Article 3. Licensure of California Health And Safety Code >> Division 2. >> Chapter 3.3. >> Article 3.
No person or public agency within this state shall provide
adult day health care in this state, without first obtaining a
license therefor as provided in this chapter.
(a) (1) Each applicant for a license to operate an adult
day health care center shall disclose to the department the name and
business address of each general partner if the applicant is a
partnership, or each director and officer if the applicant is a
corporation, and each person having a beneficial ownership or control
interest of 5 percent or more in the applicant corporation, company,
(2) If any person described in paragraph (1) has served or
currently serves as an administrator, general partner, trustee or
trust applicant, sole proprietor of any applicant or licensee who is
a sole proprietor, executor, or corporate officer or director of, or
has held a beneficial ownership or control interest of 5 percent or
more in, any health facility as defined in Section 1250, adult day
health care center, residential care facility for the elderly, home
health agency, clinic, or community care facility licensed pursuant
to Chapter 3 (commencing with Section 1500), the applicant shall
disclose the relationship to the department, including the name and
current or last address of the health facility, adult day health care
center, residential care facility for the elderly, home health
agency, clinic, or community care facility and the date the
relationship commenced and, if applicable, the date it was
(3) (A) If the center is operated by, or proposed to be operated
in whole or in part under, a management contract, the names and
addresses of any person or organization, or both, having an ownership
or control interest of 5 percent or more in the management company
shall be disclosed to the department.
(B) This paragraph shall not apply if the management company has
submitted an application for licensure with the department and has
complied with paragraph (1).
(4) If the applicant or licensee is a subsidiary of another
organization, the information shall include the names and addresses
of the parent organization of the subsidiary and the names and
addresses of any officer or director of the parent organization.
(b) The information required by subdivision (a) shall be provided
to the department upon initial application for licensure, and upon
payment of the annual renewal licensure fee.
(c) Failure to comply with subdivision (a) or (b) may result in
action to revoke or deny a license. The information required by
subdivisions (a) and (b) shall be made available to the public upon
request, and shall be included in the public file of the center.
(d) On or after January 1, 2002, no person may acquire a
beneficial or control interest of 5 percent or more in any
corporation, company, or partnership licensed to operate an adult day
health care center or in any management company under contract with
a licensee of an adult day health care center, nor may any person
become an officer or director of, or a general partner in, a
corporation, partnership, or management company of this type without
the prior written approval of the department. Each application for
departmental approval pursuant to this subdivision shall include the
information specified in subdivision (a) with regard to the person
for whom the application is made.
(e) The department may deny approval of a license application or
of an application for approval under subdivision (d) or revoke a
license if a person named in the application, as required by this
section, was suspended as a Medi-Cal provider or excluded as a
medicaid or Medicare provider, was an officer, director, general
partner, or owner of a 5 percent or greater beneficial or control
interest in a licensee of, or in a management company under contract
with a licensee of, a health facility, community care facility,
residential care facility for the elderly, home health agency,
clinic, or adult day health care center at a time when one or more
violations of law were committed therein that resulted in suspension
or revocation of its license, or at a time when a court-ordered
receiver was appointed pursuant to Section 1327, or at a time when a
final medicaid decertification action was taken under federal law.
However, the prior suspension, revocation, or court-ordered
receivership of a license shall not be grounds for denial of the
application if the applicant shows to the satisfaction of the
department that both of the following conditions exist:
(1) The person in question took every reasonably available action
to prevent the violation or violations that resulted in the
(2) The person in question took every reasonably available action
to correct the violation or violations once he or she knew, or with
the exercise of reasonable diligence should have known, of the
violation or violations.
(f) No application shall be denied pursuant to this section until
the department provides the applicant with notice in writing of
grounds for the proposed denial of application and affords the
applicant an opportunity to submit additional documentary evidence in
opposition to the proposed denial.
(g) This section shall not apply to a bank, trust company,
financial institution, title insurer, controlled escrow company, or
underwritten title company to which a license is issued in a
An applicant for initial licensure as an adult day health
care center shall file with the department, pursuant to its
regulations, an application on forms furnished by the department,
that shall include, but not be limited to, the following:
(a) Evidence satisfactory to the department that the applicant,
its directors, officers, and the person designated to manage the
day-to-day affairs of the proposed adult day health care center are
of reputable and responsible character.
