Hands N Hands Childcare
4217 CLARK AVE, San Antonio, TX 78223 · Bexar County
Program
- Type
- Licensed center
- Licensed capacity
- 88
- Ages
- Infant, Toddler, Pre-Kindergarten, School
- Hours
- 06:00 AM-06:00 PM
- Director / administrator
- Cassandra Estrada
- Phone
- (210) 600-4116
- Regulated since
- Apr 30, 2019
- HHSC IDs
- Operation 1318541 · number 1682546
- Official record
- HHSC Child Care Search
Violations by category
Year by year
| Year | Violations | Serious | Main categories |
|---|---|---|---|
| 2026 | 2 | 0 | Illness & medication (1), Records & paperwork (1) |
| 2025 | 2 | 1 | Illness & medication (1), Safety & premises (1) |
| 2024 | 6 | 2 | Cleanliness & sanitation (1), Safety & premises (1), Other (4) |
| 2023 | 18 | 3 | Cleanliness & sanitation (3), Illness & medication (3), Supervision & ratios (1), Safety & premises (5), Staff background & training (3), Other (3) |
| 2022 | 8 | 2 | Supervision & ratios (1), Safety & premises (2), Staff background & training (1), Records & paperwork (2), Other (2) |
| 2021 | 1 | 1 | Staff background & training (1) |
Inspections, investigations & assessments
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Sep 22, 2026 Inspection · No deficiencies cited
No violations cited on this visit.
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Aug 22, 2026 Report · No deficiencies cited
No violations cited on this visit.
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Aug 20, 2026 Inspection · No deficiencies cited
No violations cited on this visit.
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Aug 19, 2026 Report · Deficiencies cited
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Records & paperwork
During the course of the investigation, it was determined that infant daily reports were not being shared with parents.
HHSC 746.2431 — Infant Daily Report - Share with Parent
HHSC risk weight: Medium High. Corrected 2026-09-11. Correction verified 2026-09-22.
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Records & paperwork
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Aug 17, 2026 Inspection · Deficiencies cited
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Illness & medication
Two of the four children's immunizations were not updated at the time of inspection.
HHSC 746.613(b) — Immunization Records, Exceptions, and Exemptions Current
HHSC risk weight: Medium High. Corrected 2026-09-17. Correction verified 2026-09-14.
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Illness & medication
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Jun 3, 2026 Inspection · No deficiencies cited
No violations cited on this visit.
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Dec 3, 2025 Inspection · No deficiencies cited
No violations cited on this visit.
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Nov 20, 2025 Inspection · No deficiencies cited
No violations cited on this visit.
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Nov 13, 2025 Inspection · No deficiencies cited
No violations cited on this visit.
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Nov 12, 2025 Report · Deficiencies cited (self-report)
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Safety & premises Serious
Based on the interviews conducted by the staff and parent it was determined a child was dropped off at the wrong elementary school by a daycare driver.
HHSC 746.1205(a)(1) — Responsibilities of Caregivers - Know children responsible for
HHSC risk weight: High. Corrected 2025-11-25. Correction verified 2025-12-03.
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Safety & premises Serious
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Oct 30, 2025 Inspection · Deficiencies cited
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Illness & medication
Three out of five children's files reviewed did not have current immunization records available for review.
HHSC 746.603(a)(4) — Children's Records - Immunizations
HHSC risk weight: Medium. Corrected 2025-11-20. Correction verified 2025-12-23.
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Illness & medication
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Oct 24, 2025 Inspection · No deficiencies cited
No violations cited on this visit.
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Oct 17, 2025 Inspection · No deficiencies cited
No violations cited on this visit.
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Oct 16, 2025 Report · No deficiencies cited (self-report)
No violations cited on this visit.
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Nov 6, 2024 Inspection · Deficiencies cited
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Other
The posted Children's Products Annual Certification was expired. This was corrected at inspection when the Director completed a current form.
HHSC 746.4135(b) — Children's Products- Annual Certification
HHSC risk weight: Medium. Corrected at inspection. Corrected 2024-11-06.
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Other
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Sep 30, 2024 Inspection · No deficiencies cited
No violations cited on this visit.
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Sep 10, 2024 Inspection · Deficiencies cited
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Other Serious
Two caregivers in the toddler rooms did not know the names of the children or ages they were responsible for.
