In California, there are currently 7,500 licensed Residential Care Facilities for the Elderly (RCFE) with occupancy levels at approximately 174,000 beds.

RCFEs are also known as an assisted living facility, board and care home or retirement home. These are all RCFE’s and they all have the same regulations. According to a recent report by the California Advocates for Nursing Home Reform, there is a growing demand for increased assisted living facilities and capacity.

In this demanding environment, many RCFE administrators are looking to convert their homes into an assisted living facility. Indeed, operating an RCFE out of your home can be a fruitful and rewarding endeavor, but it’s important to understand what you are getting into.

Let’s explore some of the considerations of opening an RCFE in your home and provide some information that can help you decide if opening an RCFE home is right for you.

Preliminary Considerations of Opening a Home RCFE

Operating an assisted living facility is a meaningful privilege, but also a heavy responsibility and a state-regulated endeavor. Before you begin this journey here are some suggestions to consider as you begin the initial process of licensing your home as an RCFE.

1. Make sure you are committed to the project and the thought of losing the privacy of your home life.
2. Create a mission statement which is a set of goals you hope to achieve by opening your home as a senior facility.
3. Research state laws and local zoning regulations about assisted living facilities and determine if your home is compatible.
4. Take all the state-mandated RCFE classes to assure you have the proper training and information to begin the licensing process.

Like any other business, you will want to create a solid business plan. This plan will help guide you so that you will always know “what’s next.”

Evaluate the Local Need for a New Assisted Living Facility

Like most other businesses, you will want to begin by determining the need in your area for the services you are offering. Your future residents are the cornerstone of a successful RCFE, so give them top priority as you put a plan in place. 

Even with a building that meets requirements, proper licensing, administrator certification and compassionate staff, you cannot run a successful facility without an adequate number of residents. You also need to consider the number of bedrooms, bathrooms and available living space in your home.  

Keeping your rooms occupied and your residents happy is vital to the success of your RCFE.

So how can you determine the need for assisted living in your area? 

Consider these resources:

Visit the California Department of Social Services (CDSS) website and select the “Find licensed facilities” box. You can search by city or zip code to locate facilities in your area.

• Contact local government agencies and organizations that serve senior citizens.
• Research and visit assisted living facilities in the area.
• Talk with patient advocates at local clinics and hospitals.
• Reach out to regional assisted living training institutions, including community or technical colleges.

RCFE License Application California

Once you have done your homework, verifying that there is an adequate need in your community, then turn your attention to obtaining proper credentials. 

In California, CDSS requires that you have an RCFE license for your home before you admit any residents for care. You also personally need RCFE certification to prove you completed training and have the knowledge to safeguard the residents. As the owner of a home turned into an assisted living facility, you will need both.

It is important to keep in mind that RCFE licensing and RCFE administrator certification training takes time, patience and resources to complete. 

The process begins by taking the required orientation course on the CDSS website. 

Additionally, you will also have to fill out an application and sign up for an accredited RCFE administrator training course. You will also have to meet state educational and experience requirements when applicable. 

The required qualifications are generally reasonable and you should be able to obtain any that you might be missing, but this can add some time to the certification and licensing processes. 

One important requirement to plan for is the CDSS requirement that you show proof of three months of operating expenses in designated savings accounts before approving your license.

Once you have completed your certification and submitted your RCFE licensing application, CDSS will begin processing the application in Sacramento. 

Once your paperwork has been reviewed and any missing paperwork submitted, your application packet will be sent to the local CDSS office that will oversee your facility. 

A Licensing Program Analyst (LPA) will be assigned to your facility. The LPA will contact you and set up the Component II interview. Once this interview has been conducted, the LPA will order a fire inspection and verify operating funds in your account.

Finally, after you have received approval from the local fire marshal, LPA will send a checklist and schedule an on-site visit to inspect and approve your home.

Waiting to Process Your Assisted Living License – Use the Time Wisely

Sometimes it can seem like there is a lot of downtime in this process, but there are actually a lot of ways you can utilize that to your advantage. 

While you are waiting for the DSS to review your license application, we suggest you also work on marketing your assisted living  facility to prospective residents as well as finding caring, competent and reliable employees to help run your facility. 

Although you may adjust your opening date along the way, you will want to have employees trained and your home ready for admissions when you do open your doors. You should also consider creating a list of senior social activities to keep your guests engaged once they make your home their home.

Seek Professional Assistance

As our population continues to age there will certainly be an increase in the need for high-quality RCFE’s. 

If you feel like this could be a good fit for you, then the first step is to do your homework and create a plan. 

If this process seems overwhelming, you would be correct. 

CDSS has guidelines they follow during the application process and if you do not reply or submit missing documents in time, you could be at risk for CDSS to deny your application. This would mean you are not allowed to resubmit an application for one year. 

Yikes!

To prevent this scenario from happening, you would be wise to seek the assistance of someone who has experience in licensing and working with CDSS.

