California - Title 22 RCFE Admission & Retention Requirements

Operating a Residential Care Facility for the Elderly (RCFE) in California requires strict adherence to Title 22 of the California Code of Regulations, enforced by the California Department of Social Services (CDSS), Community Care Licensing Division (CCLD). Among the most scrutinized areas during a licensing visit, complaint investigation, or annual inspection are Admission and Retention Requirements.

Failure to comply with Title 22 RCFE admission and retention regulations can result in deficiencies, civil penalties, conditional licenses, or revocation proceedings. For owners and administrators, understanding these rules is not optional. It is a core compliance obligation.

This article provides a structured, detailed explanation of California Title 22 RCFE Admission & Retention Requirements, including prohibited conditions, hospice residents, eviction procedures, and regulatory risks.

Regulatory Framework

California RCFEs are governed primarily by:

• California Code of Regulations, Title 22, Division 6, Chapter 8

• Health and Safety Code §§1569 et seq.

• CDSS Community Care Licensing policies
  

The key sections related to admission and retention include:

• §87608 – Postural Supports

• §87615 – Prohibited Health Conditions

• §87616 – Restricted Health Conditions

• §87224 – Admission Agreements

• §87223 – Eviction Procedures

1. Admission Requirements Under Title 22

An RCFE may only admit residents whose needs can be met within the scope of the facility’s license and staffing capabilities.

Pre-Admission Assessment

Before admission, the facility must:

• Conduct a pre-admission appraisal

• Evaluate functional capacity

• Assess medical conditions

• Review physician reports

• Determine care and supervision needs

The facility must document that it can safely meet the resident’s needs without violating prohibited condition rules.

Admission must be denied if:

• The resident has a prohibited health condition

• The facility lacks staff competency to manage care

• The physical plant cannot support the resident’s needs

2. Prohibited Health Conditions (§87615)

One of the most critical aspects of California Title 22 RCFE Admission & Retention Requirements involves Prohibited Health Conditions.

An RCFE may NOT admit or retain residents with:

• Stage 3 or Stage 4 pressure injuries

• Dermal ulcers requiring complex wound care

• Gastrostomy tubes

• Nasogastric tubes

• Total parenteral nutrition (TPN)

• Conditions requiring 24-hour skilled nursing care

• Residents who are bedridden beyond allowed limits

• Untreated serious psychiatric disorders requiring acute care

If a resident develops a prohibited condition after admission, the facility must initiate discharge procedures unless a regulatory exception applies.

This is one of the most common deficiency areas during CDSS inspections.

3. Restricted Health Conditions (§87616)

Restricted conditions are allowed under specific circumstances if certain regulatory requirements are met.

These include:

• Stage 1 or 2 pressure injuries

• Colostomy or ileostomy care

• Urinary catheter care

• Diabetes management, including insulin injections

• Oxygen administration

• Hospice care

• Limited wound care

For restricted conditions:

• Staff must be properly trained

• Physician orders must be current

• Care plans must be updated

• Documentation must be maintained

• Equipment must meet safety standards

Failure to properly document restricted conditions often results in citations.

4. Hospice Residents in RCFEs

California permits residents to receive hospice services while residing in an RCFE, but strict compliance is required.

An RCFE may retain a hospice resident if:

• The facility can meet care needs

• Staffing levels remain sufficient

• The resident is not bedridden beyond regulatory limits

• The total number of hospice residents does not exceed regulatory thresholds (if applicable based on facility size)

The facility must coordinate care with the hospice agency and ensure:

• Hospice plan of care is integrated into RCFE care plan

• Communication logs are maintained

• Staff are trained in end-of-life care support

Improper hospice retention is frequently cited during complaint investigations.

5. Bedridden Residents

Title 22 defines “bedridden” as a resident confined to bed and unable to independently leave the building in an emergency.

Retention limits vary depending on:

• Facility fire clearance

• Size of facility

• Licensing approval

Small facilities may be limited in the number of bedridden residents permitted.

