Revision 19-1; Effective July 1, 2019

 

PI conducts time-sensitive, evidence-based investigations of allegations of physical, sexual and, verbal or emotional abuse, neglect, and exploitation involving people receiving services from certain providers.

DFPS SWI provides HHSC PI with an intake containing information related to a person receiving services.

PI then:

  • notifies the provider and, if applicable, HHS regulatory program, law enforcement, and OIG;
  • collects relevant evidence,
  • analyzes the evidence to reach a finding,
  • documents the conclusion; and
  • provides the final report to the provider and, if applicable, HHS regulatory program, law enforcement, and OIG.

 

3100 Intake

Revision 19-1; Effective July 1, 2019

 

 

3110 Intake Meets the Definition of Abuse, Neglect, or Exploitation

Revision 19-1; Effective July 1, 2019

 

Before investigating an intake, PI reviews the intake and determines whether:

  • the information is within PI’s jurisdiction;
  • the information meets the definition of an allegation of abuse, neglect, or exploitation; and
  • a referral to the provider or another agency or an investigation by PI is appropriate.

Time frames for investigation contacts and completion are based on the location of the incident and the priority of the intake.

 

3120 Intake Priority

Revision 18-1; Effective September 1, 2018

 

PI maintains a prioritization system for investigations conducted in all provider settings. The priority of the allegation is assigned by SWI. The investigator verifies the provider type at the time of intake to ensure the correct priority and that the time frame for completing the investigation is accurate. The investigator may change the intake priority based on information gathered by preliminary investigation activities.

Priority I: Initial contact is required within 24 hours of the report.

Priority I reports:

  • have a serious risk that a delay in the investigation will impede the collection of evidence; or
  • allege that the victim has been subjected to abuse, neglect, or exploitation by an act or omission that caused, or may have caused, serious physical or emotional harm.  

Priority I reports include:

  • death;
  • sexual abuse;
  • an injury caused by serious physical abuse;
  • serious verbal or emotional abuse; or
  • incitement to harm self or others.

Priority II: Initial contact is required within three calendar days of the report.

Priority II reports:

  • have some risk that a delay in investigation will impede the collection of evidence; or
  • allege that the victim has been subjected to abuse, neglect, or exploitation by an act or omission that caused, or may have caused, non-serious physical injury or emotional harm not included in Priority I.

Priority II reports include:

  • a non-serious injury caused by physical abuse; or
  • non-serious verbal or emotional abuse.

Sexual abuse reports cannot be prioritized as a Priority II.

Priority III: Initial contact is required within seven calendar days of the report.

Priority III reports allege:

  • abuse, neglect, or exploitation that would otherwise be classified as Priority I or II, but:
    • the alleged incident occurred more than 30 days before the date of the report; and
    • there is no known or perceived risk; or
  • exploitation when it is the only allegation type in the report.  

If another allegation type occurs in conjunction with exploitation, the report is classified as the more urgent priority.

The following allegations cannot be classified as a Priority III:

  • allegations of abuse, neglect, or exploitation in a state supported living center; or
  • allegations involving children in any setting. 

 

3200 Notifications

Revision 18-1; Effective September 1, 2018

 

PI must make a notification of an allegation within specific time frames to:

  • the administrator or designee of a provider;
  • other state agencies; and
  • law enforcement in specific situations.

The investigator notifies providers of allegations so that the provider may ensure the health and safety of the individual receiving services and preserve evidence relevant to the allegation.

 

3210 Notifications to Law Enforcement or the Office of the Inspector General (OIG)

Revision 19-1; Effective July 1, 2019

 

PI notifies law enforcement and OIG of alleged abuse, neglect, and exploitation in certain circumstances according to the location of the incident and age of the alleged victim.

If the provider is a state supported living center or state hospital, the investigator makes the following notifications:

  • Law enforcement, within one hour of any allegation of abuse, neglect, or exploitation involving a child.
  • Law enforcement, within one hour of any allegation of abuse, neglect, or exploitation involving an adult believed to constitute a criminal offense under any law.
  • OIG, within one hour of any allegation of abuse, neglect, or exploitation involving a person receiving services believed to constitute a criminal offense under any law.

For all other providers, unless law enforcement reported the allegation to the department, the investigator notifies law enforcement within 24 hours of any allegation of abuse, neglect, or exploitation involving:

  • a child; or
  • an adult believed to constitute a criminal offense under any law;

The investigator notifies law enforcement using a mutually agreed upon method between PI and the law enforcement agency.

The identity of the reporter is revealed to law enforcement and OIG.

The investigator notifies law enforcement and OIG if the person receiving services dies during an investigation and it is suspected that the death is related to abuse or neglect. The investigator cooperates with law enforcement and OIG.

See related 26 TAC 711.401.

 

3220 Notifications to the Provider and Applicable Regulatory Program

Revision 19-1; Effective July 1, 2019

 

The investigator makes the appropriate notifications when the alleged perpetrator is an employee of a provider in accordance with 26 TAC §711.402.

