadows Rehabilitation Center CreekGolden Healthcare and Woodland Springs Nursing Center Rehabilitation LP ManorRegency Nursing and Rehabilitation LP Bluebonnet Nursing and Colonial ManorColonial Care Center Rehabilitation LP Blanco Villa Nursing and Meridian Care Rehabilitation Center ParkOak Nursing and Parklane West Healthcare Center San Antonio West Retama Manor Nursing Center/ Rehabilitation Center Southeast Nursing & Rehabilitation Center Ebony Nursing Lake and Rehabilitation Center Stockdale Residence and Date Visit Exit 12/16/2015 08/04/2016 04/07/2016 09/14/2015 12/16/2015 04/05/2016 04/22/2016 11/20/2015 04/08/2016 09/29/2015 12/04/2015 02/05/2016 12/18/2015 07/17/2015 02/04/2016 02/05/2016 Imposed $3,600 $90,000 $1,500 $2,100 $1,500 $4,200 $3,000 $4,500 $4,500 $4,200 $1,500 $1,500 $3,000 $1,500 $3,000 $4,500 Assessed

$2,000 Collected $0 $3,000 $2,100 $3,600 $1,500 $4,200 $3,000 $4,500 $4,500 $4,200 $1,500 $3,000 $3,000 $1,500 $4,500 $2,000 Balance $0 ($1,500) $0 $0 $0 $0 $0 $0 $0 $0 $0 ($1,500) $0 $0 $0 $0 H N N N N N N N N N N N N N N N Y

Nursing Facility Actions 171 172 Nursing Facility Administrative Penalties for FY 2016

Facility Visit Exit Region City Facility Imposed Assessed Collected Balance H ID Date

11 - Corpus Christi Kingsville 005398 Kingsville Nursing and 09/29/2015 $51,250 $32,500 $32,500 $0 Y Rehabilitation Center Totals $1,574,150 $34,500 $365,631 DADS RegulatoryFY 2016 Annual Services Report 51 nursing facility administrative penalties imposed Notes: 1 . eTh Imposed column is the total amount of penalty after the state has reviewed and confirmed the administrative penalty citation and amount . This is the amount due and payable if no alternative amount results from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or the facility consents to the administrative penalty, fails to respond to the department’s notice letter in a timely manner or fails to correct the violation to the department’s satisfaction . 3 . The Collected column is the amount of money the facility has paid to DADS . 4 . The Balance column is the amount of penalty the facility owes . These amounts do not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, there is no total for this column . An administrative penalty with a negative balance may indicate an overpayment or that the penalty was rescinded after payment . 5 . The H column stands for Hearing, and a “Y” in this column indicates the facility requested a hearing on the violation . Once a facility requests and meets the criteria for a hearing on the violation, the case results will be pending until the appeal process is complete . An “N” indicates no hearing was requested by the facility . Nursing Facility Injunctive/Other Relief and Civil Penalty Referrals to the Office of the Attorney General for FY 2016

Referred Region City Facility ID Facility Date

01 - Lubbock Canadian 004437 Edward Abraham 12/10/2015 Memorial Home 03 - Arlington Farmersville 004668 Hinton Home Inc 02/05/2016 2 Total nursing facility injunctive/other relief and civil penalty referrals to the Office of the Attorney General

Nursing Facility Amelioration of Violations for FY 2016

Facility Decision Region City Facility Decision ID Date

01 - Lubbock Lubbock 004929 Whisperwood Nursing & 07/28/2016 Approved Rehabilitation Center in Part 08 - San San 004107 Normandy Terrace Nursing 10/22/2015 Approved Antonio Antonio & Rehabilitation Center 11 - Corpus Corpus 005006 Trisun Care Center – 06/06/2016 Approved Christi Christi Westwood 3 Total nursing facility ameliorations processed

Nursing Facility Trusteeships for FY 2016

DADS did not order any trustees placed in nursing facilities in FY 2016 .

Nursing Facility Closures Under Trusteeship for FY 2016

DADS did not close any nursing facilities under trusteeship in FY 2016 .

Nursing Facility Emergency Suspension and Closing Orders for FY 2016

DADS did not issue any emergency suspension or closing orders to a nursing facility in FY 2016 .

Nursing Facility Suspensions of Admission for FY 2016

DADS did not issue any suspension of admission orders to a nursing facility in FY 2016 .

Nursing Facility Actions 173 Nursing Facility Denial of Payment for New Admissions for FY 2016

Facility Visit Exit Region City Facility Start Date End Date ID Date

01 - Lubbock Littlefield 004520 Littlefield Hospitality 12/18/2015 01/26/2016 04/25/2016 01 - Lubbock Littlefield 004509 Littlefield Nursing and 06/17/2016 07/16/2016 07/31/2016 Rehabilitation LP 02 - Abilene Abilene 004028 Coronado Nursing Center 11/06/2015 12/08/2015 02/21/2016 02 - Abilene Brownwood 004266 Cross Country 09/02/2015 09/24/2015 10/01/2015 Healthcare Center 03 - Arlington Bedford 000268 Parkwood Healthcare 09/21/2015 10/20/2015 10/30/2015 Community 03 - Arlington Dallas 004117 Golden Acres Living and 04/08/2016 05/10/2016 05/19/2016 Rehabilitation Center 03 - Arlington Dallas 004432 The Lennwood Nursing and 11/20/2015 12/23/2015 12/24/2015 Rehabilitation 03 - Arlington Decatur 004483 Heritage Place of Decatur 12/18/2015 01/27/2016 01/30/2016 03 - Arlington Fort Worth 004980 Trinity Healthcare Residence 05/20/2016 06/18/2016 06/30/2016 03 - Arlington Pilot Point 004311 Pilot Point Care Center 04/16/2016 05/14/2016 05/29/2016 04 - Tyler Longview 005129 Heritage at Longview 07/19/2016 07/27/2016 08/01/2016 Healthcare Center 04 - Tyler New Boston 004185 New Boston Healthcare Center 05/18/2016 06/17/2016 06/23/2016 04 - Tyler Texarkana 004848 Christian Care Center 05/18/2016 06/17/2016 06/20/2016 04 - Tyler Texarkana 005150 Edgewood Manor 09/16/2015 10/14/2015 10/30/2015 05 - Beaumont Hemphill 105621 Mount Moriah Health and 03/29/2016 04/27/2016 06/16/2016 Rehabilitation, LLC 06 - Houston Baytown 103620 Cedar Bayou Nursing 08/27/2015 09/26/2015 10/01/2015 & Rehab Center 06 - Houston Columbus 103831 Trucare Living Centers – 09/26/2015 10/24/2015 12/21/2015 Columbus 06 - Houston Eagle Lake 105688 Eagle Lake Nursing and 04/14/2016 05/13/2016 05/15/2016 Rehabilitation, LP 06 - Houston Houston 005316 Beechnut Manor 10/21/2015 11/17/2015 11/19/2015 06 - Houston Houston 005177 Cypresswood Health and 04/22/2016 05/18/2016 06/15/2016 Rehabilitation Center 06 - Houston Houston 004446 Galleria Residence and 12/21/2015 01/22/2016 03/03/2016 Rehabilitation Center 06 - Houston Houston 004823 Jacinto City Healthcare Center 01/13/2016 02/13/2016 04/03/2016 06 - Houston Houston 102907 Legend Oaks Healthcare 03/22/2016 04/16/2016 06/16/2016 and Rehabilitation Center – Northwest Houston 06 - Houston Houston 004392 Montebello Wellness Center 09/10/2015 02/10/2016

174 DADS Regulatory Services FY 2016 Annual Report Nursing Facility Denial of Payment for New Admissions for FY 2016

Facility Visit Exit Region City Facility Start Date End Date ID Date

06 - Houston Houston 000184 The Vosswood Nursing Center 12/01/2015 12/30/2015 01/31/2016 06 - Houston Lake Jackson 005139 Lake Jackson Healthcare Center 04/08/2016 05/11/2016 06/17/2016 06 - Houston Lake Jackson 005369 Oak Village Healthcare 03/11/2016 04/08/2016 05/05/2016 06 - Houston The Woodlands 005203 The Woodlands 03/03/2016 03/31/2016 04/10/2016 Healthcare Center 06 - Houston Tomball 005135 Lawrence Street Health 08/25/2015 09/25/2015 10/29/2015 Care Center 06 - Houston Webster 004940 Manorcare Health Services 10/03/2015 10/31/2015 11/02/2015 07 - Austin Austin 004461 Stonebriar Nursing and 12/31/2015 01/30/2016 03/10/2016 Rehabilitation Center 07 - Austin Hearne 004722 Hearne Healthcare Center 04/28/2016 05/26/2016 06/22/2016 07 - Austin Lampasas 004906 Regal Healthcare Residence 02/09/2016 03/23/2016 03/30/2016 07 - Austin Madisonville 005342 Riverwood Healthcare and 10/02/2015 10/31/2015 11/10/2015 Rehabilitation 08 - San Antonio Converse 005343 Rosewood Rehabilitation 08/21/2015 09/23/2015 10/19/2015 and Care Center 08 - San Antonio Kerrville 000127 Alpine Terrace 03/23/2016 04/22/2016 05/01/2016 08 - San Antonio New Braunfels 103443 Sundance Inn Health Center 05/27/2016 06/28/2016 06/30/2016 10 - El Paso El Paso 004791 Mountain View 01/08/2016 02/10/2016 02/14/2016 Healthcare Center 11 - Corpus Christi Corpus Christi 005114 Harbor View Care Center 05/10/2016 05/21/2016 06/27/2016 39 Total nursing facility denial of payment for new admissions imposed

Nursing Facility License Denials and Revocations Proposed for FY 2016

Facility Proposed Revoked Denied Region City Facility Status ID Action Date Date

04 - Tyler New Boston 004185 New Boston Revoke Rescinded Healthcare Center 05 - Beaumont Shepherd 005350 Woodland Park Deny Rescinded 06 - Houston Houston 004610 Brookhollow Heights Deny Hearing Transitional Care Center 3 Total nursing facility license denials and revocations proposed Notes: Status column values: 1 . Hearing – the facility has requested a hearing . 2 . Rescinded – DADS withdrew the proposed action .

Nursing Facility Actions 175 176 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

01 - Lubbock Amarillo 004031 Heritage Convalescent 08/11/2015 $1,500 Y $975 $975 $0 F Center

DADS RegulatoryFY 2016 Annual Services Report 01 - Lubbock Amarillo 004383 Hillside Heights $16,500 Y $10,725 $10,725 $0 F Rehabilitation Suites 01 - Lubbock Amarillo 004348 Legacy Rehabilitation $1,600 N $1,658 $0 F and Living 01 - Lubbock Amarillo 005231 Plum Creek Healthcare 11/06/2015 $8,750 N $8,862 $0 F Residence 01 - Lubbock Clarendon 004918 Community Care 08/22/2015 $20,100 N $0 $20,100 F Center of Clarendon 01 - Lubbock Dimmitt 004948 Cambridge LTC 12/17/2015 $6,000 Y $3,900 $3,900 $0 F Partners Inc 01 - Lubbock Levelland 005279 Lynwood Nursing and 10/30/2015 $2,000 Y $1,300 $1,300 $0 F Rehabilitation LP 01 - Lubbock Littlefield 004520 Littlefield Hospitality 12/18/2015 $52,000 N $0 $52,370 F 01 - Lubbock Littlefield 004509 Littlefield Nursing and $11,500 Y $7,475 $0 $7,475 F Rehabilitation LP 01 - Lubbock Littlefield 004509 Littlefield Nursing and $9,000 Y $5,850 $0 $5,850 F Rehabilitation LP 01 - Lubbock Littlefield 004509 Littlefield Nursing and 06/17/2016 $9,000 N $0 $0 F Rehabilitation LP 01 - Lubbock Lubbock 005338 Heritage Oaks Nursing 08/06/2015 $1,800 Y $1,170 $1,170 $0 F and Rehabilitation Center 01 - Lubbock Lubbock 100947 The Mildred & Shirley 11/23/2015 $1,500 N $0 $1,500 F L Garrison Geriatric Education and Care Center 01 - Lubbock Plainview 005328 Prairie House 03/24/2016 $251,400 N $0 $251,400 F Living Center Nursing Facility Civil Money Penalties for FY 2016 177 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

