Who Regulates Assisted Living in California?

California does not have a separate license called assisted living. Large communities and small board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), all hold the same kind of license. Our guide to RCFE vs. assisted living explains the names.

The license comes from the California Department of Social Services. The department's consumer guide describes its Community Care Licensing Division as responsible for the licensing and oversight of primarily non-medical, community-based facilities that care for seniors. The division has regional offices around the state that provide local oversight, and each home is assigned to one of them.

The same guide says the division checks compliance by conducting inspection visits and complaint investigations, requiring staff background checks and reviewing facility records. It also says a license sets the standards a home must meet in providing care and supervision, and that the license must be posted where the public can see it.

Not every senior residence needs a license. California Advocates for Nursing Home Reform notes that senior housing complexes and retirement hotels that provide only housing, housekeeping and meals are not required to be licensed as RCFEs. If a place offers care and supervision, ask to see its license.

Two sets of rules govern these homes. The statute is the part of the California Health and Safety Code that begins at section 1569. The detailed regulations are in Title 22 of the California Code of Regulations, Division 6, Chapter 8. Between them they cover:

• Who may hold a license, and the fire clearance a building needs.
• The administrator's qualifications and the training staff must have.
• Who a home may admit and keep, including health conditions that are restricted or prohibited.
• The basic services every home must provide, such as meals, personal care and observation.
• Residents' personal rights and the content of the admission agreement.
• Inspections, deficiencies, civil penalties and action against a license.

You do not need to read the regulations to choose a home. It helps to know they exist, because a good administrator can tell you which rule applies when you ask about night staff, medications or a health condition. Our guide to staffing requirements explains one of the areas families ask about most.

Health and Safety Code section 1569.33 says every licensed RCFE is subject to unannounced inspections, and that since January 1, 2019 the department is to conduct annual unannounced inspections of all RCFEs. The same section shows that the law allowed longer gaps before 2019: in 2018, for example, a home had to be inspected at least once every two years.

When an inspection finds a problem, the department must notify the home in writing of each deficiency. Under section 1569.33, the home must remedy it within 10 days unless the plan of correction sets a different date. The same section makes inspection reports, lists of deficiencies and plans of correction open to the public, and requires each home to display a poster in its main entryway that tells people where to report a complaint or emergency.

Complaints trigger their own visits. Under section 1569.35, any person may ask for an investigation, orally or in writing. Unless the complaint has no reasonable basis, the department must make an onsite inspection within 10 days of receiving it, and must tell the person who complained what it decided, in writing, within 10 business days of finishing the investigation.

To see what inspectors found at a particular home, follow the steps in how to check an RCFE license.

The Ombudsman program is run through the California Department of Aging, not the licensing agency. The department says Ombudsman representatives help residents of long-term care facilities with problems related to day-to-day care, health, safety and personal preferences. Examples it gives include violations of residents' rights or dignity, poor quality of care, and improper transfer or discharge.

An Ombudsman representative follows the wishes of the resident. The Department of Aging says the services are free, complaints are confidential, and the statewide hotline is answered 24 hours a day, 7 days a week. Every long-term care facility must post the local Ombudsman office's number and the statewide hotline where people can see them.

In short, Community Care Licensing enforces the rules against the home, and the Ombudsman speaks up for the person who lives there. Families often contact both.

A skilled nursing facility is a health facility, and it answers to a different regulator. The comparison below shows the main differences. For the differences in care and cost, see assisted living vs. a nursing home.

If someone is in immediate danger, call 911. Complaints about a licensed home, including concerns about neglect, abuse or unsafe conditions, go to California's Community Care Licensing Division. The Department of Social Services says your name stays anonymous unless you give permission to use it, and that if you believe physical or sexual abuse is involved you should also report it to local law enforcement.

Our guide to complaints about assisted living walks through each step, including raising the issue with the home first.

Hamssa Benrekia is a senior living placement specialist in Torrance who holds an RCFE Administrator Certificate. She refers families only to licensed homes she has toured herself, and she checks a home's public licensing record before suggesting it. She works with families in the South Bay and Harbor area of Los Angeles County, whether they are looking at a large community or a board and care home. For the rest of the decision, see the California Assisted Living Placement Guide, or contact Hamssa to talk through your situation.