(b) Evidence satisfactory to the department of the ability of the
applicant to comply with the provisions of this chapter and of rules
and regulations adopted pursuant thereto by the department.
(c) Evidence satisfactory to the department that the applicant for
a license to operate an adult day health care center possesses
financial resources sufficient to operate each licensed center for a
period of not less than 30 calendar days and that these resources are
identified for adult day health care center operations. The
financial reserve requirements may be met, in whole or in part, by a
line of credit or a loan.
(d) Any other information as may be required by the department for
the proper administration and enforcement of this chapter.
(a) If an adult day health care center or an applicant for
a license has not been previously licensed, the department may only
issue a provisional license to the center as provided in this
(b) A provisional license to operate an adult day health care
center shall expire one year from the date of issuance, or at an
earlier time as determined by the department at the time of issuance.
(c) Within 30 days prior to the expiration of a provisional
license, the department shall give the adult day health care center a
full and complete inspection, and, if the adult day health care
center meets all applicable requirements for licensure, a regular
license shall be issued. If the adult day health care center does not
meet the requirements for licensure but has made substantial
progress towards meeting the requirements, as determined by the
department, the initial provisional license shall be renewed for six
(d) If the department determines that there has not been
substantial progress towards meeting licensure requirements at the
time of the first full inspection provided by this section, or, if
the department determines upon its inspection made within 30 days
prior to the termination of a renewed provisional license that there
is lack of full compliance with the requirements, no further license
shall be issued.
(e) If an applicant for a provisional license to operate an adult
day health care center has been denied a license, the applicant may
contest the denial by requesting an adjudicative hearing. The
proceedings to review the denial shall be conducted pursuant to
(f) The department shall not apply less stringent criteria when
issuing a provisional license pursuant to this section than it
applies when issuing a regular license.
(a) The department may issue a provisional license to an
adult day health care center if all of the following conditions are
(1) The adult day health care center and the applicant for
licensure substantially meet the standards specified by this chapter
and regulations adopted pursuant to this chapter.
(2) No violation of this chapter or regulations adopted under this
chapter exists in the adult day health care center that jeopardizes
the health or safety of patients.
(3) The applicant has adopted a plan for correction of any
existing violations that is satisfactory to the department.
(b) A provisional license issued under this section shall expire
not later than one year after the date of issuance, or at an earlier
time as determined by the department at the time of issuance, and may
not be renewed.
(c) At the expiration of the provisional license period, the
department shall assess the adult day health care center's full
compliance with licensure requirements. If the adult day health care
center meets all applicable requirements for licensure, the
department shall issue a regular license.
(d) The department shall not apply less stringent criteria when
issuing a provisional license pursuant to this section than it
applies when issuing a regular license.
(a) If the department determines that the adult day health
care center operating under a provisional license has serious
deficiencies that pose a risk to the health and safety of the
participants, the department may immediately take any of the
following actions, including, but not limited to:
(1) Require a plan of correction.
(2) Limit participant enrollment.
(3) Prohibit new participant enrollment.
(b) When appropriate, the California Department of Aging and the
department shall coordinate an action or actions to ensure
consistency and uniformity.
(c) The licensee shall have the right to dispute an action or
actions taken pursuant to paragraphs (2) and (3) of subdivision (a).
The department shall accept, consider, and resolve disputes filed
pursuant to this subdivision by a licensee in a timely manner.
(d) The director shall ensure that public records accurately
reflect the current status of any action or actions taken pursuant to
this section, including any resolution of disputes.