01 - Lubbock Slaton 004321 Slaton Care Center 05/13/2016 $56,650 N $0 $56,650 F 01 - Lubbock Wheeler 005178 Wheeler Nursing and 05/11/2016 $7,500 Y $4,875 $0 $4,875 F Rehabilitation LP 02 - Abilene Abilene 004028 Coronado $235,450 Y $153,043 $153,043 $0 F Nursing Center 02 - Abilene Abilene 004028 Coronado $235,450 Y $153,043 $0 $153,043 F Nursing Center 02 - Abilene Abilene 004028 Coronado $118,000 Y $76,700 $0 $76,700 F Nursing Center

02 - Abilene Abilene 004028 Coronado $118,000 Y $76,700 $76,700 $0 F Actions Facility Nursing Nursing Center 02 - Abilene Abilene 004028 Coronado 11/06/2015 $10,000 N $0 $0 F Nursing Center 02 - Abilene Abilene 106050 Silver Spring 12/03/2015 $23,100 N $0 $23,537 F 02 - Abilene Abilene 005033 The Oaks at $7,000 Y $4,550 $0 $4,550 F Radford Hills 02 - Abilene Abilene 005033 The Oaks at 08/26/2015 $134,650 Y $87,523 $0 $89,657 F Radford Hills 02 - Abilene Ballinger 004835 Central Texas Nursing 12/18/2015 $1,950 Y $1,268 $1,268 $0 F & Rehabilitation 02 - Abilene Brownwood 004266 Cross Country $950 N $950 $0 F Healthcare Center 02 - Abilene Brownwood 004266 Cross Country $15,300 N $15,300 $0 F Healthcare Center 02 - Abilene Brownwood 004266 Cross Country 09/02/2015 $1,750 N $1,750 $0 F Healthcare Center 02 - Abilene Brownwood 004266 Cross Country 04/19/2016 $2,000 Y $1,300 $0 $1,300 F Healthcare Center 02 - Abilene Coleman 004161 Holiday Hill Inc 07/20/2016 $2,000 N $0 $2,000 F 178 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

02 - Abilene Eastland 004933 Eastland Nursing & 09/29/2015 $1,750 Y $1,138 $1,138 $0 F Rehabilitation

DADS RegulatoryFY 2016 Annual Services Report 02 - Abilene Snyder 005133 Snyder Oaks 02/10/2016 $14,250 $14,250 N $0 $14,250 F Care Center 02 - Abilene Wichita Falls 005155 Midwestern Healthcare 12/18/2015 $1,850 Y $1,203 $1,203 $0 F Center 03 - Arlington Arlington 101157 Arbrook Plaza 02/11/2016 $9,450 Y $6,143 $0 $6,143 F 03 - Arlington Arlington 004276 Oakwood Nursing and $63,800 N $0 $63,800 F Rehabilitation LP 03 - Arlington Arlington 004276 Oakwood Nursing and 07/07/2016 $3,500 N $0 $0 F Rehabilitation LP 03 - Arlington Bedford 000268 Parkwood Healthcare 09/21/2015 $56,850 Y $36,953 $36,953 $0 F Community 03 - Arlington Bonham 004830 Seven Oaks Nursing 01/22/2016 $84,800 Y $55,120 $55,120 $0 F and Rehabilitation LP 03 - Arlington Crowley 103223 Senior Care of Crowley 07/14/2016 $0 N $0 $0 F 03 - Arlington Dallas 004117 Golden Acres Living $61,050 N $0 $61,050 F and Rehabilitation Center 03 - Arlington Dallas 104696 Lakewest 08/10/2015 $35,250 N $0 $0 F Rehabilitation and Skilled Care 03 - Arlington Dallas 105087 The Hillcrest of 11/25/2015 $123,300 Y $80,145 $80,145 $0 F North Dallas 03 - Arlington Dallas 004432 The Lennwood 11/20/2015 $35,200 Y $22,880 $0 $22,880 F Nursing and Rehabilitation Nursing Facility Civil Money Penalties for FY 2016 179 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

03 - Arlington Dallas 004432 The Lennwood 01/17/2016 $21,150 Y $13,748 $0 $13,748 F Nursing and Rehabilitation 03 - Arlington Decatur 004483 Heritage Place 12/18/2015 $54,000 Y $35,100 $0 $35,100 F of Decatur 03 - Arlington Desoto 005116 Desoto Nursing & $28,000 Y $18,200 $0 $0 F Rehabilitation Center 03 - Arlington Desoto 005116 Desoto Nursing & 01/01/2016 $181,500 Y $117,975 $117,975 $0 F Rehabilitation Center 03 - Arlington Duncanville 004512 The Laurenwood 09/05/2015 $8,500 N $8,500 $0 F Nursing and Actions Facility Nursing Rehabilitation 03 - Arlington Ennis 104339 Legend Oaks 09/04/2015 $3,700 Y $2,405 $2,405 $0 F Healthcare and Rehabilitation – Ennis 03 - Arlington Fort Worth 000274 Cityview Care Center $5,000 Y $3,250 $3,250 $0 F 03 - Arlington Fort Worth 000274 Cityview Care Center $121,000 Y $78,650 $78,650 $0 F 03 - Arlington Fort Worth 005371 Fireside Lodge 08/04/2016 $0 N $0 $0 F Retirement Center Inc 03 - Arlington Fort Worth 104379 Fort Worth Center of 03/31/2016 $58,800 Y $38,220 $38,220 $0 F Rehabilitation 03 - Arlington Fort Worth 103112 Green Valley 07/29/2016 $9,300 N $0 $9,300 F Healthcare and Rehabilitation Center 03 - Arlington Fort Worth 004529 Immanuels Healthcare 02/29/2016 $25,935 N $0 $25,935 F 03 - Arlington Fort Worth 105172 The Harrison 05/15/2016 $23,205 N $0 $23,205 F at Heritage 03 - Arlington Fort Worth 004980 Trinity Healthcare 05/20/2016 $12,600 Y $8,190 $0 $8,190 F Residence 180 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

03 - Arlington Fort Worth 004960 Wedgewood $4,000 Y $2,600 $2,639 $0 F Nursing Home

DADS RegulatoryFY 2016 Annual Services Report 03 - Arlington Gainesville 005292 Pecan Tree Rehab and 02/17/2016 $2,000 Y $1,300 $0 $1,300 F Healthcare Center 03 - Arlington Granbury 005089 Granbury Care Center 07/15/2015 $41,000 Y $26,650 $26,650 $0 F 03 - Arlington Granbury 005089 Granbury Care Center 04/18/2016 $26,000 Y $16,900 $16,900 $0 F 03 - Arlington Grand 005073 Metroplex Nursing and 02/09/2016 $0 N $0 $0 F Prairie Rehabilitation LP 03 - Arlington Greenville 005107 Greenville Health & 12/11/2015 $50,300 $32,695 N $32,695 $0 F Rehabilitation Center 03 - Arlington Honey Grove 004858 Honey Grove 03/09/2012 $38,850 N $49,858 $0 F Nursing Center 03 - Arlington Irving 004426 Ashford Hall 12/18/2015 $4,400 Y $2,860 $0 $2,894 F 03 - Arlington Irving 105761 The Villages on 05/06/2016 $4,000 Y $2,600 $0 $2,600 F Macarthur 03 - Arlington Kaufman 004653 Kaufman 05/28/2016 $60,300 Y $39,195 $0 $39,195 F Healthcare Center 03 - Arlington Lancaster 103338 Millbrook Healthcare 10/17/2015 $92,200 Y $59,930 $59,930 $0 F and Rehabilitation Center 03 - Arlington Lancaster 004998 Westridge Nursing and 07/28/2016 $84,750 N $0 $84,750 F Rehabilitation LP 03 - Arlington Mabank 004254 Mabank 09/04/2015 $108,650 N $0 $108,650 S Nursing Home 03 - Arlington Pilot Point 004311 Pilot Point 04/16/2016 $147,800 N $0 $147,800 F Care Center 03 - Arlington Southlake 105651 The Landing $150,150 $83,940 N $83,940 $0 F at Watermere Nursing Facility Civil Money Penalties for FY 2016 181 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

03 - Arlington Weatherford 100950 Hilltop Park 02/19/2016 $279,300 N $0 $279,300 F Rehabilitation and Care Center 03 - Arlington Weatherford 004865 Weatherford Health 05/19/2016 $8,750 N $0 $8,750 F Care Center 03 - Arlington Weatherford 004865 Weatherford Health 08/04/2016 $3,500 N $0 $0 F Care Center 04 - Tyler Athens 004009 Athens Healthcare and 06/30/2016 $2,900 N $0 $2,900 F Rehabilitation Center 04 - Tyler Athens 004634 Park Highlands 05/14/2015 $1,950 Y $1,268 $1,268 $0 F Nursing & Actions Facility Nursing Rehabilitation Center 04 - Tyler Athens 004634 Park Highlands 03/17/2016 $1,800 N $0 $1,800 F Nursing & Rehabilitation Center 04 - Tyler Atlanta 004798 Rose Haven Retreat 07/29/2015 $8,515 N $8,515 $0 F 04 - Tyler Cooper 004873 Birchwood Nursing $9,000 Y $5,850 $5,850 $0 F and Rehabilitation LP 04 - Tyler Cooper 004873 Birchwood Nursing 09/29/2015 $39,150 N $0 $0 F and Rehabilitation LP 04 - Tyler Cooper 004873 Birchwood Nursing and 06/23/2016 $0 N $0 $0 F Rehabilitation LP 04 - Tyler Dekalb 004553 Ponderosa Nursing and $3,800 N $3,800 $0 F Rehabilitation 04 - Tyler Gilmer 005293 Upshur Manor 02/12/2016 $2,000 N $0 $2,000 F Nursing Home 04 - Tyler Gladewater 005266 Truman W Smith 09/03/2015 $1,800 Y $1,170 $1,170 $0 S Childrens Care Center 04 - Tyler Henderson 004499 Autumn Leaves Nursing 11/05/2015 $1,600 Y $1,040 $1,040 $0 F and Rehab Inc 182 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

04 - Tyler Hughes 004959 The Springs 09/10/2015 $1,450 N $0 $1,450 F Springs

DADS RegulatoryFY 2016 Annual Services Report 04 - Tyler Kilgore 004515 Kilgore Health & 03/04/2016 $54,100 Y $35,165 $0 $35,165 F Rehabilitation 04 - Tyler Marshall 103421 Heritage House of 01/21/2016 $4,200 N $0 $4,200 F Marshall Health & Rehabilitation Center 04 - Tyler Marshall 103421 Heritage House of 07/06/2016 $4,750 N $0 $4,750 F Marshall Health & Rehabilitation Center 04 - Tyler Mount 104115 Greenhill Villas $23,200 N $23,677 $0 F Pleasant 04 - Tyler New Boston 004185 New Boston 03/01/2016 $1,450 N $0 $1,450 F Healthcare Center 04 - Tyler New Boston 004185 New Boston 05/19/2016 $17,550 Y $11,408 $0 $11,408 F Healthcare Center 04 - Tyler Pittsburg 004749 Pittsburg 08/14/2015 $96,265 N $84,713 $11,552 F Nursing Center 04 - Tyler Pittsburg 004749 Pittsburg 10/29/2015 $83,300 Y $54,145 $54,145 $0 F Nursing Center 04 - Tyler Sulphur 005278 Carriage 03/24/2016 $1,900 Y $1,235 $1,235 $0 F Springs House Manor 04 - Tyler Texarkana 004848 Christian Care Center 05/18/2016 $1,950 Y $1,268 $0 $1,268 F 04 - Tyler Texarkana 005150 Edgewood Manor $117,600 Y $76,440 $76,440 $0 F 04 - Tyler Texarkana 005182 The Villa at Texarkana 05/20/2016 $22,100 N $0 $22,100 F 04 - Tyler Tyler 005229 Briarcliff $14,600 Y $9,490 $9,840 $0 F Health Center 04 - Tyler Tyler 005229 Briarcliff $18,900 Y $12,285 $12,680 $0 F Health Center Nursing Facility Civil Money Penalties for FY 2016 183 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

04 - Tyler Tyler 103454 Providence Park 06/16/2015 $3,500 Y $2,275 $2,275 $0 F Rehabilitation and Skilled Nursing 04 - Tyler Tyler 005186 The Clairmont Tyler 06/18/2015 $4,000 N $4,000 $0 F 04 - Tyler Tyler 104599 The Heights of Tyler 08/10/2016 $1,450 N $0 $1,450 F 04 - Tyler Tyler 104956 Watkins-Logan- 09/23/2015 $14,850 Y $9,653 $9,653 $0 F Garrison Texas State Veterans Home 04 - Tyler Wills Point 004777 Free State Crestwood 07/15/2015 $29,000 Y $18,850 $18,850 $0 F

