Nevada residential facility for groups license: how assisted living is licensed

One license for group homes and assisted living

In Nevada, assisted living is not its own license. The statute defines a residential facility for groups as “an establishment that furnishes food, shelter, assistance and limited supervision to a person with an intellectual disability or with a physical disability or a person who is aged or infirm,” and adds that the term “includes, without limitation, an assisted living facility.”⁠¹ A six-bed home in a Las Vegas subdivision and a 120-unit assisted living building in Reno therefore hold the same license type. They differ in the resident categories, bed count and endorsements printed on that license.⁠²

The statute excludes several arrangements:⁠¹

• Day-only care. That is a facility for the care of adults during the day, covered in our Nevada adult day care facility license guide.
• One or two people in your own home. A natural person caring for “no more than two persons in his or her own home” is not an RFG. If those residents are unrelated and you are paid, Nevada licenses that home separately as a home for individual residential care. See our Nevada home for individual residential care license guide.
• Relatives within the third degree of consanguinity or affinity.
• Recovery houses for substance use disorders, homes receiving community-based or supported living arrangement services while those services are delivered, and locations providing rehabilitative residential mental health care.

The “own home” exclusion covers a natural person only. An LLC, or anyone placing residents in a house where they do not live, has no small-home carve-out, so even a two-resident operation of that kind needs an RFG license.

Running one without a license is a misdemeanor. The Division can serve a cease-and-desist order and, if you do not stop or apply within 30 days, go to court. A court can impose a civil penalty of up to $10,000 for a first offense and $10,000 to $25,000 for a later one. The Division can also bill you for the actual cost of investigating you.⁠¹

If you plan to serve people in their own homes rather than house them, that is a different license. See our Nevada personal care agency license guide and Nevada home health agency license guide.

Who regulates you after the 2025 reorganization

Licensing sits with the Health Care Purchasing and Compliance Division of the Nevada Health Authority. NRS chapter 449 now names it in the bond and licensing provisions.⁠¹ The agency’s website still uses the name Health Care Quality & Compliance (HCQC), and applications go through its online portal, myhealthfacilitylicense.nv.gov.⁠³ Older documents, including the NAC text and Nevada Medicaid’s provider checklist, still refer to the Division of Public and Behavioral Health or “the Bureau.”⁠²⁠⁷ They mean the same licensing office.

Two other bodies matter from day one:

• The Board of Examiners for Long-Term Care Administrators (BELTCA) licenses the administrator. That is a separate license, which you must secure before HCQC will issue yours.⁠¹⁠⁴⁠⁵
• The State Fire Marshal, or a local fire agency it designates, inspects and approves the building for fire safety on the Division’s behalf.⁠¹⁠²

Category 1 or Category 2: the decision that shapes your building

Every RFG license states “the category of residents who may reside at the facility.”⁠² The categories turn on a four-minute self-evacuation test:⁠²

Source: ⁠²

A facility licensed for Category 1 residents only that later wants Category 2 residents must apply to modify its license. Switching categories counts as a license modification with a $250 fee.⁠² It can also trigger building work. Separately, the statute requires a fire sprinkler system in any RFG with “three or more residents who would have difficulty perceiving danger or moving to safety in the event of a fire.”⁠¹

The administrator: a separate state license

NRS 449.186 says an RFG “must not be operated except under the supervision of an administrator of a residential facility for groups or a health services executive licensed pursuant to the provisions of chapter 654 of NRS.”⁠¹ The administrator’s name appears on your facility license.⁠² If the administrator changes, you must notify the Division within 10 days with proof of the new person’s license. Missing that deadline costs 150 percent of the $250 modification fee.⁠²

To be licensed by BELTCA as an RFG administrator, a person must, among other things:⁠⁵

• hold a high school diploma, GED or college degree;
• pass the examination of the National Association of Long Term Care Administrator Boards;
• complete a Board-approved program on Nevada’s residential group care statutes and regulations;
• submit fingerprints for state and FBI background checks;
• show health care experience within the last six years: 2 years including management and supervision, or 1 year with an associate degree, or 6 months with a bachelor’s or higher degree;
• complete 100 hours of Board-approved study in the domains of practice for running an RFG; and
• complete 40 hours of study under a Board-approved mentor.

