Arizona assisted living facility license: homes, centers and ADHS steps

One license class, three sizes

Arizona has no separate “residential care home” or “personal care home” license. The statute defines an assisted living facility as a residential care institution, “including an adult foster care home,” that provides or contracts to provide supervisory care, personal care or directed care services on a continuous basis.⁠¹ Within that one class, size decides which version you are opening:⁠¹

Scroll the table sideways to see every column.

An adult foster care home is a narrow option. It exists to serve people in the Arizona Long Term Care System (ALTCS) or under VA contracts. If fewer than four ALTCS participants live there, other adults may receive services, but the total may never exceed four.⁠¹ A licensee who is a licensed nurse may provide nursing care in an adult foster care home and must keep a record of it.⁠¹ If you plan a small private-pay home, you need an assisted living home license, not an adult foster care license.

ADHS’s Bureau of Assisted Living Facilities Licensing handles all three types. The same bureau licenses adult day health care facilities.⁠⁴ If you want a day program alongside the residence, you can ask for adult day health care services on your assisted living application.⁠² A freestanding day program needs its own license; see the Arizona adult day health care facility license guide.

Pick your care level before anything else

Your application must name one level of service: supervisory care, personal care or directed care. It must also say whether you want to add adult day health care or behavioral health services beyond behavioral care.⁠² The level shapes your building, staffing, policies and admissions, so decide it first.

• Supervisory care: general supervision, daily awareness of how residents are functioning, the ability to step in during a crisis, and help with self-administering prescribed medications.⁠¹
• Personal care: help with activities of daily living. It includes coordinating or providing intermittent nursing and medication administration by a licensed nurse.⁠¹
• Directed care: services, including supervisory and personal care, for people who cannot recognize danger, summon help, express needs or make basic care decisions.⁠¹ Arizona’s memory care training statute applies to facilities licensed at this level.⁠¹¹

Some limits apply at every level. You may not accept or keep anyone who needs continuous medical services, continuous behavioral health services, or continuous nursing (except under the adult foster care nurse-licensee rule). You may not admit anyone whose primary condition is behavioral, or anyone who needs restraints, and bedrails count as restraints.⁠² Before admission, each resident must provide documentation dated within 90 days and signed by a physician, nurse practitioner, registered nurse or physician assistant. It must state whether the person needs continuous medical services, continuous or intermittent nursing services, or restraints.⁠²

A personal care facility may not admit someone who cannot direct their own care. A resident confined to a bed or chair may stay if the condition results from a short-term illness or injury. Otherwise, as with a resident who has a stage 3 or 4 pressure sore, the resident or representative must request it and the resident’s primary care provider or another medical practitioner must sign a determination that the facility can meet the resident’s needs. That practitioner must re-examine the resident at least every six months.⁠² A directed care facility must have a designated representative for each resident who cannot direct self-care, wandering policies, and a way out of the building for residents without a key. That exit must lead to an outside area at least 30 feet from the building with controls or alerts, or use an International Building Code special egress-control device.⁠²

The manager certificate

Every assisted living facility must have a manager designated in writing who is at least 21. Except in an adult foster care home, the manager must hold an assisted living facility manager certificate, or a temporary certificate, from the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers.⁠²⁠⁸

To earn the certificate by examination you need:⁠⁸⁠¹⁰

• a high school diploma or GED, or a qualifying license (for example a nursing license)
• completion of a Board-approved caregiver training program and a Board-approved manager training program (licensed nurses and some other licensees are exempt from the caregiver course and the CPR/first-aid requirement)
• 2,080 hours of paid work experience in a health-related field within the five years before applying
• a score of at least 75% on the Arizona examination
• adult CPR and basic first aid training
• a valid fingerprint clearance card (or proof that you applied for one), which you must keep valid for the life of the certificate

Since July 1, 2021, every new certificate must be approved by both the Board and ADHS.⁠⁸ Certificates expire 30 days after the holder’s birthday in odd-numbered years and are then renewed.⁠⁸ The Board can issue a temporary certificate without the exam for a single, nonrenewable 150-day period.⁠⁹ Applicants must file at least 30 days before they plan to take the Arizona exam.⁠¹⁰

If the manager will be away, or has been away, for more than 30 days, you must designate an acting manager with the same qualifications. You must notify ADHS when the manager changes.⁠² Whenever the manager is off the premises, a caregiver at least 21 years old must be designated in writing as the person in charge.⁠²

Building, zoning and fire safety

Homes and centers follow different building routes.

