(a) Any individual, firm, partnership, association, corporation or governmental entity desiring to obtain a license shall file with the licensing agency an application on forms furnished by the licensing agency. The licensee shall cooperate with the licensing agency in providing verification and/or documentation as requested by the licensing agency. The application and supporting documents shall contain the following:
(1) Name or proposed name and address of facility.
(2) Name and address of the applicant and documentation verifying completion by the applicant of certification requirements as specified in Section 87406, Administrator Certification Requirements.
(A) This section shall apply to all applications for license, unless the applicant has a current license for another residential care facility for the elderly which was initially licensed prior to July 1, 1989, or has successfully completed an approved certification program within the prior five years.
(B) If the applicant is a firm, partnership, association, or corporation, the chief executive officer or person serving in a like capacity or the designated administrator of the facility shall meet the requirements of this section.
(3) If the applicant is a partnership, the name, signature and principal business address of each partner.
(4) If the applicant is a corporation or association, the name, title and principal business address of each officer, executive director, and member of the governing board. The application shall be signed by the chief executive officer or authorized representative. In addition, a copy of the Articles of Incorporation, Constitution and By-laws, and the name and address of each person owning more than 10 percent of stock in the corporation shall be provided.
(5) If the applicant is a corporation, each member of the board of directors, executive director, and any officer shall list the name of all facilities which they have been licensed to operate, employed by or a member of the board of the directors, executive director or an officer.
(6) Procedures as required pursuant to Section 1569.175 of the Health and Safety Code.
(7) Name and address of owner of facility premises if applicant is leasing or renting.
(8) The category of facility to be operated.
(9) Maximum number to be served.
(10) The name, residence and mailing addresses of the facility administrator, a description of the administrator's background and qualifications, and documentation verifying the required education and administrator certification.
(11) Copy of the current organizational chart showing type and number of positions and line of authority. However, facilities for less than sixteen persons may furnish, in lieu of an organization chart, a list of positions and the periods of time that persons in these positions will be providing services at the facility.
(12) Evidence pursuant to Health and Safety Code, section 1520(b).
(13) A financial plan of operation on forms provided or approved by the Department. Start-up funds shall be sufficient to meet a minimum of three (3) months operating costs. In addition:
(A) Where construction is anticipated to meet the requirements for a license, sufficient financing for the construction shall be available.
(B) The scope of the applicant's services shall be such that an adequate quality of service will be permitted from available funds. The licensing agency shall have the right to verify the availability of these funds.
(14) When there is a change of licensee, the required documentation shall include the information specified in Section 87217(k).
(15) Information concerning insurance carried by the applicant relating to the operation of the facility.
(16) A plan of Operation as specified in Section 87208, Plan of Operation.
(17) The fee for processing the application for the requested capacity as specified in Section 87156, Licensing Fees.
(18) Name, address and telephone number of the city or county fire department, the district providing fire protection services, or the State Fire Marshal's Office having jurisdiction in the area where the facility is located.
(19) Such other information as may be required by the licensing agency for the proper administration and enforcement of the licensing law and regulations.
(b) An application shall be filed with the licensing agency which serves the area in which the facility is located.
Credits
Note: Authority cited: Sections 1569.23, 1569.30 and 1569.616, Health and Safety Code. Reference: Sections 1569.1, 1569.2, 1569.10, 1569.15, 1569.151, 1569.1515, 1569.16, 1569.17, 1569.185, 1569.19, 1569.20, 1569.21, 1569.22, 1569.23, 1569.24, 1569.312, 1569.45, 1569.60, 1569.616 and 1569.62, Health and Safety Code.
History
1. Change without regulatory effect adopting new article 3 (sections 87155-87163) and renumbering section 87218 to new section 87155, including amendment of section, filed 3-5-2008 pursuant to section 100, title 1, California Code of Regulations (Register 2008, No. 10).
This database is current through 4/26/24 Register 2024, No. 17.
