Connecticut residential care home license: DSS certificate of need first, then DPH

Which homes count as a residential care home

Connecticut law defines a residential care home, or “rest home,” as a community residence that gives food and shelter to two or more persons unrelated to the proprietor. It must also provide services beyond basic food, shelter and laundry ⁠¹. Statutes that still say “home for the aged” are read as meaning residential care home ⁠¹. The regulation spells out the service level. These are personal services “which do not require the training or skills of a licensed nurse,” such as help with bathing and dressing, special diets, supervision of medications residents take themselves, or medication given by certified staff ⁠².

The threshold is low. Two unrelated residents in a private house who receive help with dressing or medications put you inside the definition, and no statute sets a maximum size ⁠¹. DPH lists residential care homes among the institutions that need its license ⁠³. Operating any listed institution without one is prohibited ⁠¹.

The definition also states that an RCH “may qualify as a setting that allows residents to receive home and community-based services funded by state and federal programs” ⁠¹. That wording matters for the Medicaid waivers covered below.

Neighbouring licenses you might be confusing it with

• No adult family home or adult foster home license. Many states have a small-home tier for one to six residents. Connecticut does not, so a two-bed home and a sixty-bed home follow the same regulation ⁠¹⁠².
• Assisted living in Connecticut is not a building license. DPH licenses an assisted living services agency (ALSA) that provides nursing and daily-living help to residents of a managed residential community. Those communities are private-unit housing for people mainly 55 and older ⁠⁸. If your plan involves nursing services in private apartments, see /guides/connecticut-assisted-living-services-agency-license/.
• Rest homes with nursing supervision are a nursing home category. DPH may not grant new licenses for them ⁠¹.
• In-home help without housing is either a Department of Consumer Protection homemaker-companion registration (/guides/connecticut-homemaker-companion-agency-registration/) or a DPH home health care or homemaker-home health aide agency license ⁠¹.

Step one is DSS, not DPH: the certificate of need

DSS, not DPH, runs the certificate of need (CON) program for nursing homes, residential care homes and intermediate care facilities ⁠⁴. Its CON page lists “requests to license a new residential care facility” among the activities that need CON approval first ⁠⁴. The statute counts residential care homes as “facilities” for CON purposes. It also requires DSS permission to transfer ownership or control before initial licensure, add or expand a service, or relocate beds. Capital spending needs approval above $2 million, or above $1 million when it adds more than 5,000 square feet or 5% of existing floor area, whichever is greater ⁠⁵.

The DSS process, as published on 2026-10-12 ⁠⁴:

1. Letter of intent

   Email it to [email protected]. It must give the applicant’s name, the project type, the estimated capital cost, the town, and a short project description.

2. Notices

   When you submit the letter, an RCH must notify the Office of the Long-Term Care Ombudsman in writing. Existing facilities also notify residents and responsible parties and post a public notice.

3. DSS decides whether a CON is needed

   If it is, DSS sends you the CON application. You then have 180 days to file it. After that the request is treated as withdrawn and you start over.

4. Review

   DSS may weigh your financial responsibility and business interests, financial feasibility and the effect on rates, regional quality, access and cost, and the needs of current and future residents.

DSS will not give feedback on an idea before it has a letter of intent. Its stated route for feedback is to submit one ⁠⁴. The statutory moratorium in CGS 17b-354 covers additional nursing home beds ⁠⁵. We found no matching statutory moratorium on RCH beds. The DSS page does not say whether it is approving new private-pay homes or applying any informal limit on new RCH beds, so ask DSS when you submit the letter of intent.

The building: what 19-13-D6 requires

RCSA 19-13-D6 was written for purpose-built homes and was last amended February 17, 2023 ⁠². Newly built facilities must contain every element it lists. After a change of ownership, the standards apply “insofar as existing structures physically permit” ⁠². A separate clause in the same regulation says a new owner after a sale must also meet the requirements for new structures, so ask DPH how it applies the two together to the building you are buying ⁠².