Assisted living centers must meet the physical plant codes ADHS incorporates by reference, using the edition in effect on the date you submitted architectural plans.⁠² That means the license application must include either the architectural plans packet or documentation of ADHS’s approval of the plans.⁠³ ADHS’s overall time-frame for plan review is 105 days (45 for completeness, 60 for substantive review).⁠³ In areas providing personal or directed care, a center needs an NFPA 72 fire alarm system and an NFPA 13 sprinkler system. Areas providing only supervisory care may meet the home-style fire rules instead. The local fire department or State Fire Marshal must inspect the center before it is first licensed.⁠²

Assisted living homes are not held to those physical plant codes. Instead, the application must include documentation from your city or county that the building complies with local building codes and zoning ordinances. If the local jurisdiction will not provide it, you must document that and submit a general contractor’s inspection stating the building is safe for occupancy as an assisted living home.⁠³ Homes need:⁠²

• a mounted fire extinguisher rated at least 2A-10-BC (rechargeable units serviced every 12 months and tagged)
• smoke detectors in each bedroom, each hallway next to a bedroom, storage rooms, the laundry room, an attached garage and next to the kitchen, battery-powered or hard-wired with battery backup, tested monthly with records kept 12 months

A home may install a center-grade alarm and sprinkler system instead.

Space and fixture minimums apply to both homes and centers:⁠²

• no more than two people per bedroom or residential unit (older exceptions aside)
• private bedroom at least 80 square feet; shared bedroom at least 60 square feet per person, not counting closets or bathrooms
• residential units at least 220 square feet for one person plus 100 square feet for each additional person
• at least one toilet and one sink for every eight residents, and one bathtub or shower for every eight residents
• a common area, a dining area, and at least one bathroom reachable from the common area
• hot water between 95°F and 120°F wherever residents use it
• beds at least 36 by 72 inches

The application also asks whether the site is within a quarter mile of agricultural land. If it is, you must name the landowner or lessee and attach your written agreement with them.⁠³

Staff: ages, training and who must be awake

Article 8 sets no numeric staff-to-resident ratio. Instead, the manager must ensure enough qualified managers, caregivers and assistant caregivers to provide the services in your scope, meet each resident’s needs and keep residents safe.⁠² Some fixed rules apply:⁠²

• Caregivers must be 18 or older and document completion of a caregiver training program approved by ADHS or the Board. Other listed credentials also qualify, such as a nursing license or a nursing care institution administrator license.
• Assistant caregivers may be 16 and work under a manager’s or caregiver’s supervision.
• Centers: at least one manager or caregiver must be present and awake whenever a resident is on the premises.
• Homes: the manager or a caregiver must be present whenever a resident is home. They may sleep at night only if they can hear and respond to a resident. A home authorized for directed care must also have a written process for nighttime checks on directed-care residents. Homes need a written backup plan for when the assigned caregiver is unavailable.
• Before providing services, every manager and caregiver needs current adult first aid and CPR, and every caregiver and assistant caregiver needs duty-specific orientation.
• Anyone with more than eight hours a week of direct contact with residents must show freedom from infectious tuberculosis before starting.
• In a home, other household members who are not residents or staff must hold a fingerprint clearance card or interact with residents only under supervision. Those aged 12 or older must also show TB clearance.

Board-approved caregiver training programs must provide at least 62 hours of instruction, including at least 12 hours of instructor-supervised skills training. Students must score at least 75% on the knowledge exams.⁠¹⁰ By statute, the Board’s caregiver standards must be consistent with AHCCCS’s training and testing standards for in-home direct care workers.⁠¹⁵

Fingerprints and the APS registry. Owners, employees, contracted persons and volunteers who provide services must meet the fingerprint clearance card requirement. They must submit the Department of Public Safety application within 20 days of starting work.⁠⁷ Since January 1, 2025, you must check that a job applicant is not on the Adult Protective Services registry before hiring. You must recheck every employee once a year.⁠⁷ You must also make documented good-faith efforts to contact previous employers.⁠⁷

Policies ADHS expects to see

The governing authority must put the scope of services in writing and adopt a quality management program, which it reviews every 12 months.⁠² The manager must have written policies covering at least:⁠²

