A step-by-step walkthrough of the HHSC complaint process for a Texas assisted living facility — who to call in San Antonio, what to document, and what regulators actually do with your report.
By San Antonio Senior Advisor Care Team · July 25, 2026
If something is going wrong at your parent's assisted living community in San Antonio, the HHSC complaint process for a Texas assisted living facility is the formal channel that puts a state surveyor on the property. Texas Health and Human Services Commission (HHSC) is the licensing and regulatory agency for assisted living facilities under Texas Health and Safety Code Chapter 247, and it operates a single statewide intake unit — Complaint and Incident Intake, usually shortened to CII — that receives every allegation about a licensed long-term care provider in the state. That means a family in Stone Oak, a daughter in Alamo Heights, and a son calling from out of state about a facility on the far Northwest Side near Helotes all report through the same front door. There is no separate Bexar County licensing board, no city inspector for assisted living, and no municipal complaint route that substitutes for HHSC. Understanding this matters because families frequently waste weeks escalating inside a facility's own corporate chain — executive director, regional director, corporate compliance line — and only later learn that none of those internal steps create a regulatory record or trigger an on-site investigation. Filing with HHSC does both.
The distinction that trips up the most families in San Antonio is where abuse and neglect allegations go. In Texas, if the person is living in an HHSC-licensed setting — an assisted living facility, a nursing facility, or a licensed home health provider — allegations of abuse, neglect, or exploitation are reported to HHSC Complaint and Incident Intake at 1-800-458-9858, not to Adult Protective Services. APS, reached at 1-800-252-5400, investigates adults in the community: someone living at home in Southtown, with a relative on the South Side, or in an unlicensed board-and-care arrangement. Calling the wrong agency does not usually mean your report vanishes — intake staff cross-refer — but it adds days, and in a situation involving an unexplained injury or a medication error, days matter. Know which setting your loved one is in before you dial, and if you are not certain the facility is licensed at all, verify it first at the HHSC public disclosure search at apps.hhs.texas.gov/HSPubDisclosure.
HHSC has jurisdiction over whether a licensed assisted living facility is complying with state licensing standards — the requirements in Chapter 247 and the administrative rules that implement it. Complaints that fall squarely within that jurisdiction include: insufficient staffing to meet residents' assessed needs; medication errors, missed doses, or unlicensed staff administering medications outside what Texas permits; unsanitary conditions, pest problems, or unsafe physical plant issues; failure to follow the resident's service plan; improper involuntary discharge or a 30-day notice that does not meet the rule's requirements; residents left in soiled clothing or bedding; unreported falls or injuries; and a Type B facility accepting or retaining a resident it is not licensed or staffed to serve. That last one matters in San Antonio because the Type A / Type B distinction is the backbone of Texas assisted living licensing — Type A serves residents who can evacuate without physical assistance, Type B serves residents who need staff assistance to evacuate, which is why memory care units operate under Type B. A resident whose condition has advanced past what the license permits is a legitimate and serious complaint.
What HHSC generally will not resolve for you: billing and fee disputes, contract disagreements over deposits or refunds, personality conflicts with staff, food you find unappetizing, and most quality-of-life complaints that do not connect to a licensing standard. Those are real frustrations, but they are civil or consumer matters, and the more productive routes are the facility's grievance process, the Long-Term Care Ombudsman, or in a significant financial dispute, the Texas Attorney General's consumer protection division or a private attorney. Families sometimes bundle everything into one complaint — a genuine neglect allegation buried in six paragraphs about the dining room. Separate them. Lead with the licensing violation, be concrete about it, and route the rest to the ombudsman, who is far better equipped to negotiate the day-to-day issues that regulation does not reach.
There are three ways to file. By phone, call HHSC Complaint and Incident Intake at 1-800-458-9858; the line takes reports about licensed long-term care providers statewide and is the fastest route for anything involving immediate risk. Online, use the complaint submission portal on the HHSC website at hhs.texas.gov, which lets you attach documents — useful if you have photographs, a care-plan copy, or written correspondence with the facility. By mail, HHSC accepts written complaints, though this is the slowest path and is rarely the right choice for anything urgent. You do not need an attorney, you do not need the facility's permission, and you do not need to be the resident's legal representative. Anyone with knowledge of the situation can file — a family member, a friend, a visiting hospice nurse, a former employee. You may file anonymously, though intake staff cannot call you back for clarifying details if you do, which occasionally weakens an otherwise strong report. If you are worried about retaliation, note that Chapter 247 contains anti-retaliation protections; consider giving your name to HHSC while asking that it not be released to the facility.