(a) As a prudent business practice, a licensee shall
maintain sufficient financial resources for adult day health care
operations to enable each licensed facility to operate for 30
(b) The financial resource requirement contained in subdivision
(a) may be met, in whole or in part, by a line of credit, grant, or
(c) Whenever a licensee fails to meet the financial resource
requirement contained in subdivision (a) for a period of 10 working
days, the licensee shall notify the department of that fact within 48
(a) (1) The State Department of Public Health, prior to
issuing a new license, shall obtain a criminal record clearance for
the administrator, program director, and fiscal officer of the
proposed adult day health care center. The department shall obtain
the criminal record clearances each time these positions are to be
filled. When the conditions set forth in paragraph (3) of subdivision
(a) of Section 1265.5, subparagraph (A) of paragraph (1) of
subdivision (a) of Section 1338.5, and paragraph (1) of subdivision
(a) of Section 1736.6 are met, the licensing and certification
program shall issue an All Facilities Letter (AFL) informing facility
licensees. After the AFL is issued, facilities shall not allow newly
hired administrators, program directors, and fiscal officers to have
direct contact with clients or residents of the facility prior to
completion of the criminal record clearance. A criminal record
clearance shall be complete when the department has obtained the
person's criminal offender record information search response from
the Department of Justice and has determined that the person is not
disqualified from engaging in the activity for which clearance is
(2) The criminal record clearance shall require the administrator,
program director, and fiscal officer to submit electronic
fingerprint images to the Department of Justice.
(3) An applicant and any other person specified in this
subdivision, as part of the background clearance process, shall
provide information as to whether or not the person has any prior
criminal convictions, has had any arrests within the past 12-month
period, or has any active arrests, and shall certify that, to the
best of his or her knowledge, the information provided is true. This
requirement is not intended to duplicate existing requirements for
individuals who are required to submit fingerprint images as part of
a criminal background clearance process. Every applicant shall
provide information on any prior administrative action taken against
him or her by any federal, state, or local government agency and
shall certify that, to the best of his or her knowledge, the
information provided is true. An applicant or other person required
to provide information pursuant to this section that knowingly or
willfully makes false statements, representations, or omissions may
be subject to administrative action, including, but not limited to,
denial of his or her application or exemption or revocation of any
exemption previously granted.
(b) A past conviction of any crime, especially any crime involving
misuse of funds or involving physical abuse shall, in the discretion
of the department, be grounds for denial of the license, and shall
be grounds to prohibit the person from providing services in an adult
day health care center.
(c) Suspension of the applicant from the Medi-Cal program or prior
violations of statutory provisions or regulations relating to
licensure of a health facility, community care facility, or clinic
shall also be grounds for a denial of licensure, where determined by
the state department to indicate a substantial probability that the
applicant will not comply with this chapter and regulations adopted
(d) No applicant which is licensed as a health facility, community
care facility, or clinic may be issued a license for an adult day
health care center while there exists a subsisting, uncorrected
violation of the statutes or regulations relating to such licensure.
(e) The department shall develop procedures to ensure that any
licensee, direct care staff, or certificate holder for whom a
criminal record has been obtained pursuant to this section or Section
1265.5 or 1736 shall not be required to obtain multiple criminal
(f) Notwithstanding any other provision of law, the department may
provide an individual with a copy of his or her state or federal
level criminal offender record information search response as
provided to that department by the Department of Justice if the
department has denied a criminal background clearance based on this
information and the individual makes a written request to the
department for a copy specifying an address to which it is to be
sent. The state or federal level criminal offender record information
search response shall not be modified or altered from its form or
content as provided by the Department of Justice and shall be
provided to the address specified by the individual in his or her
written request. The department shall retain a copy of the individual'
s written request and the response and date provided.
Each application for a new license or renewal submitted to
the state department shall be accompanied by an annual Licensing and
Certification Program fee set in accordance with Section 1266.
The director shall approve an application for a new license
if no substantial basis for denial of the license exists under
Section 1575.7, and the applicant has met all the requirements for
licensure set forth in this chapter and regulations adopted
hereunder. Otherwise the director shall deny issuance of the license.
Each license issued or renewed pursuant to this chapter
shall not be transferable and the initial license shall expire 12
months from the date of its issuance. The director shall be given the
discretion to approve applications for relicensure for a period of
up to 24 months. Application for annual renewal of a license,
accompanied by the required fee, shall be filed with the department
not less than 30 days prior to the expiration date. Failure to submit
a renewal application prior to that date shall result in expiration
of the license.
