Nevada adult day care license: the facility for the care of adults during the day

Who needs the license: no client minimum

Nevada defines a “facility for the care of adults during the day” as “an establishment operated and maintained to provide care during the day on a temporary or permanent basis for aged or infirm persons.”⁠¹ The definition contains no client count, and NRS 449.030 bars anyone from operating a “facility for the dependent” without a license; adult day care is one of the facility types the statute lists under that heading.⁠¹ So a program for four clients needs the same license as one for forty. The only size line in the rules is a fee break at 50 clients present at one time.⁠²

A few boundaries worth knowing before you apply:

• Recovery houses are excluded. The definition expressly leaves out recovery houses for people recovering from alcohol or other substance use disorders.⁠¹
• Overnight care is a different license. If clients will sleep at your site, you are looking at a residential facility for groups or a home for individual residential care, both separate facility types in NRS 449.0045.⁠¹
• Care in clients’ homes is a different license. Non-medical help at home falls under the personal care agency license; skilled nursing at home needs a home health agency license.
• Sharing a building with another licensed facility. An adult day program may not be run in combination with another medical facility or facility for the dependent unless it is licensed “as a separate and distinct unit.”⁠² A group home that wants to host a day program must license that program as its own unit.

The state’s own fact sheet describes the typical user as a caregiver who needs coverage during working hours or respite. It counted 30 licensed adult day care facilities statewide as of June 2019.⁠⁹ You can pull the list of licensed facilities from findahealthfacility.nv.gov by choosing “Facility for the Care of Adults During the Day” as the credential type.⁠³

Who licenses you after the 2025 reorganization

NRS 449.0032 now defines the licensing “Division” as “the Health Care Purchasing and Compliance Division of the Nevada Health Authority.”⁠¹ The licensing website, forms and checklists still use the older Health Care Quality and Compliance (HCQC) name, and the adult day care rules themselves (NAC 449.4061) still name the Division of Public and Behavioral Health.⁠²⁠³ It is one office under different names. Your certificate of insurance must list “Health Care Purchasing and Compliance Division, 727 Fairview Drive, Suite E, Carson City, NV 89701” as certificate holder.⁠⁴

Applications go through the state’s online licensing system linked from the HCQC adult day care page (myhealthfacilitylicense.nv.gov).⁠³ HCQC also runs an email list for adult day care operators: send “subscribe ADULTDAYCARE” in the body of an email to the listserv address on the agency page.⁠³

Plan review comes first, even in an existing building

Nevada counts adult day care among the facility types that “must submit a plan review application for initial licensure and prior to any construction projects.”⁠⁵ Leasing a finished commercial space does not get you out of plan review. NAC 449.4063 also says the Bureau “shall not approve a facility for licensure until all construction is completed and a survey is conducted at the site.”⁠²

How plan review works, per the HCQC compliance resource and NAC 449:

• Who draws the plans. Plans must be prepared by a Nevada-licensed architect, licensed general contractor or residential designer.⁠⁶ NAC 449.0115 still describes “two complete sets” of plans; the HCQC compliance resource asks for a digital PDF set sent to one of the state’s third-party plan reviewers.⁠²⁠⁶
• Who you pay. You choose a third-party reviewer and pay that reviewer directly under its own fee calculator. These costs are nonrefundable and come on top of the license fee.⁠²⁠⁶
• Local building permit. Plans also go to the city or county for the building permit. You do not need the local permit before filing plan review, but changes the local building department requires later “may incur additional fees.”⁠⁶
• Approval period. An approved plan for an adult day care is valid for 42 months, unless the plans, ownership or intended use change.⁠²
• Optional advisory inspection. Once at least 80% of construction is done, you can ask in writing for an on-site advisory inspection: $500 for projects up to $500,000, $1,000 up to $1,000,000, and $2,000 above that.⁠²
• Certificate of need. The compliance resource warns that a facility in a county with fewer than 100,000 residents whose construction project exceeds $2,000,000 may need certificate of need approval under NRS 439A.100.⁠⁶
• Clock after construction. You have one year from construction completion to finish the process and become licensed.⁠⁶

Small refurbishing (painting, new flooring, window repairs, new wall or window coverings) does not trigger plan review once you are licensed.⁠²

Kitchen permit above 10 clients

If you are licensed for more than 10 clients, you also need a commercial food establishment permit from HCQC’s environmental health staff. Kitchen plans go to an HCQC office, not to the third-party plan reviewers. The permit issues only after an on-site inspection.⁠⁶⁠⁷