• job descriptions, orientation and in-service training
• CPR and first aid training
• staffing and recordkeeping
• resident acceptance, resident rights and termination of residency
• making influenza and pneumonia vaccination available
• knowing residents’ whereabouts
• medical records
• personal funds accounts
• complaints
• health care directives
• medication assistance and administration
• food services
• contracted services
• infection control
• incident reporting

Policies must be reviewed at least every three years.⁠²

You also need a disaster plan, reviewed every 12 months. It must cover where residents go, how their records and medications follow them, and how you will get food and water. You must run a disaster drill on each shift every three months and an evacuation drill every six months, and post an evacuation path in each hallway.⁠²

Other operating rules matter when you design your business model:⁠²

• A resident’s personal funds account you manage may not exceed $2,000. You must give the resident a statement at least every three months.
• Fee increases need 30 days’ written notice, unless the resident’s care needs change.
• You must post the license, along with phone numbers for the ADHS licensing unit, Adult Protective Services, the State Long-Term Care Ombudsman and the Arizona Center for Disability Law.
• You must produce documentation within two hours when ADHS asks for it.

Applying through the Licensing Management System

ADHS takes applications only through its online Licensing Management System (LMS). Paper forms are no longer accepted.⁠⁴ By statute you must apply at least 60 and no more than 120 days before you plan to open.⁠⁵ A workable order:

1. Fix the type, size and care level

   These drive everything else, including whether you need architectural plan approval and a center-grade fire alarm and sprinklers.⁠²

2. Line up the manager

   Start the Board certificate early. The 2,080-hour work requirement, two training programs, the exam and dual Board/ADHS approval all take time.⁠⁸⁠¹⁰

3. Center: get architectural plans approved

   Submit plans with the review fee. ADHS’s overall time-frame is 105 days.⁠³

4. Home: get local sign-off

   Obtain city or county documentation of building code and zoning compliance (or the contractor inspection alternative).⁠³

5. File the LMS application

   It covers the facility’s name, address and tax ID, and whether the building is leased (attach the lease). It lists owners, partners, LLC managers or corporate officers, and any license denial, revocation or suspension involving an owner or anyone holding 10% or more. It also names the statutory agent and the chief administrative officer’s education and experience. Attach entity documents, a site plan, and a floor plan showing every door, window, exit, plumbing fixture and fire protection device. Add your scope of services, the requested care level and add-ons, and the $50 application fee.⁠²⁠³

6. Tell ADHS you are ready for inspection

   The application is not complete until you give written notice that the facility is ready for a licensing inspection. If ADHS sends a notice of missing documents, you have 60 calendar days to supply them or the application is treated as withdrawn. After ADHS’s one comprehensive request for information during substantive review, a license applicant who does not respond within 120 calendar days receives a denial.⁠³

7. Licensing inspection

   ADHS inspects before issuing the license. It can issue a regular license or a provisional license of up to one year.⁠⁶

8. Pay the licensing fee

   It is due within 60 days of ADHS’s written notice of approval, or within 90 days with a $250 late fee.⁠³

ADHS’s overall time-frame for an initial license is 120 days: 30 days for the completeness review and 90 days for substantive review. Time you spend answering requests does not count.⁠³

Fees as published on 2026-10-12

ADHS charges a $50 application fee and a licensing fee based on licensed capacity. The licensing fee is due at approval and again every year after that.⁠³

At these rates, a 10-bed assisted living home owes $980 a year in licensing fees and a 40-bed center owes $3,080, plus the one-time $50 application fee. Adult foster care homes are exempt from the licensing fee.⁠³ The architectural drawing review fee for centers is $50 for projects costing $100,000 or less, $100 for projects over $100,000 and under $500,000, and $150 for projects of $500,000 or more. All fees are nonrefundable.⁠³

After you open: annual fee, annual inspection

An Arizona health care institution license does not expire. It stays valid unless ADHS revokes or suspends it, or it becomes void because you missed the licensing fee or civil penalties.⁠⁶ ADHS notifies you at least 90 days before your annual fee is due. You confirm your facility information and pay no earlier than 60 days before the license anniversary. Up to 30 days late is allowed with a $250 late fee.⁠³

ADHS must inspect each facility at least once a year. Other facility types can go 24 months without a survey after a deficiency-free one, but residential care institutions such as assisted living facilities are generally excluded from that break (the exclusion does not apply to one with the same owner as a licensed hospital).⁠⁶ You must keep current inspection reports on site and post a notice saying where they can be read.⁠⁶

