Essential Components of Licensing for Congregate Living Health Facilities

Licensing and Oversight

• Licensing Authorities:

  • CDPH licenses and inspects CLHFs to ensure compliance with medical and safety standards.

  • CDSS licenses other types of community care facilities, such as Residential Care Facilities for the Elderly (RCFEs) or Adult Residential Facilities (ARFs), which provide non-medical care.

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• Capacity: Most CLHFs are limited to a maximum of 18 beds, though some facilities operated by a city/county may have up to 59 beds. Facilities with 6 or fewer beds often have different local zoning requirements.

  
  

• Zoning: Facilities with more than six beds may require a conditional use permit from the local city or county. 

  
  

Facility and Safety Standards

• Physical Environment: The facility must maintain a safe, clean, and healthful "noninstitutional, homelike environment".

• Sanitation: There must be at least one toilet and washbasin per six residents and one bathtub or shower per 10 residents.

• Safety: All potential hazards, such as stairways or ramps, must be well-lit and equipped with sturdy hand railings.

• Fire Safety: Facilities must comply with specific fire and life safety codes, potentially including special provisions for locked doors/perimeters if approved by the department. 

Staffing and Care Standards

• Service Provided: CLHFs provide a higher level of care than typical assisted living, focusing on residents who require recurring, intermittent, extended, or continuous skilled nursing care.

• Specialized Services: Facilities must provide at least one specialized service, such as care for the ventilator-dependent, terminally ill (life expectancy of six months or less), or catastrophically/severely disabled individuals needing active rehabilitation.

• Staffing Ratios: Specific minimum staffing ratios are mandated based on facility size and shift:

  • RN/LVN Presence: An RN or LVN must be awake and on duty at all times. An RN is generally required to be on duty for eight hours per day, five days per week.

  • On-Call RN: An on-call RN must be available with a response time of 30 minutes or less when not physically on the premises.

  • CNA/Aide: A Certified Nursing Assistant (CNA) or equivalent must also be on duty in specific ratios (e.g., one per shift for 6 or fewer beds, two per shift for 7-12 beds).

• Training: Staff must receive an orientation of at least 16 hours during their first 40 hours of employment. Staff caring for residents with dementia require additional specialized training. 

Resident Rights and Plans

• Personal Rights: Residents must be advised of their personal rights upon admission, which include dignity, a safe environment, and the right to receive visitors during reasonable hours.

• Individual Services Plan (ISP): An ISP must be developed for each resident by an "Individual Services Team" that includes a registered nurse case manager, the resident's physician, and the resident/representative. 

For detailed regulatory text, operators can refer to the California Department of Public Health website for CLHF requirements or the California Department of Social Services website for information on other facility types and general Title 22 regulations.