Zoning and the local business license

The rules require compliance with local zoning ordinances and building and fire codes, and the stricter standard wins where state and local rules differ.⁠² At application you upload a city or county business license, conditional use verification form or special use permit that shows your DBA name and physical address. HCQC states that payment receipts “will not be accepted.”⁠⁴ Zoning stays a condition of keeping the license: NRS 449.089 lets the Division refuse renewal if the facility has not “conformed to all applicable local zoning regulations.”⁠¹

Building standards the surveyor will check

NAC 449.4074 is short but specific.⁠² Plan your floor plan around these numbers:

The client capacity you put on the application (NAC 449.011 requires the “maximum number of clients allowed to occupy the facility at one time”) must fit within these ratios, and that number decides your fee tier.⁠²

You also need a fire and emergency plan that every employee understands, posted in a conspicuous place and reviewed yearly. Evacuation drills are monthly, with written records kept for 12 months. Any fire or disaster must be reported to the Bureau within 24 hours.⁠² A first-aid kit must be on site.⁠²

What the state checklist asks you to upload

HCQC’s initial-license checklist lists the documents it expects in the online application. State staff send the fire inspection request only after every item is uploaded:⁠⁴

• Resume of the director, matching the name in the application.
• A copy of the director’s elder abuse, neglect and exploitation training, still in date.
• A copy of the Nevada State Business License from the Secretary of State with your NV business ID. HCQC states that SilverFlume receipts or screenshots are not accepted.
• A fully executed lease that names the facility and its address and shows you may operate there, or a recorded deed if you own the property.
• Entity documents: articles of organization and operating agreement (LLC), articles of incorporation and bylaws (corporation), or partnership agreement.
• A three-year business history: either owner resumes showing three years of owning the same type of facility, or a resume and one reference letter for each owner.
• A certificate of liability insurance naming the facility and address as insured and the Division as certificate holder.
• The local business license, conditional use verification or special use permit.
• The plan review application.
• Background checks for each owner holding 10% or more.
• A floor plan with dimensions.
• The State Fire Marshal certificate of compliance, which you upload once the Fire Marshal issues it.

These items track the rule. NAC 449.011 requires ownership information (including anyone with a 10% or larger interest who also holds a mortgage, deed of trust or similar obligation on the facility), personal references, three years of financial and business history, and copies of the certificate of occupancy, business license, special use permits and lease. The 10% background-check line comes from the HCQC checklist.⁠²⁠⁴ The insurance policy must carry an endorsement giving the Division 30 days’ notice before cancellation or nonrenewal, and “a license will not be issued until that certificate is furnished.”⁠²

The application, in order

1. Form the business and get the state business license

   The checklist requires the Secretary of State business license and entity documents before you can upload a complete application.⁠⁴

2. Secure the site and local approval

   Sign the lease, confirm zoning, and get the local business license or use permit.⁠²⁠⁴

3. Complete the elder abuse training

   The applicant (or, for an entity, the person in charge) must complete training to recognize and prevent abuse of older persons before the license is issued. Training finished within the year before the application counts.⁠¹

4. File the license application and fee online

   Under NAC 449.013 an application is valid for one year; if you are not licensed within that year, you must reapply and pay again.⁠² HCQC’s compliance resource adds that when plan review is involved the application stays in the system until construction is complete and the one-year clock starts at completion, and that plan review documents can be submitted once the license application and fee are initiated.⁠⁶

5. Go through plan review and, if needed, the kitchen permit

   Build or remodel to the approved plans.⁠⁵⁠⁶⁠⁷

6. Submit fingerprints

   Each applicant sends fingerprints to the Central Repository for Nevada Records of Criminal History for an FBI check and authorizes a search of child abuse registries covering the past five years.⁠¹

7. Fire Marshal inspection

   Once every checklist item is uploaded, state staff send the inspection request to the State Fire Marshal, who contacts you about the fee and scheduling.⁠⁴⁠⁶ Adult day care is not on the list of licensees exempt from the fire inspection report.⁠² The Fire Marshal’s fee is not published on the HCQC pages.