HHSC 746.1205(a)(1) — Responsibilities of Caregivers - Know children responsible for
HHSC risk weight: High. Corrected 2024-09-10. Correction verified 2024-09-30.
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Cleanliness & sanitation
There were five ceiling tiles missing in the operation.
HHSC 746.3407(9) — Floors, ceilings and Walls in Good Repair and Clean
HHSC risk weight: Medium High. Corrected 2024-09-24. Correction verified 2024-09-30.
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Other Serious
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Sep 6, 2024 Report · Deficiencies cited
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Safety & premises Serious
The vehicles used to transport children do not have proper restraints for the age group transporting. Children ages 3 years to 7 years were not secured in a booster seats.
HHSC 746.5607(e) — Safety restraint devices for child used when vehicle is on and during all time vehicle in motion
HHSC risk weight: High. Corrected 2024-09-17. Correction verified 2024-09-30.
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Safety & premises Serious
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Jul 23, 2024 Inspection · No deficiencies cited
No violations cited on this visit.
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Jul 9, 2024 Inspection · Deficiencies cited
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Other
The toddler caregiver was seen on her cell phone during nap time. Note, corrected at inspection after talking to the caregiver and director about no personal cell phone usage while in the classroom.
HHSC 746.1203(3)(D) — Personal use of electronic devices, such as cell phones, MP3 players, tablets, and video games
HHSC risk weight: Medium High. Corrected 2024-07-09. Correction verified 2024-07-23.
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Other
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Jun 14, 2024 Report · No deficiencies cited
No violations cited on this visit.
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Feb 8, 2024 Inspection · No deficiencies cited
No violations cited on this visit.
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Jan 26, 2024 Inspection · Deficiencies cited
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Other
The available health inspection posted was last conducted on 12.1.22.
HHSC 746.3401(a) — Annual Sanitation Inspection
HHSC risk weight: Medium High. Corrected 2024-03-26. Correction verified 2024-03-14.
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Other
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Jan 24, 2024 Report · No deficiencies cited
No violations cited on this visit.
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Nov 13, 2023 Inspection · Deficiencies cited
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Staff background & training
Four of the eight staff files were missing First aid and CPR training.
HHSC 746.1315(a) — Each Caregiver and the Director Must Have Current Training in pediatric first aid with rescue breathing and choking.
HHSC risk weight: Medium High. Corrected 2024-01-01. Correction verified 2023-12-11.
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Staff background & training
One of the two staff transporting didn't have training available for review.
HHSC 746.1316(a) — Transportation Safety Training -Director and Employee Complete 2 Hours Annually
HHSC risk weight: Medium High. Corrected 2023-11-20. Correction verified 2023-11-15.
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Illness & medication
A written, signed and dated medication authorization was not available for review for one child.
HHSC 746.3803(a)(1) — Medication Authorization - Signed and Dated
HHSC risk weight: Medium High. Corrected 2024-01-05. Correction verified 2024-01-08.
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Safety & premises
A written procedure on how to handle transportation emergencies was not available for review.
HHSC 746.5619 — Plan to Handle Transportation Emergencies
HHSC risk weight: Medium High. Corrected 2023-11-20. Correction verified 2023-11-15.
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Illness & medication
One of the eight children files didn't have a current immunization record.
HHSC 746.603(a)(4) — Children's Records - Immunizations
HHSC risk weight: Medium. Corrected 2024-02-01. Correction verified 2024-01-23.
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Safety & premises
Six out of the eight children files were missing special care information. One of the eight children files were missing food allergy information. One of the eight children files were missing emergency authorization care information. One of the eight children files were missing emergency contact address.
HHSC 746.605(13) — Required Admission Information - Special Needs Statement
HHSC risk weight: Medium High. Corrected 2023-11-20. Correction verified 2023-11-15.
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Staff background & training
Five of the eight staff files were missing education qualifications. Three of the eight staff files were missing affidavits.
HHSC 746.901(2) — Required Personnel Records- Meets Requirements
HHSC risk weight: Medium. Corrected 2023-11-20. Correction verified 2023-11-27.
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Staff background & training
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Jul 11, 2023 Inspection · No deficiencies cited
No violations cited on this visit.