Changes. You must give ADHS 30 days’ written notice before a name change or closure.⁠³ A planned change of ownership also needs 30 days’ notice, and the new owner may not operate until ADHS issues it a license.⁠⁵ Changes in controlling persons must be reported within 30 days.⁠⁵

Memory care training and other changes since 2024

• Memory care training (effective July 1, 2025). House Bill 2764 (2024) added A.R.S. § 36-405.03. It is effective after June 30, 2025.⁠¹² The statute directs ADHS to set memory care standards for every assisted living facility licensed for directed care. It requires at least 8 hours of initial memory care training and 4 hours of annual continuing education for staff and contractors, plus 4 more initial hours for managers. ADHS must approve the training programs, and the completion certificate is portable between directed-care facilities. During a survey or investigation, missing training records are cited as a deficiency.⁠¹¹ The statute tells ADHS to adopt the memory care standards and training rules, and ADHS has run a rulemaking on Article 8 for that purpose. This guide could not confirm the final rule text or its effective date from an official source, so the Article 8 provisions quoted here come from ADHS’s published version effective November 5, 2019. Before you apply for directed care, ask ADHS’s Bureau of Assisted Living Facilities Licensing which Article 8 version applies, what memory care standards it adds to directed care, and which training programs it has approved. If a staff member has not worked at a directed care facility for 12 months, the statute requires them to complete the initial training within 30 days after hire, rehire or return to work.
• APS registry checks (2025). Pre-hire and annual Adult Protective Services registry checks became mandatory in 2025.⁠⁷
• Non-resident occupants (April 6, 2026). Senate Bill 1247 (Laws 2026, chapter 14) took effect immediately as an emergency measure. An individual who receives no supervisory, personal or directed care may now live in a resident’s unit or another unit, if the facility allows it. ADHS may not require that person to have a service plan or meet requirements residents would not have to meet.⁠¹³

Getting paid through ALTCS

Arizona’s Medicaid long-term care program, ALTCS, can pay for home and community based services in adult foster care homes, assisted living homes and assisted living centers. Those services are delivered through ALTCS program contractors to members found to need an institutional level of care. ALTCS members living in an assisted living center must be offered a single-occupancy option.⁠¹⁴ An adult foster care home depends entirely on this funding (or VA contracts), because its residents must be ALTCS participants or VA-contract residents.⁠¹ Contracting terms are set by AHCCCS and its contractors, not by the ADHS license.

If you would rather send caregivers into clients’ homes than run a residence, Arizona licenses home health agencies as a separate ADHS health care institution class. Their licensing fee is set in the same rule, A.A.C. R9-10-106(C)(5), at $365 plus $91 per licensed bed, or $365 for an agency with no licensed capacity, as published on 2026-10-12.⁠³

Sources

1. 1
   Arizona State Legislature, A.R.S. § 36-401 (Definitions; adult foster care) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Arizona Department of Health Services, 9 A.A.C. 10, Article 8 (Assisted Living Facilities), unofficial version effective November 5, 2019 Checked 12 Oct 2026 · Back to text ↑
3. 3
   Arizona Secretary of State, Arizona Administrative Code, Title 9, Chapter 10 (Department of Health Services: Health Care Institutions: Licensing), Article 1 Checked 12 Oct 2026 · Back to text ↑
4. 4
   Arizona Department of Health Services, Assisted Living Facilities Licensing Checked 12 Oct 2026 · Back to text ↑
5. 5
   Arizona State Legislature, A.R.S. § 36-422 (Application for license; change of ownership) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Arizona State Legislature, A.R.S. § 36-425 (Inspections; issuance of license; provisional license) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Arizona State Legislature, A.R.S. § 36-411 (Fingerprinting requirements) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Arizona State Legislature, A.R.S. § 36-446.04 (Manager certificate qualifications) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Arizona State Legislature, A.R.S. § 36-446.06 (Temporary licenses and certificates) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Arizona Secretary of State, Arizona Administrative Code, Title 4, Chapter 33 (Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Arizona State Legislature, A.R.S. § 36-405.03 (Memory care services standards; staff training) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Arizona State Legislature, House Bill 2764, Senate engrossed version (2024, long-term care; enforcement; memory care) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Arizona State Legislature, Laws 2026, Chapter 14 (Senate Bill 1247) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Arizona State Legislature, A.R.S. § 36-2939 (ALTCS long-term care system services) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Arizona State Legislature, A.R.S. § 36-446.03 (Board powers; caregiver training standards) Checked 12 Oct 2026 · Back to text ↑

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