California adult day program license: CDSS rules, plus the separate ADHC path
California has two adult day licenses. A non-medical Adult Day Program is licensed by the CDSS Community Care Licensing Division under Title 22, Chapter 3, with no minimum client count. A medical-model Adult Day Health Care center is licensed by CDPH, and most also get Medi-Cal CBAS certification from the Department of Aging, a process CDA says may take 18 to 24 months.
Contents13 sections
Key takeaways
- There is no small-program exemption: any business giving day care and supervision to adults 18 or older needs a CDSS Adult Day Program license, unless it falls into a narrow exemption such as care by a relative.13
- Plan staffing around 1 direct care staff member per 8 clients, 1 per 4 for clients who depend on others for all daily activities, and never fewer than two people on duty once two clients are present.3
- The administrator needs a human-services degree plus a year of management, or three years of human-services experience, must be at least 21, and owes 30 hours of continuing education every two years.3
- CDSS application fees run from $182 (1 to 15 clients) to $1,513 (121 or more), with annual fees from $91 to $757, per the schedule effective January 1, 2015.9
- Adult Day Health Care is a separate CDPH health-facility license with an $8,830 fee for 2026-27, and new ADHC/CBAS applications need prior Department of Aging approval.1316
- No ADHC moratorium is posted: on October 12, 2026 CDA was accepting CBAS applications in all counties, but it tells applicants to check first whether Medi-Cal managed care plans are contracting with new centers.1415
Quick facts
| Agency (Adult Day Program) | CDSS Community Care Licensing, Adult and Senior Care Program; applications go to its Centralized Applications Bureau |
|---|---|
| Licensing threshold | Any number of adults 18+ receiving care and supervision for less than 24 hours |
| Application fee | $182 (1-15 clients) to $1,513 (121+), plus $54.85 orientation (as published, checked Oct 12, 2026) |
| Staffing | 1:8 direct care overall; 1:4 for fully ADL-dependent clients; 2 on duty minimum |
| CDSS processing | 90 to 120 days expected for the whole application |
| Medical model (ADHC) | CDPH license, $8,830 fee for FY 2026-27; CBAS certification by CDA may take 18-24 months |
Fees and timeframes as published by CDSS, CDPH and the California Department of Aging, checked on October 12, 2026.
Two licenses, two departments
California splits adult day care between two agencies, and the first decision you make is which one you are building for.
| Adult Day Program (ADP) | Adult Day Health Care center (ADHC) | |
|---|---|---|
| Model | Non-medical care and supervision | Therapeutic, social and skilled nursing services |
| Licensing agency | CDSS Community Care Licensing, Adult and Senior Care Program | CDPH Licensing and Certification |
| Law | Health and Safety Code 1500 et seq.; Title 22, Division 6, Chapter 3 | Health and Safety Code 1570-1596.5; Title 22, Division 5, Chapter 10 |
| Medi-Cal CBAS | Not available (CBAS certification requires an ADHC license) | Usually paired with CBAS certification from the Department of Aging |
| Application fee | $182 to $1,513 by capacity | $8,830 (FY 2026-27 license fee) |
The non-medical license covers “any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis” 1. CDSS’s Adult Care Licensing Program licenses and monitors these programs through 14 regional offices 4. Adult day health care is a different service: an organized day program of therapeutic, social and skilled nursing health activities, regulated by the State Department of Public Health 11, and no one may provide it without a CDPH license 12.
Most of this guide covers the CDSS Adult Day Program, the path open to a new founder without a nursing and therapy staff. The ADHC section near the end explains what changes if you want to bill Medi-Cal for medical day services. For 24-hour care of older adults, see the California RCFE guide; other states’ adult day rules are compared on the adult day license page.
Who needs the CDSS license
Title 22 sets no minimum client count. Unless an exemption applies, no person, company, county, city or other public agency may “operate, establish, manage, conduct or maintain an adult day program, or hold out, advertise or represent by any means to do so” without a current license 3. Statute applies the same rule to every community care facility 2.
The exemptions in 22 CCR 82007 are narrow 3:
- Licensed health facilities and clinics (they fall under CDPH instead).
- Day programs run by and for adherents of a religion that relies on prayer or spiritual healing.
- Care by a relative or conservator.
- Care for people from only one family by a close friend, if the friend does not work for or hold a license for an adult residential facility, adult day program or RCFE, and the arrangement is not of a business nature.
- Placement agencies, and the Department itself.
If you advertise day care for adults, you are outside the close-friend exemption. CDSS can serve a Notice of Operation in Violation of Law, refer you for prosecution, and assess an immediate civil penalty, which the regulations reprint from Health and Safety Code 1547 as $200 per day 3.
Who can run it: the administrator
Every adult day program must have an administrator who meets one of two routes under 22 CCR 82064 3:
Degree route
A bachelor’s degree in psychology, social work or a related human services field, plus at least one year managing a human services delivery system.