05 - Beaumont Beaumont 103739 Jefferson Nursing and 08/25/2015 $1,800 N $0 $0 F Actions Facility Nursing Rehabilitation Center 05 - Beaumont Crockett 005125 Winfield Rehab 12/16/2015 $1,800 N $0 $1,800 F & Nursing 05 - Beaumont Elkhart 005034 Elkhart Oaks 05/19/2016 $7,000 Y $4,550 $0 $4,550 F Care Center 05 - Beaumont Hemphill 105621 Mount Moriah 03/29/2016 $4,500 N $0 $4,500 F Health and Rehabilitation, LLC 05 - Beaumont Huntington 103330 Huntington Health 05/19/2016 $16,100 N $0 $16,100 F Care & Rehabilitation Center 05 - Beaumont Lufkin 004441 Larkspur 05/17/2016 $63,550 N $0 $63,550 F 05 - Beaumont Lufkin 005253 Southland 07/06/2015 $2,000 N $0 $2,000 F Rehabilitation and Healthcare Center 05 - Beaumont Nacogdoches 005305 Westward Trails 04/20/2015 $3,700 N $0 $3,700 F Nursing and Rehabilitation 05 - Beaumont Nacogdoches 005225 Willowbrook $2,300 Y $1,495 $0 $1,551 F Nursing Center 05 - Beaumont Palestine 004584 Palestine 08/04/2015 $9,000 Y $5,850 $5,850 $0 F Healthcare Center 184 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

05 - Beaumont Palestine 104417 Trucare 06/03/2015 $1,900 Y $1,235 $1,235 $0 F Living Centers

DADS RegulatoryFY 2016 Annual Services Report 05 - Beaumont Vidor 005100 Vidor Health & 02/17/2016 $8,100 Y $5,265 $5,265 $0 F Rehabilitation Center 06 - Houston Angleton 004261 Country Village Care 06/21/2016 $5,850 N $0 $5,850 F 06 - Houston Bay City 004650 Bay Villa 02/18/2016 $2,900 Y $1,885 $1,885 $0 F Healthcare Center 06 - Houston Baytown 004682 Saint James House $18,900 $13,080 N $13,080 $0 F of Baytown 06 - Houston Baytown 004682 Saint James House 05/27/2015 $30,250 $21,020 N $21,020 $0 F of Baytown 06 - Houston Conroe 004500 Conroe Health 04/12/2016 $1,950 N $0 $1,950 F Care Center 06 - Houston Conroe 100790 Park Manor 03/23/2016 $2,950 Y $1,918 $1,918 $0 F of Conroe 06 - Houston Eagle Lake 105688 Eagle Lake Nursing $1,700 Y $1,105 $0 $1,105 F and Rehabilitation, LP 06 - Houston Houston 004811 Ashford Gardens 12/22/2015 $2,500 Y $1,625 $0 $1,625 F 06 - Houston Houston 004611 Briarwood Nursing 01/08/2016 $58,050 Y $37,733 $0 $37,733 F & Rehabilitation 06 - Houston Houston 103815 Brookdale 04/27/2016 $1,700 N $0 $1,700 F Willowbrook Place 06 - Houston Houston 005177 Cypresswood Health 09/19/2015 $9,400 Y $6,110 $6,110 $0 F and Rehabilitation Center 06 - Houston Houston 004446 Galleria Residence and 12/21/2015 $21,600 Y $14,040 $0 $14,040 F Rehabilitation Center 06 - Houston Houston 004062 Highland Park $5,500 Y $3,575 $3,575 $0 F Care Center Nursing Facility Civil Money Penalties for FY 2016 185 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

06 - Houston Houston 004823 Jacinto City 01/13/2016 $93,900 N $0 $93,900 F Healthcare Center 06 - Houston Houston 004823 Jacinto City 05/21/2016 $26,200 N $0 $26,200 F Healthcare Center 06 - Houston Houston 105089 La Hacienda Nursing $35,400 Y $23,010 $0 $23,010 F & Rehab Center 06 - Houston Houston 105089 La Hacienda Nursing $18,900 Y $12,285 $0 $12,285 F & Rehab Center 06 - Houston Houston 105089 La Hacienda Nursing 01/20/2016 $8,000 Y $5,200 $0 $0 F & Rehab Center Nursing Facility Actions Facility Nursing 06 - Houston Houston 102907 Legend Oaks 03/22/2016 $3,400 N $0 $3,400 F Healthcare and Rehabilitation Center – Northwest Houston 06 - Houston Houston 004392 Montebello $12,600 N $0 $12,600 F Wellness Center 06 - Houston Houston 004392 Montebello $3,750 N $0 $3,750 F Wellness Center 06 - Houston Houston 004392 Montebello $144,000 N $0 $144,000 F Wellness Center 06 - Houston Houston 105395 SCC at Clear Brook 02/23/2016 $163,600 Y $106,340 $0 $106,340 F Crossing Rehabilitation and Heatlhcare Center 06 - Houston Houston 005174 St Dominic Village 02/26/2016 $39,300 N $0 $39,300 F Rehabilitation and Nursing Center 06 - Houston Houston 000184 The Vosswood 06/17/2015 $1,950 Y $1,268 $0 $1,268 F Nursing Center 06 - Houston Houston 106098 West Houston $3,900 Y $2,535 $0 $2,535 F Rehabilitation and Healthcare Center 186 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

06 - Houston Houston 106098 West Houston $16,200 Y $10,530 $0 $10,530 F Rehabilitation and Healthcare Center DADS RegulatoryFY 2016 Annual Services Report 06 - Houston Houston 106098 West Houston $22,350 Y $14,528 $0 $14,528 F Rehabilitation and Healthcare Center 06 - Houston Houston 005348 West Oaks Nursing & $63,000 Y $40,950 $40,950 $0 F Rehab Center 06 - Houston Houston 005348 West Oaks Nursing & 04/14/2016 $39,950 Y $25,968 $0 $25,968 F Rehab Center 06 - Houston Houston 005056 Westchase Health and 09/15/2015 $1,950 N $1,950 $0 F Rehabilitation Center 06 - Houston Houston 005056 Westchase Health and 01/16/2016 $24,000 Y $15,600 $0 $15,600 F Rehabilitation Center 06 - Houston Houston 004826 Winterhaven 12/28/2015 $3,600 N $3,600 $0 F Healthcare Residence 06 - Houston Humble 004967 Humble 06/19/2015 $1,950 N $1,950 $0 F Healthcare Center 06 - Houston Katy 103520 Heritage Park of $20,250 Y $13,163 $13,163 $0 F Katy Nursing and Rehabilitation 06 - Houston Katy 103520 Heritage Park of $30,450 Y $19,793 $19,793 $0 F Katy Nursing and Rehabilitation 06 - Houston Katy 103520 Heritage Park of $18,600 Y $12,090 $12,090 $0 F Katy Nursing and Rehabilitation 06 - Houston Katy 103448 The Grace Care $7,000 N $0 $7,000 F Center of Katy 06 - Houston Lake Jackson 005139 Lake Jackson $44,850 Y $29,153 $0 $29,153 F Healthcare Center Nursing Facility Civil Money Penalties for FY 2016 187 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

06 - Houston Lake Jackson 005139 Lake Jackson $21,200 Y $13,780 $0 $13,780 F Healthcare Center 06 - Houston Lake Jackson 005139 Lake Jackson $76,500 Y $49,725 $0 $49,725 F Healthcare Center 06 - Houston Lake Jackson 005369 Oak Village Healthcare 03/11/2016 $2,000 N $0 $2,000 F 06 - Houston Missouri 005226 First Colony Health $2,500 Y $1,625 $0 $1,625 F City and Rehabilitation Center 06 - Houston Pasadena 004368 Faith Memorial $3,100 Y $2,015 $0 $2,015 F Nursing Home Nursing Facility Actions Facility Nursing 06 - Houston Pasadena 004368 Faith Memorial $14,200 Y $9,230 $0 $9,230 F Nursing Home 06 - Houston Pasadena 004368 Faith Memorial 11/03/2015 $10,000 Y $6,500 $6,500 $0 F Nursing Home 06 - Houston Pasadena 103086 The Courtyards at 03/10/2016 $1,800 N $0 $1,800 F Pasadena 06 - Houston Pearland 103462 Tuscany Village 12/30/2015 $3,900 N $0 $3,900 F 06 - Houston Richmond 004511 Richmond Health Care $0 Y $0 $3,510 ($3,510) F Center 06 - Houston Richmond 004511 Richmond Health Care 07/28/2015 $63,450 Y $41,243 $0 $41,243 F Center 06 - Houston Rosenberg 005112 Rosenberg Health & 05/15/2016 $34,700 $22,555 N $0 $22,555 F Rehabilitation Center 06 - Houston Sugar Land 005145 Sugar Land Health 02/25/2016 $1,950 N $0 $1,950 F Care Center 06 - Houston Texas City 005368 Oceanview Healthcare $17,100 Y $11,115 $11,115 $0 F and Rehabilitation 06 - Houston Texas City 005368 Oceanview Healthcare $29,000 Y $18,850 $18,850 $0 F and Rehabilitation 06 - Houston Texas City 004807 Seabreeze Nursing and 06/25/2015 $3,900 Y $2,535 $2,535 $0 F Rehabilitation LP 188 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

06 - Houston Texas City 004549 The Lakes at Texas City $60,500 $29,218 N $0 $29,218 F 06 - Houston Texas City 004549 The Lakes at Texas City $29,400 $29,218 N $0 $29,218 F

DADS RegulatoryFY 2016 Annual Services Report 06 - Houston The 104661 Park Manor of The $28,700 Y $18,655 $18,655 $0 F Woodlands Woodlands 06 - Houston The 104661 Park Manor of The $15,150 Y $9,848 $9,848 $0 F Woodlands Woodlands 06 - Houston The 005203 The Woodlands 03/03/2016 $3,900 Y $2,535 $2,535 $0 F Woodlands Healthcare Center 06 - Houston Webster 004940 Manorcare 10/03/2015 $1,950 N $0 $2,047 F Health Services 06 - Houston Weimar 004747 Parkview Manor 03/31/2016 $10,000 N $0 $10,000 F Nursing and Rehabilitation 06 - Houston Wharton 004115 Wharton Nursing and 07/09/2015 $1,950 $1,268 N $1,268 $0 F Rehabilitation Center 07 - Austin Austin 000230 Buckner Villa 01/08/2016 $1,800 Y $1,170 $0 $1,209 F Siesta Home 07 - Austin Austin 004548 Oakcrest Manor 07/02/2015 $2,100 N $2,100 $0 F Nursing Home 07 - Austin Austin 102537 Senior Care of 04/07/2016 $54,200 N $0 $54,200 F West Oaks 07 - Austin Austin 104778 Southpark Meadows 02/05/2016 $1,900 Y $1,235 $1,235 $0 F Nursing and Rehabilitation Center 07 - Austin Austin 005117 Southwood 11/24/2015 $2,000 Y $1,300 $0 $1,300 F Care Center 07 - Austin Austin 004461 Stonebriar Nursing and 12/31/2015 $111,000 Y $72,150 $0 $72,150 F Rehabilitation Center Nursing Facility Civil Money Penalties for FY 2016 189 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

07 - Austin Bastrop 005247 Silver Pines Nursing $65,000 Y $42,250 $42,250 $0 F and Rehabilitation LP 07 - Austin Bastrop 005247 Silver Pines Nursing $60,150 Y $39,098 $39,098 $0 F and Rehabilitation LP 07 - Austin Belton 005235 Park Place Manor Inc 07/02/2015 $2,000 Y $1,300 $1,300 $0 F 07 - Austin Bremond 005161 Bremond Nursing and 11/19/2015 $49,500 Y $32,175 $32,175 $0 F Rehabilitation Center 07 - Austin Brenham 004558 High Hope Care 04/26/2016 $4,450 Y $2,893 $0 $2,893 F Center of Brenham