For all allegations of abuse, neglect, or exploitation of a person receiving services, the investigator makes the following notifications, as appropriate:

When the alleged perpetrator is a direct provider of a …

PI notifies

Within…

Facility, community center, local
authority, HCS or TxHmL waiver program provider

The facility, community
center, local authority,
HCS or TxHmL waiver
program provider

One hour of receipt of the
allegation by DFPS Statewide Intake (SWI)

HCS or TxHmL waiver program provider

HHSC Office of Ombudsman

24 hours of receipt of the
allegation by DFPS SWI or the next
working day

Community Provider - service provider

Service provider

24 hours of receipt of the
allegation by DFPS SWI

Community Provider - limited service provider

Limited service provider & service provider

24 hours of receipt of the
allegation by DFPS SWI

Managed care organization

Managed care
organization

24 hours of receipt of the
allegation by DFPS SWI

Consumer Directed Service (CDS) Option employer

CDS employer, and as appropriate, the MCO service coordinator, PCS
case manager, or HHSC Financial Management Services
Agency (FMSA)

24 hours of receipt of the
allegation by DFPS SWI

 

SSLC Commencement Requirements

PI complies with the Department of Justice Settlement Agreement. PI communicates with the facility to ensure the facility provides for the safety of the person receiving services and protects relevant evidence. Communication with the facility occurs within one hour of receipt of the intake and then additional information is obtained within 24 hours.

 

3230 Notifications Involving Other State Agencies or Entities

Revision 18-1; Effective September 1, 2018

 

Notifying Child Protective Services

If the alleged victim is a child or young adult and is listed in an open DFPS CPS conservatorship case, PI notifies the CPS primary worker. 

The program providing the service to the child notifies the parent or conservator.

Notifying HHSC Guardianship

PI notifies the HHSC guardianship caseworker if an HHSC ward is the alleged victim in an abuse, neglect, or exploitation investigation.

Notifying the Court That Has Jurisdiction

PI notifies the applicable probate court when a ward is alleged to be a victim of abuse, neglect, or exploitation and is receiving services from a provider.

For the addresses of probate courts in Texas, see Texas Courts Online.

 

3240 Notifications Involving Independent School Districts (ISD)

Revision 18-1; Effective September 1, 2018

 

PI makes notifications as listed in the chart below when allegations involve ISDs:


If:

Then:

The investigator determines that an abuse, neglect, or exploitation allegation involves:

  • an employee of a public primary or secondary school providing educational services at a facility, on campus grounds, under either a contract or memorandum of understanding; and
  • an individual receiving services who is an alleged victim and who is a student at the school.

PI notifies (by phone or in person):

  • the facility within one hour; and
  • the superintendent of the school district within 24 hours of receipt of the report or the next business day.

Investigations of school employees are a special category, and notifications at the close of an investigation are handled differently than other types of investigations.

School employees with a finding of Confirmed are eligible for an administrative review.

 

3300 Evidence Collection

Revision 18-1; Effective September 1, 2018

 

PI uses preponderance as the standard of evidence for confirming abuse, neglect, and exploitation in an investigation. PI does the following for every allegation, except in certain circumstances where a case is rapidly closed without full investigation:

  • makes an initial contact with the alleged victim;
  • interviews the reporter, relevant witnesses, and alleged perpetrators;
  • obtains and reviews relevant demonstrative evidence such as photographs, diagrams, and video surveillance;
  • reviews and obtains copies relevant information from client records;
  • gathers and reviews relevant administrative forms (for example, incident reports, client injury reports, timesheets); and
  • analyzes all relevant evidence and documents the outcome in the final investigative report.

Physical evidence is any item or substance related to an allegation that can be seen or touched. PI does not collect and store physical evidence, but may document it by taking photographs of it in place and describing it in the case report. Law enforcement or other investigative agencies may collect and store physical evidence.

PI collects relevant evidence from multiple sources in order to determine a finding in the investigation. The finding is based on the more convincing evidence and its probable truth or accuracy, and not on the amount of evidence collected.

 

3310 Prior Case History

Revision 18-1; Effective September 1, 2018

 

At the initiation of each investigation, the investigator conducts a search of relevant prior case history of the alleged victim and alleged perpetrator in all provider settings. The results of the prior case history search may be used to inform the current investigation.

 

3320 Contacts

Revision 18-1; Effective September 1, 2018

 

Alleged Victim Contact

PI makes contact with the alleged victim as part of its investigation under 26 TAC §711.415.

PI may make a telephone contact with the alleged victim when the intake alleges:

  • exploitation, neglect, physical abuse, or verbal or emotional abuse; and
  • there is no physical or emotional injury to the alleged victim and no risk of physical or emotional injury or death to the alleged victim.

PI conducts a face-to-face contact with the alleged victim when:

  • the allegation involves an SSLC or state hospital; or
  • the intake alleges sexual abuse. 

If during the course of an investigation PI determines a face-to-face contact with the alleged victim is necessary, PI conducts such contact within the timeline established by the priority of the case.

See Intake Priority for time frames

 

Other Investigation Contacts

PI attempts to contact individuals with direct or circumstantial knowledge of the allegation. The contact may be conducted in person or by telephone with the following:

  • the reporter, if known, in all investigations;
  • the alleged perpetrator, when appropriate; and
  • collateral witnesses.