Approvals before construction ⁠¹⁠²:

• DPH must approve the site of a new institution. The site must be away from nuisances such as industrial noise or odors.
• Plans for new construction or alterations go to DPH, the local fire marshal, the local building inspector and local zoning before work begins. Projects must follow the national facility guidelines for health care construction that DPH has adopted.
• A private well or septic system needs written approval from the local director of health. Homes over 120 beds need public water and sewer.
• The building must meet the State Building Code, the State Fire Safety Code, NFPA 101 Life Safety Code, state labor laws, local fire codes and zoning. Any home caring for more than four persons falls under the state fire safety code.

The required space list also includes a lobby with visitor toilets, an office, central storage, a laundry if laundry is done on site, staff facilities, and a room for the dignified holding of a deceased resident ⁠². Statute adds two operating minimums. Resident areas must be kept at 71°F or warmer, and no more than 14 hours may pass between the evening meal and breakfast unless a substantial bedtime snack is offered ⁠¹.

Each bedroom is numbered, with its licensed capacity posted by the door. The census may never exceed the licensed number ⁠².

Who can hold the license

Connecticut’s RCH rules do not set an administrator credential, degree or exam. The proprietor or licensee is responsible for running the home in compliance with the regulation ⁠². With the initial application, the licensee supplies character references from three responsible people not related to them ⁠². The regulation also asks for a physician’s certificate of physical and mental health. Statute has barred DPH from requiring it since July 1, 2011 ⁠¹.

DPH can make licensure conditional on signing a consent order that assures compliance with the Public Health Code. The application does not need to be notarized ⁠¹. The FLIS forms list includes ownership forms for LLCs and partnerships, trusts and corporations, plus a sample certificate of insurance. It also has the local fire marshal’s certificate, affidavits for long-term care facilities and an applicant attestation ⁠³.

Staffing, background checks and training

Attendant ratio. At least one attendant must be on duty for every 25 residents or fraction of 25 from 7 a.m. to 10 p.m. From 10 p.m. to 7 a.m., one attendant must be in residence for every 25 residents ⁠². A home with three residents still needs an attendant on duty all day and one in residence overnight. An RCH colocated with a nursing home may ask DPH to share overnight staff ⁠¹.

Background checks. For DPH’s background search program, an RCH counts as a “long-term care facility.” Before offering a job or contract to anyone with direct access to residents, you must have them submit to a background search ⁠¹. The same applies to volunteers expected to do similar work. A clean search from the previous three years can be accepted ⁠¹. DPH runs this through its Applicant Background Check Management System (ABCMS), and surveyors ask for ABCMS verification of staff hired in the past year ⁠⁷.

Orientation and continuing education. New staff must complete an orientation before working independently. It covers safety and emergency procedures, the home’s policies, and resident rights ⁠². Program staff then need continuing education equal to 1% of their annual hours worked, capped at 12 hours a year. Topics include resident rights, behavior management, personal care, nutrition and food safety, and health and safety ⁠². You must keep a written continuing education plan, and training records for two years after an employee leaves ⁠².

Medication: the certification you need before you admit anyone who needs help

Residents may take their own medications and staff may open containers for them ⁠². A home that admits residents who need help with medication administration must have an appropriate number of certified unlicensed staff, as the home determines ⁠¹. The regulation allows uncertified staff to apply only a short list of non-prescription topicals, such as ointments free of antibiotic, antifungal or steroid components, with the resident’s written permission ⁠². Certification comes from DPH, the Department of Children and Families or the Department of Developmental Services, with recertification every two years (CGS 19a-495a as amended through P.A. 22-58) ⁠¹. Certified staff may give medications that are not injected, unless a resident’s physician requires licensed personnel ⁠¹. Unlicensed staff may also take blood pressure and temperature with automated digital devices, record weights, and help residents use glucose monitors ⁠¹.

Under the regulation, training must come from a pharmacist, physician, PA, APRN or RN ⁠². It must be followed by a written exam and a practicum with three medication passes ⁠². The regulation also describes a separate certification for pre-measured, commercially prepared injectables for residents who may need emergency treatment ⁠². The statute, however, only authorizes certified unlicensed staff to give medications that are not injected ⁠¹. Neither source says how DPH reconciles the two, so ask FLIS before planning for staff to give any injectable. In its February 2023 presentation, DPH described a two-phase process ⁠⁷. Phase 1 is an online interagency course through CT Train with a proctored 100-question exam and an 85% pass mark. Phase 2 is an agency-specific practicum ⁠⁷.

