Tips Concerning Survey Expectations For HCS Providers

by | Nov 16, 2025

November 16th, 2025

HCS providers have been contacting Twogether Consulting about certain requirements and/or changes in what surveyors are asking for this year from HCS providers. Below are a few things you should make sure you have completed and/or corrected prior to your survey.  I will try to update this as we receive feedback from providers, provider associations, and even HHSC staff.

Here are some areas surveyors are focusing on:

    1.  Smoke detectors: must be in working order and have working batteries, and they need to have appropriate placement inside each bedroom and “immediately” outside of the bedrooms
      1. (This last part is subject to interpretation, but to be safe we would recommend you have a smoke detector just outside of each bedroom, even if they are in the same hallway)
        1. This goes for Host Homes and Group Homes
      2. In some cases, surveyors have asked providers for their “smoke detector” policy, but I am assuming this is due to the fact that batteries were not being replaced regularly..
        1. We advise making this part of a regular inspection process of the home or scheduling your direct care staff in the home to inspect 1 x a month/qtr, or perhaps if you have maintenance staff or residential/house managers, this might be a part of their responsibilities.
    2. Emergency evacuation plans, policies, and training
      1. Provider must have a current and appropriately updated ER/EVAC Plan. Review and revise at least annually
      2. ER/EVAC policy and procedures
      3. Evidence of training on ER/EVAC plans to staff
      4. Posting of exit routes/egresses
      5. Fire drills:
        1. Must be completed quarterly for both Group Home and Host Home
          1. Group Homes: (1 per shift, per qtr/Q 90 days)
          2. Host Homes: (quarterly).  At least 2 of which must be overnight/when individuals are asleep.
        2. Documentation: For each drill, the facility must maintain a record that includes the date, time, and the name of the staff member who conducted the drill. Copies must be maintained in the home.
        3. Reporting: Providers must complete and maintain the HHSC Fire Drill Report form (4719) for each drill.  Please be sure you are using this form. 
        4. Availability: Records must be provided to HHSC surveyors upon request
        5. Staff training:
          • New staff must participate in a fire drill within 90 days of being hired.
          • Staff must participate in a fire drill at least once per year.
          • The provider must ensure staff can explain the emergency plan for the residence.
          • If a staff member does not follow the emergency plan during a drill, they must receive additional training
    3. Registering with the new emergency communication tool-AlertMedia  ( This also applies to  providers of ICF/IID,TxHmL, HCSSAs and DAHS which includes ISS)
    4. Matresses
      1. In the Group Home or Host Home
      2. Must have a mattress cover
      3. mattress must not be on the floor (needs to be on bed frame)
      4. Any modification (a reason for not having the mattress cover or having an individual sleeping on a matress on the floor) must be discussed with SPT, approved by SPT, and written into the PDP
    5. Adaptive Aids
      1. Are the individuals’ AA’s in the home of the individual requiring them?
      2. Are AA’s in working order?
      3. Has the individual and/or all appropriate staff received training on the AA?
      4. Is there evidence of this training with signatures and inservice sheet or material for any staff trained?
      5. Have they been replaced if the equipment is broken/not working anymore and did you document when that was replaced?
    6. Ensuring that Group Homes have working equipment for taking vitals signs (blood pressure devices, digital thermometer or other device for temps, pulse oximeters for SAO2’s, etc.. specifically for persons with these  “special needs” requiring for them to have regular vitals taken (blood pressure, temperature, oxygen saturation levels, etc.
      1. If you do have someone in the home requiring regular vital checks it might be a good idea to have staff check the equipment regularly (monthly/quarterly) to ensure the items are in the home, working and have working batteries is necessary

 

Note:  Enforcement and Survey are 2 different departments. Enforcement applies the administrative penalties based on scope and severity of the violation.

In addition, please be sure to appeal any violations you do not agree with, including the severity (critical vs non-critical), immediately upon receiving your final report.  You only have 10 days from receiving your final report/ statement of deficiencies to request an informal dispute resolution (IDR).  If you need help with your IDR or Plans of Correction (POC’s), please contact us at: info@twogetherconsulting.com.  We have resources, contractors, and other consultants who can help you.