To ensure that you do everything correctly the first time and save precious time during the licensing process, Assisted Living Education can help. Our experience and positive relationship with CDSS can save you time and money while you complete the process to get your building licensed. We have helped hundreds of individuals successfully obtain an RCFE license for their buildings and helped them on the path to having a viable and safe assisted living facility.  

If this is something you are interested in, don’t hesitate to reach out to us. We are here to help.

10 Frequently Asked Questions About Converting Your Home into an Assisted Living Facility in California

1. Can I legally convert my home into an RCFE in California?

Yes, you can convert your home into a Residential Care Facility for the Elderly (RCFE) in California, provided your property meets specific zoning regulations, building codes, and licensing requirements. Before beginning the process, you must research local zoning laws to ensure your residential area allows for assisted living operations. The California Department of Social Services (CDSS) regulates all RCFEs, and you’ll need to obtain proper licensing before admitting any residents. Your home must pass fire safety inspections, meet accessibility standards, and provide adequate space for the number of residents you plan to serve.

2. How long does it take to get an RCFE license for my home?

The RCFE licensing process typically takes 6 to 12 months from start to finish, though timelines can vary based on several factors. The process begins with completing the mandatory CDSS orientation course and RCFE administrator certification training. After submitting your application, CDSS reviews it in Sacramento before forwarding it to your local CDSS office. A Licensing Program Analyst (LPA) will then be assigned to conduct a Component II interview, order fire inspections, verify your operating funds, and perform an on-site home inspection. Delays can occur if documentation is incomplete or if modifications are needed to meet safety requirements, so working with experienced licensing consultants can help streamline the timeline.

3. What are the financial requirements to convert my home into an RCFE?

California requires proof of three months of operating expenses in designated savings accounts before approving your RCFE license. Operating expenses typically include staff salaries, utilities, food costs, insurance, supplies, and emergency reserves. For a small home-based RCFE with 6 residents, this could range from $30,000 to $75,000 depending on your staffing model and location. Beyond the operating reserve, you’ll need capital for initial licensing fees (approximately $1,000-$3,000), administrator certification training costs, facility modifications to meet code requirements, liability insurance, and initial marketing expenses. Many aspiring RCFE owners underestimate startup costs, so creating a detailed business plan with realistic financial projections is essential.

4. Do I need to make structural changes to my home?

Most homes require at least some modifications to meet RCFE standards, though the extent varies based on your home’s current condition and the number of residents you plan to serve. Common modifications include installing fire sprinkler systems or additional smoke detectors, widening doorways for wheelchair accessibility (minimum 32 inches clear), adding grab bars in bathrooms, ensuring adequate emergency exits, improving lighting in hallways and stairways, and potentially converting spaces to add bathrooms (typically one bathroom per four residents). Your home must also meet ADA accessibility requirements and have adequate common areas for dining and activities. The Licensing Program Analyst will provide a detailed checklist during the inspection process, and working with a contractor experienced in RCFE conversions can help ensure compliance.

5. How many residents can I have in my home-based RCFE?

The number of residents allowed in your home-based RCFE depends on your available space, layout, and local regulations. California RCFEs are categorized by size: small facilities serve 6 or fewer residents, while larger facilities can accommodate more. Most home conversions fall into the small facility category due to space limitations. Each resident must have adequate bedroom space (typically 80-100 square feet for single occupancy), access to bathroom facilities, and shared access to common areas. You’ll also need to consider staff-to-resident ratios, which impact your ability to provide quality care. Starting smaller allows you to build experience and reputation before potentially expanding, and it often requires less extensive modifications to your home.

6. What certifications and training do I need as the owner-administrator?

As the owner-administrator of a home-based RCFE, you must complete the RCFE Administrator Certification Training, which covers essential topics including resident rights, medication management, emergency procedures, nutrition, and California RCFE regulations. This training typically consists of 80 hours of coursework through an accredited program. Additionally, you must complete the CDSS orientation course and may need to meet educational and experience requirements depending on your background. First aid and CPR certifications are also required. If you don’t meet certain educational requirements, you may need to complete additional coursework or demonstrate relevant work experience in healthcare or social services. Continuing education is required annually to maintain your certification and stay current with regulatory changes.

7. Will I lose the privacy of my home by operating an RCFE?

Operating an RCFE from your home significantly impacts your personal privacy and lifestyle, which is why this is a critical consideration before beginning the conversion process. Your home becomes a licensed care facility subject to state inspections, resident and family visits, and staff presence. You’ll need to dedicate specific areas exclusively for resident use, including bedrooms, bathrooms, dining areas, and common spaces. Depending on your home’s layout, you may be able to maintain a separate living area for your family, but your daily life will be intertwined with facility operations. Many owner-administrators find the experience rewarding and enjoy being closely involved in resident care, but others struggle with the loss of personal space and privacy. Honestly assessing your comfort level with this lifestyle change before committing to the conversion is essential for long-term success.

