The most common assisted living violations in Texas, from state records
Last updated · Texas data: HHSC roster as of 10/28/2026, TULIP records collected through Oct 30, 2026
What do Texas inspectors find most often in assisted living? The public record answers that in two layers. Citations tell you how often and where (building or care). Penalties tell you which rules the state considered serious enough to fine. Here are both, computed from every licensed facility in the state.
Layer 1: citations, building vs. care
Our data has 11,225 citations at 1,569 of 2,012 facilities. The public citation record says which kind of inspection each citation came from, but in the data we collect it doesn't say which rule was broken, so we can't rank individual citation topics. Here's what we can say:
- Most citations are about the building. 8,292 (73.9%) came from Life Safety Code inspections, which cover fire protection, exits, emergency power and similar items. 2,933 (26.1%) came from Health inspections, which cover care and operations.
- LSC visits produce more citations per visit. A cited LSC visit averaged 5.8 citations, compared with 3.6 for a cited Health visit.
- Health citations are common, though. 821 facilities (40.8%) have at least one Health citation on record.
- Most records are recent. 61.8% of cited visits in our data are from 2025 or 2026, because TULIP mostly shows the latest cited visit of each type.
Layer 2: the rules behind every penalty
Administrative penalties do name the rules involved. TULIP lists 354 penalties at 276 facilities, imposed from Nov 3, 2023 to Oct 29, 2026 and totaling $940,444. 314 of them name rules from a single section. The rest name several, so the shares below add up to more than 100%.
| Rule section (26 TAC) | What it covers | Penalties | Share | Median amount |
|---|---|---|---|---|
§553.267 | Residents' rights | 188 | 53.1% | $2,250 |
§553.261 | Coordination of care (medications, infection control, restraints and more) | 58 | 16.4% | $2,850 |
§553.253 | Employee qualifications, training and staffing | 50 | 14.1% | $2,250 |
§553.104 | Safety operations (fire marshal inspections, fire safety plan, drills, hazards) | 17 | 4.8% | $3,750 |
§553.103 | Site and location | 7 | 2% | $3,750 |
§553.259 | Admission policies and procedures | 7 | 2% | $2,350 |
§553.273 | Reporting abuse, neglect or exploitation to HHSC | 7 | 2% | $2,250 |
§553.311 | Physical plant requirements for Alzheimer's units | 7 | 2% | $3,000 |
§553.5 | Types of assisted living facilities | 5 | 1.4% | $3,000 |
§553.143 | Means of egress, existing large Type B facility | 4 | 1.1% | $3,750 |
§553.275 | Emergency preparedness and response | 3 | 0.8% | $3,750 |
§553.123 | Means of escape, existing small Type B facility | 2 | 0.6% | $3,375 |
§553.113 | Means of escape, existing small Type A facility | 1 | 0.3% | $3,000 |
§553.145 | Fire protection systems, existing large Type B facility | 1 | 0.3% | $3,000 |
§553.147 | Mechanical requirements, existing large Type B facility | 1 | 0.3% | $700 |
§553.257 | Human resources | 1 | 0.3% | $7,500 |
§553.307 | Admission, assessment and service plan in an Alzheimer's certified facility or unit | 1 | 0.3% | $625 |
The ten most-cited specific rules
| Rule | What it requires | Penalties |
|---|---|---|
§553.267(a)(3)(E)(ii) | Residents' rights: the right to be free from abuse, neglect, and exploitation | 173 |
§553.253(c)(3)(E) | Staffing: enough staff to make sure each resident gets the supervision and care they need | 24 |
§553.253(c)(3)(F) | Staffing: enough staff to evacuate the building safely in an emergency | 22 |
§553.261(a)(1)(A) | Medications: given only by a licensed nurse, a permitted medication aide, or an RN-delegated, trained employee | 18 |
§553.267(a)(3)(F) | Residents' rights: a safe and decent living environment | 14 |
§553.261(a)(1) | See the rule text | 9 |
§553.261(b)(1)(A) | Accidents and injuries: arrange emergency care or transfer when a resident needs it | 9 |
§553.261(a)(2) | See the rule text | 8 |
§553.104(c) | See the rule text | 7 |
§553.273(b) | See the rule text | 6 |
What stands out
- Abuse and neglect lead by a wide margin. 173 penalties (48.9%) cite
§553.267(a)(3)(E)(ii), a resident's right to be free from abuse, neglect and exploitation. In the current rules, a repeat rights violation can't be avoided by correcting it, which may be one reason this rule shows up so often in fines (§553.751). - Staffing and medications come next. The staffing rule (§553.253) and the coordination-of-care rule (§553.261, which covers medications, accidents and injuries, infection control and restraints) together appear in 108 penalty listings.
- Building rules are rarely fined. Most citations come from Life Safety Code visits, but only 41 penalties (11.6%) name a building, fire-safety or emergency-preparedness section (§553.103–§553.147, §553.275 or §553.311).
Penalties by year
| Year imposed | Penalties | Total imposed |
|---|---|---|
| 2023 | 20 | $56,450 |
| 2024 | 104 | $290,744 |
| 2025 | 87 | $240,100 |
| 2026 | 143 | $353,150 |
TULIP's enforcement list in our data begins on Nov 3, 2023, so the first year is partial, and so is the current year. Year-to-year changes can reflect how the state reports, not just how facilities perform.
Who gets fined
| Group | Facilities | With a penalty | Penalties per 100 facilities |
|---|---|---|---|
| Small (16 beds or fewer) | 1,113 | 8% | 9.2 |
| Large (17 beds or more) | 899 | 20.8% | 28 |
| Type A | 335 | 11.6% | 13.4 |
| Type B | 1,669 | 14.2% | 18.5 |
Large facilities are much more likely to have been fined than small ones. That's partly just scale: more residents, more staff and more complaint visits. It's a reason to compare similar facilities, not a verdict on large ones.
To check a specific place, find it on the Texas pages, then use our red flags guide and tour questions.
A note on rule numbers
The rule numbers above are the ones printed on each penalty, under the Chapter 553 numbering in effect when it was imposed. In September 2026, HHSC proposed a broad rewrite of Chapter 553 that would renumber many sections (the residents' rights rule, for example, would move from §553.267 to §553.287). See the Texas Register notice. If the rewrite is adopted, newer penalties may cite different numbers for the same topics.
How we got these numbers
Citation counts are the Health and Life Safety Code totals TULIP lists for each facility. Penalty counts come from TULIP enforcement actions. Every enforcement action in our data is an administrative penalty. A penalty is counted once per rule section and once per specific rule, even if it repeats a rule. Section descriptions are our plain-language summaries of the official section titles. Specific-rule descriptions are shown only where we checked the rule text. Medians use imposed amounts.
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
- TULIP long-term care provider search (HHSC) (official)
- HHSC: Assisted Living Facilities (ALF) provider page, with links to 26 TAC Chapter 553 and Health and Safety Code Chapter 247 (official)
- Texas Register, Sept. 4, 2026: HHSC proposed rules for 26 TAC Chapter 553 (reprints the current rule text in brackets) (official)
- 26 TAC §553.267, Rights (unofficial copy, Cornell LII)
- 26 TAC §553.253, Employee qualifications and training (unofficial copy, Cornell LII)
- 26 TAC §553.261, Coordination of care (unofficial copy, Cornell LII)
- 26 TAC §553.751, Administrative penalties (unofficial copy, Cornell LII)
- Assisted Living Inspections: methodology and 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.