The BELTCA application fee is $150, plus the cost of the state-law training, as published on 2026-10-12.⁠⁵ An administrator licensed for two years in another state that requires the national exam may qualify without retaking it.⁠⁵ Renewal requires 16 continuing education units every two years.⁠⁵

The administrator, or the employee designated to be in charge when the administrator is absent, must be present at the facility at all times, and that employee’s name must be posted in a public place while in charge.⁠² For an Alzheimer’s endorsement, the administrator also needs at least 3 years of experience caring for residents with dementia in a licensed facility, or education and training the Bureau accepts as equivalent.⁠²

HCQC’s checklist asks for the BELTCA license itself. It must show the administrator’s name exactly as on your application, the facility’s DBA name, its physical address, and “the exact bed count that this facility is applying for.”⁠⁴ In practice, the administrator’s license is tied to your facility before you file.

Building and fire requirements

Sprinklers are mandatory for new licenses. Since January 14, 1997, the Division “shall withhold the issuance of an initial license” to any RFG without an automatic sprinkler system that complies with NRS chapter 477 and local ordinances.⁠² Once installed, the system must be checked every calendar quarter by someone who understands it, and every year by an inspector licensed under NAC chapter 477.⁠² The facility must be “approved for residency by the State Fire Marshal,” and exit doors may not need a key from the inside unless the Fire Marshal approves.⁠²

Plan review starts at 11 beds. A facility with fewer than 11 beds does not need state plan review. At 11 or more, you must submit construction or remodeling plans, including materials, get the Division’s approval, and tell the Bureau the expected completion date.⁠² HCQC also requires a food establishment (kitchen) permit application at that size.⁠³⁠⁴ The kitchen of any RFG with more than 10 residents must meet the food establishment rules in NAC chapter 446, with equipment inspected by the Division and fire authorities.⁠²

Room and bathroom minimums. The window-glass rule and the toilet and bathing ratios apply to facilities licensed on or after January 14, 1997. Facilities with fewer than seven residents that were first licensed before then need only enough bathrooms for residents, staff and others at the facility. The rest apply to every facility:⁠²

Source: ⁠²

An assisted living endorsement raises the bar. Residents must live in their own units that contain toilet facilities and a sleeping area, shared only if both occupants consent.⁠¹ The statute lets the Division waive the in-unit toilet only for facilities licensed on or before July 1, 2005 with 10 or fewer beds, built as single-family homes.⁠¹ A new house with hall bathrooms can be licensed as an RFG but cannot claim to provide assisted living services.

Zoning. Before licensing, the Bureau inspects for compliance with the rules and “the applicable zoning ordinances and regulations.”⁠² HCQC requires a city or county business license, conditional use verification form, or special use permit showing your DBA name and the facility address. Payment receipts are not accepted.⁠⁴ Failing to conform to local zoning is also grounds to refuse renewal.⁠¹

Small-county construction. In a county under 100,000 people, or a city or town under 25,000 in a larger county, NRS 439A.100 requires Director approval before a “health facility” spends more than the greater of $2,000,000 or an amount set by regulation on new construction. Land, parking, maintenance and renovation to meet licensure standards are excluded.⁠⁶ NRS 439A.015 defines a health facility as one “in or through which health services are provided,” and NRS 439A.017 defines health services as care and observation of patients, treatment, rehabilitation or related services. Neither statute says whether an RFG counts, and HCQC’s RFG page does not address it. Ask the Division and the Director’s office in writing before committing to a large new build outside the larger counties, because a missed approval is a ground to refuse renewal.⁠¹

Endorsements: assisted living, dementia, mental illness, intellectual disability

Endorsements are added to the base license, and each brings its own conditions.⁠² HCQC’s application sends an endorsement attachment after you submit.⁠⁴

Sources: ⁠¹⁠²⁠³

Nevada enforces the assisted living label strictly. Under NRS 449.0302, an RFG “shall not claim that it provides ‘assisted living services’” unless it meets the disclosure and unit requirements and runs on seven statutory core principles. These include privacy, individualized services and minimizing the need for residents to move out as their condition changes.⁠¹ Advertising must not “misrepresent accommodations, services or programs.”⁠² HCQC posts a separate notice on the assisted living endorsement on its RFG page.⁠³

Who you can admit and keep

Residents must be at least 18. Without a special approval, an RFG may not admit or keep anyone who:⁠²

• is bedfast (cannot change position in bed without help, or is immobile);
• requires restraint;
• requires confinement in locked quarters (allowed only under the Alzheimer’s endorsement); or
• requires skilled nursing or other medical supervision 24 hours a day.