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Jun 30, 2023 Inspection · Deficiencies cited
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Other
The school age teacher was unaware of the name of the youngest and oldest of the group. NOTE: This was corrected at inspection when a name to face was conducted.
HHSC 746.1205(a)(3) — Responsibilities of Caregivers - Know children's names and ages
HHSC risk weight: Medium High. Corrected 2023-06-30. Correction verified 2023-07-11.
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Supervision & ratios
The toddler teacher was observed with six children SAG of 12-17 months which made the teacher over by one child. NOTE: This was corrected when the youngest child was moved to the infant classroom.
HHSC 746.1601 — Child/ Caregiver Ratio - 13 or More Children
HHSC risk weight: Medium High. Corrected 2023-06-30. Correction verified 2023-07-11.
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Other
The health inspection was last conducted on 5.12.22.
HHSC 746.3401(a) — Annual Sanitation Inspection
HHSC risk weight: Medium High. Corrected 2023-07-31. Correction verified 2023-08-11.
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Safety & premises Serious
The fire inspection was last conducted on 5.16.22.
HHSC 746.5101(a) — Annual Fire Inspection - Before Initial Permit Issued and Every 12 Months
HHSC risk weight: High. Corrected 2023-07-31. Correction verified 2023-07-25.
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Other
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Jun 23, 2023 Report · No deficiencies cited
No violations cited on this visit.
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Apr 4, 2023 Inspection · Deficiencies cited
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Cleanliness & sanitation
Diaper changing supplies in the toddler and two infant classrooms were observed accessible in the children cubbies. NOTE: This was corrected at inspection.
HHSC 746.3501(6) — Diaper Changing Steps-Supplies Kept Out of Child's Reach
HHSC risk weight: Medium High. Corrected at inspection. Corrected 2023-04-04.
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Cleanliness & sanitation
On the changing table of the toddler classroom a Lysol spray can was observed accessible to the children. In addition to diaper cream on the changing table in the infant classroom. NOTE: This was corrected at inspection when it was removed.
HHSC 746.3701 — Safety - Areas Free From Hazards
HHSC risk weight: Medium High. Corrected at inspection. Corrected 2023-04-04.
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Safety & premises
Documentation for the carbon monoxide, extinguisher and smoke detectors were not documented for January, February and March. NOTE: This was corrected at inspection.
HHSC 746.5537(a)(2) — Electronic or Battery-Operated Carbon Monoxide Detector-Check All Detectors Monthly
HHSC risk weight: Medium High. Corrected at inspection. Corrected 2023-04-04.
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Safety & premises Serious
Emergency medical information for 7 children were not available for review. NOTE: This was corrected at inspection.
HHSC 746.5617(a)(2) — Required Equipment in Vehicles - Emergency Medical Information
HHSC risk weight: High. Corrected at inspection. Corrected 2023-04-04.
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Illness & medication
Two of the eight children did not have shot records available for review. In addition to one of the eight children missing medical authorization information. NOTE: One of the two shot records was provided.
HHSC 746.603(a)(4) — Children's Records - Immunizations
HHSC risk weight: Medium. Corrected 2023-05-04. Correction verified 2023-04-12.
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Cleanliness & sanitation
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Mar 28, 2023 Inspection · No deficiencies cited
No violations cited on this visit.
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Mar 23, 2023 Report · No deficiencies cited
No violations cited on this visit.
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Feb 15, 2023 Report · Deficiencies cited
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Cleanliness & sanitation Serious
Based on the information gathered, and interviews conducted the operation staff did not demonstrate good judgment by not assisting in the basic care with toileting for a child who was partially toilet trained.
HHSC 746.1201(1) — Responsibilities of Employees and Caregivers -Demonstrate Competency, Good Judgment, Self-control
HHSC risk weight: High. Corrected 2023-03-28. Correction verified 2023-04-04.
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Other
Based on the information gathered, and interviews conducted during this investigation parents were not notified in writing within 48 hours about the outbreak of lice.
HHSC 746.307(e) — Parental Notification of Infestation
HHSC risk weight: Medium Low. Corrected 2023-03-28. Correction verified 2023-04-04.
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Cleanliness & sanitation Serious
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Feb 6, 2023 Inspection · No deficiencies cited
No violations cited on this visit.
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Jan 28, 2023 Report · No deficiencies cited
No violations cited on this visit.
