HHSC citations, scope and severity: what Texas actually publishes

Last updated Oct 30, 2026 · Texas data: HHSC roster as of 10/28/2026, TULIP records collected through Oct 30, 2026

If you've looked at nursing home ratings, you may expect every citation to come with a severity grade. Texas assisted living records don't work that way. Here's what the state does define, what it publishes, and how to tell a routine citation from a serious one.

The short version

A citation is a finding that a licensing standard in 26 TAC Chapter 553 wasn't met on a visit.
Texas rules define severity (potential for minimal harm, actual harm, immediate threat) and scope (isolated, pattern, widespread). Those terms decide whether a violation can lead to a fine and whether the facility gets a chance to fix it first.
TULIP, the public record, lists each cited visit's date, type (Health or Life Safety Code) and correction date. It doesn't show a severity or scope level for each citation, and neither do we.
The clearest public sign that the state considered something serious is an administrative penalty, which does name the rules involved.

How Texas defines severity and scope

These definitions come from §553.3 of the assisted living rules. We've paraphrased them closely:

Term	What it means in the rule
Potential for minimal harm	A violation that could cause no more than a minor negative impact on a resident.
Actual harm	A negative outcome that compromises a resident's physical, mental or emotional well-being.
Immediate threat to the health or safety of a resident	A situation that causes, or is likely to cause, serious injury, harm or impairment to a resident, or a resident's death.
Isolated	A very limited number of residents and staff are involved, or the situation happened only occasionally.
Pattern of violation	Repeated failures, not widespread, that are found throughout the facility's services or involve the same residents or employees.
Widespread in scope	A violation that's pervasive throughout the facility's services, or a systemic failure that affects or could affect many residents.

Where severity shows up: penalties

Severity and scope matter most when HHSC decides on an administrative penalty under §553.751. When it sets the amount, the state considers the penalty schedule in the rule, how serious the violation was (including the hazard to residents), the facility's history of violations, deterrence, the facility's efforts to correct, and the size of the facility and its owner.

For most violations, a facility has a right to correct: if it fixes the problem within 45 days of the state's notice, no penalty is assessed. The rule lists exceptions where correcting doesn't avoid the fine. They include:

a pattern of violation, or a widespread violation, that caused actual harm;
a widespread violation with potential for more than minimal harm in certain core areas (such as assessments, staffing, medications, infection control, restraints and emergency preparedness);
a violation that was an immediate threat to residents' health or safety;
a second or later violation of the same resident's rights, or of the same right for all residents, under §553.267;
false statements to the state, refusing an inspection, and retaliation against the state, the ombudsman, or people who complain.

The license holder can consent to a proposed penalty or ask for a hearing. That's why the amounts we show are the amounts imposed, which aren't always what was finally paid.

What the Texas penalty record looks like

In our data, TULIP lists 354 administrative penalties against 276 of 2,012 licensed facilities, imposed between Nov 3, 2023 and Oct 29, 2026. Together they total $940,444. The median penalty is $2,250 and the largest is $9,750.

Rights violations dominate. 173 of the 354 penalties cite §553.267(a)(3)(E)(ii) (residents' rights: the right to be free from abuse, neglect, and exploitation). Because the right-to-correct exceptions include repeat rights violations, abuse, neglect and immediate threats, a penalty tied to these rules is a reasonable signal that the state considered the problem serious. See the most common violations for every rule.

Telling routine from serious without a severity code

Check the visit type. 73.9% of Texas citations in our data come from Life Safety Code visits. Many are fixable building items. Health citations are more likely to involve care.
Look for a penalty. If a visit was followed by an administrative penalty, read which rules it names.
Read the narrative in TULIP. Inspectors describe what they saw. Words like "harm", "injury", "fall", "elopement" or "abuse" tell you more than any count.
Ask the facility. They have the full statement of deficiencies and their plan of correction.

How we got these numbers

Penalty counts, dates, amounts and rule numbers come from the enforcement actions TULIP lists for each facility. A penalty is counted once per rule even if the rule appears twice in the same action. The median and maximum use the imposed amounts. The rule definitions are paraphrased from the current text of 26 TAC §553.3 and §553.751 (the current text is reprinted in brackets in the September 4, 2026 Texas Register notice of HHSC's proposed rewrite).

All counts on this page are computed from the same Texas data that powers the facility pages on Assisted Living Inspections: the HHSC licensed assisted living roster and the inspection citations and enforcement actions published in TULIP. They're recalculated every time the site is rebuilt. Full details are in our methodology.

Sources

Informational only, not medical or legal advice. This guide explains public records and Texas rules in plain language. It isn't a rating of any facility and isn't a substitute for advice from a doctor, lawyer or the state. Rules change. HHSC proposed a broad rewrite of Chapter 553 in September 2026, so check the current rule text before you rely on a specific section number. If something here doesn't match the official record, the official record wins.