NAC 449.2712 to 449.2734 add condition-by-condition rules for residents who use oxygen, catheters or colostomies, or who have diabetes, contractures, wounds or tracheostomies. The administrator can ask the Division in writing to admit or keep a resident with a restricted condition. The request must include current medical records, a care plan, and a signed statement that caregivers can meet the need.⁠² A resident on hospice may stay even when bedfast or needing 24-hour skilled care, if the Division grants that request.⁠² HCQC publishes a bedfast exemption form and review process on its RFG page.⁠³

Staff may not provide medical services unless they are medical professionals, except for the specific tasks NAC 449.1985 allows caregivers to do.⁠²

Staffing, training and background checks

Coverage. At least one caregiver must be on site whenever a resident is present. Above 20 residents, one employee must be awake and on duty at all times, and a second must be able to arrive within 10 minutes.⁠² The Alzheimer’s endorsement requires awake staff regardless of size.⁠² You must keep a monthly written shift schedule for 6 months.⁠²

Caregiver qualifications. Caregivers must be at least 18. They must read, write, speak and understand English, and sign a statement that they have read the RFG regulations.⁠² Training requirements:

Sources: ⁠¹⁠²

Caregivers may help with medication only when the resident is stable, the dose is at a maintenance level, and a physician or registered nurse has written a care plan. Injections and IV administration are excluded, except where regulations authorize them.⁠¹

Background checks. Within 10 days of hiring an employee, accepting a temp worker or engaging a contractor, you must get their written statement on disqualifying convictions and submit fingerprints to the Central Repository for Nevada Records of Criminal History for an FBI check.⁠¹ HCQC also requires a background check for each owner holding 10 percent or more.⁠⁴ Personnel files must hold tuberculosis health certificates, reference checks, background-check evidence and CPR certification. You must produce them within 72 hours of a Bureau request.⁠²

What HCQC wants uploaded

You open the application in the HCQC licensing system. HCQC’s checklist for new and change-of-ownership RFG applications lists these uploads:⁠⁴

• Administrator resume and current elder abuse, neglect and exploitation training certificate.
• Nevada state business license from the Secretary of State showing your NV business ID. Receipts or SilverFlume screenshots are not accepted.
• Lease, fully executed, naming the facility and address, or the recorded deed. “All Licensed facilities must have a physical location in the State of Nevada.”
• Entity documents: articles of organization and operating agreement (LLCs), articles of incorporation and bylaws (corporations), or a partnership agreement.
• Three-year business history: either the owners’ resumes showing 3 years owning the same type of facility, or a resume and one reference letter for each owner.
• Local business license, conditional use verification form, or special use permit.
• Certificate of liability insurance naming the facility in the “Insured” box. The certificate holder must be the Health Care Purchasing and Compliance Division, 727 Fairview Drive, Suite E, Carson City, NV 89701.
• Surety bond (see below).
• Plan review and kitchen permit applications, for 11 or more beds.
• Owner background checks, the BELTCA administrator license, and a floor plan with dimensions.
• The endorsement attachment, which HCQC provides after you submit.
• The State Fire Marshal’s Certificate of Compliance. State staff request the Fire Marshal inspection only after every other checklist item is uploaded.

Liability insurance. No license issues until the insurance certificate is on file. The policy must give the Bureau 30 days’ notice before cancellation or nonrenewal.⁠²

Surety bond. NRS 449.065 requires a bond at application and every renewal, payable to the Aging and Disability Services Division. It indemnifies residents aged 60 or older whose property the facility fails to protect.⁠¹

Source: ⁠¹

HCQC’s checklist describes the middle tier as “7-24” employees. The statute says 7 to 25.⁠¹⁠⁴ The license is suspended by operation of law if the bond lapses.⁠¹ A bank deposit of equal amount can substitute with approval.⁠¹ The Division’s administrator may also waive the bond for an RFG where it “would result in undue hardship.”⁠¹

