Overview of Congregate Living Health Facilities (CLHFs) Regulations

General Rule

• These standards are temporary until permanent regulations are adopted.

• The State Department can grant exceptions (case by case) if health, safety, and quality of patient care are not compromised.

• No exceptions allowed for building standards.

• Requests for exceptions must be in writing with supporting documentation and prior written approval.

  
  

Key Requirements

1. Fire & Safety

• Facilities must obtain and maintain valid fire clearance from the local fire authority.

• The State Fire Marshal sets fire/life safety rules, recognizing that CLHFs are residential, not institutional.

  
  

2. Environment & Living Standards

• Facilities must be in a homelike residential setting with sufficient space, comfort, and privacy.

• Common rooms (living, dining, recreation) are required for activities and visits.

  
  

Bedrooms

• Must allow for wheelchairs, lifts, and easy nursing care.

• No more than two residents per room.

• No rooms like halls, garages, or attics may be used as bedrooms.

• Bedrooms cannot be passageways.

  
  

Bathrooms

• One toilet & sink per 6 residents.

• One bathtub/shower per 10 residents.

• Must provide privacy.

• Separate facilities required for staff.

• Premises must be clean, safe, and well-maintained.

  
  

3. Safety Hazards

• Hazards must be minimized:

- Secure stairways/ramps with lighting and rails.

- Maintain night lights in halls.

- Keep passageways clear.

- Screen fireplaces/heaters.

- Restrict access to pools, ponds, hot tubs, etc.

4. Care Standards

• Facilities must provide equipment, supplies, and staff to meet residents’ routine and specialized needs.

• Must comply with most of Title 22, Division 5, Chapter 3 regulations (with specific exceptions listed).

  
  

5. Staffing & Administration

• Must have an administrator responsible for daily operations.

- Can be an RN, nursing home administrator, or licensee.

- Limits on how many facilities one administrator can oversee.

Nursing Staff Requirements

• Facilities > 6 beds:

- A RN or LVN awake/on duty 24/7.

- RN must be on duty 8 hours/day, 5 days/week.

• Facilities ≤ 6 beds:

- RN visits at least twice a week for 2 hours or more as needed.

• In all cases:

- RN must be available within 30 minutes if not on site.

- Certified Nurse Assistants (CNAs) must be awake/on duty with minimum ratios:

- ≤ 6 beds: 1 per shift.

- 7–12 beds: 2 per shift.

- 13–25 beds: 3 on day/evening, 2 overnight.

- Nursing staff cannot be assigned housekeeping/dietary duties.

Staff Training

• At least 16 hours of orientation in the first 40 hours of work, covering patient care needs.

  
  

Volunteers

• Allowed, but cannot replace required staff.

• Must have training, job descriptions, and performance evaluations.

  
  

Effective Period

• These interim standards remain in place until permanent regulations are filed with the Secretary of State.

  
  

Location & Licensing Rules

General Rule

• CLHFs must be freestanding facilities (independent structures).

• They may be on the same premises as a hospital, but must have their own license.

  
  

Exception – Multiple Facilities in One Building

• Multiple CLHFs can exist in the same multi-floor building if:

- Each facility complies with all other building standards.

- Each facility is separated by permanent walls/floors, though they may share elevators or stairwells.

- The project is supported by the county health department and county board of supervisors.

- The facilities are located in specific McClellan Air Force Base buildings (Nos. 522, 523, 524, or 525 in McClellan, California).

Zoning and Land Use for Congregate Living Health Facilities (CLHFs)

Small Facilities (6 or Fewer Residents)

• Treated as residential property for zoning purposes.

• Cities/counties may apply rules on building height, setbacks, lot size, or signs, but only if those rules are the same as for single-family homes.

  
  

Application of Local Ordinances

• Local governments can still enforce ordinances related to health, safety, building codes, environmental standards, etc., except where explicitly preempted by state law.

  
  

Larger Facilities (More Than 6 Beds)

• Facilities serving the terminally ill or catastrophically/severely disabled are subject to conditional use permit (CUP) requirements of the city/county.

• Exception: If a facility was already operating as a CLHF for the terminally ill at the law’s effective date, and becomes licensed within 18 months, it is exempt from CUP requirements (unless it expands bed capacity).

  
  

Summary

• ≤ 6 beds = residential use (same as a single-family home).

• > 6 beds = must go through local conditional use permits, unless grandfathered in.

• Local governments can still apply general health/safety/building regulations.

  
  

Be sure to stay tuned for Part II -

Here’s a concise summary of that section on Congregate Living Health Facility (CLHF) location requirements.