8. Prelicensure survey

   The Division investigates the premises, staff qualifications, methods of operation and policies, and surveys the facility before issuing the license.⁠²

9. Post the license

   Display it in a conspicuous location.⁠²

Fees as published on October 12, 2026

Third-party plan review, the kitchen permit and the State Fire Marshal inspection carry their own charges, set outside NAC 449.013.⁠²⁠⁶

Staffing, training and background checks

Nevada does not set a staff-to-client ratio for adult day care. NAC 449.4072 requires “the number and kind of employees required by the physical characteristics of the facility, the number of clients and the services provided.”⁠² The fixed rules are:

• Director. At least 21, with a high school diploma or equivalent, and “the personal qualities which will enable him or her to understand the problems of aged and infirm adults.” The director must name a similarly qualified acting director for absences.⁠²
• Supervision. A client “must be supervised by an employee of the facility at all times during the operating hours.” Staff report any change in a client’s physical, mental, emotional or social functioning to the director, and the report goes in the client’s file.⁠²
• First aid and CPR. At least one employee trained in first aid and CPR must be on the premises at all times.⁠²
• Training hours. Every employee and volunteer gets a general orientation, a copy of the policies and procedures, and at least 12 hours of training a year at the facility.⁠²
• Elder abuse training. The administrator or person in charge must complete it before the facility serves anyone, and each care employee before providing care; both repeat it annually. The facility pays.⁠¹
• Health screening. Employees must be in good physical and mental health, and personnel files must document the tuberculosis tests or certificates required by NAC 441A.375. Volunteers meet employee standards but need only a tuberculin test result, not a full physical.⁠²
• Background checks. Within 10 days of hiring an employee, taking a temp-agency worker or signing an independent contractor, you must get a written statement about convictions listed in NRS 449.174, verify licenses, and submit fingerprints for state and FBI checks. The check is repeated at least every five years, and each renewal application must include a statement that you are in compliance with NRS 449.115 to 449.125 and 449.174, the background-check statutes.⁠¹
• Personnel files. NAC 449.4073 lists 11 items each file must hold, including evaluations, health certificates, accident records, training records, license verification and proof of orientation.⁠²

Medications and health tasks

If you admit a client who cannot take their own medication, an employee licensed to administer medications must give it.⁠² Since January 30, 2019, unlicensed staff may check blood glucose, help with insulin from an FDA-approved auto-injector (for stable clients on maintenance doses with no sliding scale) and weigh clients. They need training from a physician, PA, licensed nurse or qualified trainer before starting, every year after, and whenever the device changes.⁠² Restraints, or sedatives used in place of restraints, need a physician’s order.⁠²

Clients: admission, care plans, meals and records

Admission. Before admission each client provides a physical exam result from a physician, PA or APRN within the past six months; a medical history summary from the past six months; a physician’s statement that your facility is an appropriate setting; and any special dietary needs. Each client names a physician to call in an emergency.⁠² Your admission policy must include a nondiscrimination statement and eligibility criteria, signed by the director and the client.⁠²

Required services. You must help with activities of daily living, offer activities suited to each client, watch clients’ health and tell family of significant changes, set medication procedures, provide fluids to prevent dehydration, give clients information about other agencies that may help, and distribute a monthly activity calendar to clients and families.⁠²

Assessments and care plans. An initial written assessment is done at admission and a fuller one within 30 days. The fuller assessment covers physical and mental health, social history, support systems, daily-living abilities, financial assistance programs and a care plan. Each client’s needs against the plan are reassessed at least every three months.⁠² These assessment, care plan and menu sections (NAC 449.4086 to 449.4089) sit under the rules’ “Medical and Ancillary Services” heading, but their text refers to “any person admitted” and “each client,” and HCQC’s fact sheet presents the menu rule as a general requirement, so plan on following them either way.⁠²⁠⁹ Clients who leave for good receive a written care summary and referrals.⁠²

Meals. A client present five hours or more gets a meal, and one present more than six hours gets additional nourishment. Each meal supplies one-third of the recommended daily allowances. If you cook on site, a licensed dietitian must consult at least four hours a month. If meals are delivered, you must provide an alternative for special diets, and you may not accept a client whose prescribed diet you cannot meet.⁠² Menus are written a week ahead, posted, and kept for six months with substitutions noted.⁠²

Records. Client files are kept in a locked, fire-resistant place for five years after the client leaves.⁠² Written policies on admission, discharge and care, employees, and fiscal procedures are reviewed yearly, NAC 449.4086 calls for a written plan for the annual evaluation of your programs, and advertising must describe only services you actually provide.⁠²

Medical services and Medicaid’s adult day health care

The basic license covers a social model. To add medical or ancillary services, you either contract for them under NAC 449.4084 or provide them directly after meeting NAC 449.4086 to 449.4089: an annual program evaluation plan, the 30-day assessment, three-month care plan reviews and the menu rules.⁠² A contract has to be in writing and must spell out supervision, coordination, clinical notes for the client file and how charges are set. The contractor must meet the same qualifications as your own staff.⁠²

