Delaware adult day care facility license: DHCQ rule 3360, space, staffing and fees

What counts as an adult day care facility in Delaware

Delaware licenses adult day programs under one rule, 16 DE Admin. Code 3360. The same rule covers social and health-oriented programs alike. Rule 3360 applies to any program that provides health, social and related support services to four or more functionally impaired adults who live in the community and need the services according to a pre-admission assessment ⁠¹. Three more conditions define the license ⁠¹:

• Services last less than 12 hours during the day.
• Services happen somewhere other than a participant’s home or the residence of the facility operator. A day program run out of your own house is outside this rule.
• The program is not intended exclusively or primarily for people with developmental disabilities or mental illness. Those day programs fall outside 3360.

“Functionally impaired adult” has a specific meaning: a person 18 or older who needs supervision because of a cognitive or physical impairment, or who cannot independently perform at least one activity of daily living (ambulating, transferring, grooming, bathing, dressing, eating or toileting) ⁠¹. Every participant you admit must meet that definition ⁠¹.

Rule 3.1 is direct: no one may establish, conduct or maintain an adult day care facility in Delaware without a license from the Department of Health and Social Services ⁠¹. The authority is 16 Del.C. § 122(3)(s), which directs DHSS to set standards for adult day care facilities and lets the Secretary issue restricted, provisional and other types of licenses ⁠².

If you are also weighing an overnight setting, those are separate DHCQ licenses with their own rules: the assisted living facility license and the family care home license for 2 or 3 residents. Services delivered in clients’ homes need the personal assistance services agency license or a skilled home health agency license (see the home health license page). Other states’ adult day rules are compared on the adult day license page.

The agency and the size of the field

The Office of Health Facilities Licensing and Certification in the Division of Health Care Quality (DHCQ) handles these licenses, at 263 Chapman Road, Suite 200, Newark, DE 19702 ⁠⁴⁠⁵. The contact page lists the Office of Health Facilities Licensing and Certification at (302) 292-3930, or 1-800-942-7373 toll-free, at that address. A Licensing and Certification Section in DHCQ’s Office of Long-Term Care is listed at (302) 421-7400, the same number given for criminal background checks and mandatory drug testing ⁠⁵. Documents for the renewal process are emailed to [email protected] ⁠⁴.

DHCQ publishes a list of licensed adult day care centers, each with a license ID in the form ADC-001 ⁠³. On October 12, 2026 the list showed 10 centers. The state’s aging division notes that adult day programs are not operated by the state and are available in all three counties ⁠⁶.

DHCQ does not post an initial application packet online. Rule 3.4.1 says applicants “shall request a licensure application from the Department” ⁠¹, so your first contact is a request to the Licensing and Certification Section. The DHCQ pages on adult day centers do not post an initial application form, a checklist or a processing time, and rule 3360 sets no deadline for DHCQ to act. Ask the Licensing and Certification Section for the current form, its attachments and how long review takes before you sign a lease.

Site, building and the approvals that come before opening

Several Delaware sign-offs have to be in place before a provisional license is possible. Rule 3360 lists them across sections 5 and 6:

1. Site approval

   The site must be “approved in advance and considered suitable by the Department”. It also has to be safe and easily drained, with suitable sewage disposal and a potable water supply ⁠¹.

2. Plan review for construction

   If you will build, extensively remodel or convert a building, submit one copy of plans and specifications for the entire facility. You need written DHCQ approval before work starts, and DHCQ inspects and approves the space before you occupy it ⁠¹. DHCQ’s plan review starts with a call to the Office of Health Facilities Licensing and Certification at (302) 292-3930 for a project code, which expires after one year. State-licensed-only facilities also submit approval from the fire marshal with jurisdiction, and the submission memo carries the seal or registration number of the Delaware-licensed architect or engineer, and the floor plan goes in by email ⁠⁸. Where DHCQ’s design standard and rule 3360 conflict, the higher standard governs ⁠¹.

3. Water and sewage

   DHSS approves the water supply and the Department of Natural Resources and Environmental Control (DNREC) approves sewage disposal ⁠¹. Plumbing follows municipal or county code, or the Department’s Sanitary Plumbing Code where there is no local code ⁠¹.

4. Local codes

   The facility must meet all local and state building codes and ordinances for this occupancy ⁠¹.

5. Fire marshal letter

   Fire safety falls under the State Fire Prevention Commission’s regulations. Every license application and every renewal must include a letter from the fire marshal with jurisdiction certifying compliance ⁠¹. A notice of noncompliance from the fire marshal is grounds for revocation ⁠¹.