07 - Austin Bryan 101864 Lampstand Nursing 10/29/2015 $2,000 Y $1,300 $0 $1,300 F Actions Facility Nursing and Rehabilitation LP 07 - Austin Caldwell 103889 Copperas Hollow 07/10/2015 $67,550 N $68,452 $0 F Nursing & Rehabilitation Center 07 - Austin College 004952 Fortress Nursing and 01/08/2016 $23,100 Y $15,015 $15,015 $0 F Station Rehabilitation LP 07 - Austin College 005050 Magnified Nursing and 09/22/2015 $51,000 Y $33,150 $0 $33,150 F Station Rehabilitation LP 07 - Austin Fairfield 102704 Fairfield Nursing & 09/12/2015 $146,700 Y $95,355 $0 $100,466 F Rehabilitation Center 07 - Austin Georgetown 104710 Estrella Oaks 03/23/2016 $159,000 Y $103,350 $0 $103,350 F Rehabilitation and Care Center 07 - Austin Giddings 005307 Oakland Manor 11/13/2015 $2,000 Y $1,300 $1,300 $0 F Nursing Center 07 - Austin Granger 004871 Granger Villa $54,600 $35,490 N $35,490 $0 F 07 - Austin Granger 004871 Granger Villa 07/03/2015 $4,000 N $0 $0 F 07 - Austin Harker 000232 Indian Oaks 11/02/2015 $1,700 Y $1,105 $1,105 $0 F Heights Living Center 07 - Austin Hearne 004722 Hearne 08/14/2015 $69,290 Y $45,039 $91,565 ($46,527) F Healthcare Center 190 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

07 - Austin Hearne 004722 Hearne 04/28/2016 $48,000 N $0 $48,000 F Healthcare Center

DADS RegulatoryFY 2016 Annual Services Report 07 - Austin Lampasas 004222 Lampasas Nursing and 12/23/2015 $11,830 Y $7,690 $0 $7,690 F Rehabilitation Center 07 - Austin Lampasas 004906 Regal Healthcare 02/22/2016 $128,100 Y $83,265 $83,265 $0 F Residence 07 - Austin Madisonville 005342 Riverwood Healthcare 10/02/2015 $116,550 N $0 $116,550 F and Rehabilitation 07 - Austin Rosebud 004857 Heritage House 05/26/2015 $39,600 Y $25,740 $25,740 $0 F Nursing and Rehabilitation 07 - Austin Round Rock 103508 Park Valley Inn 08/06/2015 $1,200 Y $780 $780 $0 F Health Center 07 - Austin San Saba 004476 Pecan Valley 04/05/2016 $30,250 N $0 $30,250 F Healthcare Residence 07 - Austin Temple 004748 Regency Manor $23,150 N $23,150 $0 F Healthcare Center 07 - Austin Temple 004748 Regency Manor 05/27/2016 $8,000 Y $5,200 $0 $5,200 F Healthcare Center 07 - Austin Temple 004785 Senior Care of 01/15/2016 $7,000 Y $4,550 $0 $4,550 F Marlandwood West 08 - San Antonio Converse 005343 Rosewood 08/21/2015 $69,550 Y $45,208 $45,208 $0 F Rehabilitation and Care Center 08 - San Antonio Dripping 005205 Hill Country Care $40,500 Y $26,325 $0 $26,325 F Springs 08 - San Antonio Johnson City 004903 LBJ Medical Center 02/07/2016 $6,550 N $6,550 $0 S 08 - San Antonio Kerrville 000269 Brookdale Guadalupe 07/03/2015 $31,450 Y $20,443 $20,443 $0 F River Plaza 08 - San Antonio Llano 004078 Hill Country $0 N $0 $0 F Healthcare Center Nursing Facility Civil Money Penalties for FY 2016 191 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

08 - San Antonio Llano 004078 Hill Country $48,600 N $0 $48,600 F Healthcare Center 08 - San Antonio New 103443 Sundance Inn $0 N $0 $0 F Braunfels Health Center 08 - San Antonio New 103443 Sundance Inn $10,100 N $0 $10,100 F Braunfels Health Center 08 - San Antonio New 103443 Sundance Inn 05/27/2016 $8,500 N $0 $0 F Braunfels Health Center 08 - San Antonio San Antonio 004754 Mesa Vista Inn 01/29/2016 $6,050 Y $3,933 $0 $3,933 F Health Center Nursing Facility Actions Facility Nursing 08 - San Antonio San Antonio 004754 Mesa Vista Inn 04/11/2016 $3,500 Y $2,275 $0 $2,275 F Health Center 08 - San Antonio San Antonio 101669 Mystic Park Nursing 11/17/2015 $3,200 Y $2,080 $2,080 $0 F & Rehab Center 08 - San Antonio San Antonio 005211 San Pedro Manor 09/17/2015 $30,250 N $0 $30,250 F 08 - San Antonio Yorktown 004759 Yorktown Nursing and 04/20/2016 $8,500 Y $5,525 $5,525 $0 F Rehabilitation Center 09 - Abilene Brady 004744 Brady West Rehab $4,500 N $0 $4,500 F & Nursing 09 - Abilene Brady 004744 Brady West Rehab $25,200 N $0 $25,200 F & Nursing 09 - Abilene Brady 004744 Brady West Rehab 01/06/2016 $41,150 N $0 $41,150 F & Nursing 09 - Abilene Brady 004744 Brady West Rehab 06/09/2016 $3,000 N $0 $0 F & Nursing 09 - Abilene Fort 005310 Fort Stockton Living 06/11/2015 $69,300 N $71,744 $0 F Stockton & Rehabilitation 09 - Abilene Fort 005310 Fort Stockton Living 04/08/2016 $37,600 N $0 $37,600 F Stockton & Rehabilitation 191 192 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

09 - Abilene Midland 004280 Desert Gardens $131,200 Y $85,280 $85,280 $0 F Nursing and Rehabilitation Center DADS RegulatoryFY 2016 Annual Services Report 09 - Abilene Midland 004280 Desert Gardens 03/11/2015 $11,100 Y $7,215 $7,215 $0 F Nursing and Rehabilitation Center 09 - Abilene Midland 004280 Desert Gardens 04/07/2016 $21,750 Y $14,138 $0 $14,138 F Nursing and Rehabilitation Center 09 - Abilene Monahans 005164 Monahans Managed 09/02/2015 $0 N $0 $0 F Care Center 09 - Abilene Odessa 004164 Deerings Nursing and 02/23/2016 $3,750 Y $2,438 $2,438 $0 F Rehabilitation LP 09 - Abilene Odessa 004164 Deerings Nursing and 05/24/2016 $3,000 N $0 $0 F Rehabilitation LP 09 - Abilene San Angelo 005236 Cedar Manor Nursing 11/13/2015 $3,750 Y $2,438 $2,438 $0 F and Rehabilitation 09 - Abilene San Angelo 000170 Senior Care of 05/13/2015 $46,950 Y $30,518 $30,518 $0 F Meadow Creek 10 - El Paso El Paso 102314 Ambrosio Guillen 01/06/2016 $58,700 N $0 $58,700 F Texas State Veterans Home 10 - El Paso El Paso 004994 Mesa Hills $4,500 Y $2,925 $2,925 $0 F Healthcare Residence 10 - El Paso El Paso 004994 Mesa Hills 03/04/2016 $24,200 Y $15,730 $15,730 $0 F Healthcare Residence 10 - El Paso El Paso 004791 Mountain View Health 06/08/2016 $3,500 N $0 $3,500 F & Rehabilitation 10 - El Paso El Paso 004791 Mountain View 01/08/2016 $295,600 Y $192,140 $192,140 $0 F Healthcare Center 10 - El Paso El Paso 004619 Oasis Nursing & 10/15/2015 $2,250 Y $1,463 $1,463 $0 F Rehabilitation Center Nursing Facility Civil Money Penalties for FY 2016 193 Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

10 - El Paso El Paso 005239 Pebble Creek 05/05/2016 $5,500 Y $3,575 $0 $3,575 F Nursing Center 10 - El Paso El Paso 005404 Regent Care Center $10,900 N $10,900 $0 F of El Paso 10 - El Paso El Paso 105607 St . Teresa Nursing and 01/15/2016 $80,050 N $0 $80,050 F Rehabilitation Center 11 - Corpus Brownsville 102455 Brownsville Nursing $8,850 N $0 $0 F Christi and Rehabilitation Center 11 - Corpus Brownsville 102455 Brownsville Nursing 05/27/2016 $17,000 N $0 $0 F Nursing Facility Actions Facility Nursing Christi and Rehabilitation Center 11 - Corpus Corpus 102375 Cimarron Place Health 08/19/2015 $112,150 N $0 $112,150 F Christi Christi & Rehabilitation Center 11 - Corpus Corpus 102639 Corpus Christi 10/15/2015 $22,500 Y $14,625 $0 $14,625 F Christi Christi Nursing and Rehabilitation Center 11 - Corpus Corpus 005006 Trisun Care 12/16/2015 $1,950 Y $1,268 $0 $1,268 F Christi Christi Center – Westwood 11 - Corpus Falfurrias 004951 Falfurrias Nursing and 12/15/2015 $50,000 Y $32,500 $32,500 $0 F Christi Rehabilitation LP 11 - Corpus Harlingen 004745 Veranda Rehabilitation 09/15/2015 $2,000 N $2,000 $0 F Christi and Healthcare 11 - Corpus Kingsville 004571 Kleberg County 01/14/2016 $3,700 Y $2,405 $0 $2,405 F Christi Nursing and Rehabilitation LP 11 - Corpus Laredo 105179 Laredo Nursing and 07/16/2015 $1,900 Y $1,235 $1,235 $0 F Christi Rehabilitation Center 11 - Corpus Laredo 004758 Retama Manor 07/06/2015 $2,000 Y $1,300 $1,300 $0 F Christi Nursing Center/ Laredo-West 194 Nursing Facility Civil Money Penalties for FY 2016

Waiver Facility Visit Exit Y/N Region City Facility Imposed Assessed 35% Collected Balance IA ID Date Waiver Amount

11 - Corpus Sinton 004582 Trisun Care 11/19/2015 $43,000 Y $27,950 $0 $27,950 F Christi Center – Sinton

DADS RegulatoryFY 2016 Annual Services Report 11 - Corpus Weslaco 004636 Valley Grande Manor 01/15/2016 $5,950 N $0 $5,950 F Christi Totals $8,445,540 $282,733 $3,271,073 262 Total nursing facility civil money penalties imposed

Notes: 1 . eTh Imposed column is the total amount of penalty after the review and confirmation of the civil money penalty citation and amount . This is the amount due and payable if no alternative amount results from an appeal held or settlement agreement reached . 2 . The Assessed column is the amount due after the appeal process has been completed (or an agreement to settle has been reached) and a final amount has been decided, or the facility consents to the administrative penalty, fails to respond to the department’s notice letter in a timely manner or fails to correct the violation to the department’s satisfaction . 3 . The Y/N Waiver column has a “Y” if the facility requested to waive appeal rights in order to receive a 35 percent reduction in the amount of the civil money penalty . An “N” indicates the facility did not request to waive its appeal rights . 4 . The Waiver 35% Amount is the total amount of the penalty due if the facility chose to waive its appeal rights in order to receive a 35 percent reduction . 5 . The Collected column is the amount of money the facility has paid . 6 . The Balance column is the amount of penalty the facility owes . The amount in the Balance column does not necessarily reflect the final amount the facility may owe . The amounts can change based on a hearing or negotiated settlement . Since these amounts may change, there is no total for this column . 7 . The IA column indicates the Imposing Authority . An “F” (federal) appears for Centers for Medicare and Medicaid Services-imposed penalties and an “S” (state) appears for DADS-imposed penalties . DADS imposes civil money penalties on Medicaid-only facilities . Nursing Facility Complaint and Incident Intakes

Complaints A complaint is any allegation received by DADS other than an incident reported by the facility. Such allegations include, but are not limited to, abuse, neglect, exploitation or violation of state or federal standards and may be reported by residents, family members or others.

Incidents An incident is an official notification to the state survey agency from a nursing facility provider that the physical or mental health or welfare of a resident has been or may be adversely affected by mistreatment, neglect or abuse. These reports also include injuries of unknown source and exploitation or misappropriation of resident property.

Priority Assignment DADS evaluates each complaint or incident based on its own unique circumstances and assigns priorities accordingly. When timeliness is crucial to the health and safety of a resident(s), such as in a situation of heating or air conditioner equipment failure, alleged staff walkout, etc., an investigation may be initiated immediately by telephone, regardless of the priority code assignment. After the initial telephone contact, an on- site visit is conducted according to the time frame specified by the priority assignment. The priorities available for a nursing facility are: • On or before 24 hours • On or before 14 calendar days • On or before 30 calendar days • On or before 45 calendar days • Professional review • Financial (Medicaid facilities only) • Withdrawn • Not required

On or Before 24 Hours

Immediate response by Regulatory Services is warranted because a provider allegedly created or allowed a present and ongoing situation in which the provider’s noncompliance with one or more requirements of licensure or certification has failed

Nursing Facility Actions 195 to protect residents from abuse, neglect or mistreatment or has caused, or is likely to cause, serious injury, harm, impairment or death to a resident.

