What Is Title 22? California Care Facility Rules and Rights

Title 22 of the California Code of Regulations is the state’s rulebook for licensed community care facilities. It sets the minimum health, safety, and welfare standards that assisted living homes, child care centers, group homes, adult day programs, and similar providers must meet to operate legally in California. The California Department of Social Services (CDSS) enforces these rules through its Community Care Licensing Division (CCLD), which can inspect without notice, issue citations, fine facilities, and revoke licenses.

If you are placing a parent in assisted living, enrolling a child in day care, or trying to understand what a facility owes a resident, Title 22 is the body of regulation that answers most of your questions. The California Health and Safety Code and Title 22 together form the two primary legal authorities behind community care licensing.¹

Which Facilities Title 22 Covers

Title 22 is organized by division and chapter, with each chapter addressing a different type of licensed care. Division 6 alone covers more than a dozen facility categories, including:

Residential Care Facilities for the Elderly (RCFEs), the assisted living and board-and-care homes for older adults who need help with daily activities but not full nursing care.
Adult Residential Facilities (ARFs) for adults with developmental disabilities, mental health needs, or physical limitations.
Group Homes and Enhanced Behavioral Supports Homes for children and young adults.
Community Crisis Homes for people with developmental disabilities in behavioral crisis.
Small Family Homes licensed to care for up to six children or adults in a family residence.
Foster Family Homes and the Foster Family Agencies that certify them.
Residential Care Facilities for the Chronically Ill, serving adults with conditions like HIV/AIDS.
Adult Day Programs and Adult Day Support Centers.

Division 12 of Title 22 separately covers child care centers, infant care centers, and school-age day care programs.² Family day care homes have their own licensing chapter.

What Title 22 Does Not Cover

Not every arrangement in which someone receives help counts as a licensed facility. Title 22 specifically exempts care provided by family members, no matter how extensive. It also exempts housing that provides only room and board without any care or supervision, religious healing facilities operated by and for a church’s adherents, and recovery houses where residents live together without receiving supervised care.³ A close friend caring for someone from a single family can also qualify for an exemption if the friendship existed before any caregiving began.

Resident Rights Guaranteed by Title 22

Every resident of a community care facility has a written set of personal rights that the facility must post publicly and provide at admission. Residents sign to acknowledge receipt.⁴ For RCFEs, the regulation guarantees:

The right to be treated with dignity by staff, other residents, and visitors.
Freedom from humiliation, intimidation, abuse, and punitive actions such as withholding money or interfering with eating and sleeping.
The right to leave the facility at any time. Residents cannot be locked into any room or building, though facilities may lock exterior doors at night with CDSS permission.
Private visits during reasonable hours without prior notice, including from ombudspersons and advocacy representatives.
The right to keep personal clothing, toilet articles, and money, with access to individual storage.
Reasonable access to telephones for confidential calls and the right to send and receive unopened mail promptly.
The right to receive or refuse medical care and other services.
Voluntary participation in religious services.
The right to be told how to file complaints with CDSS and contact the long-term care ombudsman.

Facilities must also keep a resident’s designated representative informed about care activities and respond promptly to their communications.⁴

The Admission Agreement

Before or within seven days of admission, every RCFE must complete a written admission agreement with the resident and their responsible person or conservator. Families often skim this document, but it controls almost every financial and operational question that comes up later.⁵ Title 22 requires it to include:

All basic services included in the monthly rate and a breakdown of what is covered versus charged separately.
A fee schedule for optional services, with a signed acknowledgment of any optional services declined at signing.
Any preadmission fees, clearly described and refundable under stated conditions. Only one preadmission fee per admission is allowed.
Rate change procedures, including at least 30 days’ written notice before any change to the basic rate.
Refund conditions and the specific circumstances that could lead to eviction.
Policies on family visits and third-party services, including who pays for outside health care providers used within the facility.