Space and fixtures the rule measures

Rule 3360 sets a sliding space formula: 100 square feet for each of the first five participants, then 60 square feet for each additional participant ⁠¹. Office space, bathrooms, storage, the examination room and the dining room do not count, unless the dining room is also used for activities ⁠¹. By that formula, 20 participants need 1,400 sq ft of program space and 30 need 2,000 sq ft.

You also need a telephone participants can use in private, storage for participants’ coats and belongings, and one chair per participant and staff member, plus reclining lounge chairs as needs require ⁠¹. If you offer occupational, physical or speech therapy, the rule requires separate additional space with wheelchair provisions, storage, privacy and a hand-washing sink in the therapy area ⁠¹.

DHCQ can waive a standard only on a written request with full justification that addresses safety and infection control. Waivers are approved “only for compelling reason” ⁠¹. If a waiver could affect participants’ health or safety, participants and their representatives must see the request before you submit it, and must be told they can object to the Department ⁠¹.

Who runs the program: director, nurse and activities coordinator

Director. The director must have one of the following ⁠¹:

• a bachelor’s degree in health or social services or a related field, with one year of supervisory experience in a social or health service setting;
• comparable technical and human service training, with demonstrated competence and experience managing in a health or human service setting; or
• an RN license with two years of supervisory experience in a social or health care setting.

The director, or a designee, must be present and in charge during all hours participants are on the premises ⁠¹. A qualified substitute must be authorized in writing ⁠¹, and you must tell DHCQ in writing within 15 days of any change of director ⁠¹.

Nurse. Rule 12.4 requires at least one RN or LPN on the premises at all times participants are present, for facilities serving participants who need nursing services ⁠¹. Medication for participants who cannot self-administer must be given under the Nurse Practice Act ⁠¹. In practice, the nurse requirement depends on whom you admit. DHCQ’s 2023 renewal form asks every center for a nurse’s email and Delaware RN license number ⁠⁴. The rule ties the on-site nurse to participants who need nursing services as the rule defines them, and the sources do not say that every center must have one. Ask DHCQ whether your planned participant mix triggers rule 12.4 before you decide on nurse staffing.

Activities coordinator. The coordinator needs one of four combinations ⁠¹:

• a bachelor’s degree and one year of experience running activities for the population served;
• an associate degree in a related field and two years of experience;
• national certification as an activity or therapeutic recreation professional and two years of experience; or
• a high school diploma or equivalent and three years of experience.

Staffing ratios, aides and training

Volunteers and employees who have not finished orientation do not count toward the minimums. If you run separate sections, each section must meet the staffing rules on its own ⁠¹. The rule also tells you to raise staffing as participants’ functional and cognitive impairment rises ⁠¹.

Aides must complete an orientation of at least 40 hours of instruction and supervised practicum. They must also hold one of the following: CNA certification, one year of experience in a health care setting, or enrollment in a nursing program with a completed medical-surgical clinical practicum ⁠¹. Every aide must pass a competency evaluation before giving unsupervised care ⁠¹. The orientation must cover ten listed topics, from personal care and nutrition to body mechanics and keeping the environment least restrictive ⁠¹.

Before starting work, all staff are trained in fire, illness and emergency responsibilities, infection control, body mechanics, first aid and the needs of the participants served ⁠¹. Direct-care staff then need at least 12 hours of staff development every year ⁠¹. A center that gives direct health care to people with Alzheimer’s disease or other dementia must give annual dementia-specific training that covers communication, the person’s psychological, social and physical needs, and safety measures ⁠¹. That requirement was added in 2011 (15 DE Reg. 220) ⁠¹.

Screening every hire

Rule 13.1 requires compliance with Delaware’s employment rules for health care facilities. That means service letters from prior employers (19 Del.C. § 708), the check under 11 Del.C. § 8563 and the Adult Abuse Registry check (11 Del.C. § 8564) ⁠¹. The renewal form also has you attest that every employee and contractor has had a criminal background check and drug testing under 16 Del.C. §§ 1145 and 1146 ⁠⁴. No employee may be under 18. No one convicted of a crime against a person may be employed, whether the crime was a felony or a misdemeanor ⁠¹. New hires need a pre-employment physical and TB testing that follows current CDC recommendations, and every employee needs an annual performance review ⁠¹.