8. How do I determine if there’s enough demand in my area?

Researching local demand is crucial before investing time and money in the conversion process. Start by visiting the CDSS website’s “Find Licensed Facilities” tool to search for existing RCFEs in your area by city or zip code. A high concentration of facilities might indicate strong demand, but it also means more competition. Contact local government aging services departments, senior centers, and organizations serving elderly populations to discuss community needs. Visit competing facilities to understand their occupancy rates, services offered, and pricing. Talk with discharge planners at local hospitals and patient advocates at clinics, as they often refer patients to assisted living. Consider demographic trends in your area—communities with growing senior populations and limited existing RCFE capacity present the best opportunities. Understanding your specific niche (such as dementia care or affordability) can help you succeed even in competitive markets.

9. What happens if my RCFE license application is denied?

If CDSS denies your RCFE license application, you cannot reapply for one full year, making it critical to get everything right the first time. Common reasons for denial include incomplete documentation, failure to meet financial requirements, facility deficiencies that aren’t corrected within the required timeframe, criminal background check issues, or not responding to CDSS requests within specified deadlines. To avoid denial, maintain thorough documentation throughout the process, respond promptly to all CDSS communications, work with experienced consultants who understand CDSS requirements and procedures, and address any facility deficiencies immediately when identified. If you receive a notice of deficiencies, take it seriously and correct all issues promptly. Many denials result from applicants not understanding the complexity of the process or failing to meet deadlines rather than disqualifying factors, which is why professional guidance from organizations like Assisted Living Education can significantly improve your success rate.

10. Should I hire professional help for the licensing process?

While it’s technically possible to navigate the RCFE licensing process independently, working with experienced professionals can save significant time, money, and stress. The licensing process is complex, with specific documentation requirements, strict deadlines, and detailed facility standards that can be challenging to navigate without experience. Professional consultants who specialize in RCFE licensing understand CDSS procedures, can help you avoid common pitfalls, accelerate the timeline by ensuring all documentation is correct the first time, provide guidance on facility modifications and compliance, and leverage their positive relationships with CDSS to facilitate smoother processing. Organizations like Assisted Living Education have successfully helped hundreds of individuals obtain RCFE licenses and can provide comprehensive support throughout the process. The cost of professional assistance is often offset by avoiding application denials (which result in a one-year waiting period), reducing costly modification mistakes, and opening your facility months earlier than you might independently. For most people, especially those without healthcare licensing experience, professional guidance is a worthwhile investment in ensuring success.

For Residential Care Facilities for the Elderly (RCFEs), the margin between a smooth survey and a costly citation is often a result of one thing: whether leaders and staff understand the rules well enough to translate them into everyday practice. 

Continuing Education Units (CEUs) are not merely a renewal obligation for an assisted living administrator; they’re the mechanism that keeps policies current, documentation defensible, and care consistent. When CEUs are approached strategically—selected for relevance, timed throughout the year, and reinforced on the floor—they safeguard residents, reduce violations, save money, and protect your community’s reputation.

What are California’s Title 22 Assisted Living Regulations?

California’s Title 22 sets the standards that govern RCFE operations, from admission and retention criteria to medication management, resident rights, staff training, documentation, and emergency preparedness. The regulations exist to safeguard residents, which is precisely why they are both detailed and evolving. 

A policy that satisfied an analyst two years ago may no longer reflect the most current expectations, and a process that works in theory can still fail at 3 a.m. during a crisis. CEU coursework helps administrators and staff convert regulatory language into clear steps, assign responsibility, and document what was done so auditors can verify it. If you need a refresher on interpreting the code in daily operations, this overview on remain(ing) compliant with California Title 22 is a practical place to start.

Why CEUs Reduce Violations (and stress)

Most fines and deficiencies don’t come from apathy but from knowledge drift, staff turnover, and documentation gaps. A nurse leaves, a new med tech learns by shadowing, an admission gets rushed, and a tiny shortcut becomes the “way we do things.” The right RCFE administrator certification online and CEU plan interrupts that drift. 

Courses focused on medication systems, incident reporting, admission and retention, and individualized service plans (ISPs) provide concrete workflows and checklists. After a strong CEU, frontline staff know precisely what “good” looks like, and supervisors know how to monitor it. The result is a quieter building, fewer surprises during surveys, and a standard of care you feel comfortable showing to families and regulators alike.

Live Versus Online: Use Both, Intentionally

There is a good case for mixing formats. RCFE live CEU classes provide the kind of two-way learning that turns “I think I understand” into “I know exactly what to do.” 

In a live setting, instructors can walk through gray-area scenarios—Can we retain this resident? What if hospice is involved?—You can ask for follow-ups until you have a step-by-step plan. 

