Texas Assisted Living Compliance: The Complete 2025 Provider Guide

Texas assisted living providers must follow strict regulations to remain licensed and provide safe, high-quality care. In 2025, those rules include both longstanding laws and new updates, especially around memory care, dementia training, and emergency preparedness.

Whether you operate a small residential home or a large memory care community, this complete 2025 guide explains what you need to know. We break down HHSC licensing requirements, staffing, medication rules, inspections, common citations, and how to stay compliant all year long.

Texas’s Regulatory Framework

All assisted living facilities (ALFs) in Texas are licensed and regulated by the Texas Health and Human Services Commission (HHSC) under the Texas Administrative Code (TAC), Title 26, Chapter 553.

? View the full code here

This rulebook covers everything from licensing and staffing to emergency drills and resident rights. It also explains the three types of licenses:

• A: For residents who can evacuate on their own and don’t need regular overnight care.
  
• B: For residents who may need help evacuating or require staff at night.
  
• C: A legacy 4-bed license used for adult foster care homes (no longer issued).
  

Memory care units must be licensed as Type B and get special Alzheimer’s certification if they advertise dementia services.

Getting Licensed in Texas

All ALFs must be licensed by HHSC before admitting residents. The basic steps include:

1. Take the HHSC Pre-Licensure Training
   
2. Submit Form 3720 + fees
   
3. Pass background checks for owners and staff
   
4. Secure fire marshal and building approvals
   
5. Pass a licensing inspection
   

Get the licensing application and training info

Licenses last 3 years, but HHSC can inspect at any time. You must report ownership changes, location changes, or closures. Licenses aren’t transferable.

Key 2025 Updates for Texas ALFs

Texas introduced several important regulatory changes in 2024 and 2025:

• New required dementia training for all staff, even in non-memory care facilities (per HB 1673)
  
• Immediate suspension of employees on the abuse registry (HB 1009)
  
• Disaster registry enrollment required by April 1, 2025 (HB 4611)
  
• Emergency plans must follow updated HHSC standards, including eight core functions
  

These updates are now law. Failing to follow them can result in serious penalties or license suspension.

Staffing Rules and Training Requirements

Texas does not set strict staff-to-resident ratios. Instead, HHSC expects you to:

• Hire enough staff to meet each resident’s needs
• Keep at least one caregiver on-site at all times
• Have awake staff at night in all Type B and large Type A facilities

Required Training

Keep proof of all training and certifications in personnel files. Missing documentation is one of the most common survey citations.

Medication Management and MARs

Texas allows ALFs to:

• Help residents take meds with reminders and supervision
  
• Store meds securely in a locked cabinet or cart
  
• Use RN delegation or med aides for direct administration
  

Key requirements:

• Medications must be labeled and tracked on a Medication Administration Record (MAR)
  
• Staff must record missed or refused doses and PRN use
  
• Expired or discontinued meds must be disposed of by a pharmacist or with proper documentation
  

Want to simplify MAR tracking? Synkwise’s digital MARs include timestamped entries and audit logs to make compliance easier.

Resident Admission and Service Planning

You must assess every resident before or upon admission and develop a personalized service plan. This plan must:

• Match the care provided (ADLs, medication support, mobility, etc.)
  
• Be signed by the resident or their representative
  
• Be updated after any significant change in condition
  

Don’t admit residents whose needs exceed your license type. For example:

• A Type A facility cannot accept someone who needs evacuation help.
  
• A Type B facility cannot care for someone who is permanently bedbound.

Emergency Preparedness and Fire Drills

All ALFs must have a written Emergency Preparedness and Response Plan that covers:

1. Warning and alerts
2. Staff communication
3. Shelter-in-place procedures
4. Evacuation steps
5. Transportation
6. Staffing
7. Supplies and resources
8. Recovery after the emergency

• Conduct fire drills monthly
• Train staff on their emergency roles
• Keep water, food, and power backups available

In 2025, all ALFs must also register with the 211 Texas disaster system and inform families about it.

Resident Rights

Texas residents have the right to:

• Be treated with dignity and respect
  
• Refuse services and make personal choices
  
• Have privacy and personal property
  
• Receive visitors and practice religion
  
• Report concerns without retaliation
  

ALFs must post the Residents’ Bill of Rights and educate all staff about it.

? Download the Texas Assisted Living Resident Rights Guide (PDF)

Inspections, Fines, and Common Violations

HHSC surveys your facility at least every two years. They can also investigate complaints at any time, often unannounced.

Top Violations in 2024–2025:

• Incomplete or outdated service plans
  
• Improper medication storage or MAR errors
  
• Lack of dementia training records
  
• Fire drills not documented
  
• Expired food or medication
  
• Unqualified or unsupervised staff administering meds
  
• Failure to report incidents (like abuse or elopement)
  

Fines range from $500 to $5,000 per violation, and up to $10,000 per day for serious issues like abuse, neglect, or operating without a license.

How Synkwise Helps Texas Providers Stay Compliant

Synkwise gives you compliance peace of mind with tools built for Texas ALFs:

• Digital MARs and service plans
• Drill tracking and emergency plan logs
• Training and credential reminders
• One-click incident report documentation
• Plus more!

? Ready to stay inspection-ready all year? Book a Synkwise demo

Conclusion

Assisted living compliance in Texas isn’t just about passing surveys, it’s about protecting residents and running a high-quality home. In 2025, with new dementia care mandates and emergency preparedness updates, providers must stay sharp and organized.

By understanding license types, following the rules in TAC Chapter 553, and using smart tools like Synkwise, your team can meet every standard with confidence.

References

1. Texas Administrative Code – Title 26, Chapter 553
   Governs licensing, staffing, training, and emergency preparedness for assisted living facilities in Texas.
   ? https://www.law.cornell.edu/regulations/texas/title-26/part-1/chapter-553
2. Texas Health and Safety Code Chapter 247
   Authorizes HHSC oversight of ALFs and outlines provider requirements and resident protections.
   ? https://statutes.capitol.texas.gov/Docs/HS/htm/HS.247.htm
3. HHSC – Assisted Living Facility Licensing Overview
   Explains licensing types, application steps, and compliance responsibilities.
   ? https://www.hhs.texas.gov/providers/long-term-care-providers/assisted-living-facilities-alf
4. Form 3720 – ALF License Application (PDF)
   Official application form to start or renew a licensed assisted living facility in Texas.
   ? https://www.hhs.texas.gov/providers/long-term-care-providers/assisted-living-facilities-alf/how-become-alf-provider
5. Your Rights in an Assisted Living Facility – HHSC Flyer
   State-mandated brochure outlining resident rights in Texas ALFs.
   ? https://www.hhs.texas.gov/sites/default/files/documents/alf-residents-rights-flyer.pdf