Policies and program rules DHCQ will look for

Your application must include policy and procedure manuals ⁠¹. The rule names the topics those manuals must cover:

• Incidents and wandering. Handling and documenting incidents, accidents and medical emergencies, and preventing participants with cognitive disabilities from wandering away from safe areas ⁠¹.
• Complaints. A procedure approved by the Department that tells participants and families they can report concerns to DHSS without fear of reprisal ⁠¹.
• Admission and discharge. Written criteria. A participant may be discharged only for one of five listed reasons, with at least 2 weeks’ notice unless a sudden change in care needs requires immediate transfer ⁠¹.
• Medications. Written, signed physician orders; a current drug reference; locked storage; a 2-lock system for Schedule II drugs, counted with the family when brought in; and policies against diversion ⁠¹.
• Infection prevention. A program based on CDC guidance, with a designated lead and a written plan. COVID-19 testing of staff, vendors and volunteers follows Division of Public Health guidance, and the policies must address exclusion, testing refusals and outbreak staffing ⁠¹.
• Quality improvement. Tracked performance measures, an annual review of goals, review of grievances and actions taken, and participant satisfaction monitoring ⁠¹.
• Housekeeping. Cleaning procedures and safe storage of chemicals and soiled linen ⁠¹.

Assessment and care plans. You must complete a written assessment within 30 days before admission. The physical part, including activities of daily living and sensory limits, is completed by a licensed nurse ⁠¹. A preliminary care plan is required before admission and a full written plan within 30 calendar days of the first day. The plan is reviewed with the participant at least every six months and updated annually ⁠¹. The participant record also needs a physician’s history and physical from within 6 months before admission and a TB screening from within 1 year before admission. Progress notes must include a monthly health, functional and psychosocial assessment ⁠¹. Records are kept at least five years ⁠¹.

Activities and meals. Planned activities must fill at least 65% of open hours. You post a written monthly schedule and keep 12 months of past schedules ⁠¹. Anyone attending 4 or more hours gets at least one meal meeting one-third of the recommended dietary allowance, and a morning snack must be offered daily ⁠¹. If you cook on site, the State of Delaware Food Code applies and menus follow a dietitian-approved two-week cycle ⁠¹. If you bring meals in, they must come from a permitted kitchen that complies with the Food Code ⁠¹. A dietitian must be available for consultation and must train staff at least once a year ⁠¹.

Transportation. If you transport participants yourself or by contract, the rule requires the following ⁠¹:

• drivers with a valid Delaware license for the vehicle;
• a driver or attendant trained in CPR and first aid;
• secured wheelchairs, a first aid kit, fire extinguisher, safety triangles and two-way communication in each vehicle;
• help from the ground floor of the participant’s home to the ground floor of the center.

Restraints. Participants have the right to be free from physical and chemical restraints. If a restraint becomes necessary, you must follow 42 CFR 482.13 and 483.13 and 16 Del.C. § 1121 ⁠¹.

Applying, in the order Delaware requires

1. Request the application

   Contact the Office of Health Facilities Licensing and Certification for the licensure application ⁠¹⁠⁵.

2. Get the site approved, and plans approved if you are building or converting

   You need written approval before construction begins, then a DHCQ inspection before occupancy ⁠¹.

3. Line up water, sewage and local approvals

   These come from DHSS, DNREC and your local building authority, plus a Food Code permit if you prepare food ⁠¹.

4. Obtain the fire marshal’s compliance letter

   It must go in with the application ⁠¹.

5. Assemble the disclosures

   These cover the other facilities you own or manage; the officers, directors, general partners or managing members (or the governing body for a government operator); anyone with a financial interest of 5% or more; and any officer, director, partner, employee, managing member or governing body member with a felony record. Add the director’s name, the policy manuals, and proof of not-for-profit status if you claim it ⁠¹.

6. Pay the $100 application fee

   set by 16 Del.C. § 122(3)(s) ⁠².

7. Open on a provisional license

   Once the application process is complete, DHCQ grants a provisional license of less than one year. The on-site survey takes place during the first 90 days of operation ⁠¹. DHCQ sets the conditions and time period of a provisional license ⁠¹.

8. Pass the survey and receive the annual license

   A 12-month license goes to facilities in substantial compliance ⁠¹. A provisional license cannot be renewed unless DHCQ has approved a Plan for Corrective Action and you have carried it out ⁠¹.

