For home owners
How do I stay survey-ready when the State is coming?
. By Erika Crossley, AI Perfect Fit Senior Living Placement, Houston.
Survey-ready means the paperwork matches the care. HHSC's own list of the ten most-cited violations for fiscal year 2024 is mostly documentation: service plans finished within 14 days (26 TAC 553.259(b)), yearly registry checks on every employee (553.257(b)(5)), quarterly fire drills on each shift logged on the HHSC form (553.104(d)), medications given and recorded as ordered (553.261(a)(1)(A)), and written abuse or neglect reports filed within five days (553.273(d)). Fix those five binders and you have fixed most of what surveyors cite.
Step by step
Start with HHSC's own list, not a consultant's
HHSC Long-Term Care Regulation publishes a short course on the ten most frequently cited assisted living violations for fiscal year 2024 (posted May 16, 2025). Number one is resident rights, specifically keeping residents free from abuse, neglect and exploitation (26 TAC 553.267(a)(3)(E)(ii)). Numbers two through seven are the five documentation items below plus food labeling. HHSC does not publish how many times each was cited, so no counts appear here.
1. Service plan within 14 days: 26 TAC 553.259(b)
The rule text: within 14 days of admission, a resident comprehensive assessment and an individual service plan for providing care, based on that assessment, must be completed. HHSC's summary of the citation is a home that failed to assess a resident or to develop, approve, sign or follow a service plan within the allowable time. Put the admission date on the front of every resident file and a 14-day due date under it. Then follow the plan you wrote; following it is part of the rule.
2. Yearly registry search on every employee: 26 TAC 553.257(b)(5)
HHSC's summary: the home searched the Nurse Aide Registry and Employee Misconduct Registry when it hired someone and then never searched again. The rule requires the search at least every 12 months for each employee. The companion citation, 553.257(b)(2), is skipping the search before hire. One spreadsheet with every caregiver's hire date, last search date and the printout stapled in the file closes both.
3. Fire drills, each shift, each quarter, on the HHSC form: 26 TAC 553.104(d)
The rule requires one fire drill on each shift every calendar quarter, with at least one drill in every month, documented on the HHSC Fire Drill Report form (HHSC's course names it Form 4719). HHSC's example of the citation is a home that never drilled the 8 p.m. to 8 a.m. shift. The same section requires the fire safety plan to be reviewed yearly, every employee trained on it yearly, and the yearly local fire marshal inspection kept on file.
4. Medications given as the doctor ordered, by someone allowed to give them: 26 TAC 553.261(a)(1)(A)
HHSC's summary: the home failed to ensure a licensed person, or a trained, authorized and delegated person, administered medications according to the physician's orders. The example is a blood pressure pill documented in the record and not given for days. The medication record is the proof; an unsigned box reads as a missed dose. HHSC's September 2026 proposal would require documenting doses given rather than doses missed, so build the habit now.
5. Abuse, neglect or exploitation reported on time: 26 TAC 553.273(d)
HHSC's summary: the home failed to make the oral report or failed to send the written report of its investigation to HHSC when required; the example is a written report not filed within the required five calendar days after a fall was reported. Have the report form, the HHSC number and a blank investigation template in one folder before you need them. Number ten on the list (553.273(b)) is a home that wrote its own abuse policy and then did not follow it, so keep your policy short enough to follow.
The sixth item is the refrigerator
26 TAC 553.261(e)(6), dietary services, is cited when food is not labeled and dated in dry storage and the refrigerator. A roll of masking tape and a marker fixes it the same afternoon.
Know that the rule numbers are about to move
On September 4, 2026 HHSC published a proposal in the Texas Register to reorganize Chapter 553, repealing 553.261, 553.267 and 553.273 and replacing them with new sections, with the earliest adoption date October 4, 2026. The requirements above stay; the citation numbers may change. When the State writes a tag, read the number they used, not the one in your old binder. HHSC's course on writing an acceptable plan of correction is also on the training page.
Sourced facts
Every law, fee and coverage statement above rests on one of these government pages, read on October 7, 2026. Anything marked ESTIMATE on this page is not from a government source and is labeled where it appears.
- HHSC's FY 2024 top ten for assisted living, ranked with each 26 TAC 553 cite. Source: Texas Health and Human Services Commission, Long-Term Care Regulation, Ten Most Frequently Cited Violations in Assisted Living Facilities (ALFs), Fiscal Year 2024.
- HHSC's own one-line description of each of the five documentation citations and the five-calendar-day written report. Source: Texas Health and Human Services Commission, Long-Term Care Regulation, Ten Most Frequently Cited Violations in ALFs, FY 2024: HHSC's summary of each violation.
- Rule text: assessment and service plan completed within 14 days of admission. Source: Texas Secretary of State, Texas Register (26 TAC §553.259(b), in-force text), 26 TAC §553.259 Admission Policies and Procedures, subsection (b) Resident assessment and service plan.
- Rule text: one fire drill per shift per quarter, at least one per month, on the HHSC Fire Drill Report form; yearly plan review and staff training; yearly local fire marshal inspection on file. Source: Texas Secretary of State, Texas Register (26 TAC §553.104, in-force text), 26 TAC §553.104 Safety Operations: local fire marshal inspection, fire safety plan, fire drills.
- HHSC proposes to repeal and renumber parts of Chapter 553; earliest adoption October 4, 2026. Source: Texas Secretary of State, Texas Register, September 4, 2026 issue (51 TexReg 5947 and following), HHSC proposed amendments, repeals and new rules reorganizing 26 TAC Chapter 553.
- HHSC training on writing an acceptable plan of correction for assisted living. Source: Texas Health and Human Services Commission, Long-Term Care Regulation, Writing Acceptable Plans of Correction, Assisted Living Facilities (web-based training).
6 government sources cited on this page.
Questions people ask next
What is the single most-cited violation in Texas assisted living?
For fiscal year 2024 HHSC ranks resident rights first: keeping each resident free from abuse, neglect and exploitation (26 TAC 553.267(a)(3)(E)(ii)). HHSC's examples are a fall with no risk assessment or updated service plan, and an elopement with no supervision plan, so even the number one item comes back to a written plan that was followed.
How often does the State survey a small home?
HHSC does not state a fixed interval on the pages read for this article, and the agency also arrives for complaint investigations. Treat every month as the month before survey; the five binders above are the ones they open first.
Which form do I use for fire drills?
The HHSC form titled Fire Drill Report, which HHSC's course calls Form 4719, or a form that carries at least the same information. The rule requires it for every drill.
How many days do I have to file the written abuse or neglect report?
HHSC's own summary of citation 553.273(d) says the written investigation report is due within five calendar days after the oral report. Make the oral report immediately; the five days run from there.
From Erika
I built a license check into the way I refer families, which means a home with a clean record is a home I can put in front of a discharge planner with a straight face. If yours is one of them, list it and tell me. I am not a lawyer and I do not run a home, so none of this is legal advice; it is what the state's own pages say, linked so you can read them yourself.