Nevada Medicaid pays for adult day health care through its 1915(i) State Plan home and community-based services option, under provider type 39.⁠¹⁰ Chapter 1800 of the Medicaid Services Manual, revised effective March 1, 2025, layers its own requirements on top of the license:⁠¹¹

• The provider must hold licensure under NAC 449 and must email DHCFP within 24 hours of any closure, suspension or adverse action by HCQC.
• A full-time RN with at least one year of experience with seniors, people with disabilities or people with a history of aggressive behavior must oversee medical services. An RN, or an LPN supervised by an RN, must be on the premises whenever a Medicaid recipient is present.
• A full-time program director needs two or more years of education or experience with the same populations.
• Daily attendance logs (time in and out) and nursing logs are required.
• Recipients qualify by needing hands-on help or prompting with at least two ADLs plus a listed risk factor, such as social isolation or a chronic condition that needs RN supervision.

Provider enrollment questions go to [email protected].⁠¹⁰

Renewal, changes and enforcement

Nevada health facility licenses expire on December 31.⁠⁸ NRS 449.089 says a license runs one year from issue, and HCQC puts most facility types, adult day care included, on the calendar-year cycle.⁠¹⁠⁸ File the renewal online by November 15. Between November 16 and December 31 you pay the renewal fee plus half again. If the license lapses without a renewal application, you cannot renew and must apply as a new facility.⁠²⁠⁸ Your license stays active while a timely renewal is under review, but all outstanding fees must be paid first, and you cannot change the license during renewal.⁠⁸ The licensee must complete elder abuse training each year before the license can be renewed.⁠¹

Between renewals, notify the Division immediately of any change in ownership, location, services or maximum client count. Report an administrator change within 10 days, and report a transfer of the real property within 10 days, with a copy of any lease, if the operator stays the same.⁠² A name change or similar modification needs a new application and a $250 fee.⁠² If a surveyor finds a facility out of compliance, the Division issues a written notice that names the problem and sets a deadline to fix it.⁠² For violations of the elder abuse training law, the Division may take disciplinary action under NRS 449.160 and 449.163.⁠¹

Recent changes

• 2025 agency rename. Statute now assigns licensing to the Health Care Purchasing and Compliance Division of the Nevada Health Authority. NAC 449.4061 and HCQC pages still use older names, while newer state contact addresses use the nvha.nv.gov domain.⁠¹⁠²⁠⁵⁠¹⁰
• 2025 statute amendments. The 2025 Legislature amended the elder abuse training section (NRS 449.093), the licensing requirement (NRS 449.030) and renewal (NRS 449.089), which apply to adult day care.⁠¹
• Medicaid 1915(i) renewal, effective March 1, 2025. The renewal broadened the needs-based eligibility criteria and added serious-occurrence reporting rules for adult day health care providers.⁠¹¹

Sources

1. 1
   Nevada Legislature, Nevada Revised Statutes, Chapter 449: Medical Facilities and Other Related Entities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Nevada Legislature, Nevada Administrative Code, Chapter 449 (NAC 449.4061 to 449.4089: Facilities for Care of Adults During the Day) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Health Care Quality and Compliance, Nevada Health Authority, Adult Day Care (ADC) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Health Care Quality and Compliance, Nevada Health Authority, Licensing Checklist for Adult Day Facilities (ADC) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Health Care Quality and Compliance, Nevada Health Authority, Construction and Plan Review Checked 12 Oct 2026 · Back to text ↑
6. 6
   Health Care Quality and Compliance, Nevada Health Authority, Compliance Resource for Plan Review Checked 12 Oct 2026 · Back to text ↑
7. 7
   Health Care Quality and Compliance, Nevada Health Authority, Facility Kitchen and Pools Checked 12 Oct 2026 · Back to text ↑
8. 8
   Health Care Quality and Compliance, Nevada Health Authority, Nevada Health Facility License Renewal Checked 12 Oct 2026 · Back to text ↑
9. 9
   Bureau of Health Care Quality and Compliance, Adult Day Care Facilities (fact sheet, June 2019) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Nevada Medicaid, Adult Day Health Care Services (1915(i) State Plan Option) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Division of Health Care Financing and Policy, Medicaid Services Manual Chapter 1800, 1915(i) State Plan Option: Adult Day Health Care and Habilitation (MTL 03/25, effective March 1, 2025) Checked 12 Oct 2026 · Back to text ↑

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