Frequently Asked Questions

LIC 200 - Application for a Community Care Facility or Residential Care Facility for the Elderly License.

This is the Application Form that a prospective RCFE Licensee must complete as part of the process to obtain a license to operate an RCFE. This form requires information about facility location, organization type, facility ownership, property ownership, as well as information about what type of facility the applicant wishes to open (i.e. type of clients served, total number of residents, and whether the clients will be ambulatory, non-ambulatory, etc.).  

After licensure, this form is used to request an increase in capacity, request a change of ownership, or request approval to provide additional services. 
 

If CARR has a scanned LIC 200 for an individual facility, it will be shown as a document icon, identified as LIC200.

To view:  http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC200.pdf

The LIC 203, or more properly LIC 203A, is the License itself.  This document is the evidence from the state that the facility is licensed to provide care and supervision for the stated capacity of the facility, and to provide such additional services as may be stipulated on the document.  The License will be updated by CCL, from time to time, as the facility becomes approved for more or fewer services, changed name, or when there is a change in Licensee.  

CARR refers to this document as "LIC 203",  for ease of standardizing the file names for the scanned documents. 

The LIC 215 – Applicant Information. 

This form is one of the items in the Application package that must be completed and submitted to CCLD as part of the Application process. The form is not a public document, as it contains detailed personal information about the prospective Licensee (i.e. education, work experience, references and financial information).  According to Title 22, CCLD  looks for 'satisfactory evidence that the applicant is of reputable and responsible character'. [Title 22, §87155].

To the best of CARR's understanding this document is retained in CCLD's Confidential File for a specific facility.  

To view:  http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC215.pdf

Licensed facilities are required to have an authorized person continuously present at the facility during operational hours (24/7) to represent the facility and to accept licensing reports. This form is used to designate an authorized person to act in the absence of the Licensee.  The authorized person is required to meet all the qualifications of a licensed administrator as set forth in Title 22 (§ 87405).

To view the actual document, visit the link below:

http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC308.pdf

If a facility's Licensee is a legal entity (corporation, public agency, limited liability corporation, limited liability partnership), the form is required as part of the application process.   

If CARR has a scanned Administrative Organization document in its database for a facility, it will be found as a document icon, identified as MISC-LIC309ORG.

To view the actual document, visit the link below:

http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC309.pdf

Facilities handling residents' cash resources must be bonded for not less than $1,000.  This provision does not apply, however, if the facility handles amounts less than $50 per person or $500 for all persons per month.  Facilities may also choose not to handle residents' cash resources.  Bonding requirements are stipulated in Title 22, §87216.

To view:  http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC400.pdf

The LIC 401 is a form the applicant completes, estimating its monthly expenses and revenues.  The document is used by CCLD to a) verify a facility's operating budget is reasonable, and b) as the basis for the facility to pledge three-months' assets necessary to carry the facility through its first three months of operation.  

if CARR has scanned LIC 401s for any individual facility, the document will be displayed as a document icon, identified as LIC 401.  

  • Food Budget: On this form, you can see how much the Licensee has estimated for food.  Take that monthly number, divide by the number of residents the facility is licensed for.  You now have the monthly food budget for 1 resident.   Divide that number by 3 to estimate the amount per meal the Licensee plans on spending on your resident.

  • Profit:  You can also evaluate the amount of profit the Licensee is projecting by looking at the last line on the LIC 401.

  • In 95% of the files, the only LIC 401 in the file is the one the Licensee submitted with his application.  Annual updates of the LIC 401 are not required, nor collected by CCL.   

 

In most cases, the figures provided by a facility are estimates (actuals are only available if the Licensee operates another facility prior to the opening of the current one under consideration).  

To view the form: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC401.pdf

This form, the LIC 402 - Surety Bond,  is required if a facility chooses to handle residents' cash resources (as reported on Form LIC 400).  It states the name of the bonding company and specific terms of the agreement.  Examples of when a bond is needed are: (1) The Licensee/facility employee cashes a resident's check and returns the money to the client; (2) The Licensee/facility employee keeps a resident's money in a safe place (including a financial institution) and controls its distribution.

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC402.pdf

The LIC 500 form - Personnel Report - Roster of Current Personnel, is intended to record the current roster of all facility personnel, other adults residing in the facility including backup persons and volunteers. 

The purpose of this using this form during the application phase, is to ensure that the facility is adequately planning for the staff coverage necessary to operate the facility in compliance with the regulations. This form lists all planned employee positions, and the days and hours staff are scheduled for duty.  During the application process, many facilities have not yet hired the staff they need, so the placeholder for positions and the designated employee is listed as "to be hired".