If a resident becomes bedridden beyond approved limits, the facility must:

• Notify licensing

• Evaluate fire clearance

• Consider discharge if unsafe

Failure to comply can trigger immediate compliance action.

6. Admission Agreements (§87224)

A legally compliant admission agreement must include:

• Basic services

• Optional services and fees

• Rate change policies

• Refund conditions

• Eviction policies

• Resident rights

• Complaint procedures

• Medication management policies

Improper or incomplete admission agreements are among the most cited deficiencies in RCFE operations.

Agreements must be signed prior to or at time of admission and maintained in resident files.

7. Eviction and Involuntary Transfer (§87223)

Eviction procedures must follow strict legal standards.

Valid grounds for eviction include:

• Nonpayment of fees

• Violation of lawful facility policies

• Prohibited health condition development

• Change in care needs beyond facility capability

• Threat to health and safety of others

Required notice periods:

• 30-day written notice (standard eviction)

• 3-day notice (serious safety threat)

• Immediate relocation may occur only under emergency conditions

Notice must include:

• Effective date

• Reason for eviction

• Appeal rights

• Ombudsman contact information

Improper eviction procedures can lead to civil penalties and enforcement actions.

8. Documentation Requirements

Documentation is central to compliance with California Title 22 RCFE Admission & Retention Requirements.

Facilities must maintain:

• Pre-admission appraisal

• Physician’s report

• Functional assessment

• Care plan

• Updated service plan

• Medication records

• Incident reports

• Hospice coordination notes (if applicable)

Documentation must demonstrate ongoing evaluation and ability to meet care needs.

9. Common Survey Deficiencies

Based on enforcement trends, common deficiencies include:

• Retaining residents with prohibited conditions

• Inadequate hospice coordination

• Missing physician reports

• Failure to update care plans

• Improper eviction notices

• Inadequate staff training documentation

• Failure to reassess after condition change

Administrators should conduct internal audits quarterly to reduce risk.

10. Risk Management and Best Practices

To remain compliant with California Title 22 RCFE Admission & Retention Requirements:

1. Implement a formal admission screening checklist.

2. Train staff on prohibited vs restricted conditions.

3. Conduct quarterly care plan audits.

4. Review all hospice residents for compliance.

5. Update physician reports annually or upon condition change.

6. Maintain clear documentation of capability assessments.

7. Consult regulatory professionals when unsure.

Facilities that proactively monitor admission and retention compliance significantly reduce enforcement exposure.

Why Admission & Retention Compliance Matters

Admission and retention violations often escalate quickly. Unlike minor documentation issues, improper retention of prohibited conditions may be classified as serious violations affecting resident safety.

Repeated violations may result in:

• Civil penalties

• License probation

• Conditional status

• Revocation proceedings

• Increased complaint investigations
  

Regulatory scrutiny in California has increased, particularly for facilities managing complex medical residents.

Conclusion

California Title 22 RCFE Admission & Retention Requirements are designed to protect elderly residents by ensuring facilities only admit and retain individuals whose needs can be safely met.

Administrators must carefully evaluate:

• Prohibited conditions

• Restricted conditions

• Hospice coordination

• Bedridden limitations

• Eviction procedures

• Documentation standards
  

Compliance requires structured policies, trained staff, and continuous oversight.

Facilities that treat admission and retention as a compliance priority rather than a paperwork task are better positioned to maintain regulatory stability and protect their licensure status.

URL References:

California Code of Regulations Title 22 (RCFE Regulations)
https://www.cdss.ca.gov/inforesources/community-care-licensing/residential-care-facilities-for-the-elderly

California Department of Social Services – Community Care Licensing
https://www.cdss.ca.gov/inforesources/community-care-licensing

Health and Safety Code – Residential Care Facilities for the Elderly
https://leginfo.legislature.ca.gov

California Long-Term Care Ombudsman Program
https://aging.ca.gov/programs-and-services/long-term-care-ombudsman

Fire Clearance and Bedridden Resident Guidelines
https://osfm.fire.ca.gov