When you’re ready to add this kind of interactive training to your calendar, consider booking RCFE CEU live classes so you and your leads can bring real cases to the table. Online CEUs, by contrast, shine for targeted refreshers and flexible scheduling. They’re ideal for onboarding, documentation tune-ups, or role-specific learning when you can’t pull the entire team off the floor. A well-curated package of RCFE CEU classes online lets you space learning across the year so renewal never becomes a last-minute crisis.

Taking online CEU courses is a great way to make sure that your RCFE certification remains up-to-date.

From Certification to Competency

New leaders often arrive with an assisted living administrator certification and a solid foundation in statutes. The next step is turning that knowledge into supervision and coaching. 

CEUs that emphasize implementation by focusing on topics such as how to audit a MAR, triage incident reporting timelines, and evaluating retention criteria. 

Treat every course as a chance to refine leadership: set expectations, observe practice, provide feedback, and recognize improvements so the right habits stick.

High-Risk Domains Where CEUs Pay for Themselves

Medication management is the quintessential example. A single missed signature on a MAR can prompt a deficiency; repeated patterns can trigger heightened scrutiny. 

Courses that break down the medication cycle of ordering, managing receipt, storage, administration, PRN follow-up, and destruction equip teams with repeatable steps and double-checks. 

Incident reporting is another hot spot. Understanding which events rise to the level of immediate notification, what timelines apply, and how to document communication with families reduces both risk and anxiety. Admission and retention decisions rarely go wrong on purpose; they go wrong when documentation is thin or the assessment process is inconsistent. 

CEUs that revisit admission criteria, hospice coordination, and reappraisal timing help you decide confidently and record your rationale in a way that surveyors can follow. Emergency and disaster preparedness deserves special mention. 

Plans that look good on paper can falter if staff haven’t practiced their roles or if vendor lists, evacuation routes, or backup power procedures aren’t current. A focused CEU followed by a brief drill can transform this from a binder exercise into muscle memory.

Renewal Without the Rush

Cramming CEUs in the weeks before expiration is stressful and makes it harder to integrate the material. 

Plan a cadence instead. 

Many administrators map topics to the calendar to keep learning steady and useful, such as:

• Early year: Medication systems, aligned with annual physician orders.
• Mid-year: Incident reporting and resident rights.
• Before fire season: Emergency and disaster preparedness.
• Before flu/RSV surges: Admission and retention, with special attention to changing clinical profiles.

Spreading coursework this way reduces overtime, improves retention, and gives you clean documentation trails. 

As you approach the end of your cycle, a quick review of requirements and certificates against your transcript makes certification renewal routine rather than frantic. 

Dollars and Sense

It’s tempting to view CEUs as a cost center, but in reality, they’re an insurance policy with a predictable premium and a large deductible avoidance. 

Civil penalties, temporary staffing to resolve deficiencies, emergency consultant fees, and potential resident move-outs can far exceed the price of a few well-chosen courses. 

There’s also the reputational cost that shows up in referral patterns and online reviews. These are areas where prevention is markedly cheaper than repair. 

CEUs that directly target your facility’s vulnerabilities have a measurable ROI, not just in reduced citations but in calmer operations and higher staff confidence.

Choosing Courses that Actually Change Practice

Quality matters. Look for training that connects California Title 22 to the day-to-day reality of your building. Case-based instruction, forms and checklists you can adopt immediately, and clear guidance on what surveyors typically ask to see are the hallmarks of a course that will reduce violations. 

Access to instructors for clarifying questions is invaluable, particularly for thorny retention scenarios. Just as important is the administrative side: certificates you can retrieve easily, rosters that match your staff list, and content that aligns with your internal policies so you’re not teaching two different versions of “right.”

Practical Next Steps

If you’re building or updating your plan, start by identifying the two or three domains where you’ve seen the most rework or anxiety during surveys. Choose a live class for at least one of those domains to accelerate understanding.

RCFE CEU live classes are designed for exactly this kind of intensive, scenario-driven learning. Fill the remainder of your requirement with flexible courses from an RCFE CEU classes online package, as well as timing modules so they reinforce upcoming audits or policy updates. 

Keep certificates centralized, ensure your roster reflects who completed what, and set reminders so your assisted living administrator credential never approaches the deadline in a panic. 

When it’s time, the logistics of RCFE administrator renewal will be straightforward because you’ve treated learning as part of operations, not as an afterthought.

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CEUs are more than a checkbox. For an RCFE, they are the engine that turns regulation into routine, anxiety into clarity, and risk into reliability. By choosing courses that emphasize application, mixing live and online formats, and folding insights into daily practice, you’ll avoid expensive consequences, keep your team sharp, your records clean, and your community confidently compliant with Title 22.

Natural disasters, power outages, medical emergencies, and other unexpected events can strike at any time. For assisted living facilities, having a robust emergency preparedness plan isn’t just recommended, it’s essential for protecting the vulnerable residents in your care.

Over the past two decades working with assisted living facilities across California, the Assisted Living Education staff has witnessed firsthand how proper emergency preparedness can mean the difference between chaos and calm during a crisis. 