Experience route
Three years in a human services delivery system, including at least one year in a management or supervisory job, and two years of experience or training in caring for clients of a licensed adult day program or adult day health care center, or for the client groups your program will serve.
The administrator must also be at least 21 and complete at least 30 clock hours of continuing education every 24 months 3. The licensee, or a board member of a corporate licensee, may serve as administrator if qualified 3. One administrator may oversee two or more programs only if each site has an on-site employee with either a human-services bachelor’s degree or a year of supervisory or management experience in human services 3. If the administrator will be away more than 30 consecutive days, you must designate a substitute who meets the full administrator qualifications 3.
Staffing and training
Chapter 3 sets three staffing floors 3:
- Overall ratio: at least one direct care staff member for each group of eight clients present, or fraction of eight. Volunteers count only if they meet the direct care staff definition.
- Clients who rely on others for all activities of daily living: at least one direct care staff to four such clients (Regional Center clients follow the Regional Center’s staffing).
- Minimum on duty: at least two people, one of them direct care staff, whenever two or more clients are present.
Staff doing support work such as cooking, cleaning or bookkeeping do not count toward the ratio while they do it 3. Direct care staff need at least 8 hours of documented training a year, under a written training plan you keep 3. Anyone who supervises or gives care must be at least 18 3. Direct care staff need current first aid and CPR training, and at least one full-time staff member with a current first aid and CPR certificate must be present during operating hours 3.
Before hire, each employee needs a health screening by or under a physician, with a negative tuberculosis test, done no more than a year before or seven days after starting work 3. Every employee and volunteer subject to a criminal record review must have a California clearance, an exemption or an approved transfer before they are present in the program 3. CDSS runs the background check through LiveScan fingerprinting and its Guardian system 6.
Medication rules shape your client mix. Staff assist only with self-administration; they may not give injections unless authorized by law 3. Programs may not admit or keep clients with naso-gastric tubes, active communicable TB, stage 3 or 4 pressure sores, or conditions requiring 24-hour nursing care 3. Other conditions, such as diabetes, catheters or wounds, are “restricted” and need a written care plan 3.
The site: fire clearance, space and plant rules
California does not set a square-footage-per-client figure for adult day programs. CDSS sets your licensed capacity during application review from your fire clearance, the physical features of the site, including activity space, and the staff you have available 3. Plan the building with these Title 22 requirements in mind 3:
- Fire clearance from the city or county fire department, fire district or State Fire Marshal, requested through CDSS. If you want delayed-egress devices on exterior doors or gates (common in dementia programs), the fire clearance must approve them, and you must then run fire and earthquake drills every three months on each shift.
- A separate room or area for clients who become ill, office space for private interviews, rest areas, outdoor space (if offered) with shade and protection from traffic, and enough parking for safe drop-off.
- One toilet with privacy and one handwashing sink for every 15 clients of licensed capacity.
- Room temperature between 68 and 85 degrees F, and hot water at fixtures between 105 and 120 degrees F.
- Pools, spas and ponds made inaccessible by a fence or locking cover if you serve clients with physical, mental or developmental disabilities.
- If water comes from a private source, an on-site inspection and bacteriological test before licensure, then retesting annually (7 to 15 clients), semiannually (16 to 24) or quarterly (25 or more).
Notify CDSS before any construction or alteration 3. For local approvals, the CDSS bureau lists obtaining a conditional use permit as a step “for larger facilities” and tells applicants to have it in hand before submitting 5. Ask your city or county planning department which permit your site needs.
Plans you must write before applying
The application packet includes a written plan of operation that CDSS reviews and later enforces; you can be cited for not running the program the way the plan says 3. It must include your purpose and goals, admission policies, services, hours, client group, admission agreement, staffing plan and duties, a floor plan with room dimensions and rooms for non-ambulatory clients, a dimensioned sketch of the grounds, one week of sample menus if you serve meals, transportation arrangements, your fee and refund policy, and a plan for an annual internal evaluation 3. If you will accept clients with restricted health conditions, total dependence on others for daily activities, or behaviors that can harm others, the plan must explain how you will serve them safely 3.
Two further plans are required:
- Infection Control Plan. Since July 1, 2023, each program must name an Infection Control Lead and train new staff within 10 calendar days of hire 3. CDSS requires the plan in every initial, ownership and location application and publishes form LIC 9283 for adult day programs 5.
- Disaster and mass casualty plan. It covers exits, transport, relocation sites and contacting local agencies, with drills at least every six months and records kept for a year 3.
Meals must meet the USDA adult meal pattern in 7 CFR 226.20(c) 3. Each client needs a written medical assessment by a physician or licensed designee, no more than a year old, within 30 days of acceptance 3.
