California RCFE Resources

Owning and operating one or more RCFEs in California and taking care of the elderly is not only a socially satisfying service but also also a beneficial career option for many entrepreneurs. Here is a collection of resources for Residential Care Facilities For the Elderly (RCFEs) in California – the RCFE 101 Guide.

In California, RCFEs are essentially Assisted Living Facilities providing elder care for seniors above age 60. RCFEs are also known as Board and Care Homes or Group Care Homes or simply Residential Care Homes by the consumers.

Is it necessary to have a License to operate a Residential Care Facility for the Elderly (RCFE) in California?

 California Assisted Living RCFE ServicesYes. In the state of California, it is mandatory to obtain a license from the state to own and operate a RCFE care home.

Who licenses and oversees the RCFEs?

Community Care Licensing Division (CCLD) of California Department of Social Services processes the license approvals and renewals for residential care facilities. For more information take a look at the following link: California RCFE Licensing Information.

Who is an LPA?

LPAs or Licensing Program Analysts 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. Consumers can lodge complaint against facilities by contacting the respective LAs.

Who can open and operate RCFEs in California?

Anyone can submit an application to CCLD to open an RCFE. The regulation states that CCLD needs “evidence satisfactory to the department that the applicant is of reputable and responsible character” 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.

Can a RCFE offer Hospice Services to the terminally ill resident?

Yes, a RCFE can provide hospice related services. However they have to work with a hospice agency and follow the respective guidelines.

Can a RCFE administer medications for the residents?

RCFE can help residents to take medications. By regulation, facility staff are only allowed to assist in self-administration of medications.  If a resident requires someone else to administer medications, that someone must be a skilled medical professional.

When a resident cannot self administer medications, RCFE employed skilled professionals can administer medications.

Who is a Skilled Professional in the RCFE?

According to California RCFE regulations, a skilled professional (aka a licensed professional, or medical professional) refers to a person licensed in California to provide medical care or therapy or to perform necessary medical procedures.  This includes:

  • Physicians / surgeons / physician’s assistants;
  • RNs / LVNs / Nurse practitioners;
  • Physical / occupational / respiratory therapists;
  • Psychiatric technicians, etc.

Each skilled professional must operate within his / her scope of practice.

Is there any specific staffing requirements for Residential Care Facilities for the Elderly?

CCLD regulations in California do not mandate staffing requirements for residential care facilities for the elderly. It states that the facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. However, it is important to meet other regulations (such as RCFE Skilled Professionals, etc) as necessary. Also, it is critical to maintain required documentation on all employees.

Who can take Vital Signs of a resident in a RCFE?

Oxymeter Vital Signs RCFE caregiverAny RCFE staff may take the vital signs of a resident.  However, if the reading is to be used to determine the need for medication, the reading must be taken by a skilled professional, as defined above.

Can Incontinence Services be provided to the residents in RCFEs?

Residential care facilities are permitted to accept or retain residents who have a manageable bowel and/or bladder incontinence condition provided the condition can be managed with any of the following:

(1) Self care by the resident

(2) A structured bowel / bladder retraining program designed by an appropriately skilled professional that assists the resident in restoring a normal pattern of continence

(3) A program of scheduled toileting at regular intervals

(4) The use of incontinent care products

If a facility chooses to provide care for a resident with an incontinence issue, they are responsible for ensuring all of the following:

(1) Residents that would benefit from scheduled toileting are assisted and / or reminded to go to the bathroom at regular intervals rather than being diapered. Note that diapering should be used as a convenience and comfort for the residents, not for the convenience and comfort of the facility staff.

(2) Residents that are incontinent are checked during those periods of time when they are known to be incontinent, including during the night.

(3) Residents that are incontinent must be kept clean and dry and the facility must remain free of odors from incontinence.

(4) Bowel and / or bladder programs are designed by an appropriately skilled professional with training and experience in care of elderly persons with bowel and / or bladder dysfunction and with experience in the development of retraining programs for restoration of normal patterns of continence.

(5) The appropriate skilled professional who developed the incontinence program for the facility provides training to facility staff responsible for implementing the program and must re-assess residents’ conditions and evaluate the effectiveness of the current program.

(6) Privacy is always afforded when incontinence care is provided.

(7) Facilities and their staff are never allowed to withhold fluids to control a resident’s incontinence nor are they allowed to catheterize an incontinent resident for the convenience of staff.

What are the general services that can be provided by RCFE?

RCFEs are required to provide safe and healthful living accommodations and services, regular observation of the resident’s physical and mental condition, three meals per day plus snacks, personal assistance with ADLs, medication management, social and recreational activities, transportation, housekeeping and maintenance.

The services provided by the facility shall be conducted so as to continued and promote, to the extent possible, independence and self-direction for all persons accepted for care.  Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility an in the community. Basic services must be provided to obtain and retain an RCFE license from the state of California CCLD / DSS.

What are the staff requirements for nightly supervision in RCFEs?

Per state regulations, the RCFE licensee must designate the following number of people to assist in caring for elderly residents in the event of an emergency between the hours of 10 pm and 6 am:

  • For facilities with 16 or fewer residents, one employee must be on the premise but need not be awake.
  • For facilities with 16 to 100 residents, a total of two employees must be available.  At least one person shall be on the premises and awake.  Another employee shall be on call, and be capable of responding within 10 minutes.
  • For facilities with 101 to 200, a total of three employees must be available.  One employee must be on the premise and awake.  Another employee on the premise but on call.  And still another, on call and capable of responding within 10 minutes.
  • For every additional 100 residents (or fraction thereof), an additional employee must be on the premise and awake.
  • In facilities that require a signal system, at least one employee must be located to enable an immediate response to the signal.  If the signal system is visual only, this employee must be awake.

What are the city / local regulations to be followed by RCFEs?

RCFEs with six beds and under are not regulated by the city / local authorities at all. These residential care facilities can be located in residential areas and there are no zoning or other specific requirements. However, its is essential to follow and adhere to the fire codes. Also, it is essential to be in touch with the local emergency, police and fire authorities as you may be coming in touch with them.

Can Carevium Assisted Living Software be used by California RCFEs?

Yes. Carevium web based care management software is designed with requirements for California RCFEs in mind. Carevium can be used by RCFE staff, seniors and family members for assessments, care activities scheduling, medication management, progress notes, vital signs tracking, service plan maintenance, billing and reporting purposes. Visit Carevium Assisted Living Software Features and Benefits section to  learn more about Carevium and how it can be leveraged to follow best practices in care management.

What are the resident admission documents?

Documentation must include:

  • Admission Agreement
  • POLST / Physician Order
  • ADL Assessment
  • Health / Medical / Social Assessment
  • Self Medication Assessment
  • Fall Assessment
  • Care / Service Plan

What are the regular operations and resident care documents to be maintained by RCFEs?

Please see the RCFE documentation, forms and reports section for more detailed information.

Ongoing documentation includes:

  • Resident Face Sheets
  • Admission documents and appraisal
  • Periodic Resident Assessments
  • Care Plans
  • Vital Signs Log
  • Medication Administration (MAR) Log
  • Narcotics Inventory Register
  • Medication Returns and Destruction / Disposal Log
  • Care Activities Log
  • Incident Log
  • Resident Appointments Log
  • Employee records including Health Screening and Criminal Record statements
  • Physician Orders
  • Therapy Logs
  • Resident Check-in / Check-out Logs
  • Resident / Responsible Person consent documents for Medical Exam / Emergency
  • Resident Personal Property and Valuables Statement
  • Billing details