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. The title is blunt: Texas did not fully comply with federal waiver and state health, safety, and administrative requirements at all 20 adult day activity and health service facilities the auditors visited.

The report was posted March 11, 2025. Texas concurred with the recommendations. OIG later closed those recommendations as implemented, in May and June 2025.

The sample was 20 DAHS providers. It was not a census of the state. It was still enough to put a number on a problem directors already recognize: the inspection looks at the building, the staff, and the file.

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 counts 253 instances of provider noncompliance across those 20 sites.

OIG's public summary says providers did not always meet the needs of program participants or maintain compliance with state requirements, and that the state's inspections were not enough to keep a continuously safe environment. People with special health care needs were at risk in numerous instances.

OIG recommended that Texas:

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

Those are OIG's words about the state agency. They are not a scorecard for any one center reading this.

Why a DAHS nurse or director should still read it

The audit is more than a year old. The recommendations are closed. The reason to keep it on the desk is simpler: the next reviewer will look at the same kinds of records.

Texas DAHS rules the auditors cited 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 — name, strength, dosage, amount received, directions, route, prescription number, pharmacy name, and the date the pharmacy issued the medication. A nurse must 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, section 6260, tells providers they may use monthly nursing notes, daily progress notes, or other clinical documentation such as medication logs to show that the treatments and interventions on Form 3050 were actually delivered. Blood pressure or glucose checked daily should be written down daily.

None of that is new. The OIG report is a reminder that someone outside the building reads it.

The article covers regulatory oversight, facility standards, staffing, training, and state-specific requirements.

What to pull from your own chart

If you want a practical pass after reading the report, start with the records you already keep:

• Physician's Order (Form 3055) and Health Assessment (Form 3050) for each person who needs them — new enrollment, transfer, or a change in condition. HHSC section 4222 (Revision 26-2, effective June 1, 2026) still points at those two forms.
• Medications in the Nursing Center, with strength, dosage, route, directions, prescription number, pharmacy, and issue date filled in so the Medication Profile and the weekly MAR have something to print.
• A Monthly Nursing Assessment or a Nurse's Note that actually describes the care on the plan, not a blank month.
• Vital signs on the assessment where you take them. ElderSuite does not have a standalone Vitals screen. Blood pressure, pulse, respiration, temperature, height, weight, and blood sugar are entered on Form 3050 or the monthly ES3500 assessment.

Ask Eddie can show you the Nursing Center path for each of those screens. The OIG PDF and the HHSC handbook are the source for what a reviewer may ask for.

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