CARR's review of the facility files found the LIC 500s are rarely updated following the original date of licensing; 75% of all files reviewed in 2009 contained incomplete reports (Master's Thesis, Murphy,C. 2010).  

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC500.pdf

The LIC501 form is only completed if the administrator is not the Licensee.  It lists the administrator's work experience, education and references for CCLD to review during the application process.  If the administrator is the Licensee, this same information is gathered on the LIC 215 form.   These forms and, therefore, the information on the qualifications of those individuals operating RCFEs, are not considered public documents.

View the document: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC501.pdf

The LIC 503 is required as part of the application process, and is used to verify the health (general well-being, lack of communicable diseases, etc.) of the Licensee and/or administrator, if they are different people.  It is also used within facilities during the hiring process for staff. It requires completion and signature by a physician

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC503.pdf

State law (Health & Safety Code §1569.17) requires that persons associated with licensed facilities be fingerprinted and disclose any convictions. The LIC 508 or LIC 508D, completed during the application and hiring process, asks for any criminal history of Licensees and facility employees.

Criminal Record Clearance requirement for all RCFEs.

To view the actual document, visit the link below:

http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC508.PDF

http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC508D.PDF

Each facility is required to have an annually updated emergency disaster plan. This form should be found prominently posted in every facility near a telephone (a copy is also maintained at CCLD in the facility's file).  This form contains important items such as (1) staff task assignments during an emergency, (2) emergency contact information and exit information, (3) temporary relocation sites and (4) transportation arrangements.  

Prudent consumers may want to confirm the feasibility of the proposed plan. Will the relocation sites truly be able and available to accommodate the resident during a disaster? Is the staffing adequate at all times to evacuate the type of residents served by the facility? Is the transportation reliable and promptly available? 

 

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC610E.PDF

This document is available to RCFEs if they centrally store their medications.

To view the form: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC622.PDF

The LIC 809 or Facility Evaluation Report is the key record of the state's inspection of an RCFE.  The Licensing Program Analyst (LPA) uses this document during site visits to record the compliance of a facility.  

This document can be viewed in conjunction with Compliant Investigation Reports (LIC 9099s) to better inform the consumer about a facility's performance.  Consumers can view these public documents on CARR's website by using the Facility Search, or by filing a request with Community Care Licensing Division (CCLD).

To view the form: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC809.pdf

Before a facility can accept residents,  CCL must obtain a fire clearance for the facility from the local fire inspection authority having jurisdiction in the area the facility is located.  CCL submits the request for an inspection to the cognizant Fire Marshal's office.  The purpose of the inspection is to verify that the physical features of the facility can safely provide for the capacity and ambulatory status of the residents the facility wishes to care for, and also notifies which rooms are approved for non-ambulatory residents. Fire clearances are required prior to obtaining certain types of waivers. 

On this site, if CARR has the Fire Marshal Clearance for a particular facility, it will appear in the Facility Search as an icon identified as  FMC. 

To view the actual document, visit the link below:

http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC9054.pdf

The LIC 9099 or Facility Complaint Report is another key record to be used as evidence of the state's oversight of RCFEs.  Any person can file a complaint with CCLD against a particular Licensee or facility.  CCLD is obliged to initiate investigation of a complaint within 10 working days after the date of complaint filing.

For each specific complaint filed with CCLD, CCLD must make a finding;

  • a complaint can be substantiated,
  • determined inconclusive, or
  • can be deemed unfounded.  

An LPA will find a complaint 'substantiated' if corroborating evidence can be found for the allegation.  If there is conflicting or ambiguous information surrounding a complaint, the complaint is frequently inconclusive.  When little to no corroborating evidence, or when evidence is counter to an allegation, the frequent finding for a complaint is unfounded.  

Substantiated complaints generally include violations of Title 22 regulations, and deficiencies are usually cited as part of the final complaint findings.  

This document can be viewed in conjunction with Facility Evaluation Reports (LIC 809s) to better inform the consumer about a facility's performance.  Consumers can view these public documents on CARR's website by using the Facility Search option or by filing a request with Community Care Licensing Division (CCLD).

To view the form: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC9099.PDF

The LIC 999 - Facility Sketch, provides a sketch of all indoor and outdoor space used by residents. It offers specifics such as room dimensions and purpose (i.e. staff rooms, rooms approved for non-ambulatory residents, etc.), utility shut-off locations, and exit routes. This form is supplied to CCL during the application process and maintained in CCL's facility's file.

If the facility is later remodeled as to room configurations or use, or if the facility is expanded to add square footage, a reviewed LIC 999 is required by the CCL. 

