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Who Regulates Assisted Living Facilities in California?

Assisted living facilities in California are licensed, monitored and regulated by the State Department of Health and Human Services along with the California Department of Social Services.

The California Department of Public Health inspects properties only once every five years. However, if the facility has frequent complaints or poor inspection results, it will be inspected annually.

According to reports, California has conveniently integrated information about licensed communities and information about violations and inspection results.

The state has generally been transparent with assisted living records, and increased significantly in industry rankings because required inspections occur every two years. Here are few regulations and points to be aware of in California.

Note that each state health department or social services office regulates assisted living communities, sometimes more broadly referred to as “residential care settings.” There are no federal government ratings for these communities.

Assisted living communities are known to provide senior housing, supportive services, personalized assistance with activities of daily living (ADLs), and various levels of healthcare.

Also, most states also regulate residential care homes, also called personal care homes or board and care homes. These typically have a home – like setting and fewer residents than assisted living communities.

Even though there is a national nursing home website to view the audit and licensing history of Medicare – approved nursing homes, no such website exists for assisted living communities. Especially since states — not the federal government — regulate assisted living communities.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency that regulates and provides ratings for nursing homes and skilled nursing facilities — not assisted living communities.

But since the CMS does offer guidance to state Medicaid services regarding rules for facilities that are Medicaid – certified, it includes about half of all assisted living facilities. Assisted living regulations vary by state, and here are few assisted living regulations in California.

Assisted Living Regulations in California

1. Scope of Care

In the State of California, two types of services are provided at assisted living communities: basic services and care and supervision services.

Basic services involve: Personal assistance and care, Observation and supervision, planned activities, Arrangement for obtaining incidental medical and dental care.

Care and supervision involves the following services: Assistance with activities of daily living, such as dressing, bathing, other personal hygiene needs, assistance with self – administering medications and monitoring food intake or adherence to a specialized diet.

In addition, assisted living communities in California are expected to define the scope of services it provides to residents in writing.

2. Admission Requirements

Assisted living communities in California are mandated not to accept any resident who requires any of the following services:

  • Access to 24 – hour skilled nursing care
  • Care for Stage III and IV dermal ulcers (open sores)
  • Care related to gastrostomies, nasogastric tubes or tracheostomies
  • Treatment for a staph infection or any other serious infection
  • Assistance with ALL activities of daily living
  • Assistance because they are bedridden
  • Ongoing care for a communicable disease
  • Care for mental disorder that causes ongoing behaviours that could be upsetting or disruptive for other residents

Residents are expected to direct their own care and may be admitted if they have a licensed third party help them with certain health conditions, such as administering oxygen, catheter care, diabetes complications, dementia or incontinence.

3. Facility Requirements

Assisted living communities in California are not required to provide private apartments for seniors. Arizona may provide residences that are apartment-style or bedrooms which offer single or double – occupancy. But note that every unit is required to have one toilet for every 6 residents with a shower or tub for every 10 residents.

For seniors who have the Assisted Living Facility Waiver, requirements include private occupancy, with shared occupancy only by residents’ choice, and units are expected to have a refrigerator and cooking appliance.

4. Staffing Requirements

Note that all assisted living facilities in California are expected to have a licensed administrator and a designee to be available when the administrator is not present.

Licensed nurses or appropriately skilled professionals can also be hired to offer medication administration or incidental medical services. In terms of ratios, staffing requirements tend to vary based on how many resident reside in a given facility.

Howbeit, for 16 residents or less, there must be staff available in the facility. For 16 – 100 residents, one staff member is expected to be awake.

For 101 – 200 residents, one staff member is expected to be awake with another on call. Additional wake staff are needed for each additional 100 residents.

5. Medicaid Policy

Also note that residents in California may find help with cost coverage through an Assisted Living Waiver available California’s Medicaid program, known as Medi – Cal.

The Medicaid waiver can cover medical and care related services for California seniors who live in an assisted living community, but it does not cover expenses for room & board.

6. Medication Management Regulations

In California, residents may administer their own medication as long as a doctor deems them mentally and physically able to do so.

Note that staff that assist with medication self – administration have to complete coursework, pass an examination and complete hours of training depending on how many residents live in the facility. A nurse, pharmacist or physician must oversee the training and examination.

7. Staff Training Requirements

Administrators in assisted living facilities are expected to complete 40 hours of continuing education every 2 years – with at least 8 of those hours being for Alzheimer’s and dementia care training.

Also note that all personnel at the facility are expected to be trained on the job or have experience in housekeeping and sanitation procedures or skills and knowledge needed to provide care and supervision for residents – which includes safely assisting with prescribed medications and recognizing the early signs of illness.

Do not forget that all staff that assists residents directly with activities of daily living has to receive at least 10 hours of initial training within the first month of employment and at least 4 additional hours each year.

8. Reporting Abuse

There is an online complaint form available through California’s Bureau of Medi – Cal Fraud and Elder Abuse to conveniently and anonymously register concerns about a community.


Choosing the right assisted living facility for yourself or a loved one is one of the most important decisions you will need to make as a senior, and so thorough research of potential facilities is critical.

While state regulations cover many of the same aspects of assisted living, the specifics of the requirements as shown above vary considerably from state to state.