To operate an adult day care center in Texas, you need a Day Activity and Health Services (DAHS) license issued by the Texas Health and Human Services Commission (HHSC). The license is required under Texas Human Resources Code Chapter 103 for any facility providing daytime supervision, socialization, and health-related services to adults with chronic conditions.1Legal Information Institute. 26 Texas Admin Code 559.205 – Criteria for Licensing Texas adult day care licensing requirements cover the full operation: how you apply, how the building must be built, how many staff must be on the floor, how medications are given, what the daily schedule must include, and what happens when inspectors find problems.
Getting the DAHS License
The licensing process is governed by Texas Administrative Code Title 26, Part 1, Chapter 559, and applies to any provider offering individualized skills and socialization services on-site.2Legal Information Institute. 26 Texas Admin Code 559.201 – Purpose You submit the application through HHSC’s online licensure portal, upload the required documentation, and pay the fee.1Legal Information Institute. 26 Texas Admin Code 559.205 – Criteria for Licensing
Fees depend on term length: $25 for a one-year license, $50 for two years, and $75 for three years.3Legal Information Institute. 26 Texas Admin Code 559.219 – License Fees HHSC uses a staggered expiration system, so terms may vary.
Two inspections sit between you and an active license. First, HHSC performs an on-site life safety code inspection to confirm the building meets physical plant requirements. After the facility admits between one and three clients, you notify HHSC through the portal to schedule the health inspection, which covers operational and care standards. An annual inspection by the local fire marshal is also required, and the report must be uploaded at renewal.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Centers that accept Medicaid funding take on federal compliance requirements on top of the state license.
Facility and Safety Standards
The physical plant is checked at the initial life safety survey and again during later inspections. Standards cover accessible design, lighting, ventilation, temperature control, and overall maintenance. Because participants often have mobility limitations, wheelchair-accessible doorways, hallways, and restrooms are expected under both federal accessibility standards and state construction rules.
Fire safety is central. Working smoke detectors, fire extinguishers, and clearly marked exits are required, along with a written emergency response plan addressing natural disasters, medical crises, and power outages. Fire drills must be run and documented on a regular schedule, and the fire marshal report must be kept current.4Texas Health and Human Services. DAHS Standard Inspection Checklist
If the center prepares meals, the kitchen needs a written sanitation and food preparation program that meets or exceeds state and federal rules, including Texas Administrative Code Chapter 228 (Retail Food) and applicable USDA or FDA standards. The person overseeing food preparation should hold a current certification from a food safety course approved by the Texas Department of State Health Services.5Texas Health and Human Services. Area Agency on Aging Policies and Procedures Manual – F-1800 Food Service Requirements Restrooms need handwashing stations, and staff must follow infection control procedures when handling medical waste or assisting with personal hygiene.
Staffing Ratios, Training, and Background Checks
The staffing floor is one direct service staff member for every eight participants. That ratio must hold during all service hours, with the only exception being facility-provided transportation.6Legal Information Institute. 26 Texas Admin Code 559.61 – Staffing Ratio and Hours Centers with higher-acuity participants often staff above the minimum, but 1:8 is what HHSC enforces.
Everyone with direct participant contact — administrators, care staff, and volunteers — must complete orientation and ongoing training. Required topics include elder care techniques, communication skills, and recognizing signs of abuse or neglect. Training hours must be documented and available for HHSC review during inspections.
Criminal History and Registry Checks
Before offering employment to anyone in a position with direct participant contact, the facility must obtain criminal history information from the Texas Department of Public Safety (DPS).7Texas Health and Human Services. Appendix VIII, Criminal History Check of Employees in Certain Agencies Serving Elderly or Persons with Disabilities Applicants must be told up front that a conviction check is required before any offer. The DPS check can be run online, through a private agency, or by fingerprint submission.
You also have to search the Employee Misconduct Registry (EMR) and the Nurse Aide Registry before hiring, and then again every year. Anyone listed on either registry — people found to have abused, neglected, exploited, or committed misconduct against a resident or consumer — is unemployable at a regulated facility.8Texas Health and Human Services. Employee Misconduct Registry (EMR) The annual recheck matters. A clean record at hire doesn’t mean a clean record a year later.