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC999.PDF

LICENSE

Title 22, §87101 (l)(1) and H&SC §1569.2(g) defines  "license" to ". . . mean a basic permit to operate a residential care facility for the elderly."

The license should be posted prominently in every facility, demonstrating Community Care Licensing's (CCLD's) care parameters approved by the state. 

LICENSEE

Title 22, §87101 (l)(3) " 'Licensee' means the individual, firm, partnership, corporation, association, or county having the authority and responsibility for the operation of a licensed facility." 

The Licensee's name appears on each License. 

The Licensee is the individual, partnership or corporation that has the authority and responsibility for the operation of the licensed RCFE.  To become a Licensee, the individual or 'legal entity' must attend the mandatory orientations, and successfully complete the application process.  The License to operate an RCFE is issued in the name of the Licensee. 

According to the regulations, the Licensee may, or may not, act as the administrator of the RCFE.  It is very common in smaller facilities (1-6 bed facilities), for the Licensee to also act as the Administrator.  In larger facilities, an Administrator is usual hired by the Licensee.  The individual serving as the Administrator of an RCFE must meet the educational and experience requirements of Title 22. 

Licensing Program Analysts, or LPAs,  are the employees of Community Care Licensing Division (CCLD)  responsible for licensing, evaluating, and investigating Residential Care Facilities for the Elderly (RCFEs).  They conduct site visits and, in the presence of deficiencies, have the authority to issue citations and civil penalties.

A full description of their duties is available at : http://www.ccld.ca.gov/Res/pdf/LPA-Residential.pdf

Title 22, §87101(s)(2) states that  "'may' means permissive."

 

 Nothing in Title 22  authorizes caregivers to directly administer medications; this task is reserved for appropriately skilled professionals.  Most facilities do not retain appropriately skilled professionals, since Title 22 does not require it.  Therefore, it is imperative consumers clarify with facilities what the facility means when it advertises "Medication Management Services";  does the facility have a nurse on staff to oversee the handling of both prescription and non-prescription drugs?

To directly administer medications (per CARR's recent discussions with CCLD's Sacramento office), is to place the medication in a resident's mouth or, in the case of injections, to fill a syringe and/or inject a resident with medication.  Unlicensed (not appropriately skilled professional) caregivers are not allowed to administer medications.  They are allowed to prepare medications (i.e. dispense and pour).  This preparation is what is meant by "assist with self-administration" in the regulations.  Facilities that provide assistance with medications are responsible for accurately logging dosage and maintaining medical records, and for prompt communications with resident's physician.     

When considering placement, the consumer should consider the ability of the resident  to self-administer medications.  Matching the resident's ability to the competency and capabilities of the facility is critical to be avoid medication errors.

Provided here is Title 22's (§ 87455 & § 87465) guidance and requirements for medication assistance. 

(§87455}

RCFEs are allowed to accept or retain:

  • Persons capable of administering their own medications,
  • Persons who because of forgetfulness or physical limitations need only be reminded or to be assisted to take medication usually prescribed for self-administration,
  • Persons receiving needed medical care from a visiting nurse.

(§87465)

1) Staff designated by the licensee may assist persons with self-administration as needed.  Assistance shall be limited to the following:

  • Medications usually prescribed for self-administration which have been authorized by the person's physician.
  • Medications during an illness determined by a physician to be temporary or minor.
  • Assistance required because of tremor, failing eyesight, and similar conditions.
  • Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's rights to refuse medications.

2) Staff shall be permitted to assist if:

  • the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or non-prescription PRN ("as needed") medication.
  • the resident's physician has stated in writing that the resident is unable to determine his/her own need for PRN medications but can communicate his/her symptoms clearly. Provided there is written direction from the physician, on a prescription blank, specifying all administering information; the medication is given according to the physician's directions; a record of each dose is maintained in the resident's record (including the date and time given, the dosage, and the resident's response).
  • the resident is unable to determine his/her own need for PRN medications, and is unable to communicate symptoms clearly.  Provided staff contact the resident's physician prior to each dose, describe resident's symptoms, and receive direction to assist the resident in self-administering that dose of medication; the date and time of each contact with the physician, the physicians directions, are documented and maintained in resident's record; the date and time the PRN med was taken, dosage, and resident's response recorded.

3) For every PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank maintained in the residents file and a label on medication (both containing specific symptoms to indicate need, exact dosage, minimum number of hours between dosage and maximum number of doses allowed in 24-hour period).

In conversations between CCLD's Duty Worker, and CARR in May 2011, to administer PRN ("as needed") medications, a physician must be contacted prior to each dosage.  Medications administered daily must be given according to the physician's directions which must be reflected on the prescription bottle and in the resident's file (§87465 (c)(2)).  Records of daily medications must be maintained as  well. 

