A Study of the CLHF Regulations Part I

We have compiled the regulations and provide the following overview:

Here’s a plain-language summary of the section you provided on Congregate Living Health Facilities (CLHFs) in California.

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, 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 regs (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.

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

Location & Licensing Rules

1. 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.

2. 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).

       Here’s a clear summary of that section on zoning and land use for Congregate Living Health Facilities (CLHFs):

       Zoning & Local Regulation Rules

       1. 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.

       2. 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.

       3. 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).

       ✅ In short:

       • ≤ 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 -