The First RCFE Licensing Visit

CDSS lists eleven steps for an initial RCFE license ^[1]. Steps 1 to 4 are the application itself, and the facility license page covers them. Steps 5 to 11 happen after you file:

5. Preliminary review. The Centralized Applications Bureau (CAB) assigns a facility number and sends an acceptance letter with the application status, your assigned application specialist and a list of missing or incomplete documents ^[1].
6. Complete the criminal background check process. Each person who needs a background check must get a criminal record clearance or exemption, and fingerprints go in through Live Scan ^[1]. CDSS estimates results in about 3 days from the Department of Justice and about 5 days from the FBI when there is no criminal history, and longer if there is one ^[13].
7. Application review. The bureau sends a fire clearance request to the local fire authority, reviews your start-up funds and runs a credit check. It also looks at the applicant's prior compliance history, if any, and schedules the Component II operational readiness interview with you ^[1][11]. The reviewing analyst holds that interview one-on-one with you once the application is submitted and reviewed ^[11].
8. Obtain a fire clearance. The local fire authority contacts you to schedule a fire safety clearance inspection and sends CDSS the clearance ^[1].
9. Pre-licensing inspection and Component III session. The regional office schedules the pre-licensing inspection and a Component III training session ^[1]. Once the fire clearance is approved, the analyst asks the regional office to schedule the inspection ^[14].
10. Complete requirements. You submit any corrections by the due date ^[1].
11. Final review and license issuance. CDSS does a final review and issues the license ^[1].

CDSS says the time varies with how fast you send documents, how quickly the criminal record and fire clearances come through, any construction delays and how ready the home is for the inspection ^[1].

The local regional office contacts you to schedule the on-site pre-licensing inspection ^[1]. CDSS tells applicants to refer to its "CARE tools (pre-licensing inspection) page for guidance on requirements" ^[1]. CDSS says its Licensing Program Analysts (LPAs) use the CARE Tools "when conducting inspections in licensed facilities" ^[3].

CDSS says pre-licensing visits take place before the license is issued "to ensure the facility is in full compliance with all applicable licensing requirements," and that they "verify that the physical plant and facility policies meet regulatory standards for licensure and are ready to begin operating" ^[1].

CDSS's applicant FAQ (undated, and still using older names such as "Centralized Application Unit") says the analyst schedules an appointment with the applicant "to inspect and tour the facility to ensure the facility meets licensing requirements prior to licensure" ^[14]. At the visit the home "should comply with all licensing requirements and be ready for use", and licensing staff verify adequate furnishings, adequate spacing between the furniture items and a seven-day supply of non-perishable food ^[14]. "In some instances a follow-up inspection may be necessary to ensure corrections for compliance have been completed prior to licensure" ^[14].

CDSS publishes an RCFE Pre-Licensing Tool as an Excel workbook and links it from its CARE Tools page ^[3][4]. Its twelve tabs, as CDSS names them ^[4]:

• Infection Control
• Operational Requirements
• Phys Plant & Environment Safety
• Staffing
• Personnel Records-Training
• Resident Rights-Information
• Planned Activities
• Food Service
• Incidental M&D
• Resident Rec-Incident Reports
• Disaster Preparedness
• Residents with SHN

Its rows include the building permit rule ("Prior to construction or alterations, all facilities shall obtain a building permit") and the liability insurance requirement in Health and Safety Code § 1569.605 ^[4]. CDSS adds that the tools "do not contain all applicable statutes, regulations, or licensing standards" and that using them does not limit its inspection authority ^[3].

CDSS's Inspection Process page lists the senior care domains the tools cover, including "plan of operation, required insurances, fire clearance" and "administrator presence, sufficient staffing, night supervision" ^[5]. CDSS's Evaluator Manual, the manual its licensing staff work from, is public on its Policy page ^[12].

• In the application. The acceptance letter lists missing or incomplete documents ^[1], while the application booklet warns that an incomplete packet can be returned whole ^[8]. The statute says failing to cooperate in completing the application may result in its denial ^[9].
• For the fire clearance. The fire authority completes the final fire clearance inspection within 30 days of receiving the request for it, or of the date you request the final pre-licensure inspection by CDSS, whichever is later ^[7].
• At the pre-licensing visit. At the end of the inspection, your LPA tells you whether corrections or more information are needed and gives you a due date ^[1]. If corrections are required, you must provide evidence that you have satisfied all items in the plan of corrections by that date ^[1].
• After a license, if a plan of correction is missed. The state charges a $200 plan of correction fee when a licensee does not carry out a plan of correction by its date ^[10].

Section 1569.33 says every licensed RCFE is subject to unannounced inspections, as often as necessary to ensure the quality of care ^[2]. It also says: "On and after January 1, 2019, the department shall conduct annual unannounced inspections of all residential care facilities for the elderly." ^[2] Section 1569.32 lets department staff, with identification, enter and inspect "at any time, with or without advance notice" ^[6].

After an inspection, the department "shall notify the residential care facility for the elderly in writing of all deficiencies" ^[2]. "Unless otherwise specified in the plan of correction, the residential care facility for the elderly shall remedy the deficiencies within 10 days of the notification" ^[2]. Inspection reports, lists of deficiencies and plans of correction are kept on file and are open to public inspection ^[2]. As part of its evaluation, the department "shall review the plan of operation, training logs, and marketing materials of any residential care facility for the elderly that advertises or promotes special care, special programming, or a special environment for persons with dementia" ^[2].