If you want to own and operate a senior care facility in California, you must be licensed by the state. This post describes the process for obtaining Residential Care Facility for the Elderly (RCFE) licensure.
What is an RCFE?
RCFEs are unique to California. They provide seniors with care, supervision, and assistance with activities of daily living (ADLs), such as bathing and grooming. RCFEs may also provide incidental medical services under special care plans.
RCFEs may range in size from less than 6 beds to over 100. They may also be known as:
- Assisted living facilities
- Retirement homes
- Board and care homes
This post highlights the essentials of RCFE licensing. For licensing and regulations in other states, see our Regulatory and Licensing Resources by State.
Guide to the Administrator’s License
Anyone can submit an application to complete the necessary licensure testing and paperwork for RCFE operation.
RCFEs are regulated by the Community Care and Licensing Division (CCLD). Their homepage is the place to start for administrator licensing.
Step 1: Read How to Become a Certified Administrator
This document provides links and information about:
- Completing the training
- Taking the exam
- Submitting an application
- Filing for extensions
- Checking your application status
CCLD’s Administrator Certification Program page provides links to forms, fees, and contacts, as well as to newsletters and notices from the ACS (Administrator Certification Section) of the CCLD.
The Administrator Information page houses additional materials, including links to a rubric of core knowledge for administrators and lists of approved vendors for initial and continuing administrator education.
Beginning January 1, 2016, licensure requirements will tighten up under Assembly Bill 601. Specifically, additional training will be required for administrator certification. If you've begun the licensure process, you need to have passed the exam before January 1 in order for 2015 rules to apply. This McKnight's article offers further background on the new bill.
You’ll need to adhere to the timeline for certification and exam registration:
- Register more than 24 hours before a scheduled exam (weekends and holidays not included).
- Register within 30 days of the exam date.
- Take the exam within 60 days of completing your certification training program (ICTP).
Guide to Facility Regulations
Residential facilities in California are governed by the regulations in Title 22, Divisions 2 and 6. Regulations specific to RCFEs are in Chapter 8 of this code, which is broken into four sections on the regulations page:
- Articles 1 through 3: Definitions, forms, and facility licensing and application procedures
- Articles 3 (cont’d) through 6: Operating requirements, physical environment and operations, and criminal background checks
- Articles 6 (cont’d) through 9: Background checks, personnel, resident assessments and fundamental services and rights, and resident records
- Articles 9 (cont’d) through 15: Resident records, food services, health-related services and conditions, dementia, regulations enforcement, administrative action, and certification training programs
Highlights from Title 22Staffing requirements
Staffing requirements are not mandated, except that staff be adequate in number and competent to provide the necessary services.Services
As long as they employ the right personnel, RCFEs can provide certain services such as:
- Hospice services
- Medication administration (performed by skilled professionals employed by the RCFE)
- Incontinence management
- Dementia and memory care
RCFEs can partner with home health agencies to provide services for residents with restricted health conditions, as long as:
- Substantial compliance is maintained overall.
- The home health agency stays informed of duties that other facility staff aren’t allowed to perform.
- Responsibilities of both the RCFE and the home health agency are agreed upon in writing.
RCFEs are allowed to keep residents with a range of health conditions, from managed incontinence to diabetes, to healing wounds, to indwelling catheters, as long as appropriately skilled professionals are employed to administer medication when a resident is unable to administer it themselves and to perform services requiring professional care.Night Supervision
Night supervision must be provided to varying degrees, from 10:00 pm to 6:0 0am, depending on the number of residents in a RCFE:
- Less than 16 residents: One qualified employee on call on the premises.
- 16-100 residents: One qualified employee on duty and awake, with a second employee on call and capable of responding within 10 minutes.
- 101-200 residents: One employee on duty and awake, one on call on the premises, and one on call and capable of responding within 10 minutes.
- Every additional 100 residents, or fraction thereof: One additional employee on duty and awake.
Documents to be maintained at the facility fall into four categories:
- Resident records
- Personnel records
- Administrative records
- Dementia care records
- Memory care regulations and advertising requirements
- California Department of Social Services
- California Health and Human Services Agency
- California Department of Public Health
The California Department of Social Services provides this Guide to Admission Agreements for RCFEs.
This RCFE Regulation Reference Guide outlines admission requirements including pre-appraisal, medical assessment, admission agreements, and mandatory resident involvement.
Access more senior living guides and reports on our Resources page.