From the devastating wildfires that swept through Northern California to the widespread power outages that left communities in darkness, facilities with comprehensive emergency plans were able to continue providing quality care while others struggled to maintain basic operations.

Understanding Emergency Preparedness in Assisted Living

Emergency preparedness in assisted living environments requires a unique approach compared to other residential settings. The residents you serve often have mobility limitations, cognitive impairments, or medical conditions that make evacuation and emergency response more complex. 

Around 75% of RCFEs felt well prepared for fires and infectious disease outbreaks, had mixed preparedness levels for earthquakes and floods, and felt least prepared for landslides and active shooter emergencies.

For those wondering what is a RCFE, these facilities serve adults aged 60 and older who need assistance with daily activities but don’t require intensive nursing care. This population requires specialized emergency planning that considers their unique vulnerabilities and care needs.

Tip 1: Develop a Comprehensive Risk Assessment and Hazard Analysis

The foundation of effective emergency preparedness begins with understanding the specific threats your facility faces. Every assisted living home should conduct a thorough hazard vulnerability analysis (HVA) that examines both natural and human-made risks in your geographic area.

Start by identifying the most likely emergencies your facility could face. In California, this typically includes earthquakes, wildfires, flooding, and power outages. However, don’t overlook less obvious threats such as infectious disease outbreaks, chemical spills from nearby facilities, or even active shooter situations.

Consider the case of Sunset Manor, a 45-bed RCFE in Sonoma County. They had a basic fire evacuation plan but hadn’t considered the unique challenges posed by wildfire smoke. After conducting a comprehensive HVA, they realized that air quality issues could force them to shelter-in-place for extended periods, requiring additional air filtration systems and modified activity schedules.

Your risk assessment should evaluate not just the likelihood of each emergency, but also the potential impact on your specific resident population. 

Consider factors such as:

• The physical layout of your facility and potential evacuation challenges
• The mobility and cognitive status of your residents
• Your facility’s proximity to hospitals and emergency services
• Local infrastructure vulnerabilities (power grids, water systems, communication networks)
• Seasonal variations in risk (fire season, storm season, etc.)

Tip 2: Create Detailed Communication Plans and Protocols

During emergencies, clear communication can literally save lives. Your facility needs multiple communication strategies that work even when primary systems fail. This includes maintaining contact with residents’ families, coordinating with emergency services, and ensuring staff can communicate effectively with each other.

Develop a communication tree that includes primary and backup contact methods for all stakeholders. This should encompass resident emergency contacts, staff members, local emergency services, healthcare providers, and regulatory agencies. Remember that phone lines may be down during major emergencies, so consider alternative communication methods such as text messaging, social media, or two-way radios.

Many disaster preparation tips for an RCFE facility emphasize the importance of redundant communication systems. Consider investing in battery-powered or hand-crank radios, satellite phones for extreme situations, and establishing communication protocols with neighboring facilities for mutual aid.

Your communication plan should also address how you’ll keep residents and families informed during extended emergencies. Regular updates help reduce anxiety and demonstrate that you’re maintaining control of the situation. Designate specific staff members to handle external communications so that your administrative team can focus on resident care.

Tip 3: Implement Comprehensive Staff Training and Regular Drills

Even the most detailed emergency plan is worthless if your staff doesn’t know how to execute it effectively. Regular training and practice drills are crucial for ensuring everyone knows their role during an emergency.

Your training program should cover all types of emergencies your facility might face, not just fire evacuation. Staff should understand evacuation procedures, shelter-in-place protocols, medical emergency response, and how to assist residents with various mobility and cognitive limitations.

Consider the complexity of a day in the life of an RCFE administrator and how emergency situations add additional layers of responsibility. Your training should prepare staff to handle these increased demands while maintaining quality care for residents.

Practice drills should be conducted at different times and under varying conditions to ensure staff can respond effectively regardless of when an emergency occurs. DSS requires a fire drill every three months and disaster drills every six months. 

Include scenarios where key staff members are unavailable, forcing others to step into leadership roles. This cross-training approach ensures continuity of operations even when your primary emergency response team isn’t available.

Document all training activities and maintain records of staff competencies. This documentation demonstrates compliance with regulatory requirements and helps identify areas where additional training may be needed. Many California RCFE administrator certification training programs now include enhanced emergency preparedness training, reflecting the growing recognition of its importance.

Prepare both your staff and the senior residents with ongoing talks and drills about emergency preparedness.

Tip 4: Maintain Adequate Emergency Supplies and Equipment

During emergencies, your facility may need to operate independently for 72 hours or longer before outside assistance arrives. This requires maintaining emergency supplies that can sustain both residents and staff during extended disruptions.