Applying to CDSS, step by step
Adult day program applications go to the Adult and Senior Care Program’s Centralized Applications Bureau (CAB), which states that “expectations for completing the entire application process are 90 to 120 days” 5.
Take the online orientation (Component I)
Title 22 requires it before you file 3. Adult day programs use the Adult Care orientation; the fee is $50 plus a $4.85 processing fee ($54.85), and you get 30 days of access to finish it and download the certificate 7.
Assemble the LIC 281 packet
For adult day programs it includes the LIC 200 application, applicant information (LIC 215), designation of facility responsibility (LIC 308), administrative organization for entities (LIC 309), the client cash affidavit and bond (LIC 400 and 402), financial statements (LIC 401, 401a, 403, 403a, 404 and LIC 420 budget), personnel forms (LIC 500, 501, 503), the facility sketch (LIC 999) and the fire authority form (LIC 9054), plus program description, admission policies, sample menu, proof you control the property, a first aid card and your orientation certificate 8.
Show start-up money
CDSS verifies about three months of operating funds for a new facility, counting only cash and cash equivalents or a verifiable line of credit, and it pulls your credit report 68.
Mail the packet and fee
to CAB at 744 P Street, MS 9-14-8201, Sacramento, CA 95814 (phone 833-827-6084) 5.
Get the acceptance letter
CDSS must tell you within 90 days whether the application is accepted or deficient. You then have 30 days to supply missing items, or the application is treated as withdrawn 3.
Fingerprint everyone who needs clearance
through LiveScan 6.
Component II interview and full review
CAB orders your fire clearance, checks finances, credit and compliance history, and holds an operational readiness interview 6.
Pass the fire inspection
The local fire authority contacts you and reports its clearance to CAB 6.
Pre-licensing inspection and Component III
The regional office inspects the site and then schedules a category-specific training session 6. Any corrections must be in by the due date 6.
Decision
CDSS must approve or deny within 90 days after accepting the application 3. If you are in substantial compliance and there is urgent need, CDSS may issue a provisional license for up to six months, or 12 months when delays are beyond your control 3.
Fees
The application fee depends on the capacity you request. As published in the CDSS schedule effective January 1, 2015, which the application bureau still links as its fee schedule, and as reprinted from Health and Safety Code 1523.1 in the regulations 359:
| Capacity | Initial application | Annual fee | Late fee |
|---|---|---|---|
| 1-15 | $182 | $91 | $45 |
| 16-30 | $303 | $152 | $76 |
| 31-60 | $605 | $303 | $151 |
| 61-75 | $758 | $378 | $189 |
| 76-90 | $908 | $454 | $227 |
| 91-120 | $1,210 | $605 | $302 |
| 121+ | $1,513 | $757 | $378 |
Scroll the table sideways to see every column.
Other charges: $25 to change capacity, 50 percent of the application fee to move or to change who controls a corporate licensee’s board, and a $200 fee if you fail to carry out a plan of correction by its date 3. Fees are nonrefundable 3. CDSS says there are no provisions for waiving fees or accepting partial annual payments, and the annual fee is due by the license anniversary; it makes a refund only on documented proof of a Department error or a genuine overpayment 10.
After licensure: inspections, reports and changes
The regulations reprint the Health and Safety Code rule that CDSS inspects a new facility within 90 days after issuing the license, and that every licensed community care facility is subject to unannounced visits 3. Inspectors may interview clients and staff privately and copy records 3.
Report deaths, injuries needing medical treatment, any use of an automated external defibrillator, epidemic outbreaks, fires and other unusual incidents to CDSS by its next working day, followed by a written report 3. The abuse-reporting provisions of section 82061 were updated effective July 14, 2026, and they route suspected elder or dependent adult abuse to law enforcement, the long-term care ombudsman and CDSS 3.
A new application is required to move, to change the licensee (including a majority stock sale), or when a client permanently becomes non-ambulatory. CDSS can approve a capacity increase without a new application once a fire clearance is secured 3. A license is forfeited if you sell or move the program, surrender the license, or abandon it 3.
The medical model: Adult Day Health Care and CBAS
An ADHC center is a licensed health facility, not a community care facility. It provides adult day health care under the California Adult Day Health Care Act (Health and Safety Code 1570-1596.5), and the regulations sit in Title 22, Division 5, Chapter 10 (sections 78001-78609) for licensing and Division 3, Chapter 5 (sections 54001-54507) for Medi-Cal 1117. Most ADHC centers bill Medi-Cal as Community-Based Adult Services (CBAS), a benefit for Medi-Cal members 18 or older who meet medical necessity criteria. Services include physical, occupational and speech therapy and transportation to and from home 22.
Is there a moratorium? On October 12, 2026, the Department of Aging’s CBAS Bureau stated it “is currently accepting applications for all counties across the state of California” 15. CDPH’s application page posts moratorium notices for home health agencies and hospices, and none for adult day health centers 14. The practical limit is demand. CDA encourages applicants, before they apply, to confirm with local Medi-Cal managed care plans whether those plans are contracting with new CBAS providers in the area 15.