Medication, Emergency Response, and Infection Control
Every center needs a written emergency plan covering how staff will contact emergency services, notify family members, and document incidents. Staff must be trained to respond to falls, strokes, diabetic emergencies, and similar acute events. The plan should be posted and accessible.
Medication Administration
Medication rules are strict. Only a person holding a current license under state law that authorizes medication administration may give prescription drugs to a participant who cannot or chooses not to self-administer.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications In practice that usually means a licensed nurse or trained medication aide.
All medications administered at the facility must come through a pharmacy or from the participant’s prescribing practitioner. The facility must keep a medication profile for each participant that lists the medication name, strength, dosage, directions, route of administration, prescription number, pharmacy name, and date issued.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications Sample medications are allowed only if prescribed to that specific participant with dosage instructions included.
When a nurse assists with self-administration instead of administering directly, the assistance is limited to reminding the participant to take the medication at the prescribed time, opening containers, pouring the prescribed dosage, and returning medications to locked storage.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications If a participant misses a dose, the facility must document the date, time, and medication name in writing. That paper trail is exactly what HHSC reviews during surveys.
Infection Control
Infection control protocols include routine disinfection of high-contact surfaces, proper disposal of biohazard waste, and isolation procedures when a participant shows symptoms of a contagious illness. Staff follow standard hygiene practices, use personal protective equipment where appropriate, and report outbreaks to local health authorities. Centers should follow current CDC guidance for seasonal flu, COVID-19, and other communicable diseases.
Daily Programming Requirements
A DAHS center is not just supervised sitting. Texas rules require at least three social activities each day, with a monthly activity calendar posted in a visible location at least one week before the scheduled activities.10Legal Information Institute. 26 Texas Admin Code 213.211 – Adult Day Services Activities must address participants’ social needs and interests and can take place at the facility or in the community.
Physical rehabilitative services are required as well, including restorative nursing and both group and individual exercises such as range-of-motion work.10Legal Information Institute. 26 Texas Admin Code 213.211 – Adult Day Services Programs should accommodate varying levels of mobility and cognitive function, including participants with dementia. Common offerings include music therapy, arts and crafts, memory exercises, and light physical activity.
Inspections and What Happens When You Fail One
HHSC conducts both scheduled and unannounced inspections. Surveyors review records, interview staff, observe care practices, and assess the physical environment. Facilities must make all books, records, and electronic documents accessible to HHSC on request, and HHSC may photocopy documents, photograph conditions, and use recording devices to preserve evidence.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Violations are documented as “Not Met” findings on the inspection checklist. When inspectors cite violations, they leave a copy of the checklist with the facility at the exit conference. If more problems are found after that, HHSC holds a follow-up conference identifying each additional standard that wasn’t met.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Administrative Penalties and License Actions
HHSC can impose administrative penalties under Texas Human Resources Code Chapter 103. Amounts depend on severity; publicly posted enforcement actions have ranged from a few hundred dollars to several thousand per facility. If an original penalty goes uncollected, the statute authorizes tripling the amount. Repeated or serious violations can lead to suspension or revocation of the license. Centers receiving Medicaid funding also risk losing that funding stream for noncompliance with federal standards.
Criminal Liability for Abuse or Neglect
Administrative action is not the ceiling. Texas Penal Code Section 22.04 makes it a crime to intentionally, knowingly, recklessly, or with criminal negligence cause bodily injury, serious bodily injury, or serious mental impairment to an elderly individual, defined as someone 65 or older. Penalties scale with intent: causing serious bodily injury intentionally or knowingly is a first-degree felony, acting recklessly drops it to a second-degree felony, and bodily injury caused with criminal negligence is a state jail felony. Facility owners, operators, and employees are specifically addressed in the statute, so “I was just doing my job” is not a defense.
Checking a Facility’s License
If you are evaluating a center rather than opening one, the Texas Long-Term Care Provider Search portal lets anyone look up licensed DAHS facilities, review inspection histories, and see enforcement actions. The portal is accessible through the HHSC website. The HHSC Licensing and Certification Unit can also answer questions at 512-438-2630.11Texas Health and Human Services. Day Activity and Health Services (DAHS) Asking to see the most recent inspection report during a tour is reasonable, and any reputable center will show it.