Your emergency supply inventory should include:

• Food and water for at least 72 hours (one gallon of water per person per day)
• Medications and medical supplies
• Battery-powered lighting and radios
• First aid supplies and emergency medical equipment
• Backup power sources (generators, battery systems)
• Personal protective equipment
• Sanitation and hygiene supplies
• Blankets and emergency clothing
• Tools and equipment for facility maintenance

Don’t forget about the special needs of your resident population. Many assisted living residents require specialized equipment such as wheelchairs, walkers, or medical devices. Ensure you have backup equipment and batteries for electronic devices that residents depend on. Also, residents on special diets, such as puree diets, will require special considerations if there is no power.

Regularly inspect and rotate your emergency supplies to ensure they remain usable when needed. Establish relationships with local suppliers who can provide emergency restocking if needed. Consider joining mutual aid agreements with other facilities in your area to share resources during large-scale emergencies.

Tip 5: Establish Clear Evacuation Procedures and Shelter-in-Place Protocols

Not every emergency requires evacuation, and in some cases, sheltering in place may be the safest option for your residents. Your facility needs detailed procedures for both scenarios, with clear decision-making criteria for determining which approach to take.

Your evacuation plan should address the unique challenges of moving elderly residents, some of whom may have mobility limitations or cognitive impairments. This includes having adequate transportation arranged in advance, knowing which residents require special assistance, and maintaining portable resident records that can accompany evacuees.

Consider partnering with local transportation companies or other care facilities to ensure you have access to appropriate vehicles and temporary housing if needed. 

Your senior living emergency disaster plan should include detailed evacuation routes, assembly points, and procedures for accounting for all residents and staff.

Shelter-in-place procedures are equally important, particularly for emergencies involving hazardous materials, severe weather, or security threats. These protocols should address how to seal the facility from outside contaminants, maintain life support systems, and keep residents comfortable during extended periods of confinement.

The Regulatory Landscape and RCFE Requirements

California has significantly strengthened emergency preparedness requirements for assisted living facilities in recent years. These enhanced RCFE requirements reflect lessons learned from recent disasters and the growing recognition that emergency preparedness is a fundamental aspect of resident safety.

CDSS just released a new Provider Information Notice (PIN) – 25-10-CCLD – to address preparations for extreme heat, wild fires, public safety power shutoffs and West Nile virus.

Facilities must now update their emergency preparedness plans with additional specificity, enhance staff training programs, and conduct regular drill exercises. The regulations also require facilities to purchase evacuation chairs and other specialized equipment to assist residents with mobility challenges.

For administrators working toward their California RCFE administrator certification, understanding these requirements is essential. The certification process now includes comprehensive coverage of emergency preparedness topics, reflecting the critical importance of these skills in modern assisted living administration.

Looking Forward: Building Resilience in Your Facility

Emergency preparedness isn’t a one-time project, it’s an ongoing process that requires regular review and updates. As your resident population changes, as new threats emerge, and as you learn from each emergency drill or real-world event, your plans should evolve accordingly.

Consider appointing an emergency preparedness coordinator who can focus specifically on maintaining and improving your facility’s readiness. This person should stay current on best practices, regulatory changes, and lessons learned from emergencies in other facilities.

Building a culture of preparedness among your staff and residents also contributes to overall resilience. When everyone understands the importance of emergency preparedness and their role in the process, your facility becomes better equipped to handle whatever challenges may arise.

Remember that emergency preparedness is ultimately about protecting the people you serve. The residents in your care have chosen to trust you with their safety and well-being. By implementing comprehensive emergency preparedness measures, you’re honoring that trust and ensuring that you can continue providing excellent care even in the most challenging circumstances.

The investment in emergency preparedness pays dividends not just during actual emergencies, but in the daily confidence it provides to residents, families, and staff. 

When everyone knows that thorough preparations are in place, it creates an environment where people can focus on what matters most; living well and providing quality care.

In addition, Assisted Living Education’s Emergency Disaster Plan manual provides the reference material and updated COVID-19 preparedness required by DSS. 

In Residential Care Facilities for the Elderly (RCFEs), decision-making authority is not always as clear-cut as one might hope. When a resident loses the ability to make informed decisions due to dementia, stroke, or another debilitating condition, someone must step in to make choices on their behalf. 

This is where a surrogate decision maker becomes essential.

Whether you’re new to the role or a seasoned RCFE professional, understanding how surrogate decision making functions is critical. 

At Assisted Living Education, we’ve trained thousands of administrators through our RCFE administrator training, and one recurring area of confusion revolves around the surrogate decision maker’s authority, limitations, and responsibilities.

Here are five essential things every RCFE administrator needs to know about working with surrogate decision makers.

1. What Is a Surrogate Decision Maker?

A surrogate decision maker, when it comes to healthcare and the care of others, is someone legally authorized to make decisions for another person who is no longer able to make those decisions themselves. These decisions often involve medical care, living arrangements, and personal wellbeing.