Every medication error goes in the resident’s administration record. Significant medication errors must be reported to DPH in writing within 72 hours ⁠².

Policies and records DPH will look for

The regulation sets these operating rules ⁠²:

• Admit residents only on referral from a responsible source. No emergency admissions are allowed except in a major disaster, and DPH must be told.
• Report any accident, disaster or unusual occurrence to DPH within 72 hours.
• Keep resident records on DPH-approved forms.
• Post menus that meet DPH nutrition requirements, and follow the state food code for dishwashing and food handling.
• Provide recreation with approved space and equipment.
• Notify DPH right away of structural changes, a planned sale or a planned closure.

The DPH entrance list for licensure inspections is the best preview of what the agency expects to find, as presented in February 2023 ⁠⁷:

• written policies on smoking, medication administration, safety and emergency procedures, abuse, resident rights, leave of absence and infection control
• house rules, visiting hours, and each resident’s signed receipt of the bill of rights, house rules and medication consent
• resident fund records with receipts, disbursements and consent to manage funds
• two months of menus, three months of recreation calendars, 18 months of resident council minutes and three years of incident reports
• staff lists, personnel files with annual evaluations, medication certifications, Qualified Food Operator or ServSafe certificates, last month’s staffing and continuing education attendance

DPH’s building and fire safety inspector checks the fire alarm, smoke detectors and monthly fire drills. The inspector also reviews the fire and disaster plan, generator testing, water temperatures, kitchen hood records, three years of quarterly sprinkler tests, fire door inspections, the resident call bell system and exit lighting ⁠⁷.

A strike contingency plan only becomes mandatory if a union serves notice of intent to strike. The plan is then due to DPH at least five days before the strike date. Penalties for an RCH that fails to comply can reach $10,000 a day ⁠¹.

Applying to DPH, in order

1. Get the DSS determination or CON

   for a new facility (see above) ⁠⁴.

2. Secure the site and plan approvals

   DPH approves the site and the plans, and local fire, building and zoning officials approve the plans before construction or alteration ⁠².

3. Request the initial application

   by emailing [email protected]. DPH sends initial and change-of-ownership applications by request and receives completed applications at the same address ⁠³. DPH does not post the initial RCH application packet, so its exact contents are unconfirmed; ask FLIS for the packet and a checklist when you request it.

4. Assemble the attachments

   These include the ownership form for your entity type, insurance certificate, local fire marshal’s certificate, long-term care affidavits, applicant attestation, and three character references ⁠²⁠³.

5. Pay the fee

   It is $565 per site plus $4.50 per licensed bed, as published on 2026-10-12. A 10-bed home would pay $610 ⁠¹.

6. Scheduled inspection

   DPH issues the initial license only after a scheduled inspection and investigation shows the applicant and building meet the requirements ⁠¹. If a violation letter follows, your plan of correction must state the corrective measures, the date each takes effect, how you will monitor them, and the title of the responsible staff member ⁠⁷.

The license covers only the premises and persons named in the application. It cannot be transferred or assigned and must be posted in a conspicuous place ⁠¹. DPH states no processing timeline for initial RCH applications.

Fees and the license term

As published on 2026-10-12, CGS 19a-491(d) sets the RCH charge at $565 per site plus $4.50 per bed “for the triennial licensing and inspection” of residential care homes ⁠¹. The general licensing section, CGS 19a-493(a), says licenses are valid for two years and renewable biennially after an unscheduled inspection ⁠¹. RCSA 19-13-D6(c)(2) likewise has the licensee apply every two years ⁠². The two provisions conflict on their face, and the DPH pages do not say which cycle applies to RCH licenses or fee billing. Ask FLIS when you request the application.

Renewal, inspections and enforcement

Renewals go through the CT eLicense portal. DPH sends renewal notices by email about 90 days before expiration ⁠⁷. The renewal uploads are a general liability certificate, workers’ compensation insurance, the fire marshal’s certificate, officers and directors, staff names and titles, an ownership organizational chart, the ownership form and your lease ⁠⁷. The regulation calls for an annual local fire marshal certificate with the application ⁠².

