Title 22 of the California Code of Regulations is not published as a single downloadable PDF. The regulations run across more than a dozen divisions covering health care facilities, community care licensing, Medi-Cal, environmental health, and other programs, and the official text lives on the Office of Administrative Law’s online database, where sections are searchable and updated weekly.1Office of Administrative Law. California Code of Regulations (CCR) If you’ve been hunting for a Title 22 PDF, the practical answer is to read the sections you need directly from the state database or an authorized mirror rather than relying on a static file.
Why There Is No Official Title 22 PDF
OAL refreshes the online and print versions of the California Code of Regulations once a week to reflect newly adopted, amended, or repealed regulations. A consolidated PDF would be outdated the week after it was posted. That’s the main reason the state doesn’t maintain one, and it’s also why downloaded copies circulating on third-party sites carry real risk: a licensing applicant or facility operator who relies on an old PDF can easily be working from a rule that has since changed.
The regulations are also enormous. Title 22 carries the heading “Social Security,” but it reaches well beyond what that name suggests, pulling in operating rules administered by several different California agencies. A single document covering all of it would be unwieldy even if it were kept current.
How to Read Title 22 Online
The database is organized by Title, Division, Chapter, and Section. If you already have a section number, search it directly. If not, browse by division: the structure is designed to take you to a specific provision rather than ask you to scroll through the whole code.
Cornell Law School’s Legal Information Institute mirrors the full California Code of Regulations and is a convenient alternative for reading individual sections, particularly if you want to link to a specific rule.
What Title 22 Covers
Most people searching for Title 22 are trying to find rules in one of these divisions:
- Division 1: Employment Development Department
- Division 1.8: California Department of Aging
- Division 2: Department of Social Services and Department of Health Services
- Division 3: Health Care Services, including the Medi-Cal program
- Division 4: Environmental Health
- Division 4.5: Health Planning and Facility Construction
- Division 5: Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies
- Division 6: Licensing of Community Care Facilities
- Division 9: Prehospital Emergency Medical Services
- Division 12: Child Care Facility Licensing Regulations
The California Department of Public Health enforces Division 5 for hospitals, skilled nursing facilities, and similar health care settings. The California Department of Social Services enforces Division 6 through its Community Care Licensing Division, which oversees residential care facilities for the elderly, adult residential facilities, and group homes.
Division 5: Health Care Facilities
Division 5 is the clinically detailed side of Title 22. A few of the provisions searchers ask about most often:
Medical record retention. Health records for discharged adult patients must be completed and filed within 30 days of discharge and kept for at least seven years.2Legal Information Institute. California Code of Regulations Title 22, 72543 – Patients Health Records That matters if you ever need old records for a legal claim, insurance dispute, or continuing care.
Nurse staffing ratios. California mandates specific nurse-to-patient ratios by unit type. Under Section 70217, the licensed nurse-to-patient ratio in a critical care or intensive care unit must be one nurse to two or fewer patients at all times, and in medical and surgical units, one nurse to five or fewer patients.3Legal Information Institute. California Code of Regulations Title 22, 70217 – Nursing Service Staff These are floor ratios, not shift averages. The ICU ratio also applies to intensive care newborn nurseries.
Activity programs in skilled nursing facilities. SNFs must offer social activities that promote group interaction, indoor and outdoor recreation, opportunities to participate in activities outside the facility, creative and educational programming, and exercise.4Legal Information Institute. California Code of Regulations Title 22, 73379 – Activity Program Scope Residents also have the right to attend the religious program of their choice.
Division 6: Community Care Facilities
Division 6 sets the licensing standards for facilities such as Residential Care Facilities for the Elderly and Adult Residential Facilities. These are not medical facilities, and the regulations draw a firm line between community care services and licensed medical care.
Administrator certification. Every RCFE administrator must hold a valid certificate before starting work, obtained by completing an Initial Certification Training Program and passing a written examination.5Legal Information Institute. California Code of Regulations Title 22, 87406 – Administrator Certification Operating without a certified administrator is a direct path to a citation.
Resident rights. Division 6 guarantees personal rights for every resident, including privacy, the right to file grievances without retaliation, and the right to keep and use personal belongings.6Legal Information Institute. California Code of Regulations Title 22, 87468 – Personal Rights of Residents Facilities must inform residents of these rights in writing.
Physical space standards. Each resident must have an individual adult bed with mattress, pillow, and clean linens, plus at least eight cubic feet of dresser space.7Legal Information Institute. California Code of Regulations Title 22, 87307 – Personal Accommodations and Services Facilities with a capacity of seven or more must post a current activity calendar, and outdoor areas must be furnished with shade. The pre-licensing inspection checklist covers everything from hot water temperature (105 to 120 degrees Fahrenheit) to locked storage for medications and cleaning supplies.8California Department of Social Services. Pre-Licensing Facility Evaluation Checklist – Adult Residential Facility
Criminal background checks. Before the state issues a community care license, every applicant, administrator, and non-client adult living in the facility must obtain a criminal record clearance or an exemption. Fingerprints go electronically to the California Department of Justice, with a second set forwarded to the FBI.9Legal Information Institute. California Code of Regulations Title 22, 80019 – Criminal Record Clearance Clearance must be in place before the person begins working, living, or being present in the facility. Division 5 facilities have parallel background check requirements enforced by CDPH.
Division 3: Medi-Cal
Many searches that end up at Title 22 are really looking for the Medi-Cal regulations. Division 3 contains the California Medical Assistance Program rules, organized into chapters covering eligibility determination and share-of-cost calculations, covered health care services, prepaid health plans, and the drug formulary and medical supplies listing.10Legal Information Institute. California Code of Regulations Title 22, Division 3, Subdivision 1 – California Medical Assistance Program These regulations translate the broad Medi-Cal program authorized by the Welfare and Institutions Code into the operational rules providers and county eligibility workers apply daily.
Penalties for Title 22 Violations
When a facility violates Title 22, the Department can issue citations carrying civil penalties keyed to severity:
- Class A violation: $1,000 to $5,000 per violation. These typically involve direct risk to patient or resident safety.
- Class B violation: $50 to $250 per violation. Less severe but still meaningful regulatory failures.
If a facility fails to correct a Class A or Class B violation by the deadline in the citation, a separate penalty of $50 per day runs for each day it continues. Penalties triple for a second or later violation of the same regulation within any 12-month period, where a citation was previously issued and a penalty assessed.11Legal Information Institute. California Code of Regulations Title 22, 73717 – Penalties The trebling provision is where financial exposure escalates quickly for operators who keep missing the same standard.
License Suspension and Revocation
Beyond monetary penalties, the state can suspend or revoke a facility’s license. Under the Health and Safety Code, grounds for revocation include violating Title 22 regulations, aiding or permitting violations, engaging in conduct harmful to the health, welfare, or safety of residents, and criminal convictions of the licensee or associated individuals.12California Legislative Information. California Health and Safety Code 1569.50
Licensees generally have a right to a hearing before revocation. The Director can temporarily suspend a license without a prior hearing when immediate action is necessary to protect residents from physical or mental abuse or any other substantial threat to their health or safety. In that situation, the Director notifies the licensee of the suspension and simultaneously serves an accusation that starts the formal hearing process.13Legal Information Institute. California Code of Regulations Title 22, 87775 – Revocation or Suspension of License The temporary suspension takes effect immediately, and the facility must stop operations until the matter is resolved.
For any specific rule you plan to rely on, pull the current section from the OAL database rather than a saved file. The weekly update cycle is the whole reason the state doesn’t publish a Title 22 PDF, and it’s the reason you shouldn’t trust one you find elsewhere.