 

There is not a specific regulation stating that RCFEs must centrally store all resident medications. 

According to Title 22 (§87465), "medications shall be centrally stored under the following circumstances: 

1)   Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom the medication is prescribed.

2) The medication requires refrigeration and the resident has no private refrigerator.  Such medication may not be stored in the kitchen refrigerator.  It must be kept in a safe and locked refrigerator that is not accessible to persons other than employees responsible for the supervision of centrally stored medication.

3)  A physician, the administrator, or CCLD determines that because of potential dangers related to the medication itself, or due to the physical arrangements of the facility and the condition or the habits of other persons in the facility the medication must be centrally stored to ensure the safety of residents.

4)  If a facility does centrally store its medication, the following requirements shall be actively in place:

a) The medications are kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of centrally stored medication. 

b) Each and every container shall be maintained in compliance with state and federal laws, be labeled and carry all of the following information:

  • The name of the resident for whom it is prescribed.

  • The name of the prescribing physician (While not required, the physician's phone number is not a bad idea).

  • The name, strength, and quantity of the drug.

  • The date filled.

  • The prescription number and the name of the issuing pharmacy.

  • The instructions, if any, regarding control and custody of the medication.

  • The expiration date and number of refills.

c) Each resident's medications shall be stored in its originally-received container.  No medications shall be transferred between containers, and no persons other than the dispensing pharmacist shall alter a prescription label."

(Please note that while most bottles issued by a pharmacy currently will have all of the above information printed on the label, CARR is informing you of these details should you encounter issues with storage and labeling of medications.)

To verify that all of these safeguards are in place at the facility you are considering, consumers can inquire about the following:

  • Their policy and procedures regarding medications/centrally stored medications;

  • Ask to see their storage units;

  • Possibly ask to preview a sample of their record keeping; (FYI:They might need to redact confidential information prior to your review)

  • Ask about the training and experience of those responsible for administering medications.

  • Review the facility's file for cited deficiencies, or grievances regarding medications (LIC 809s and/or LIC 9099s)

  • And most importantly, follow-up on all of these items consistently while in residence at a facility.  Consider it a good way to avoid the possibility of a medication error.

Morphine is typically prescribed to individuals experiencing chronic or severe pain or those who are terminally ill.   In assisted living facilities, residents prescribed morphine are most often times receiving hospice services.  The intended use of morphine at the end-of-life is to maintain an appropriate level of comfort for the resident. 

Morphine can be administered in many forms.  The same rules that apply to administering other medications in the assisted living setting, apply to morphine.  Most notable is the requirement that residents must be able to self-administer medications or, if unable, medications must be administered by a skilled medical professional only.  For terminally ill residents, self-administration is often times not an option and, as pain can be unpredictable, the absence of an on-site skilled medical professional presents a challenge.  (Hospice nurses do visit residents, but are not available at the facility 24/7 to meet unscheduled needs.)

To address this, Title 22 (§ 87633) allows family members or friends (NOT receiving monetary or any other form of compensation for their services) to administer medications (including morphine) to hospice residents who are unable to self-administer, as long as the following criteria are met:

  • It is written in the hospice care plan.
  • The family  members have been trained by the hospice agency in proper administration.
  • It is recorded in the plan,  that if the family or friend is not available and/or fails to arrive at the appointed time, that a licensed health professional will be made available to attend to the residents needs and administer the medication.

A few other notes on morphine/medications:

Morphine pumps are permissible if:

  • The facility has received a Hospice Care Waiver

  • The hospice resident, hospice health care professional, or other appropriately skilled professional is administering the medication

  • The procedure is specified in the Hospice Care Plan

For medications that need to be pre-drawn into an individual syringe or oral dosing unit, the following shall apply:

  • Only a registered nurse may pre-draw the medication for later administration
  • The pre-drawn medication in the individual syringe or oral dosing unit must be labeled and properly stored
  • Medications may be set up in advance for a period not to exceed 24 hours

When administering lethal medications such as morphine, residents should be closely monitored.  More information about hospice care and morphine may be found here.  

Notes in italics represent the views and/or experience of CARR regarding this topic and/or regulation. 

Anyone can submit an application to CCLD to open an RCFE.

Title 22 stipulates that CCLD needs "evidence satisfactory to the department that the applicant is of reputable and responsible character" (§87155) and that the applicant must meet  and comply with all application requirements (i.e. completed application, attendance at Orientation and other Component reviews,  payment of Licensing fees, etc).