On or Before 14 Calendar Days

The present or ongoing threat of continued abuse, neglect or mistreatment has been removed. The resident is no longer in imminent danger; however, the provider’s alleged noncompliance with one or more requirements of licensure or certification may have or has a high potential to cause harm that impacts a resident’s mental, physical or psychosocial status and is of such consequence that a rapid response by Regulatory Services is indicated. There is evidence or suspicion that system(s) failure contributed to or brought on the threat. Usually, specific rather than general information (e.g., descriptive identifiers, individual names, date, time, location of occurrence, description of harm) will factor into the assignment of this level of priority.

On or Before 30 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has caused or may cause harm that is of limited consequence and does not significantly impair the resident’s mental, physical or psychosocial status.

On or Before 45 Calendar Days

A provider’s alleged noncompliance with one or more requirements of licensure or certification has a low potential for more than minimal harm or resulted in physical, mental or psychosocial harm that did not directly affect consumer or resident health and safety and functional status. This priority may also be assigned for alleged violations of regulations that do not directly impact resident health and safety.

Professional Review

A provider who has cause to believe that the physical or mental health or welfare of a resident has been or may be adversely affected by mistreatment, neglect or abuse must self-report to the state survey agency immediately upon learning of the alleged conduct or conditions. This notice could include injuries of unknown source and exploitation/ misappropriation of resident property.

Complaint Intake unit staff assign a professional review priority when a provider self- reports an incident to Regulatory Services and the provider’s oral report indicates that the provider’s immediate corrective action is reasonably likely to ensure that abuse, neglect, mistreatment or injury to the resident will not occur again, or at least not while the provider conducts its investigation and a Complaint Intake program specialist reviews the provider’s written investigation report.

196 DADS Regulatory Services FY 2016 Annual Report Based on review of the facility investigation report, if further investigation is warranted to assess whether the provider’s abuse prohibition policies ensure compliance with regulatory requirements, the Complaint Intake unit will send notification to the Regulatory Services regional staff to schedule an on-site investigation.

Financial (Medicaid Facilities Only)

These investigations involve complaint allegations related to a Medicaid-certified nursing facility’s failure to appropriately manage resident trust funds or applied income, or failure to reimburse prorated refunds due a resident when the resident is admitted to a Medicaid bed or has been discharged.

Withdrawn

A complaint report filed with DADS is withdrawn at the request of the complainant, except when abuse, neglect or exploitation is alleged. Please refer to Survey and Certification Clarification 03-08 (www.dads.state. tx.us/providers/communications/2003/scc/SCC2003-08.pdf).

Not Required

DADS determines it has no jurisdiction to investigate a complaint or a referral, or a report to another agency, board or entity is required. Nursing Facility All Intakes by Priority and Region for FY 2016

Intake Priority 01 02 03 04 05 06 07 08 09 10 11 Total

On or before 57 50 310 73 57 196 135 158 28 17 58 1,139 24 hours On or before 392 276 1,861 569 387 1,247 850 989 232 113 422 7,338 14 days On or before 197 204 1,348 453 311 765 581 639 120 74 295 4,987 30 days On or before 208 178 1,234 442 251 607 445 490 93 64 194 4,206 45 days Professional 212 289 1,726 553 338 637 583 585 100 82 226 5,331 review Financial 28 10 102 27 28 95 44 75 8 5 34 456

Withdrawn 6 4 24 21 16 3 7 14 0 0 1 96

Not required 5 3 15 4 2 8 3 10 7 4 1 62

Total 1,105 1,014 6,620 2,142 1,390 3,558 2,648 2,960 588 359 1,231 23,615

Nursing Facility Actions 197 Nursing Facility Complaints by Priority and Region for FY 2016

Complaint 01 02 03 04 05 06 07 08 09 10 11 Total Priority

On or before 54 49 300 71 54 189 130 150 28 17 54 1,096 24 hours On or before 181 147 1,171 321 230 876 518 629 122 69 258 4,522 14 days On or before 92 108 683 171 122 463 302 362 54 37 137 2,531 30 days On or before 88 57 402 99 65 239 165 201 28 22 86 1,452 45 days Financial 28 10 101 27 28 94 44 75 8 5 34 454 Withdrawn 6 4 24 21 16 3 7 14 0 0 1 96 Not required 1 0 2 0 0 2 0 1 1 1 0 8 Total 450 375 2,683 710 515 1,866 1,166 1,432 241 151 570 10,159 Note: The intake priority “Professional review” does not apply to nursing facility complaint intakes .

Nursing Facility Incidents by Priority and Region for FY 2016

Incident 01 02 03 04 05 06 07 08 09 10 11 Total Priority

On or before 3 1 10 2 3 7 5 8 0 0 4 43 24 hours On or before 211 129 690 248 157 371 332 360 110 44 164 2,816 14 days On or before 105 96 665 282 189 302 279 277 66 37 158 2,456 30 days On or before 120 121 832 343 186 368 280 289 65 42 108 2,754 45 days Professional 212 289 1,726 553 338 637 583 585 100 82 226 5,331 review Financial 0 0 1 0 0 1 0 0 0 0 0 2 Not required 4 3 13 4 2 6 3 9 6 3 1 54 Total 655 639 3,937 1,432 875 1,692 1,482 1,528 347 208 661 13,456 Note: The intake priority “Withdrawn” does not apply to nursing facility incident intakes .

198 DADS Regulatory Services FY 2016 Annual Report Nursing Facility Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Nursing Facility Administrative Penalties Imposed and Assessed for Fiscal Years 2012–2016 • Nursing Facility Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016 • Nursing Facility Denial of Payment for New Admissions for FY 2012–2016 • Nursing Facility License Denials and Revocations Proposed for FY 2012–2016 • Nursing Facility Civil Money Penalties Imposed for FY 2012–2016 • Nursing Facility Complaint and Incident Intakes for FY 2012–2016

Nursing Facility Administrative Penalties Imposed and Assessed for FY 2012–2016

80 75 70

60 51 50 38 39 40 40 30 20 10 8 9 10 8 5 0 FY12 FY13 FY14 FY15 FY16

Imposed Assessed

Nursing Facility Actions 199 Nursing Facility Injunctive/Other Relief and Civil Penalty Referrals to the Attorney General for FY 2012–2016

6 6 5 4 3 3 2 2 2 1 1 0 FY12 FY13 FY14 FY15 FY16

Nursing Facility Denial of Payment for New Admissions for FY 2012–2016

100 90 88 90 80 81 83 70 60 50 40 30 39 20 10 0 FY12 FY13 FY14 FY15 FY16

200 DADS Regulatory Services FY 2016 Annual Report Nursing Facility License Denials and Revocations Proposed for FY 2012–2016

18 16 16 14 12 10 8 5 7 6 4 4 4 2 2 2 2 0 0 1 FY12 FY13 FY14 FY15 FY16

Denials Revocations

Nursing Facility Civil Money Penalties Imposed for FY 2012–2016

350

300 294 267 259 250 236 200 208 150 100 50 31 0 8 4 4 3 FY12 FY13 FY14 FY15 FY16 Federal State

Nursing Facility Actions 201 Nursing Facility Complaint and Incident Intakes for FY 2012–2016

14,000

13,000 12,620 13,456 12,000 11,348

11,000 10,741 10,159 10,000 10,061 9,801 8,999 9,000 8,157 8,000 8,108

7,000

6,000 FY12 FY13 FY14 FY15 FY16

Complaints Incidents

202 DADS Regulatory Services FY 2016 Annual Report Home and Community-based Services and Texas Home Living Contracts

203 Page 204 DADS Regulatory Services FY 2016 Annual Report Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Contracts The tables below contain information relating to the Home and Community-based Services and Texas Home Living waiver programs, by category, for fiscal year (FY) 2016 .

Vendor Hold If DADS determines that the program provider is not in compliance at the end of the follow-up review, DADS places a vendor hold on payments due to the program provider . DADS conducts a second on-site follow-up review between 30 and 45 calendar days after the effective date of the vendor hold .

Denial of Certification If DADS determines that the program provider is not in compliance at the end of the follow-up review to vendor hold, DADS denies certification of the program provider and recommends termination of its waiver program provider agreement .

DADS may deny certification of a program provider’s contract if there is a hazard to the health, safety or welfare of residents and the hazard is not eliminated before the end of any review, or based on a program provider’s serious or pervasive noncompliance with one or more of the program principles .

Home and Community-based Services Actions by Contract Area for FY 2016

Type of Remedy 01 02 03 04 05 06 07 08 09 Totals

Vendor hold 0 2 1 0 2 0 2 0 0 7 Denial of certification 0 1 0 0 2 3 1 0 2 9

Texas Home Living Actions by Contract Area for FY 2016

Type of Remedy 01 02 03 04 05 06 07 08 09 Totals

Vendor hold 0 0 0 0 2 0 0 0 0 2 Denial of certification 0 0 0 0 0 0 0 0 0 0

Home and Community-based Services and Texas Home Living Contract Actions 205 Home and Community-based Services Vendor Holds for FY 2016 Waiver Contract Visit Exit Contract Waiver Contract City Contract Number Date Area

2 Arlington 1009208 Trinity HCS Inc 12/08/2015 2 Ft Worth 1021509 Donna Denise Rangel 12/29/2015 3 Arlington 1009496 Trinity HCS Inc 12/10/2015 5 McKinney 1009757 All About Luv N Care Inc 06/16/2016 5 Houston 1009215 A Tap Inc 03/24/2016 7 Houston 1021488 MHMR of Texas Corp 02/25/2016 7 San Antonio 1021618 Assurance Residential Care Ser 02/05/2016 7 Total Home and Community-based Services vendor holds

Texas Home Living Vendor Holds for FY 2016

Waiver Contract Visit Exit Contract Waiver Contract City Contract Number Date Area

5 Katy 1011854 Sierra Cove Community Homes 09/18/2015 5 Houston 1010932 Avalon Healthcare Services Inc 12/11/2015 2 Total Home and Community-based Services vendor holds

Home and Community-based Services Denials of Certification for FY 2016 Waiver Contract Visit Exit Contract Waiver Contract City Contract Number Date Area

2 Fort Worth 1008246 Elliott & Joyce Langston 05/16/2016 5 Houston 1008829 Active Seniors Unlimited Inc 03/10/2016 5 Houston 1009215 A Tap Inc 06/16/2016 6 Austin 1008361 Issac D Earls 03/24/2016 6 Round Rock 1009510 Assurance Care Inc 09/11/2015 6 San Antonio 1021617 Assurance Residential Care Ser 06/10/2016 7 San Antonio 1021618 Assurance Residential Care Ser 06/04/2016 9 Brownsville 1007950 Cletus O Okonkwo 10/15/2015 9 Corpus Christi 1009582 Dabian Eli Cavazos 10/29/2015 9 Total Home and Community-based Services denials of certification Note: These are recommendations for Denial of Certification as a result of certification reviews conducted by Waiver Survey and Certification staff .

206 DADS Regulatory Services FY 2016 Annual Report Texas Home Living Denial of Certifications for FY 2016

DADS did not recommend denial of certification for any Texas Home Living in FY 2016 . Home and Community-based Services and Texas Home Living Complaints and Referrals

Complaints Complaints are received by DADS Consumer Rights and Services (CRS) . If CRS determines regulatory action is required, the complaint is referred to DADS Regulatory Services . Regulatory Services reviews the complaint to determine follow-up actions . The actions are determined by: • The severity of the complaint • The number and severity of other complaints received about that program provider • The pattern and trends of any reported abuse, neglect or exploitation associated with the program provider • The performance of the program provider on certification reviews

Desk Review

Regulatory Services completes a desk review of the complaint if it is determined that there is low risk to those served by that program provider . The determination of low risk is made if the complaint did not involve issues that relate to the health or safety of those served and if contact with the program provider indicates the situation has been satisfactorily resolved .

On-Site Visit

Regulatory Services conducts an on-site visit if there is significant risk to the clients involved in the complaint . If the program provider is found to be out of compliance with one or more program principles, the results are recorded in a certification review .