Surrogates are typically appointed based on a preexisting relationship, such as a spouse, adult child, or close friend, especially when no formal legal designation like a durable power of attorney (POA) exists. The exact process for appointing a surrogate may vary by state, but in California, the Health Care Decisions Law outlines who may serve in this role in the absence of an advance health care directive.

In the context of senior living, the RCFE surrogate decision maker becomes the voice of the resident. Administrators need to understand who that person is, how their authority was established, and what scope of decisions they are permitted to make. 

In this scenario,  the resident should have  previously obtained an Advance Health Care Directive (AHCD) or a Living Will that documents their wishes. California also has a Physician’s Order for Life-Sustaining Treatment (POLST) form that can be part of your admission packet if the resident has not completed an AHCD. The resident’s physician signs this form that details the type of care to be administered in an emergency and a decision maker is identified.

It’s important to have the proper documentation in place. In addition, the resident must be deemed incapable of making health-related decisions on their own before a surrogate can take over that role.  

Becoming a surrogate decision maker for a senior loved one can help ease decision-making in a time of need.

2. What Is the Difference Between a Surrogate Decision Maker and a Power of Attorney?

This is a question we hear often in our RCFE administrator training. While the terms can seem interchangeable, they are not the same.

• A power of attorney (POA) is a legal document in which an individual (the principal) designates another person (the agent) to make decisions on their behalf. This can include financial and legal matters.
• A healthcare proxy—sometimes used interchangeably with medical Advance Health Care Directive —is a form of POA specifically for healthcare decisions.
• A surrogate decision maker, on the other hand, is generally appointed when no POA exists and a person becomes incapacitated. Their role is often established through medical necessity and recognized by healthcare providers, not a legal document.

Understanding this difference ensures administrators know whom to turn to and under what circumstances. “Elder care advocate” is one term all RCFE administrators should know, as these advocates often work alongside or as surrogate decision makers.

3. What Are Examples of Surrogate Decision Maker Responsibilities?

The responsibilities of a surrogate decision maker are both broad and sensitive, often carrying significant emotional weight. Their core duty is to make choices aligned with the resident’s previously expressed wishes, values, and best interests.

Some common surrogate decision maker responsibilities include:

• Approving or declining medical treatments (e.g., surgeries, medications)
• Making end-of-life decisions, such as DNR (Do Not Resuscitate) orders
• Choosing or changing care facilities
• Consenting to psychiatric care or treatments
• Communicating with healthcare providers and RCFE staff

As an RCFE administrator, you must know how to verify that the surrogate has the legal right to act and understand the limits of their decision-making. For example, they may not have authority over financial matters unless separately designated under a financial POA.

Every suorrogate decision maker needs to have necessary state-certified paperwork completed to begin the decision-making process.

4. Surrogate Decision Making Must Be Documented and Respected

Every decision made by a surrogate must be recorded in the resident’s file, including:

• The surrogate’s full name and relationship to the resident
• The reason for the resident’s incapacity
• Evidence of the surrogate’s legal standing (if available)
• A log of decisions made on the resident’s behalf

Administrators must also ensure that staff are aware of who the surrogate is and are trained to communicate appropriately. Misunderstandings can lead to delays in care or legal complications.

The CDSS has a Provider Information Notice (PIN) 25-04-ASC that clarifies the different POA’s (Power of Attorney), responsibilites and exceptions in decision making.  You’ll also find a helpful chart for quick reference here.

Case Example: Navigating a Surrogate’s Role in Real Time

Consider the case of Mrs. Thompson, an 84-year-old RCFE resident with mid-stage Alzheimer’s. She had no advanced directive and no family nearby, but a close friend, Janice, had accompanied her to most doctor appointments over the years. When Mrs. Thompson was hospitalized and unable to consent to treatment, the attending physician designated Janice as the surrogate decision maker under California’s default surrogate hierarchy.

Upon Mrs. Thompson’s return to the RCFE, the administrator ensured that Janice’s status was documented, shared with staff, and used to guide care decisions. This clear chain of authority prevented confusion during a later emergency, when a decision regarding hospitalization had to be made quickly.

This real-world example demonstrates how clarity and documentation in surrogate decision making can prevent delays and distress in urgent care scenarios.

5. RCFE Administrators Play a Key Role in Supporting Surrogates

While RCFE administrators are not surrogate decision makers themselves, they do play a crucial role in facilitating the decision-making process.

Some best practices include:

• Initiating conversations early with residents and families about advance directives and POAs
• Providing educational materials about surrogate roles and responsibilities
• Serving as a liaison between surrogates and healthcare providers
• Monitoring for potential abuse or misuse of surrogate authority
• Working with the physician to determine if the resident is truly incapacitated to make decisions

It’s also essential to recognize that not all surrogate decisions will align with what the RCFE staff believes is best. Administrators should approach these situations with diplomacy, professionalism, and, when necessary, the involvement of legal counsel or Adult Protective Services.