Immediately upon the denial of any application for issuance
or renewal of a license, the state department shall notify the
applicant in writing. Not later than 10 days after the state
department mails the notice, the applicant may submit a written
petition for a hearing to the state department. Upon receipt by the
state department of the petition in proper form, such petition shall
be set for hearing. The hearing shall be held within 60 calendar days
of receipt of the petition. The proceedings shall be conducted in
accordance with Chapter 5 (commencing with Section 11500) of Part 1
of Division 3 of Title 2 of the Government Code, and the state
department has all the powers granted therein.
A provider may share space with another licensed health
facility, community care facility, senior center, or other
appropriate structure, upon the approval of the department, based
upon a determination of all of the following:
(a) The use of the shared space does not jeopardize the welfare of
the participant or other clients.
(b) The shared use does not exceed occupancy capacity established
for fire safety.
(c) The space used by the adult day health care center is not
essential to meet the other program's licensing requirements.
(d) Each entity schedules services and activities at separate
times. This subdivision shall not apply to space used for meals or
for space used by another licensed adult day services program.
For purposes of this section, "shared space" means the mutual use
of exits and entrances, offices, hallways, bathrooms, treatment
rooms, and dining rooms by an adult day health care center and
(a) Notwithstanding subdivisions (b) and (c) of Section
1570.7 or any other provision of law, if an adult day health care
center licensee also provides adult day program services, the adult
day health care license shall be the only license required to provide
these additional services. Costs shall be allocated among the
programs in accordance with generally accepted accounting practices.
(b) A provider choosing to add an adult day program within the
adult day health care facility shall submit a notice to the
department on such forms as may be required.
(c) Review and approval of the application to provide a dual
program shall not require an on-site inspection.
(d) The maximum licensed capacity shall be determined by the local
fire authority and shall include limits for ambulatory and
(a) A rural alternative adult day health care center shall
operate its programs a minimum of three days weekly, unless the
program can justify, to the satisfaction of the department, fewer
days of operation due to space, staff, financial, or participant
(b) Any program desiring to become a parent center and develop a
satellite program may be located in an area that does not meet the
population requirements of the rural service areas and need not be in
the same county as a satellite. The satellite shall be located in an
area that meets the population requirements of a rural service area,
and shall be located within a reasonable distance of the parent
center to allow sharing of administration, services, and supervision.
Parent and satellite centers shall be located in the same licensing
(c) Notwithstanding any other provision of law, the administrator
or program director of a parent center may, with the approval of the
department, serve as the administrator or program director for up to
three additional satellite sites.
(d) For the purposes of this section, the following definitions
(1) "Parent" means a licensed and certified adult day health care
center that establishes one or more satellites. A satellite may be in
the county of the parent or a rural service area. The parent center
shall provide administration, supervision, and, with the approval of
the department, may share services and staff with one or more
satellite centers. The parent center's license and certification
shall cover adult day health care services at one or more satellites.
(2) "Rural alternative adult day health care center" means an
adult day health care center located in a rural service area.
(3) "Rural service area" means an identified service area within
one hour driving time from the center and with two or more of the
(A) Is more than one-half hour direct driving time from an urban
area of 50,000 population or more.
(B) Has no other adult day health care center within one-half hour
direct driving time.
(C) Has geographic or climatic barriers, including, but not
limited to, snow, fog, ice, mountains, inadequate highways, or
weather, that make transportation to another adult day health care
(D) Is located in a county with an overall population density of
less than 100 persons per square mile.
(E) Can demonstrate in the application for licensure that a
shortage of qualified professionals exists in the county or
identified service area.
(4) "Satellite" means an adult day health care center established
in a rural service area by an existing licensed and certified adult
day health care center for the purposes of extending rural adult day
health care services to another location. A satellite shall be
located close enough to the adult day health center so that
administration, supervision, and services may be shared in a manner
that does not compromise care and makes it unnecessary for the
satellite to be separately licensed. Each satellite shall meet fire
and life safety regulations and laws. Prior approval from the
department is required before operating or opening a satellite.