California's Dementia Care Rules for Assisted Living and Board and Care Homes

Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). The dementia rules sit inside the RCFE regulations, in Title 22 of the California Code of Regulations, Article 12. Section 87705 covers the care of residents diagnosed with dementia. Section 87706 covers homes that advertise dementia care. The Health and Safety Code adds training hours and the rules on secured buildings.

Section 87705 says it applies to residents diagnosed with dementia, and that mild cognitive impairment is not considered dementia. The regulations now define dementia as a general term for major neurocognitive disorder, which includes Alzheimer's disease and related disorders such as vascular dementia, Lewy body dementia and frontotemporal dementia, diagnosed by a licensed medical professional.

For how these rules shape the thing families call memory care, see what memory care means in California.

Under section 87705, a licensee caring for residents diagnosed with dementia is responsible for the following:

• Staff training in dementia care, including hydration, nutrition, skin care, communication, activities, behavior, the environment and help with daily activities.
• Staff training to recognize things that can set off or worsen behavior, such as dehydration, urinary tract infections and swallowing problems, and the effects of medications commonly used to reduce behavior.
• In a home with fewer than 16 residents, at least one night staff person awake and on duty if any resident with dementia is found to need awake night supervision.
• An auditory device or other staff alert on exterior doors and perimeter gates that residents at risk of leaving unsupervised can reach.
• Prior written approval from the resident or conservator before using an egress alert device or a location tracking device.
• A report to the resident's representative and to the licensing agency each time a resident at risk leaves unsupervised, which the regulations call elopement.

Section 87706 applies to licensees who advertise, promote or otherwise hold themselves out as providing special care, programming or environments for residents with dementia. Health and Safety Code section 1569.627 requires such a home to disclose its special features in its plan of operation and to provide that information to the public on request.

A separate statute quoted in the regulation, section 1569.628, requires an accurate written description of the program and services to be given to each prospective resident before admission. The home must also keep copies of its dementia care advertising for at least three years, and give 30 days' written notice to residents and the licensing agency before it stops advertising dementia care.

The plan of operation must describe:

• The program's philosophy and goals.
• Which areas of the building provide dementia care, and which services are specific to residents with dementia.
• The training given to direct care staff.
• The activity program, including mental stimulation, physical activity and reminiscence.
• The physical environment, such as lighting, signs, noise, secured areas and outdoor space.
• What happens when a resident's condition changes, and the conditions that would require a resident to move out.
• How the home reviews whether its program is working.

The California Department of Social Services says the updated package took effect January 1, 2025, and that the earlier rules, last updated in 2004, were more restrictive for people with dementia and were based on a diagnosis instead of a person's individual needs. Its guide to the changes and its August 2025 questions and answers describe these among the main changes:

• New definitions for behavioral expression, elopement, unsafe wandering, major neurocognitive disorder and significant change in condition.
• Removal of provisions that barred a home from accepting or keeping a person whose main need for care came from dementia or an ongoing behavior.
• Removal of the separate yearly medical assessment for residents with a dementia diagnosis. Every resident still needs a medical assessment before admission, a reappraisal at least every 12 months, and a request for a yearly routine medical visit.
• Location tracking devices allowed alongside egress alert devices, with prior written approval.
• A requirement that homes with locked doors or gates keep a signed consent statement or a conservator's court order, and that staff on every shift have, and know how to use, what is needed to open them.
• A requirement to record, in the resident's reappraisal, a behavior that could cause harm, what happened just before it, and the least restrictive response.
• Repeal of section 87707, the old training rule for homes that advertise. Training hours now come from statute, covered in memory care staffing and training.

No. The department's questions and answers state that a person does not need to be admitted to a secured home based only on a dementia diagnosis. Admission should rest on the person's individual needs and whether the home can meet them.

The personal rights regulation still applies: a resident has the right to leave the facility at any time and not to be locked into any room, building or premises. When a home does lock exterior doors or gates, Health and Safety Code section 1569.698 says admission must be voluntary or by the lawful consent of a legal conservator, and a person who is not conserved signs a statement of voluntary entry.

The details of alarms, delayed-egress doors and secured perimeters are in wandering and exit-seeking. Medication rules are in dementia medications in care homes.

Each home also decides for itself what it can manage, so two licensed homes can give different answers about the same person. If a resident is in immediate danger, call 911. The department asks that a resident improperly admitted to or kept in a secured setting be reported to its Community Care Licensing Division, which also takes other complaints about licensed homes.

1. 1

   Ask for the written program description

   A home that advertises dementia care must give it to a prospective resident before admission. Read what it says about staff training, activities and the conditions that would require a move.

2. 2

   Ask how the exits work

   Find out whether doors are alarmed, delayed or locked, and which consent form you would be asked to sign.

3. 3

   Ask about nights

   In a small home, ask whether the night caregiver is awake and how that was decided for the current residents.

4. 4

   Read the public record

   Citations for supervision, training or exits appear in the home's licensing reports. Our guide on how to check an RCFE license shows where to find them.

Hamssa Benrekia is a senior living placement specialist in Torrance who holds an RCFE Administrator Certificate. She helps families in the South Bay and Harbor area of Los Angeles County compare licensed homes for a person living with dementia, and goes on tours with them. To talk about memory care placement, contact Hamssa. The California Assisted Living Placement Guide covers the rest of the decision.