HHS OIG Finds Widespread Noncompliance at Texas DAHS Facilities

On March 7, 2025, the U.S. Department of Health and Human Services Office of Inspector General issued report A-06-23-05000. OIG found that Texas did not fully comply with federal waiver and state health, safety, and administrative requirements at the 20 adult day activity and health services facilities it audited.

Texas concurred with all three recommendations. OIG later closed those recommendations as implemented in May and June 2025.

The sample was 20 DAHS providers, not every DAHS facility in Texas. Even so, the findings provide a useful reminder of the kinds of facility, staffing, training, and documentation issues that can surface during oversight reviews.

What the auditors reported

OIG found that the Texas Health and Human Services Commission did not fully comply with federal waiver and state requirements in overseeing DAHS providers that serve people with special health care needs.

Of the 20 providers:

• 19 did not comply with one or more health and safety requirements.
• 19 did not comply with one or more administrative requirements.

The report identified 253 instances of provider noncompliance across those 20 sites.

OIG recommended that Texas:

1. Ensure that providers correct the 253 instances identified in the report.
2. Improve oversight and monitoring of providers.
3. Work with providers to improve facilities, staffing, and training.

Those recommendations address the state’s oversight responsibilities and the findings at the audited providers; they are not a scorecard for every Texas DAHS center.

Why a DAHS nurse or director should still read it

The recommendations have been closed as implemented, but the report remains useful because it shows the kinds of records and operational conditions an outside reviewer may examine.

Texas DAHS rules cited in the audit include medication documentation. TAC §559.62 requires a facility to record an individual's medications on the medication profile record using information from the prescription label, including the medication name, strength, dosage, amount received, directions, route, prescription number, pharmacy name, and the date the pharmacy issued the medication. A nurse must also counsel a person who self-administers medication or treatment at least once a month and keep a written record of that counseling.

HHSC's DAHS provider handbook explains that providers may use monthly nursing notes, daily progress notes, or other clinical documentation such as medication logs to show that treatments and interventions on Form 3050 were delivered. When a vital sign or other clinical measurement is required daily, the supporting documentation should reflect the daily service.

What to pull from your own chart

If you want a practical review after reading the report, start with the records your center already maintains:

• Physician's Order (Form 3055) and Health Assessment & Service Plan (Form 3050) when they are required for the client and situation.
• Medications in the Nursing Center, with the required medication-profile information completed so the Medication Profile and weekly MAR contain the correct data.
• A Monthly Nursing Assessment, Nurse's Note, or other clinical documentation that reflects the services and observations actually recorded for the client.
• Vital signs on the applicable assessment. ElderSuite does not have a standalone Vitals screen; blood pressure, pulse, respiration, temperature, height, weight, and blood sugar are recorded on the applicable assessment.

Ask Eddie can show you the ElderSuite path for these screens. The OIG report and current HHSC requirements remain the authority for what a reviewer may require.

Read the report: HHS OIG, A-06-23-05000.