Home and Community-based Services and Texas Home Living Complaints for FY 2016

Referred to On-site Review Waiver Program Received by CRS WS&C Conducted

Home and Community-based 4,115 75 23 Services Texas Home Living 127 0 2 Total 4,242 75 25

Home and Community-based Services and Texas Home Living Contract Actions 207 Waiver Contract Actions Compared Over Multiple Fiscal Years This section includes charts that compare FY 2016 to previous years in the following areas: • Waiver Contract Vendor Holds for FY 2012–2016 • Waiver Contract Denials of Certification for FY 2012–2016

Waiver Contract Vendor Holds for FY 2012–2016

15 14

11 10 10

7 6 5

2 2 2 2 0 0 FY12 FY13 FY14 FY15 FY16

HCS TxHmL

Waiver Contract Denial of Certifications for FY 2012–2016

15 13 13 12

10 9

6 5

2 1 1 0 0 0 FY12 FY13 FY14 FY15 FY16

HCS TxHmL

208 DADS Regulatory Services FY 2016 Annual Report Glossary

209

Glossary

§1915(c) Medicaid Waiver – The provision of the Social Security Act that authorizes the Secretary of Health and Human Services to grant waivers of certain Medicaid statutory requirements so that a state may furnish home and community-based services to Medicaid beneficiaries who need a level of institutional care that is provided in a hospital, nursing facility or intermediate care facility .

Abuse – The infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, sexual abuse or exploitation of a person . Types of abuse include: • Physical abuse (a physical act by one person that may cause physical injury to another) • Psychological abuse (an act, other than verbal, that may inflict emotional harm, invoke fear or humiliate, intimidate, degrade or demean someone) • Sexual abuse (an act or attempted act such as rape, incest, sexual molestation, sexual exploitation, sexual harassment or inappropriate or unwanted touching of another) • Verbal abuse (using words to threaten, coerce, intimidate, degrade, demean, harass or humiliate someone)

Active treatment – A continual treatment program that each ICFs/IID resident must receive, which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services, that is directed toward the acquisition of the behaviors necessary for the resident to function with as much self-determination and independence as possible while preventing or decelerating regression or loss of current optimal functional status . Activities of daily living – Basic personal everyday activities that include bathing, dressing, transferring (e .g ., from bed to chair), toileting, mobility and eating . Adaptive aids – Devices, controls or appliances that address a person’s specific needs and enable him or her to increase his or her ability to perform activities of daily living or to perceive, control or communicate with the environment in which he or she lives . Adaptive behavior – In general, the effectiveness or degree to which someone meets the standards of personal independence and social responsibility expected of his or her age and cultural group . Administrative hearing – A proceeding in which a person’s legal rights, duties or privileges are to be determined by a state agency after an opportunity for an adjudicative hearing . Adult – A person 18 years or older, or an emancipated minor . Adult Foster Care (AFC) – A service that provides a 24-hour living arrangement with supervision in a home for people who are unable to continue living independently in their own homes because of physical, mental or emotional limitations .

Glossary 211 Advocate – A person who represents his or her own interests publicly or a person who represents the interests of another . Advance notice – A written statement describing the intent of action the state will bring against a person or his or her legally authorized representative at least 10 days before the date of action . Agency model – A program payment model in which the provider agency is the employer of record . Aging and Disability Resource Centers (ADRCs) – 22 resource centers, available statewide, which serve as a key point of access to person-centered long-term services and supports (LTSS) information, referrals and assistance . Ambulatory – Able to walk independently . Amount, duration and scope – How a Medicaid benefit is defined and limited in a state’s Medicaid plan . Each state defines these parameters, so state Medicaid plans vary in what they cover . Annual renewal – The annual activity of re-determining someone’s eligibility for waiver services . Appeal – The formal process by which an applicant, provider, person or the applicant or person’s parent, guardian or legally authorized representative requests a review of an adverse action . Applicant – Someone who has requested services and eligibility for services is in the process of being determined . Applied income – That portion of a person’s income that must be applied toward the cost of institutional care . Area agencies on aging (AAA) – The 28 agencies that provide services to help older Texans, their family members and caregivers receive the information and assistance they need in locating and accessing community services . Assisted living facility (ALF) – A residential facility that provides residents personal care and other assistance as needed with activities of daily living and instrumental activities of daily living but does not provide round-the-clock skilled nursing services . Assisted living facilities generally provide less intensive care than nursing facilities and emphasize resident privacy and choice . Attendant – A person employed to perform personal care or other non-skilled services for another . Authorization – State approval of a provider to deliver services . Autism spectrum disorder – A developmental disorder characterized by deficits in social communication and social interactions across multiple contexts; deficits in verbal and non-verbal communications; deficits in developing, maintaining and understanding relationships; and restricted repetitive patterns of behavior, interests and activities .

212 DADS Regulatory Services FY 2016 Annual Report Behavioral health care – Assessment and treatment of mental or emotional disorders and chemical dependency disorders . Beneficiary – One who benefits from a publicly funded program . Most commonly used to refer to people enrolled in the Medicare program . Benefit level – The limit or degree of services a person is entitled to receive if the services are medically necessary .

Billable activity – A service rendered to a Medicaid beneficiary for which a provider may request payment from the state .

Biologicals – Vaccines, cultures and other preparations made from living organisms and their products, intended for use in diagnosing, immunizing or treating humans or animals or in related research .

Capitation – A prospective payment method that pays the provider of service a uniform amount for each person covered, usually on a monthly basis . Capitation is used in managed care alternatives such as MCOs .

Care coordination – An ongoing process including assessing a person’s needs and effectively planning, arranging, coordinating and following up on services which most appropriately meet the identified needs as mutually defined by that person, the access and assistance staff, and where appropriate, a family member or other caregiver .

Care plan – A written plan prepared by the appropriate health care professionals .

Caregiver – A person who helps care for someone who is ill, has a disability or functional limitations and requires assistance . Informal caregivers are relatives, friends or others who provide unpaid care . Paid caregivers provide services in exchange for payment for the services rendered .

Caregiver education and training – This includes developing a resource library, developing information resources, developing and/or facilitating support groups, seminars and focus groups, facilitating individual or group counseling, and providing education services to groups or individuals .

Case manager – DADS staff who assist in the planning, coordination, monitoring and evaluation of services for someone receiving services with an emphasis on quality of care, continuity of services and cost effectiveness . (Note: In the Deaf Blind with Multiple Disabilities (DBMD) program, the case manager is not DADS staff .)

Case management – A set of activities undertaken to ensure the waiver participant receives appropriate and necessary services . Under a Home and Community-based Services waiver, these activities may include assessment, service plan development, service plan implementation and service plan monitoring, as well as assistance in accessing waiver, state plan and other non-Medicaid services and resources .

Glossary 213 Centers for Medicare & Medicaid Services (CMS) – The agency in the U .S . Department of Health and Human Services that is responsible for federal administration of the Medicare, Medicaid and State Children’s Health Insurance Program .

Certified Medicaid eligible – Someone who has gone through the Medicaid application process and has been determined by the state to be eligible for the Medicaid program . Change – A request for services resulting in an update or revision to community services being received or to the plan of care for waiver services . Chore maintenance – Performing household chores such as heavy cleaning (e .g ., scrubbing floors, washing walls and outside windows), moving heavy furniture, yard and walk maintenance that an older person is unable to handle on their own and which do not require the services of a trained homemaker . Chore services – Services needed to maintain a clean, sanitary and safe environment in an person's home, provided in the DBMD Waiver Program . Client Assignment and Registration System (CARE) – An online data entry system that provides demographic and other data about people served by local intellectual and developmental disability authorities (LIDDAs), state supported living centers, Home and Community-based Services (HCS) program providers, and Texas Home Living (TxHmL) program providers . Community Living Options Information Process (CLOIP) – Process by which DADS contracts with LIDDAs to provide information about community living options to all adult residents of state supported living facilities or their legally authorized representative at least once a year . Contracted LIDDAs are those with a state supported living center in their service area . Community Attendant Services (CAS) – An optional state plan benefit that allows states to provide home and community-based services to eligible adults and children whose health problems cause them to be functionally limited in performing activities of daily living according to a practitioner’s statement of medical need . In Texas, this optional benefit provides personal care services to those who have income in excess of SSI limitations but who would be financially qualified for services provided in an institutional setting . Community-based services – Services provided in the community, rather than in an institution . Community services – Assistance and care for people who are older or those with disabilities . The goal of community services is to help people remain as independent as possible . Community Living Assistance and Support Services (CLASS) – A 1915(c) Medicaid waiver program that provides community-based services and supports to people with developmental disabilities other than intellectual disabilities as an alternative to living in an intermediate care facility .

214 DADS Regulatory Services FY 2016 Annual Report Community Living Plan – A written agreement developed by a person’s interdisciplinary team with active participation by that person and their legally authorized representative that details the responsibilities of all parties signing the plan during and after the person’s move from a facility into a community living arrangement . Community mental health and intellectual disabilities centers – Public entities, locally governed components of the mental health and intellectual and developmental disability service delivery system located in communities throughout the state, providing community-based mental health and intellectual and developmental disability services . Compliance, Assessment, Regulation, Enforcement System (CARES) – DADS Regulatory Services database system .

Congregate meal – Meals that comply with the Dietary Guidelines for Americans and provide a minimum of one-third of the daily recommended dietary allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Science served in a congregate setting . These include standard meals and therapeutic meals/liquid supplements .

Conservator – A person appointed by the court in accordance with the Family Code for someone under the age of 18 who acts as an agent for the child’s estate or person due to physical or mental limitations .

Consumer Directed Service (CDS) – CDS is a service delivery option in which an individual receiving services, or their legally authorized representative, serves as the employer and assumes responsibilities such as hiring, training and dismissing service providers . CDS employers must select a Financial Management Services Agency (FMSA) to conduct financial management services such as payroll and employer taxes .

Consumer Managed Personal Attendant Services (CMPAS) – Personal care program in which the attendant is supervised by the service recipient .

Continuity of services – Activities undertaken to ensure coordination of services to people within and between components of the service delivery system .

Co-pay – A cost-sharing arrangement in which a covered person pays a specified amount for a specified service . Payment is usually required at the time the service is rendered .

Contract – A formal, written agreement between DADS and a provider to deliver services to someone in exchange for payment .

Contract manager – A person who is employed by the state and has significant contract management duties for the state agency, as determined by the agency . This includes staff who enroll, monitor, manage, supervise or oversee any DADS contracts, or who investigate complaints against DADS contractors .

Glossary 215 Contractor– A person or organization with whom the state has negotiated an agreement for the provision of required tasks .

Cost cap – A financial limit placed on a particular service or program .

Cost limit – The maximum amount available to a person for waiver services during the service plan period .

Data warehouse – A system that stores data in formats useful for structured query and analysis .

Day – Any reference to day means calendar day (including weekends and holidays) unless otherwise specified in the text .

Day activity and health services – An array of services provided in a congregate, non-residential setting to dependent adults who need supervision but do not require institutionalization . These services may include any combination of social or recreational activities, health maintenance, transportation, meals and other supportive services . Day Activity and Health Services facility – A licensed facility that provides day activity and health services on a daily or regular basis, excluding overnight, to four or more people who are older or have a disability .

Day Activity and Health Services (DAHS) – Daytime services designed to address the physical, mental, medical and social needs of community residents as an alternative to placement in a nursing home or other institution .

Deaf Blind with Multiple Disabilities (DBMD) – A 1915(c) Medicaid waiver program that provides community-based services and supports to people has one or more diagnosed related conditions and, as a result are deaf-blind, have a condition that will result in deaf-blindness or function as deaf blind and have one or more additional disabilities that impair their independent functioning as an alternative to living in an intermediate care facility .

Delegated health-related task – An activity the attendant may perform for someone only under a physician or registered nurse’s delegation . Such tasks require physician’s order; must be delegated by a physician in accordance with the Teas Medical Practice Act or by a registered nurse in accordance with the Texas Nursing Practice Act; and must be supervised by the delegating authority .

Dental treatment – Emergency, preventative, therapeutic and orthodontic treatment .

Designated service area – A specific geographical region .

Developmental disability – A condition occurring before age 22 that is likely to continue indefinitely and includes a mental or physical impairment or a combination of both . There must be a substantial limitation in three or more of these major life areas: self-care, expressive or receptive language, learning, mobility, capacity for independent living, economic self-sufficiency or self-direction .

216 DADS Regulatory Services FY 2016 Annual Report Dietary services – A therapy service that assists a person to meet basic or special therapeutic nutritional needs through the development of a personalized meal plan . The service is provided by a person licensed in accordance with Texas Occupational Code, Chapter 701, Dietician .

Direct care staff – Any person who works directly with and helps people with daily needs .