If CDSS orders a resident relocated due to facility problems, the resident is not held to advance-notice requirements, and the facility must refund money the resident would have received had proper notice been given.⁵

Staffing Minimums

Title 22 sets different staffing floors by facility type and population. These are minimums; higher-acuity residents routinely require more.

RCFEs must have at least one direct care staff member on duty whenever residents are present. During the day, the minimum ratio is one staff member for every ten residents. In the evening and overnight, it shifts to one for every fifteen, with at least one additional person on call within 30 minutes.⁶ For residents who cannot perform activities of daily living on their own, or whose death is imminent, the floor tightens to one staff member for every three residents.

General child care centers require one teacher for every twelve children, or one teacher and one aide for every fifteen. Programs with a fully qualified teacher and qualified aide may operate at one to eighteen for preschool-age children.⁷ Infant care centers are far stricter: one teacher for every four infants, and on outings away from the center, one adult for every two infants.⁸

Background Checks for Staff and Residents

Anyone who plans to work, live, or volunteer in a community care facility must undergo a criminal background check before being present at the facility. California requires LiveScan fingerprinting for license applicants, licensees, employees with client contact, adult residents, and volunteers under certain conditions.⁹

Every conviction other than a minor traffic violation triggers the need for a formal exemption from CDSS, including old misdemeanors and dismissed cases. An individual cannot be at the facility until clearance or an exemption is granted. Certain crimes are non-exemptible by statute. Facilities serving children face an additional screen: every associated individual must pass a Child Abuse Central Index (CACI) name check.⁹

Enforcement here moves quickly. Operating with someone who has not been cleared carries an immediate civil penalty of $100 per day for up to five days on a first offense. A repeat within twelve months extends the penalty to $100 per day for up to thirty days.¹⁰

Medication Rules

RCFEs provide non-medical care, which means staff assist residents with self-administering medications rather than administering drugs themselves. Staff cannot give injections unless separately authorized by law. Helping someone with trembling hands open a pill bottle is assistance. Forcing medication, or hiding it in food without consent, is not, and Title 22 explicitly prohibits both.¹¹

As-needed (PRN) medications have layered rules. If a physician certifies the resident can determine and communicate their own need for the medication, staff may assist with self-administration. If the resident can describe symptoms but cannot judge when medication is needed, a physician must provide written directions specifying drug, dosage, and when to discontinue. Staff must log every PRN dose with date, time, amount, and the resident’s response. For residents who cannot clearly communicate their symptoms, staff must contact the physician before each individual dose and document that call.¹¹

Physical Environment and Safety

Title 22 sets rules for the spaces where residents actually live. In group homes, no more than two children may share a bedroom, and children of different sexes cannot share a room unless both are under five, a minor parent is sharing with their own child, or a child is exercising a gender identity right. Hallways, garages, unfinished basements, and storage areas cannot be used as bedrooms. Staff who sleep at the facility must have bedrooms separate from the children.¹²

Every group home must have carbon monoxide detectors meeting state standards, and smoking is prohibited inside the facility and on the grounds. Bedrooms must be large enough to allow comfortable use of assistive devices, including wheelchairs, though the regulations do not specify an exact minimum square footage.¹²

Emergency Planning

Licensed facilities must develop written emergency plans suited to their local risks, whether wildfire, earthquake, flooding, or heat-driven power outages. Plans are developed in consultation with local emergency officials and cannot conflict with the city or county plan. They must cover both sheltering in place (alternative power for lights and medical equipment, food and water for residents and required staff, systems for preparing meals and special diets during outages, basic hygiene supplies) and evacuation (reciprocal agreements with nearby facilities and safe transportation procedures). Skilled nursing facilities conduct external disaster drills twice a year; intermediate care facilities drill at least annually. Every drill gets a written report, and all staff must be trained on the plan from the start of employment.