Before you call, spend twenty minutes building the record, because the quality of your report shapes the quality of the investigation. Write down the facility's full legal name and street address as it appears on the license, not the marketing name on the sign — many San Antonio communities operate under a corporate entity name that differs from their brand. Collect specific dates and times rather than 'a few weeks ago.' Note the names or shift descriptions of staff involved. Photograph visible conditions if you can do so without violating other residents' privacy. Keep copies of the service plan, the residency agreement, medication administration records if you have access, and any written notice the facility gave you. If your parent went to Methodist Hospital, Baptist Medical Center, University Hospital, or Christus Santa Rosa because of the incident, get the discharge summary — an emergency department record documenting dehydration, a fracture, or a pressure injury is among the most persuasive evidence a complainant can hand a surveyor. Then describe what happened chronologically and plainly, with no editorializing. Surveyors respond to facts and dates.
Once intake accepts your report, HHSC assigns it a priority based on the severity of the alleged harm and the risk to residents. Allegations suggesting an immediate threat to health or safety are investigated most urgently — typically within about 24 hours — while lower-severity allegations are scheduled out further, sometimes several weeks. The investigation itself is unannounced. A surveyor arrives on site without warning, reviews records, observes care, interviews residents and staff, and may tour areas of the building unrelated to your specific allegation, because once a surveyor is inside, anything observed can be cited. This is why a complaint about one resident's care sometimes produces citations touching medication storage, fire drills, or staff training records. Expect that you may be interviewed as well, either by phone before the visit or afterward.
After the investigation closes, HHSC notifies the complainant of the outcome if you provided contact information: the allegation is confirmed, unconfirmed, or unable to be determined. 'Unconfirmed' does not necessarily mean nothing happened — it often means the surveyor could not substantiate it to the evidentiary standard the agency applies, which is a real limitation of any records-and-interviews investigation weeks after the fact. If violations are cited, the facility receives a statement of deficiencies and must submit a plan of correction with deadlines; HHSC can also impose administrative penalties, require directed training, or in the most serious cases move toward license revocation or emergency suspension. Survey and complaint history is public. You can pull the record for any Texas assisted living facility at apps.hhs.texas.gov/HSPubDisclosure — search by facility name or county — which is also how prospective families in Bexar, Comal, Guadalupe, and Kendall counties should be vetting communities long before there is anything to complain about.
San Antonio families have a second resource that works differently and, in many situations, faster: the Long-Term Care Ombudsman. Ombudsmen are resident advocates, not regulators. They do not issue citations, but they visit facilities regularly, know the administrators, and can often resolve a problem in a phone call that would take HHSC six weeks to formally investigate. In the San Antonio region the ombudsman program is housed at the Alamo Area Council of Governments, the federally designated Area Agency on Aging for Bexar and the surrounding counties — aacog.com, (210) 362-5200. There is also a statewide ombudsman line at 1-800-252-2412. Ombudsman services are free, confidential, and available to any resident of a licensed assisted living facility or nursing facility regardless of income or how care is paid for. Critically, the ombudsman works at the direction of the resident: they will not take an action the resident does not consent to, which sometimes frustrates adult children but is exactly the protection an older adult with intact capacity is entitled to.
The right strategy in most cases is both, not either. Use the ombudsman for the problems that need negotiation — a roommate conflict, a service plan that no longer matches your mother's needs, a facility pressuring a family toward discharge, a care conference that keeps getting postponed. Use HHSC for the problems that need a regulator — injury, neglect, medication error, staffing that is plainly inadequate, retaliation. Filing with HHSC does not close the ombudsman's door, and involving the ombudsman does not weaken your complaint. For Spanish-speaking families, which is a substantial share of San Antonio given the city's roughly 65% Hispanic population, both AACOG and HHSC intake can accommodate Spanish; you can say plainly, 'Necesito ayuda en español' when you call, and you may request an interpreter for a surveyor interview. Do not let a language barrier be the reason a legitimate complaint goes unfiled — no puede ser la razón por la que no se presenta una queja legítima.
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