Durable medical equipment (DME) – Equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, generally is not useful to anyone who is not ill or injured, and is appropriate for using at home .

Dual diagnosis – A term used to describe a person’s condition involving diagnosis of more than one type of mental disability, such as mental illness occurring with intellectual and developmental disability, or mental illness occurring with chemical dependency .

Dual eligible – Qualifying for both Medicare benefits and Medicaid assistance .

Emergency response services (ERS) – A service that provides 24-hour electronic monitoring services for adults who live alone or who are isolated in the community .

Employment assistance – A service that helps people obtain competitive, integrated employment .

Enhanced match rate – Federal matching rate that is higher than the regular federal medical assistance percentage .

Enhancement – An addition or variation to a minor home modification or an adaptive aid that is not necessary to meet a person’s needs .

Enrollment – The entry of an applicant into a program .

Exploitation – An act of depriving, defrauding or otherwise obtaining someone’s personal property by taking advantage of their disability or impairment .

Fair hearing – An administrative procedure that affords people the statutory right and opportunity to appeal adverse decisions or actions regarding program eligibility or termination, suspension or reduction of services by DADS .

Federal fiscal year (FFY) – The federal fiscal year is a 12-month period that begins on Oct . 1 and ends Sept . 30 .

Federal Medicaid Assistance Percentage (FMAP) – The percentage of federal money available to a state to provide Medicaid services . This percentage is recalculated annually based on a formula designed to provide a higher federal matching rate to states with a lower per capita income .

Glossary 217 Federal poverty levels (FPL) – Income amounts published annually by the federal government that are guidelines for determining eligibility for services .

Fee-for-service reimbursement – The traditional heath care payment system under which physicians and other providers receive a payment for each unit of service they provide .

Financial Management Services (FMS) – Support provided by a financial management services agency that is provided to people who direct some or all of their services, using the consumer directed services option . This support includes operating a payroll service for the person’s employed workers and making required payroll withholdings . This support may also include paying invoices for waiver goods and services and tracking expenditures against the participant-directed budget .

Fraud – An intentional deception or misrepresentation with the knowledge the deception could result in some unauthorized benefit to himself or some other person . It includes any act that constitutes fraud under applicable federal or state law .

Freedom of choice – In general, a state must ensure that Medicaid beneficiaries are free to obtain services from any qualified provider . Exceptions are possible through waiver of Medicaid and special contract options .

Functional need – A person’s need for assistance with activities of daily living or instrumental activities of daily living, caused by a physical or mental limitation or disability .

Guardian – A person appointed by the court to care for and/or handle the affairs of someone who is deemed incompetent or incapable of administering his or her affairs . Guardian of the estate is appointed to look after a person’s property . Guardian of the person has the legal authority to make personal decisions for the person, including physical, medical and educational needs .

Habilitation – A broad term referring to procedures and intervention designed to help someone with a developmental disability achieve greater mental, physical and social development . The habilitation process enhances the person’s well-being, teaches skills and increases the possibility that he or she will make progressively independent and responsible decisions about social behavior, quality of life, job satisfaction and personal relationships .

Health Information, Counseling and Advocacy Program (HICAP) – In Texas the State Health Information and Assistance Program (SHIP) is called the Health Information, Counseling and Advocacy Program (HICAP) . HICAP has been a component of the national SHIP Network since 1992 .

218 DADS Regulatory Services FY 2016 Annual Report Health maintenance – Services that include one or more of the following activities: medical treatment by a health professional; health education and counseling services for individuals or groups about lifestyles and daily activities; home health services including but not limited to nursing, physical therapy, speech or occupational therapy; and provision of medications, nutritional supplements, glasses, dentures, hearing aids or other assistive devices .

Health screening/monitoring – Investigation or analysis by a medical or health professional to determine the need for a health service, including routine testing for blood pressure, hearing, vision, diabetes and anemia, or the periodic checking/monitoring of a known condition such as monthly blood pressure checks for hypertension or tests for anemia .

Home and Community-based Services Waiver (HCS) – A 1915(c) Medicaid waiver program that provides community-based services and supports for people with an intellectual and developmental disability or related conditions as an alternative to living in an intermediate care facility .

Home and community support services agencies (HCSSA) – A licensed entity that provides home health, hospice, or personal assistance services to people in a residence or independent living environment .

Home health services – One or more health services required by someone in a residence or independent living environment . Home health services include: nursing; physical, occupational, speech or respiratory therapy; medical and social services; intravenous therapies; dialysis; services by unlicensed personnel under the delegation or supervision of a licensed health professional; medical equipment and supplies (excluding drugs); or nutritional counseling .

Home-delivered meal – A nutritious meal delivered to an eligible person in his or her home and that complies with the Dietary Guidelines for Americans, providing a minimum of one-third of the daily recommended dietary allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Science .

Homemaker – A service provided by trained and supervised people involving the performance of housekeeping/home management, meal preparation or escort tasks and shopping assistance, provided to those who require assistance with these activities in their home . The objective is to help the person sustain independent living in a safe and healthful home environment .

Glossary 219 Hospice – An array of special palliative services provided to terminally ill people and their families or caregivers . The goal of hospice is to care for the person and the family during the final stages of life . Hospice is available for all age groups and includes physical and emotional care provided by a team of doctors, nurses, hospice aides, social workers, counselors and trained volunteers . Hospice services may be provided in the home or other residential settings, or in an inpatient facility .

Imminent danger – An immediate, real threat to someone’s safety .

Information, referral and assistance – Assessing persons’ needs by: • Finding organizations capable of meeting the needs . • Evaluating all appropriate resources . • Providing enough information about each resource to help them make informed choices . • Helping them find alternative resources . • Actively linking persons to needed services . • Performing follow-up to ensure the services were provided . Individual Plan of Care (IPC) or Individual Service Plan (ISP) – A document that describes the type and amount of services to be provided to a person .

In-Home and Family Support Program (IHFSP) – A program that disburses funds as assistance to people with physical disabilities or their families to buy services or items that are above and beyond the scope of usual needs, that are necessitated by the disability, and that directly support the person in living in his or her own home rather than living in a more restrictive setting at a higher cost .

Instruction and training – These services provide the experience and/or knowledge for those working with people to acquire skills in a formal, informal, individual or group setting .

Intellectual and developmental disability (IDD) – Severe chronic disabilities that can be cognitive (appearing before age 18), or physical (appearing before age 22), or both, and are likely to be lifelong .

Intellectual and developmental disability priority population – Those groups identified by DADS as being most in need of intellectual and developmental disability services .

Intellectual disability (ID) – A condition manifested before the age of 18 that includes significantly sub-average intellectual functioning (an intelligence quotient of approximately 70 or below) and deficits or impairments in adaptive functions .

Intellectual Disability and Related Condition Assessment (ID/RC) – An assessment used by DADS for making a level of care determination and a level of need assessment .

220 DADS Regulatory Services FY 2016 Annual Report Interest list – Lists that are maintained by program with names of persons who have contacted DADS and expressed an interest in receiving services for which there is currently no funding . Names are released from the interest lists as funding becomes available . Interest lists for community-based programs are managed either locally or statewide, depending on the program .

Intermediate Care Facility for Individuals with ID (ICF/IID) – A public or private facility that provides health and habilitation services to people with intellectual disabilities .

Intervener – A service provider with specialized training and skills in deaf blindness who, working with one individual at a time, serves as a facilitator to involve an individual in home and community services and activities, and who is classified as an “Intervener," “Intervener I," “Intervener II," or “Intervener III” in accordance with Texas Government Code, § 531 .0973 .

Legal awareness – The dissemination of accurate, timely and relevant information, eligibility criteria, requirements and procedures to older people about public entitlements, health/long-term care, individual rights, planning/protection options, housing and individual issues in a group setting .

Legally authorized representative (LAR) – A person authorized by law to act on behalf of another person and may include a parent, guardian or managing conservator of a minor, or the guardian of an adult .

Level of care (LOC) – The specification of the minimum amount of assistance that a person must require in order to receive services in an institutional setting under the state plan . Reimbursement for foster/companion care, supervised living, residential support and day habilitation is based on this assignment .

Level of need (LON) – An assignment given to someone by DADS upon which reimbursement for specific waiver services is based . The LON assignment is derived from DADS-approved standardized tests . Licensed Vocational Nurse (LVN) – A person licensed by the Board of Nurses for the state of Texas who works under the supervision of a registered nurse or a physician’s assistant . Local Intellectual and Developmental Disability Authority (LIDDA) –In accordance with the Texas Health and Safety Code, §533 .035, an entity to which the Texas Health and Human Services Commission executive commissioner delegates the state’s authority for planning, policy development, coordination, including coordination with criminal justice entities, resource allocation and resource development for oversight of intellectual disability services in one or more service areas . Long-term Care Ombudsman – Provides services to help protect the health, safety, welfare and rights of residents of nursing homes and assisted living facilities and to identify, investigate and resolve complaints made by or on behalf of residents and that relate to action, inaction or decisions that may adversely affect residents .

Glossary 221 Long-Term Services and Supports (LTSS) – Services provided to someone in the home or other community-based setting that are necessary to allow the them to remain in the most integrated setting possible . Managed care – A system in which the overall care of a patient is overseen by a single provider or organization . Many state Medicaid programs include managed-care components as a method of improving quality and controlling costs . Managing conservator – A court-appointed person with possession rights to a child in accordance with state law . Medicaid – A federal medical assistance program for certain people with low income . Medicaid is financed by both federal and state funds . Each state designs and administers its own program under the general oversight of the U .S . Department of Health and Human Services . The program was enacted in 1965 under Title XIX of the Social Security Act . Medical Assistance Only (MAO) – Someone who is eligible for Medicaid benefits but receives no cash assistance . Medicaid eligible (ME) – Someone who has been determined eligible to receive Medicaid coverage based on Medicaid program guidelines . Medicaid Estate Recovery Program (MERP) – A program that allows state Medicaid programs to recover a portion of the money spent on long-term care for Medicaid beneficiaries age 55 or older upon their death . Medical Necessity (MN) – A determination given to people based on an assessment used to certify eligibility for placement in a nursing facility . Medical Necessity and Level of Care Assessment (MN/LOC) – An assessment completed by a registered nurse and used by the contracted medical necessity determination provider to establish medical necessity and level of care for an applicant or person . Medically Dependent Children Program (MDCP) – A 1915(c) Medicaid waiver program that provides respite, flexible family support services, minor home modifications, adaptive aids, financial management services, employment assistance, supported employment and transition assistance services to children under age 21 as an alternative to nursing facility care . Medicare – The nation’s largest health insurance program financed by the federal government . The program provides insurance to people age 65 and older, who are disabled, or who have permanent kidney failure . Medicare eligible – A person who is older or who has a disability who receives Social Security or railroad retirement benefit payments and meets eligibility criteria to have certain medical expenses paid by the federal Medicare program .

Medicare Part A – Medicare hospital insurance that helps pay for medically necessary inpatient hospital care, and, after a hospital stay (for a limited period of time), for inpatient care in a skilled nursing facility, for home care by a home health agency or hospice care by a licensed and certified hospice agency .

222 DADS Regulatory Services FY 2016 Annual Report Medicare Part B – Medicare medical insurance that helps pay for medically necessary physician services, outpatient hospital services, outpatient, physical therapy and speech pathology service, and a number of other medical services and supplies that are not covered by the hospital insurance .

Medicare Part C – Previously called Medicare+Choice, this part of the Medicare program was renamed Medicare Advantage and modified by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 . It provides for certain managed care coverage options in Medicare, under which managed care organizations receive a capitated monthly payment per covered beneficiary .

Medicare Part D – A voluntary Medicare prescription drug benefit created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that began Jan . 1, 2006 . Beneficiaries who remain in traditional Medicare may choose a private drug- only plan; those who choose to enroll in a managed care organization may choose a plan that offers a drug benefit .

Mental illness – A single severe mental disorder, excluding an intellectual and developmental disability, or a combination of several mental disorders as defined in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual on Mental Disorders .

Minor – Someone under 18 years of age .

Minor home modification (MHM) – A physical adaptation to a person’s home that is essential for the resident’s safe access to and movement within the home; facilitates self- reliance and independence; and allows the resident to remain safely in the community, return safely to the community, or function with greater independence .

Money Follows the Person (MFP) – A policy that allows residents of nursing facilities to move into certain Medicaid waiver programs without having to wait on the interest list upon determination of waiver eligibility .

National Fire Protection Association (NFPA) – A nonprofit organization that works to eliminate death, injury, property and economic loss due to fire, electrical and related hazards . The NFPA delivers information and knowledge through more than 300 consensus codes and standards, as well as research, training, education, outreach and advocacy .

