Red flags in an assisted living inspection record
Last updated · Texas data: HHSC roster as of 10/28/2026, TULIP records collected through Oct 30, 2026
Most Texas facilities have a few citations, so a citation by itself isn't a reason to walk away. What matters is what was found, how recently, and whether it keeps happening. Here's what we'd look at first, with how common each pattern is across Texas.
Red flags worth a hard look
1. More than one administrative penalty
A penalty means the state didn't just cite a problem but fined the facility for it. Penalties are uncommon: 276 of 2,012 Texas facilities (13.7%) have any in our data, which covers penalties imposed from Nov 3, 2023 to Oct 29, 2026. Only 60 facilities have two or more, and 11 have three or more. Repeat penalties suggest a problem that wasn't fixed, or a facility with several problems.
2. The same rule in more than one penalty
25 facilities have been penalized more than once under the same section of the rules. That's the clearest public sign of a repeat problem. Texas rules treat repeats seriously too: a second or later violation of the same resident's rights, or of the same right for all residents, can't be cleared just by correcting it (§553.751).
3. Abuse, neglect or exploitation findings
145 Texas facilities have at least one penalty citing the right to be free from abuse, neglect and exploitation (§553.267(a)(3)(E)). This is the most common rule in Texas penalties. Read the TULIP narrative for any facility you're considering that has one. The details vary a lot, from a single incident to a pattern.
4. Staffing penalties
48 facilities have a penalty under the staffing rule (§553.253(c)), which requires enough staff to give each resident the supervision and care they need and to evacuate safely. Staffing problems tend to show up everywhere else too: falls, missed medications, slow responses.
5. Health citations and a penalty
148 facilities have both Health inspection citations and at least one penalty. Health findings are about care rather than the building, so this combination deserves direct questions on your tour.
6. An old visit with no correction date
A visit from months ago that still has no recorded correction is worth asking about. A very recent visit without one usually just means the plan of correction is still in progress.
7. Memory care problems in a memory care unit
If you're choosing memory care, look for penalties under the Alzheimer's unit rules (§553.311 for the physical plant, §553.307 for admission and service plans) and for findings about residents leaving the unit unnoticed.
Things that look worse than they are
- A big Life Safety Code count. 73.9% of Texas citations in our data come from building inspections, and a cited LSC visit averages 5.8 citations. Many are fixable items such as a door closer or an overdue inspection tag. Look at what they were, not just how many.
- Citations at a large building. More residents and more staff mean more to inspect. Compare a 100-bed building with other large buildings, not with a 6-bed home.
- Old, corrected findings. A visit from years ago with everything corrected says less about today than a recent one.
And one thing that looks better than it is
Zero citations. 440 facilities we matched in TULIP show none. That's good, but TULIP mostly shows only the latest cited visit of each type, so it isn't proof of a perfect history. A facility that opened recently, or hasn't been visited in a while, will also show zero.
What to do with a red flag
- Read the narrative in TULIP so you know exactly what happened.
- Ask the facility directly. Use our tour questions.
- Call the local long-term care ombudsman (1-800-252-2412). Ombudsmen are independent advocates for residents, and their help is free and confidential.
- If you see something unsafe, report it to HHSC.
How we got these numbers
"Same rule in more than one penalty" means a facility has at least two penalties that name a rule in the same section of Chapter 553 (for example, two penalties under §553.267). The abuse and neglect count includes penalties citing any part of §553.267(a)(3)(E). The staffing count includes any part of §553.253(c). Because TULIP mostly shows only the latest cited visit of each type, we can't reliably measure repeat citations across years from the citation data, so this guide uses penalties for the repeat-pattern measures. Penalty amounts total $940,444.
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
- 26 TAC §553.751, Administrative penalties (unofficial copy, Cornell LII)
- 26 TAC §553.267, Rights (unofficial copy, Cornell LII)
- 26 TAC §553.253, Employee qualifications and training (unofficial copy, Cornell LII)
- 26 TAC §553.3, Definitions (unofficial copy, Cornell LII)
- TULIP long-term care provider search (HHSC) (official)
- 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.