How the ADHC path differs from the CDSS license:
CDA pre-screening comes first
CDA’s resource guide says new ADHC/CBAS initial licensure and certification applications need prior CDA approval 16. The pre-screening package includes two online training modules and your contacts with local managed care plans. Once approved, you have one year to submit a complete initial certification application 15.
Two approvals, run together
The CBAS application has four parts: applicant forms and disclosures, management and services (organization chart, staffing, policies), facility (map, floor plan, ADHC license) and fiscal (balance sheet, operating budget, cash-flow forecast) 15. When you file it, you must hold an ADHC license or have applied for one with CDPH, and CDA finalizes certification only after the license issues 15. CDA says approval may take 18 to 24 months 15. The packet uses CDPH’s HS 200, HS 215A and HS 309 forms and the DHCS 9098 Medi-Cal provider agreement 18. CDPH’s Centralized Applications Branch processes the license at P.O. Box 997377, MS 3207, Sacramento, CA 95899-7377 24.
A clinical staff
CDA’s staffing form lists an administrator, program director, registered and licensed vocational nurses, social workers, an activity coordinator, physical, occupational and speech therapists, a registered dietitian, a psychiatric consultant, a staff physician and a pharmacist, with license numbers and expiration dates 20. ADHC hours of operation must be no less than six hours a day under 22 CCR 54221(a), and program service hours at least four, per Health and Safety Code 1570.7(h) 19.
Higher fees
CDPH’s license fee for adult day health centers is $8,830 per facility for fiscal year 2026-27, unchanged from 2025-26, with no Los Angeles County supplement. CDPH counted 336 licensed centers 13.
Recurring Medi-Cal surveys
CBAS certification lasts up to 24 months under Welfare and Institutions Code 14573. Renewal starts about six months before expiration, with a document review and an unannounced one- to two-day survey by CDA nurse and program staff 21.
An ADHC licensee can also add non-medical adult day program services by filing a change application with CDPH, using the form CDA publishes 23.
This guide does not state ADHC staffing ratios, space standards or minimum professional hours. The state’s online regulation text for Title 22, Division 5, Chapter 10 could not be retrieved for this review, so read sections 78001-78609 and ask CDA’s CBAS Bureau (916-419-7545, [email protected]) before you plan a budget 25.
What changed recently
- July 1, 2023: the infection control rules (22 CCR 82095.5) took effect for adult day programs, requiring an Infection Control Lead and an Infection Control Plan in every plan of operation 35.
- July 1, 2026: CDPH’s 2026-27 license fee table took effect, keeping the ADHC fee at $8,830 13.
- July 14, 2026: CDSS updated the incident and abuse reporting section (82061) of the adult day program regulations 3.
- November 2025: CDSS revised the LIC 281 application instructions used for adult day program applications 8.
Sources
- 1
- 2
- 3
- 4 California Department of Social Services, Adult Care Licensing Checked 12 Oct 2026 · Back to text ↑
- 5
- 6 California Department of Social Services, Steps to Obtaining an ASCP License Checked 12 Oct 2026 · Back to text ↑
- 7
- 8
- 9
- 10 California Department of Social Services, Licensing Fees Checked 12 Oct 2026 · Back to text ↑
- 11
- 12
- 13
- 14
- 15 California Department of Aging, Become a New CBAS Provider Checked 12 Oct 2026 · Back to text ↑
- 16
- 17 California Department of Aging, CBAS Program Authority Checked 12 Oct 2026 · Back to text ↑
- 18 California Department of Aging, CBAS Application Materials Checked 12 Oct 2026 · Back to text ↑
- 19
- 20
- 21
- 22 California Department of Aging, Community-Based Adult Services (consumer page) Checked 12 Oct 2026 · Back to text ↑
- 23
- 24 California Department of Public Health, Centralized Applications Branch Checked 12 Oct 2026 · Back to text ↑
- 25 California Department of Aging, Community-Based Adult Services (provider page) Checked 12 Oct 2026 · Back to text ↑
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Related guides
California and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| California (this guide) | Adult Day Program license (CDSS); Adult Day Health Care center license (CDPH) | Day care for adults 18+; Adult Day Health Care is separate | $182 (1-15 clients) to $1,513 (121+), plus $54.85 orientation |
| Nevada | Facility for the Care of Adults During the Day (adult day care) license | Any daytime care for aged or infirm adults; fees tier at 50 clients | $1,164 (up to 50 clients) or $1,753 (over 50) |
| Arizona | Adult Day Health Care Facility license | Day services to 5 or more unrelated adults | $50 (R9-10-106, ADHS copy effective Nov 5, 2019) |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.