Citations against RCHs are classed by severity. A Class A violation, an immediate danger of death or serious harm, carries up to $5,000. A Class B violation, a potential for death or serious harm in the foreseeable future, carries up to $3,000 ⁠¹. The regulation assigns specific provisions to each class ⁠². For example, failing the 1:25 attendant rule is Class B, and failing the fire-safety approval provision is Class A.

Selling the home requires DPH prior approval. The buyer must apply at least 120 days before the proposed date of the change in ownership ⁠¹. A change in ownership or control before initial licensure also needs DSS permission ⁠⁵.

Residents’ rights and discharge

The statutory patients’ bill of rights covers RCH residents, including the right to treat their living quarters as their home ⁠¹. An RCH may discharge or transfer a resident involuntarily only on five grounds ⁠¹:

• the resident’s welfare cannot be met in the home
• the resident has improved enough not to need it
• others’ health or safety is endangered
• the resident has not paid after reasonable notice
• the home is closing

Except in an emergency, the home must give 30 days’ written notice and help find another residence ⁠¹. It must also deliver a discharge plan within seven days of the notice. The resident can appeal to DPH within 10 days, DPH must hold the hearing within seven business days, and the discharge is stayed while the appeal is pending ⁠¹.

How RCHs are paid: state supplement rates and waivers

Many Connecticut RCH residents receive Aid to the Aged, Blind and Disabled (AABD), the state supplement. DSS sets a per-diem rate for each privately operated RCH under CGS 17b-340(h) and RCSA 17-311-52, using long-term care cost reports, for a rate year running July 1 to June 30 ⁠⁶. DSS reports 98 RCHs with about 2,710 licensed beds serving about 2,100 AABD-eligible residents ⁠⁶. If you plan to accept residents on state assistance, budget for the annual cost report.

DSS figures that affect residents’ income, as published on 2026-10-12 ⁠⁶:

• The rated housing disregard used for the State Supplement rose from $442.70 to $469.70 effective January 1, 2026.
• The rated housing personal needs allowance has been $34.75 since July 1, 2024. Under legislation freezing State Supplement standards, it did not increase on July 1, 2025.

Medicaid waivers are the other channel. In 2023, DSS required every RCH to attend training on the CMS home and community-based settings rule, which took effect March 17, 2023. The training also covered the DMHAS mental health waiver, the DDS waiver and residency agreements ⁠⁶. If you want waiver-funded residents, ask DSS how the settings rule is applied to your home in addition to 19-13-D6.

Recent and pending changes

• February 17, 2023: latest amendment to RCSA 19-13-D6 ⁠².
• P.A. 22-58: the most recent amendment to CGS 19a-495a on medication certification. The statute now requires recertification every two years and accepts certification from DPH, DCF or DDS ⁠¹.
• 2023: DSS offered $5 million in American Rescue Plan capital grants to RCHs grandfathered under outdated codes. Applications closed October 27, 2023 ⁠⁶.
• January 1, 2026: State Supplement rated housing disregard increased to $469.70 ⁠⁶.

Sources

1. 1
   Connecticut General Assembly, Connecticut General Statutes, Chapter 368v: Health Care Institutions (secs. 19a-490 to 19a-550) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Connecticut Secretary of the State, eRegulations System, Regulations of Connecticut State Agencies, Sec. 19-13-D6: Homes for the aged and rest homes Checked 12 Oct 2026 · Back to text ↑
3. 3
   Connecticut Department of Public Health, Facility Licensing (Facility Licensing and Investigations Section) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Connecticut Department of Social Services, Certificate of Need (CON) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Connecticut General Assembly, Connecticut General Statutes, Chapter 319y: Long-Term Care (secs. 17b-352 to 17b-354) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Connecticut Department of Social Services, Residential Care Homes (RCH) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Connecticut Department of Public Health, posted by the Department of Social Services, Survey Process for Residential Care Homes (DPH presentation, February 16, 2023) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Connecticut General Assembly, Connecticut General Statutes, Chapter 368bb: Managed Residential Communities Checked 12 Oct 2026 · Back to text ↑

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