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Nov 2, 2022 Inspection · Deficiencies cited
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Safety & premises
Four out of eight children's records reviewed were missing required information including emergency contact information and healthcare provider statements.
HHSC 746.603(a) — Children's Records Maintained
HHSC risk weight: Medium. Corrected 2022-11-16. Correction verified 2022-11-17.
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Records & paperwork
Three out of eight employee records reviewed were missing the required affidavit for employment.
HHSC 746.901(4) — Required Personnel Records - Required Affidavit
HHSC risk weight: Medium Low. Corrected 2022-11-09. Correction verified 2022-11-09.
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Safety & premises
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Aug 30, 2022 Inspection · No deficiencies cited
No violations cited on this visit.
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Aug 25, 2022 Report · No deficiencies cited
No violations cited on this visit.
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Jul 19, 2022 Inspection · No deficiencies cited
No violations cited on this visit.
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Jun 7, 2022 Report · Deficiencies cited
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Staff background & training Serious
During the investigation a caregiver in direct care of children had not received required background check eligibility notifications.
HHSC 745.641 — AP Background check results - Must receive notification prior to allowing subject to be present at your operation
HHSC risk weight: High. Corrected 2022-07-14. Correction verified 2022-07-19.
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Supervision & ratios
Based on the information received parents are not allowed to enter the operation.
HHSC 746.201(7) — Operation Open to Parents At All Times
HHSC risk weight: Medium. Corrected 2022-07-14. Correction verified 2022-07-19.
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Other
Based on the information received, parents were not notified of less serious injuries such as scratches during pick up time.
HHSC 746.307(c) — Parental Notification of Less Serious Injuries
HHSC risk weight: Medium. Corrected 2022-07-14. Correction verified 2022-07-19.
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Staff background & training Serious
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Mar 10, 2022 Inspection · Deficiencies cited
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Other
In the school age classroom a Tv was not anchored. This was corrected at inspection when director removed TV from the classroom.
HHSC 746.3701(9) — Safety - Televisions Anchored to Prevent Tip Over
HHSC risk weight: Medium High. Corrected at inspection. Corrected 2022-03-10.
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Safety & premises Serious
Annual first inspection had not been updated since 10/19/2020.
HHSC 746.5101(a) — Annual Fire Inspection - Before Initial Permit Issued and Every 12 Months
HHSC risk weight: High. Corrected 2022-03-10. Correction verified 2022-03-21.
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Other
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Mar 1, 2022 Assessment · Deficiencies cited
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Records & paperwork
A review of the Employees Who Left Employment in 2021 data from February 23, 2022, revealed that the center had not reported the number of employees who left employment in 2021 by February 22, 2022, as required.
HHSC 746.303(b) — Report Number of Employees
HHSC risk weight: Medium Low. Corrected 2022-03-04. Correction verified 2022-03-07.
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Records & paperwork
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Oct 5, 2021 Inspection · No deficiencies cited
No violations cited on this visit.
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Sep 24, 2021 Report · Deficiencies cited
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Staff background & training Serious
A person was present at the operation without a cleared background check and responsible for children prior to the operation receiving the eligibility letter. NOTE: This has been corrected by caregiver being removed from operation.
HHSC 745.641 — AP Background check results - Must receive notification prior to allowing subject to be present at your operation
HHSC risk weight: High. Corrected 2021-10-21. Correction verified 2021-10-21.
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Staff background & training Serious
Get the full file
HHSC publishes inspections, investigations and assessments from October 2017 onward, with each cited deficiency and its risk weight. Investigation narratives, complaint files and older history require a public information request. The Texas Public Information Act (Texas Government Code Chapter 552) gives anyone the right to ask. You don't have to say why.
Email the request Printable letter (fax or mail)
- Send to
- HHSC Open Records Coordinator, MC-1070 · OpenRecordsRequest@hhs.texas.gov · fax 512-424-6586 · 4601 W. Guadalupe Street, Austin, Texas 78751-3146 · agency instructions
Show the letter text
If something is happening now, report a concern to HHSC Child Care Regulation. For suspected abuse, contact your county child protective services or law enforcement.
Source: Texas Health and Human Services Commission, Child Care Regulation datasets on data.texas.gov. Last read Oct 1, 2026. Violation text is HHSC's own wording. The categories are ours, added to help you scan. About this data.