Trinity Advance Learning Center

Documented Annual Training- Required Content

“Three out of seven personnel files lacked the required 6 topics.”

Rule 746.1309(e). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Nov 3, 2023. Correction verified: Oct 27, 2023.

Screen Time Activities - Not Used for Under Two

“A child under two years old was observed watching television.”

Rule 746.2207(a). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Jul 21, 2023. Correction verified: Aug 1, 2023.

AP Responsibilities of Employees and Caregivers -Ensure No Child Abused, Neglected, or Exploited

“During the course of a DFPS investigation, it was determined that neglectful supervision occurred when a child exited the operation and was observed walking by himself next to a busy intersection. The operation was unaware that he had left his group or the facility until they were notified by an individual who found the child.”

Rule 746.1201(4). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Oct 4, 2023. Correction verified: Oct 16, 2023.

Responsibilities of Caregivers - Share Information with Incoming Caregivers

“Operation staff failed to ensure that they communicated that a child was being moved from one classroom group to another, resulting in a child’s absence from the program being overlooked by staff.”

Rule 746.1203(10). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Oct 4, 2023. Correction verified: Oct 16, 2023.

Screen Time Activities - Not Used for Under Two

“Children in the 18 month- 24 month room were sitting in high chairs watching a tablet while the caregiver changed diapers. Note: This was corrected when the caregiver turned the screen around so children would just be able to listen and not watch the screen.”

Rule 746.2207(a). Medium, by Texas’s label. Corrected during the inspection. Correction date, as Texas HHSC recorded it: Mar 29, 2023.

Responsibilities of Employees and Caregivers -Demonstrate Competency, Good Judgment, Self-control

“A caregiver exercised poor judgement when they failed to seek assistance or notify the parent when an infant in care refused to consume any bottles for an eight-hour period.”

Rule 746.1201(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Apr 19, 2023. Correction verified: Apr 25, 2023.

Basic Requirements for Infants - Prompt Attention to Needs

“A 5-month-old infant physical needs were not meet when the infant did not consume a bottle in an eight-hour period.”

Rule 746.2401(4). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Apr 19, 2023. Correction verified: Apr 25, 2023.

Infant Daily Report - Share with Parent

“An infant daily report was not shared to a parent at the end of the day.”

Rule 746.2431. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Apr 19, 2023. Correction verified: Apr 25, 2023.

Written Feeding Instructions - Signed and Dated by Parent or Health-Care Professional

“Infant feeding instructions were not followed when a caregiver feed a 5 month old infant baby food and also allowing a baby to go 8 hours without a bottle.”

Rule 746.2421(a). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Apr 19, 2023. Correction verified: Apr 25, 2023.

Mark Cleaning Supplies, Toxic Materials; Keep Separate from Food and Inaccessible to Children

“Two classrooms had cleaning supplies accessible to children.”

Rule 746.3407(12). High, by Texas’s label. Corrected during the inspection. Correction date, as Texas HHSC recorded it: Dec 21, 2022.

BGC-persons cannot provide direct care/have direct access to children without all required background checks unless they meet certain criteria.

“A caregiver at the operation did not have the correct background check to be left alone with children unsupervised or be counted in ratio.”

Rule HRC42.056(g). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Dec 21, 2022. Correction verified: Jan 3, 2023.

Training Requirements for Employees and Caregivers - Pre-service Training

“One caregiver lacked 9 hours of professional development.”

Rule 746.1301(2)(A). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 6, 2023. Correction verified: Jan 3, 2023.

Training Requirements for Directors 30- Annual Training

“The director lacked 10.5 hours of annual training.”

Rule 746.1301(6)(A). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 6, 2023. Correction verified: Jan 6, 2023.

CPR Training and Recertification Adhere to Guidelines-skill based

“Nine out of eleven personnel files checked had CPR completed online. CPR must be completed in person .”

Rule 746.1315(b)(1). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 13, 2023. Correction verified: Jan 12, 2023.

Transportation Safety Training -Director and Employee Complete 2 Hours Annually

“The Director lacked current transportation training.”

Rule 746.1316(a). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 2, 2023. Correction verified: Dec 29, 2023.

Safety - Areas Free From Hazards

“On the playground there are nails sticking out of the wood. The playground has wood that has rooted away and has sharp edges. In one classroom there was a bucket of water accessible to children.”

Rule 746.3701. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Dec 21, 2022. Correction verified: Jan 12, 2023.

Required Admission Information - Emergency Contact

“Two out of ten children files were lacking emergency contact address and telephones numbers.”

