The Pre-Admission Appraisal and Resident Appraisal Forms, Explained

Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). Title 22, section 87457, requires a home to interview the prospective resident and the responsible person before admission, and to complete an appraisal of the person's individual service needs measured against the state's limits on who a home may accept and keep.

The regulation names what the appraisal must document at a minimum: an evaluation of functional capabilities, mental condition and social factors, and whether the person's own safety or other residents' safety would be at risk if the person had access to certain items the home must otherwise store safely.

It is a different document from the medical assessment. Both state appraisal forms say so in their first lines. For the doctor's form, see the physician's report form explained. For the rules behind both, see the care assessment.

The California Department of Social Services posts two appraisal forms that are nearly the same. Their numbers, titles and revision dates below are as we read them on October 13, 2026.

A home is not limited to these. Both forms predate the regulation changes that took effect on January 1, 2025. They do not have a line for the access-to-items question, and the 1999 form still prints a note about bedridden residents that is older than the current regulation. In May 2025 the department told homes that some posted forms may need updating and encouraged them to use an addendum in the meantime. So an extra page, or a home's own longer form, is normal.

The Resident Appraisal is two pages. A note at the top says the information may be obtained from the prospective resident or the responsible person. The first page is written answers and the second is checklists:

• Health: overall condition, including any dietary limits.
• Physical disabilities: any physical limits, including vision, hearing or speech.
• Mental condition: the extent of any confusion or forgetfulness, and whether the person is socially active or withdrawn.
• Health history: current prescribed medications, major illnesses, surgery and accidents, and any hospital stays in the last five years.
• Social factors: likes and dislikes, interests and activities.
• Bed status: out of bed all day, in bed part of the time, or in bed most or all of the time.
• Tuberculosis information: family history, date and type of test, the result, and any recent exposure.
• Ambulatory status: four yes or no questions about walking without help, following evacuation signals and instructions, using the exit routes including stairs, and getting out reasonably quickly.
• Functional capabilities: stairs, a brace or crutch, a walker or wheelchair and whether the person can get in and out of it unassisted, and whether grab bars are needed.
• Services needed: sixteen lines, from help with transferring, bathing, dressing, eating, toileting and continence to help with medication, night supervision because of confusion or wandering, managing cash, and joining activities.

The form ends with a printed statement that, to the best of the signer's knowledge, the person does not need skilled nursing care. The applicant or responsible person signs and dates it, and so does the licensee or the licensee's designated representative.

The regulation says the prospective resident, or the responsible person, shall be involved in developing the appraisal. The interview is carried out by the licensee or the employee responsible for admissions. Homes often do it during a visit to the person at home, in the hospital or in a rehabilitation facility, or when you tour.

If a placement agency or consultant has already completed a needs assessment, the regulation says the home is to obtain it and include it in its own appraisal. The home also draws on the medical assessment, which must contain information that applies to the appraisal.

The form relies on what you tell the home. Describe an ordinary week, including nights. A home that has an accurate picture can say honestly whether it is able to meet those needs, and that answer is the point of the exercise.

The regulation covers this directly. If an appraisal identifies a service need that the home's general program does not meet, the home must get advice from a physician, social worker or other appropriate consultant on whether it can meet that need. If it can, the home and the consultant write a plan of action.

The state's form for that plan is LIC 625 (10/24), Appraisal/Needs and Services Plan. It is a grid. For each need, the home writes the objective or plan, the time frame, the person responsible and how progress will be judged. The form groups needs under five headings: socialization, emotional, mental, physical and health, and functioning skills. It has a signature line for the resident or authorized representative, who confirms taking part in the assessment.

The state forms have no score and no price. The regulations say what must be appraised and leave pricing to each home. Many homes use their own assessment tool that assigns points or a tier for each kind of help, and the tier sets the monthly care fee.

Two rules give you a way to follow the arithmetic. The admission agreement must list the rate for basic services and a fee schedule for anything charged separately. And the personal rights form lists a resident's right to receive, in the admission agreement, a comprehensive description of the method for evaluating residents' service needs. Ask to see your parent's appraisal next to that description.

The appraisal does not stay fixed. Section 87463 requires it to be updated in writing as often as necessary, and at least once every 12 months, to note significant changes in condition. The home must share each reappraisal with the resident and the representative in a meeting or call, and must look at whether it has enough direct care staff for the needs in the current appraisal. A reappraisal can change the care level. Our guide to rate increases explains the notice a home must give when it does.

Hamssa Benrekia is a senior living placement specialist in Torrance. Her work with a family starts with a conversation about care needs, health conditions, preferences and monthly budget, which helps you describe those needs the same way to every home. She then suggests licensed homes in the South Bay and Harbor area of Los Angeles County that may fit, whether a small board and care home or a memory care home, and goes on tours with you. Each home still writes its own appraisal.

To talk it through, contact Hamssa. To see where this form sits among the others, read the state forms families see, or go to the California Assisted Living Placement Guide.