Neglect – The failure to provide a person the reasonable care required, including but not limited to food, clothing, shelter, medical care, personal hygiene or protection from harm .

Nursing facility (NF) – A residential institution that primarily provides skilled nursing care and related services for residents who require medical or nursing care; rehabilitation services for the rehabilitation of a person who is injured, disabled or sick; or

Glossary 223 health-related care and services, on a regular basis, to people who, because of their mental or physical condition, require care and services, above the level of room and board, which can be made available to them only through institutional facilities .

Nursing services – A reimbursable service provided by licensed nursing personnel in accordance with Texas Occupational Code, Chapter 301 .

Nutrition consultation – The provision of information related to nutrition by a licensed dietitian or other qualified person . Services are to be provided by AAAs or nutrition providers .

Nutrition counseling - Individualized advice or guidance about options and methods for improving nutritional status for those who are at nutritional risk because of their health or nutritional history, dietary intake, medication use or chronic illness . Counseling is performed by a health professional in accordance with state law and policy .

Nutrition education – Provision of information to promote nutritional well-being .

Older person – Someone age 60 or older .

Omnibus Budget Reconciliation Act(s) (OBRA) – Federal laws that provide direction regarding how federal funds are to be spent . Amendments to Medicaid eligibility and benefit rules are frequently made in these acts .

Permanency planning – A philosophy and planning process that focuses on the services and supports needed for children with disabilities to live with families .

Person-directed Plan (PDP) – A process that empowers a person or the legally authorized representative, or both, to direct the development of a plan of services and supports that meets their desired outcomes .

Personal assistance services – Routine, ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services . The term includes personal care and health-related tasks or services performed by unlicensed personnel that are either delegated by a registered nurse or that do not require delegation .

Personal care tasks – Assistance with meals, dressing, movement, bathing or other personal needs or maintenance; the administration of medication by a person licensed to administer medication or the assistance with or supervision of medication; or general supervision or oversight of the physical and mental well-being of someone who needs assistance to maintain a private and independent residence in an assisted living facility or who needs assistance to manage personal affairs, regardless of whether a guardian has been appointed .

224 DADS Regulatory Services FY 2016 Annual Report Personal leave – An absence from a residential setting for personal reasons.

Personal Needs Allowance – Money people are permitted to keep from their incomes to pay for personal items.

Personal support team (PST) – A group of people drawn from or representing those professions, disciplines, service areas or agencies that are relevant to identifying a person’s needs and designing a program to meet those needs. Also known as an interdisciplinary team by the ICFs/IID regulations and licensing rules and contracting rules 40 Texas Administrative Code (TAC) §9.203.36.

Preadmission Screening and Resident Review (PASRR) – A federally mandated evaluation process to identify people with mental illness (MI) or an intellectual or and developmental disability (IDD) who are seeking admission to a nursing facility or who already live in a nursing facility. The purpose of PASRR is to ensure nursing facility placement is appropriate and people with MI or IDD receive the necessary services to meet their needs.

Preventive care – Comprehensive care that emphasizes prevention and early detection and treatment of conditions, generally including physical examination, immunization and well-person care.

Primary Home Care (PHC) – A Medicaid-funded community care program that provides non-technical attendant services to people who are older and those with disabilities. Recipients must be age 21 or older.

Prior authorization – A mechanism to control the use of covered items (e.g., durable medical equipment, prescription drugs) or services (e.g., inpatient hospital care). Payment is not made unless approval for the item or service is obtained in advance either from state agency personnel or from a state fiscal agent or other contractor.

Program of All Inclusive Care for the Elderly (PACE) – A Medicaid state plan program that allows Texas to provide comprehensive community and medical services under a capitated, risk-based system to people 55 years of age or older who qualify for nursing facility placement. PACE uses a comprehensive approach, providing an array of services as a cost-effective alternative to nursing facility services.

Program provider – An entity that provides services under a contract with DADS.

Promoting Independence (PI) – This is a state initiative in response to the U.S. Supreme Court ruling in Olmstead v. Zimring mandating that states provide community- based services to people with disabilities who would otherwise be entitled to institutional services when certain conditions are met.

Glossary 225 Qualified Disabled and Working Individuals (QDWI) – Medicare beneficiaries with an income limit of 200 percent of the federal poverty level who do not qualify for full Medicaid benefits. Medicaid pays Medicare Part A premiums for disabled working people.

Qualified Individuals (QI) – Medicare beneficiaries with an income limit of 175 percent of the federal poverty level who do not quality for full Medicaid benefits. Medicaid pays their Medicare Part B premium.

Qualified Medicare Beneficiary (QMB) – Medicare beneficiaries with an income limit of 100 percent of the federal poverty level who do not quality for full Medicaid benefits. Medicaid pays all of their Medicare Part A and B premiums, deductibles and coinsurance.

Quality Improvement (QI) – A continual process that identifies problems in service delivery, tests solutions to those problems and constantly monitors the solutions for improvements.

Quality monitor – A function that provides external review of the access to and the quality of care provided to Medicaid consumers enrolled in Medicaid managed care.

Related condition (RC) – A severe chronic disability attributed to a condition other than mental illness. This disability results in impairment of general intellectual functioning or adaptive behavior or both similar to that of an intellectual disability and requires treatment or services similar to those required by someone with an intellectual disability. The condition must be manifested before the age of 22, must be likely to continue indefinitely and must result in substantial functional limitations. A more specific definition is found at 40Texas Administrative Code §9.203(72).

Registered Nurse (RN) – A person licensed by the Texas Board of Nursing to practice professional nursing.

Residential care – A community services and supports program that provides services to eligible adults who require access to services on a 24-hour basis, but who do not need daily nursing intervention.

Residential repair – Repairs or modifications of consumer-occupied dwellings that are essential for the health and safety of the occupants.

Resource Utilization Group (RUG) – A level of care determination that is used to establish payment levels to nursing facilities and cost limits for people receiving MDCP and HCBS STAR+PLUS Waiver services.

Respite – Care provided on a short-term basis which results in temporary relief for unpaid primary caregivers. Respite services are provided either in or out of the home.

226 DADS Regulatory Services FY 2016 Annual Report Room and board – “Room” means shelter type expenses, including all property- related costs such as rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative services. “Board” means three meals a day or any other full nutritional regimen.

Semi-ambulatory – Mobility relying on the assistance of a device, object or person.

Service coordination – A system in which a single accountable staff person provides assistance to an applicant, individual or legally authorized representative in accessing medical, social, educational and other appropriate services and supports that will help a person achieve a quality of life and community participation acceptable to them.

Service coordinator (SC) – A person who performs service coordination.

Service back-up plan – A plan that ensures continuity of services if service delivery is interrupted.

Service delivery area (SDA) – Regions of the state established by the Texas Health and Human Services Commission for the purpose of planning and providing services.

Service plan – A written document that specifies all services, waiver and others regardless of funding, along with any assistance or informal supports people require to live in the community and avoid institutionalization. At a minimum, the service plan must contain the service, amount, frequency, duration, provider and cost.

Service planning team – A planning team for each person consisting of, at a minimum, the person, legally authorized representative and service coordinator or case manager. The person or legally authorized representative may invite others to participate in planning.

Service Responsibility Option (SRO) – A service delivery model in which the recipient has the ability to train personal attendants.

Signature – A person’s name or mark representing his or her name on a document.

Skilled nursing facility (SNF) – An institution or distinct part of a family that participates in the Medicare program and is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of the injured, disabled or sick, or on a regular basis, health-related care and services to those who, because of their mental or physical condition, require care and services (above room and board) that can be made available to them only through institutional facilities and is not primarily for the care and treatment of mental disorders. SNF requirements apply when a certified facility is billing Medicare for a resident’s per diem rate.

Social Security Administration (SSA) – The federal agency responsible for determining eligibility for Supplemental Security Income (SSI) benefits in Texas and most other states.

Glossary 227 Specialized therapies – A service component that provides assessment and treatment by appropriately licensed or certified professionals .

Specified Low-income Medicare Beneficiaries (SLMB) – Medicare beneficiaries with an income limit of 120 percent of the federal poverty level who do not qualify for full Medicaid benefits . Medicaid pays the Medicare Part B premium .

State fiscal year (SFY) – The Texas state fiscal year begins on Sept . 1 and runs through Aug . 31 .

State Health Information and Assistance Program (SHIP) – A grant funded by the Centers for Medicare & Medicaid and traditionally referred to as the CMS Basic Grant . Funds are allocated to AAAs via a request for proposal process .

State of Texas Access Reform Plus Managed Care (STAR+PLUS) – A 1115 Medicaid waiver program approved for the managed care delivery system designed to allow people who qualify for nursing facility care to receive long-term services and supports in order to be able to live in the community .

State Supported Living Center (SSLC) – A state-operated ICF/IID providing campus-based residential services for people with an intellectual disability . DADS operates 12 state supported living centers as well as the ICF component of the Rio Grande State Center .

Supplemental Security Income (SSI) – A federal entitlement program established under Title XVI of the Social Security Act to provide cash assistance to certain people who are older, blind, or disabled and whose income and resources fall below the Social Security income and resources standards that are set by the federal government .

Support consultation – An optional service provided by a support advisor that provides a level of assistance and training beyond that provided by the Consumer Directed Services Agency through Financial Management Services .

Supported employment (SE) – A service that helps people to sustain competitive, integrated employment .

Suspension – A temporary cessation of any waiver service without the loss of Medicaid or program eligibility .

Termination – A term used when someone no longer meets the program’s eligibility criteria and services are ended .

Texas Accessibility Standards – Federal and state standards merged to comply with the Americans with Disabilities Act .

228 DADS Regulatory Services FY 2016 Annual Report Texas Department of Aging and Disability Services (DADS) – Texas state agency that provides long-term services and supports to people who are older and those with physical, intellectual and developmental disabilities . DADS also regulates providers of long-term services and supports and administers the state’s guardianship program .

Texas Department of Family and Protective Services (DFPS) – Texas agency that works with communities to protect children, the elderly and people with disabilities from abuse, neglect and exploitation . DFPS also works to protect the health and safety of children in daycare, foster care and other types of 24-hour care through investigations, services and referrals, regulation, and prevention programs .

Texas Health and Human Services Commission (HHSC) – The oversight agency for health and human services in Texas and the single state Medicaid agency for Texas .

Texas Home Living (TxHmL) – A 1915(c) Medicaid waiver program that provides community-based services and supports to people with intellectual disabilities or related conditions who live in their own homes or their family’s homes as an alternative to living in an intermediate care facility .

Texas Integrated Eligibility and Redesign System (TIERS) – A project created to improve the delivery of state-funded services . The project replaces several outdated automated systems with a state of the art integrated eligibility system and improves service delivery . Third-party resource – An item, service or funds available to someone from a source other than the waiver or program such as Medicare, Medicaid Home Health, Texas Health Steps Comprehensive Care Program, private insurance, family support, community support or local school districts . Titles of the 1965 Social Security Act: • II – Old age, Survivors and Disability Insurance Benefits . • IV-A – Temporary Assistance for Needy Families; WIN Social Services • IV-B – Child Welfare • IV-D – Child Support • IV-E – Foster Care and Adoption • IV-F – Job Opportunities and Basic Skills Training • V – Maternal and Child Health Services • XVI – Supplemental Security Income • XVIII – Medicare • XIX – Medicaid • XX – Social Services • XXI – Children’s Health Insurance Program

Glossary 229 Transfer – The movement of someone from one program to another program; from one provider to another provider; or between service delivery options .

Transition Assistance Services (TAS) – One-time service provided to a Medicaid- eligible resident of a nursing facility located in Texas to assist the resident in moving from the nursing facility into the community .

Trust fund – The funds of a service recipient that are managed by a provider in a specific account with specific guidelines that must be followed .

Transportation – Taking a person who is older or someone with a disability from one location to another .

Utilization Review (UR) – A formal assessment of the medical necessity, efficiency or appropriateness of services and treatment plans on a prospective, concurrent or retrospective basis .

Vendor hold – Temporary suspension of payment from DADS to a service provider .

Waiver – An exception to the usual requirements of a Medicaid grant to a state by the Centers for Medicare & Medicaid Services .

Working day – Any day DADS is open for business except Saturday, Sundays and recognized holidays .

230 DADS Regulatory Services FY 2016 Annual Report

Texas Department of Aging and Disability Services

HHS Media Services 17D0091 • January 2017