The license is tied to the licensee and the address. It cannot be transferred to another person or location, and it must be posted in a conspicuous place ⁠¹. Separate locations need separate licenses, even under the same management. Separate buildings on the same grounds can share one ⁠¹. A change of ownership also puts the facility back on a provisional license pending a survey in its first 90 days ⁠¹.

Fees, renewal and inspections

The renewal application (Rev. 02-10-2023) is a three-page form ⁠⁴. It asks for:

• contacts for the director, nurse and activities director, and an emergency contact who is reachable at all times;
• census, capacity and support services;
• any change of ownership since the last survey;
• confirmation that aides meet rule 13.13 and that direct-care staff completed 12 hours of staff development, with a list of last year’s training attached;
• a 100% ownership interest table.

The form also asks for Exhibits A through H ⁠⁴:

• your Delaware Division of Revenue business license, and a city or town business license if one applies;
• a list of services;
• organization charts and any organizational changes;
• governing body members;
• quality improvement evidence;
• owners with their percentage interest;
• staff resumes.

Your emergency preparedness plan and the State Fire Marshal inspection letter go by email as two separate attachments ⁠⁴.

The rule requires an inspection at least once every three years ⁠¹. DHCQ may suspend or revoke a license for good cause, including rule violations, threats to participant safety, or refusing DHCQ access for surveys. Before suspension or revocation, you get 10 calendar days’ written notice and can request a hearing under the Administrative Procedures Act ⁠¹. If participants are in imminent danger, DHCQ can suspend immediately by written order and must hold a hearing within 10 working days ⁠¹.

How Delaware adult day centers get paid

Delaware’s Medicaid long-term services and supports run through Diamond State Health Plan Plus (DSHP Plus). DSHP Plus is a mandatory managed care program for Delaware residents who are elderly or physically disabled, and adult day services are in its benefit package ⁠⁷. A center that wants Medicaid-funded participants therefore works with the DSHP Plus managed care plans. The DSHP Plus page lists adult day services as a benefit but does not state what the managed care plans require of adult day providers. Ask each plan about its provider enrollment and contracting steps, and ask DHSS whether a DHCQ license is the only state credential those plans accept.

The Division of Services for Aging and Adults with Physical Disabilities refers families to the DHCQ list of licensed centers. It describes eligibility as adults 18 or older with a functional impairment or a diagnosis such as dementia ⁠⁶. Those are the same participants rule 3360 is written around ⁠¹.

Rule history and what to watch

• July 1, 2002: rule 3360 published in the Register of Regulations (6 DE Reg. 83). Centers already operating that fell short of its square footage, dining area and bathroom ratio rules got five years to comply ⁠¹.
• August 1, 2011 (Register date): annual dementia-specific training added for centers serving people with Alzheimer’s disease or other dementia (15 DE Reg. 220) ⁠¹.
• February 1, 2022 (Register date): section 16 added, requiring an infection prevention and control program and COVID-19 testing policies (25 DE Reg. 776) ⁠¹.
• February 10, 2023: date of the current DHCQ renewal application revision ⁠⁴.

The rule text on the Registrar of Regulations site on October 12, 2026 ends with the 2022 amendment (25 DE Reg. 776) as its latest history entry.

Sources

1. 1
   Delaware Registrar of Regulations, 16 DE Admin. Code 3360: Regulations for Adult Day Care Facilities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Delaware General Assembly, Delaware Code, Title 16, Chapter 1, Subchapter II (§ 122(3)(s), adult day care facilities) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Delaware Health and Social Services, Division of Health Care Quality, Adult Day Care Centers Checked 12 Oct 2026 · Back to text ↑
4. 4
   Delaware Health and Social Services, Office of Health Facilities Licensing and Certification, License Renewal Application for 3360 Adult Day Care (ADC), Rev. 02-10-2023 Checked 12 Oct 2026 · Back to text ↑
5. 5
   Delaware Health and Social Services, Division of Health Care Quality, Contact the Division of Health Care Quality Checked 12 Oct 2026 · Back to text ↑
6. 6
   Delaware Health and Social Services, Division of Services for Aging and Adults with Physical Disabilities, Community-Based Day Programs Checked 12 Oct 2026 · Back to text ↑
7. 7
   Delaware Health and Social Services, Division of Medicaid and Medical Assistance, Diamond State Health Plan Plus Checked 12 Oct 2026 · Back to text ↑
8. 8
   Delaware Health and Social Services, Division of Health Care Quality, Blueprint Plan Review and Approvals Checked 12 Oct 2026 · Back to text ↑

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