Rule 746.605(6). Medium High, by Texas’s label. Corrected during the inspection. Correction date, as Texas HHSC recorded it: Dec 21, 2022.

Children’s Records - Health Statement

“Four out ten of files children files lacked the physician statement.”

Rule 746.603(a)(3). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 6, 2023. Correction verified: Jan 12, 2023.

Children’s Records - Immunizations

“Two out of ten children files lacked current and up to date immunization records.”

Rule 746.603(a)(4). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 6, 2023. Correction verified: Jan 12, 2023.

Annual Fire Inspection - Before Initial Permit Issued and Every 12 Months

“The last fire inspection was conducted on 4/30/2021. Note: The fire inspection was scheduled during the inspection.”

Rule 746.5101(a). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 18, 2022. Correction verified: Aug 17, 2022.

Written Operational Policies - Vaccine Preventable Diseases

“The operational policies lacked information regarding vaccines for employees. Note: This was corrected when information regarding vaccines for employees was added to the operational policies.”

Rule 746.501(a)(28). Medium, by Texas’s label. Corrected during the inspection. Correction date, as Texas HHSC recorded it: Aug 16, 2022.

Prohibited Punishments - No Harsh, Cruel or Unusual

“Based on information gathered, caregivers have grabbed children as a form of punishment and tell children to fight each other.”

Rule 746.2805. High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

Prohibited Punishments - Humiliating, Rejecting, Yelling

“Based on information gathered, caregivers have yelled at children as a form of punishment.”

Rule 746.2805(6). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

Prohibited Punishments - Withholding Active Play

“A caregiver admitted to withholding active play for children who continued to misbehave while inside.”

Rule 746.2805(9). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

Infant Daily Report - Share with Parent

“Based on observations and interviews conducted, infant parents are not provided with an infant daily report each day.”

Rule 746.2431. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

Operation Open to Parents At All Times

“Based on evidence gathered, some parents are not allowed inside of their child’s classroom to observe their child. They have been told they have to remain in the foyer area and are not allowed in the classrooms.”

Rule 746.201(7). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

Positive Methods of Discipline and Guidance - Brief Supervised Separation

“A caregiver admitted to making school age children sit in time out for five to fifteen minutes at a time.”

Rule 746.2803(4)(D). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 30, 2022. Correction verified: Sep 13, 2022.

AP Background check results - Must receive notification prior to allowing subject to be present at your operation

“Operation allowed two people to be present at the operation before receiving notice from the CBCU regarding the person’s eligibility.”

Rule 745.641. High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 27, 2022. Correction verified: Jun 29, 2022.

Responsibilities of Caregivers - Supervision of Children

“School age children were observed going to the bathroom, which is located outside of the classroom unsupervised.”

Rule 746.1203(4). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 23, 2022. Correction verified: Jun 29, 2022.

Activities for Infants - Not in Restrictive Device for more than 15 Minutes

“Infants were observed in a high chair for approximately one hour.”

Rule 746.2417(2)(B). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Infant Care Area - Not Used as a Passageway

“An infant classroom is being used as a passageway for older children to get to their room.”

Rule 746.2403(6). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Infant Care Area Furnishings and Equipment -Use of Safety Straps

“Two infants were observed in a high chair and a bumbo. Safety straps were not used.”

Rule 746.2407. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Children’s Products- Review list and Remove unsafe products

“A rock-n-play was observed in the 12m-17m old room. Note: This was corrected when the rock-n-play was removed from the room.”

Rule 746.4135(a). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Written Activity Plan - No Long Waiting Periods

“The school age children and infant 12m-17m old room were observed with an hour waiting period before any activities were completed.”

Rule 746.2205(a)(4). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Notification of Change in Space

“The operation failed to notify licensing of a change of space for infants.”

Rule 746.301(2). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Child/ Caregiver Ratio - 13 or More Children

“Child/caregiver ratio was not maintained as staff were observed walking out of the classroom, leaving the other caregiver out of ratio.”

Rule 746.1601. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 14, 2022. Correction verified: Jun 23, 2022.

Infant Daily Report - Share with Parent

“Infant daily reports are not being completed for the 12m-17 month old room.”

Rule 746.2431. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 15, 2022. Correction verified: Jun 23, 2022.

Written Feeding Instructions - Review and Update Every 30 Days

“Infant monthly feeding schedules were observed not being updated for the month.”

Rule 746.2421(b). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 9, 2022. Correction verified: Mar 7, 2022.