Supporting surrogates emotionally is also part of the job. Many find the role overwhelming, particularly when facing end-of-life decisions. Helping them understand they are not alone and that the RCFE is a partner in care can make all the difference.

Final Thoughts: The Surrogate Decision Maker in the Larger RCFE Landscape

RCFE administrators should regularly revisit their facility’s policies on surrogate decision making. Ensure that staff are trained, records are complete, and residents’ rights are protected.

Families often ask, “Who will speak for my loved one if they no longer can?” The answer lies in part with the RCFE’s diligence in understanding, supporting, and collaborating with surrogate decision makers.

By mastering these five key areas, administrators can ensure their facilities meet the standards that elderly care decision makers look for in an RCFE. In doing so, they not only protect residents, but also build trust with families and elevate the quality of care their community provides.

Assisted Living Education is a leader in RCFE certification and administrator training in California. Our mission is to empower administrators with the knowledge and tools they need to thrive in the senior care industry. For more resources or to learn about our courses, visit us at assistedlivingeducation.com or read more about Important Things To Look for in an RCFE Administrator Program.

Just a cursory scroll through the RCFE Manual of Policies and Procedures from the California Department of Social Services illustrates just how many different terms you should be familiar with as an RCFE Administrator.

In fact, they number in the hundreds. Wouldn’t that be a long blog post!

In the interest of brevity, we wanted to share with you some of the most important. Here are the top 15 terms (and counting) that you need to know if you are an RCFE Administrator or are pursuing RCFE certification. 

Dementia Plan of Operation: 

An amendment to a Plan of Operation that details a facility’s dementia care intentions, policies, and procedures. The California Department of Social Services requires that you have in place a Dementia Plan of Operation before you can serve this fast and growing demand market.

Hospice Waiver Request: 

The written request a licensee must submit to the DSS and be approved for in order to be permitted to retain terminally ill patients.

RCFE Admissions Agreement: 

The contract that includes all applicable documents that a resident or their responsible guardian must sign as a condition of their admission to an RCFE.

RCFE Admission Package: 

The full packet of documents, rules, policies, releases, and agreements, etc., that a prospective resident or their conservator must read through, sign (where applicable), and return. This package includes the aforementioned Admission Agreement.

RCFE Emergency Disaster Plan: 

A plan, including emergency contacts and procedures, that is required by the DSS to prepare your facility staff and residents in the event of a disaster or emergency.

OSHA Manual for RCFE: 

A manual for Residential Care Facilities to help guide compliance with OSHA safety regulations.

RCFE Employee Handbook: 

The company policy and information manual provided to an employee by an RCFE.

Plan of Operation for RCFE: 

The definitive operational plan and its related materials that a facility must maintain on facility and submit to a licensing agency with the license application.

RCFE Operations Manual: 

The document of approved standard procedures that a Residential Care Facility for the Elderly must provide to its employees to ensure job functions are performed accurately, efficiently, and uniformly.

RCFE Staff Training Classes: 

The vital training classes that all prospective and current employees must take as a condition of employment, continued or otherwise. 

RCFE Test Preparation: 

An educational tool designed to help your study for your California Initial RCFE Administrator Certification exam.

RCFE Administrator: 

The person designated by the licensee to oversee and manage a Residential Care Facility for the Elderly. (May also be the licensee themselves.

RCFE License: 

The basic permit to operate a residential care facility for the elderly issued to you by the California Department of Social Services. RCFE Live CEUs:  The in-person, in-room continuing education classes (or units) that may be used to renew your RCFE and/or ARF certificate. The DSS requires that at least 20 of the 40 hours necessary for recertification be live.

RCFE Online CEUs: 

Online continuing education classes that may be used in conjunction with the 20 required Live CEUs to fulfill the 40 hour training requirement for certificate renewal

Department of Social Services (DSS): 

The governing body in California that provides program oversite for the most vulnerable of California’s population. Part of the DSS is the Community Care Licensing Division which is in charge of licensing and regulations for RCFE’s. Due to COVID-19, there have been changes to guidelines for every RCFE administrator and staff member to follow.

Elder Care Advocate:

A person who supports and represents the interests of elderly individuals, ensuring their needs—such as healthcare, living arrangements, or legal rights—are met effectively. They often act as a liaison between seniors, families, and service providers to promote the best possible care and quality of life.

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Earning your RCFE Certification is so much more than understanding a few words in a blog post. It’s a life-changing undertaking, and we’re here to guide you along the way. Enroll with Assisted Living Education today.

If you are interested in learning more about important terms, concepts, and informational resources related to running an RCFE, please check out our RCFE comprehensive glossary page.  This comprehensive list will point you in the right direction for getting up to speed with the latest industry terms and knowledge needed for RCFE certification and licensure.

We always welcome your feedback, and if you have other important terms you would like added to the list, please let us know. 

Assisted Living Education is a recognized leader in the industry, and our instructors have years of professional RCFE experience that will help ensure your success in this burgeoning industry.