 

3400 Evidence Analysis

Revision 18-1; Effective September 1, 2018

 

PI analyzes the evidence to reach a preponderance and determine the investigation finding.

 

3500 Investigation Completion

Revision 19-1; Effective July 1, 2019

 

Completion time frames differ depending on the specific facility or provider type and intake priority.


Setting:

Intake Priority:

Completion and approval in…

SSLC

I or II

10 calendar days

State Hospital

I or II

14 calendar days

State Hospital

III

21 calendar days

All other provider types

I, II or III

30 calendar days

 

See related 26 TAC §711.417.

 

3510 Extensions

Revision 19-1; Effective July 1, 2019

 

If additional time is required to complete the investigation, the PI program administrator or designee grants an extension for good cause. Good cause is described as a situation beyond the investigator’s control that prevents the case from being completed on time.  The investigator notifies the service provider of the extension.

See related 26 TAC §711.419.

 

3520 Investigation Status Report and Report Provision

Revision 19-1; Effective July 1, 2019

 

Five-Day Status Report

As a result of the Texas Department of Justice Settlement, PI provides a five-day status report to the provider’s administrator for investigations involving SSLCs and other settings that are considered ICF/IIDs. This updates the provider on the progress of the investigation.

 

Provider Abuse and Neglect Report

PI's Final Abuse and Neglect Report includes the following:

  • a statement of the allegation or allegations;
  • a summary of the investigation;
  • an analysis of the evidence;
  • a finding that the allegation is confirmed, unconfirmed, inconclusive, or unfounded;
  • concerns and recommendations, if any, resulting from the investigation;
  • the name of the designated perpetrator or alleged perpetrator;
  • photographs relevant to the investigation, including photographs showing the existence or the non-existence of injuries, when appropriate; and
  • all witness statements and supporting evidence.

See related 26 TAC §711.603.

 

Investigation Findings

The investigator makes the appropriate findings supported by the preponderance of the evidence.

confirmed

there is a preponderance of credible evidence to support that abuse, neglect, or exploitation occurred.

unconfirmed

there is a preponderance of credible evidence to support that abuse, neglect, or exploitation did not occur.

inconclusive

there is not a preponderance of credible evidence to indicate that abuse, neglect, or exploitation did or did not occur due to lack of witnesses or other available evidence.

unfounded

evidence gathered indicates that the allegation is spurious or patently without factual basis.

 

Designating a Systems Issue

When the preponderance of the evidence establishes that abuse, neglect, or exploitation occurred, the investigator designates a Systems Issue as the designated perpetrator in the IMPACT case management system, if:

  • the provider’s lack of established policy or procedure contributed to the abuse, neglect, or exploitation; or
  • the provider’s established policy is inadequate and fails to ensure the safety of the person receiving services.

See related 26 TAC §711.423.

 

Notification of the Findings

The investigator communicates the results of the investigation by sending the approved PI Facility Abuse and Neglect Report to the provider and, if applicable, the appropriate HHSC Regulatory Services Division program.

If the investigator notifies law enforcement or OIG at any time during the investigation, PI forwards a copy of the Facility Abuse and Neglect Report to that entity.

See related 26 TAC §711.605.

For all providers, the investigator notifies the reporter within five business days of completing the investigation, stating the outcome of the investigation and providing them with information about the appeal process.

In community provider cases, the victim is notified within one business day of completing the investigation, and receives information about the outcome of the investigation and the appeal process. The alleged or designated perpetrator is notified about the outcome of the investigation within one business day of investigation completion.

See related 26 TAC §711.609 and 26 TAC §711.611.

 

3600 PI Does Not Investigate

Revision 19-1; Effective July 1, 2019

 

When all or part of the information reported to PI fails to meet the definition of abuse, neglect, or exploitation, PI forwards the information to the provider, and if applicable, the HHSC Regulatory Services Division program, professional licensing board, or law enforcement.

PI does not investigate:

  • if another program or division of HHSC or another state agency is responsible under state law for the investigation;
  • general complaints such as:
    • rights violations; or
    • daily administrative operations;
  • operational issues related to the business of managed care or consumer directed services;
  • if the allegation involves only the clinical practice of a licensed professional;
  • theft, as defined in Chapter 31 of the Texas Penal Code;
  • allegations of exploitation less than $25.00; or
  • loans made by a person receiving services to a direct provider of a community provider.

See related 26 TAC §711.7.

 

3700 Emergency Services

Revision 19-1; Effective July 1, 2019

 

During an investigation, PI may encounter a situation in which emergency services are needed to immediately protect a person receiving services or other people from serious physical harm or death. In extreme situations, an investigator calls 911 for immediate emergency medical services or law enforcement support. PI coordinates emergency services with DFPS.

DFPS may provide emergency services when the provider and HHSC are unable to respond. Examples of emergency services include:

  • an emergency order for protective services;
  • shelter;
  • medical and psychiatric assessments;
  • medical and psychiatric treatment; and
  • medication, food, and other supplies.

DFPS maintains emergency services until the provider or HHSC provides the required services.

See related 26 TAC Chapter 711, Subchapter F.