Incident Reporting

When something goes wrong, Title 22 imposes strict reporting deadlines. Epidemic outbreaks, poisonings, fires, major accidents, deaths from unnatural causes, and any other event threatening the safety of residents, staff, or visitors must be reported to the local health officer and the licensing agency within 24 hours by phone, with written confirmation, or by telegraph.¹³

If a facility admits someone with physical injuries that appear to result from neglect or abuse, it must report to local police, the local health department, the placement agency, and the licensing agency by phone and in writing within 36 hours. Fires and explosions require a separate report to the local fire authority within 24 hours.¹³

How to File a Complaint

Anyone can file a complaint about a licensed community care facility, child care facility, or home care organization. CDSS suggests trying to resolve minor concerns directly with the provider first, but if that fails, complaints go to CDSS by phone at 844-538-8766, by email at letusno@dss.ca.gov, or through an online portal. The local licensing office makes an unannounced visit to investigate within 10 days of receiving the complaint. Investigators use a “preponderance of the evidence” standard, meaning the evidence must show it is more likely than not that the allegation is true.¹⁴ Physical or sexual abuse should also be reported to local law enforcement.

Civil Penalties for Violations

Title 22 and the Health and Safety Code create a tiered penalty structure that escalates with severity and repetition. For RCFEs, the framework runs as follows:

Standard uncorrected deficiency: $100 per day for each violation the facility fails to fix by the deadline.¹⁵
Repeat violation: Immediate $250 penalty plus $100 per day until corrected.
Serious violations: Immediate $500 penalty plus $100 per day. This category covers injuries or illness caused by a violation, fire safety failures such as inoperable smoke alarms, absence of required supervision, accessible firearms or ammunition, and refusing entry to licensing inspectors.
Repeat serious violation: Immediate $1,000 penalty plus $100 per day.
Physical abuse or serious bodily injury: $10,000.
Violation resulting in death: $15,000.¹⁵

Child care centers face a parallel structure. A deficiency that causes a child to become sick, injured, or die triggers an immediate $150 per day penalty. Repeat violations within twelve months carry an immediate $150 penalty followed by $50 to $150 per day until corrected. Standard serious deficiencies that are not fixed by the deadline accrue $50 per day, up to $150 per day.¹⁰

Beyond fines, CCLD can suspend or revoke a facility’s license. For a pattern of serious violations, or a single catastrophic failure, revocation permanently shuts the facility down.

Title 22 Versus Title 24

Title 22 is often confused with Title 24, but they regulate different things. Title 22 covers the operational side: staffing, resident rights, care plans, medication handling, and licensing standards. Title 24 is California’s building code, covering physical construction, fire safety systems, accessibility, and structural requirements. A licensed facility must comply with both. When California updated its fire code under Title 24, it aligned the definition of “child care” with the operational definitions already set in Title 22.¹⁶

1
California Department of Social Services. Laws and Regulations
2
California Department of Social Services. Child Care
3
Cornell Law School. California Code of Regulations Title 22, 87107 – Exemption from Licensure
4
Cornell Law School. California Code of Regulations Title 22, 87468.1 – Personal Rights of Residents
5
Cornell Law School. California Code of Regulations Title 22, 87507 – Admission Agreements
6
California Department of Social Services. Title 22 Regulations – RCFE Staffing Ratios
7
Cornell Law School. California Code of Regulations Title 22, 101216.3 – Teacher-Child Ratio
8
Cornell Law School. California Code of Regulations Title 22, 101416.5 – Staff-Infant Ratio
9
California Department of Social Services. Background Check
10
Cornell Law School. California Code of Regulations Title 22, 101195 – Penalties
11
Cornell Law School. California Code of Regulations Title 22, 87465 – Incidental Medical and Dental Care
12
Cornell Law School. California Code of Regulations Title 22, 84087 – Buildings and Grounds
13
Cornell Law School. California Code of Regulations Title 22, 76551 – Unusual Occurrences
14
California Department of Social Services. CCLD Complaints
15
California Legislative Information. California Health and Safety Code 1569.49
16
California Department of General Services. 2022 Title 24 California Code Changes