Fees as published

Source: ⁠²

At those rates, a 10-bed facility at private-pay prices pays $4,386 to apply and $2,193 a year to renew. All fees are nonrefundable.⁠² An application stays valid for 1 year. If you have not met every requirement by then, you file again and pay again.⁠² The applicant must complete elder abuse training before the license issues, and the administrator before the facility gives care.⁠¹ Budget the BELTCA fees separately.⁠⁵

Order of steps

1. Confirm zoning and the site

   Get the city or county land-use approval and local business license for the exact address. Decide whether you will have 11 or more beds, which triggers plan review and a kitchen permit.⁠²⁠⁴

2. Line up a licensed administrator

   Allow time for the national exam, 100 hours of study and 40 mentored hours if your candidate is not yet licensed by BELTCA.⁠⁵

3. Build or retrofit

   Install the sprinkler system and meet the bedroom, bathroom and, for assisted living, private-unit standards. Submit plans first if you have 11 or more beds.⁠¹⁠²

4. Assemble the business documents

   You need the Secretary of State business license, lease or deed, entity documents, three-year history, insurance certificate and surety bond.⁠⁴

5. Apply online and pay

   File through HCQC’s licensing system, upload the checklist items, and pay the NAC 449.016 fee. The Bureau will not inspect until the application, fee and compliance evidence are in.⁠²⁠³⁠⁴

6. Fire Marshal inspection

   HCQC requests it after your uploads are complete. You then upload the Certificate of Compliance.⁠⁴

7. HCQC inspection and license

   The Bureau inspects against the RFG rules and zoning.⁠² The license lists the administrator, address, type, maximum residents and resident category.⁠² Display it conspicuously.⁠²

HCQC publishes no processing time for initial RFG licenses.

Buying an existing facility

An RFG license “may not be transferred to another owner” and becomes invalid if the facility moves.⁠² A buyer files a change-of-ownership application with a bill of sale and a governing-body letter giving the effective date.⁠⁴ The facility must then meet the state and local health and safety requirements in force at the time of sale, not the ones in force when it was first licensed.⁠² For older homes the sprinkler rule is the costly part. A pre-1997 facility with fewer than seven residents must install a compliant automatic sprinkler system when ownership transfers, beds increase, it adds Category 2 residents, or it seeks to serve residents with dementia.⁠²

Inspections, grades and renewal

After each survey HCQC assigns a letter grade and issues a placard, which you must post in a public area within 24 hours.⁠² After a B you may request a resurvey within 30 days for $400. After a C or D you must request one within 30 days for $600, or risk revocation.⁠² A grade of D on two or more consecutive surveys is grounds to suspend or revoke the license and every endorsement on it.⁠²

Licenses expire 1 year after issue.⁠¹ Each renewal must include a statement that the licensee, administrator and staff have completed the required elder abuse training, plus a renewed surety bond.⁠¹ If you file a complete renewal by November 1 of the year the license expires, you can pay the renewal fee in two equal installments.⁠² Report a change of administrator within 10 days and a change of ownership immediately.⁠²

Medicaid: augmented personal care under the elderly waiver

Nevada Medicaid pays RFGs for augmented personal care under its Home and Community Based Services waiver for the elderly, as Provider Type 59. The checklist says “assisted living services are all inclusive services which may include any and all activities of daily living (ADL’s), instrumental activities of daily living (IADL’s) and medication oversight (to the extent permitted under state law).”⁠⁷ Its enrollment checklist, updated July 31, 2024, requires:⁠⁷

• your RFG license;
• workers’ compensation coverage;
• commercial general liability of at least $2 million aggregate and $1 million per occurrence;
• employee-dishonesty crime coverage of at least $25,000 per loss;
• business auto coverage of $750,000 combined single limit;
• the Division of Health Care Financing and Policy named as an additional insured on the liability, crime and auto policies; and
• a signed business associate addendum.

These limits exceed anything the licensing rules set, so price them before you plan on a Medicaid census. Facilities charging less than $1,000 per bed per month pay the reduced $35 per-bed licensing fee.⁠²

Recent changes to watch

• Agency restructuring (2025). Licensing authority moved to the Health Care Purchasing and Compliance Division of the Nevada Health Authority. The statutes were amended in 2025, but NAC chapter 449 and some forms still use the old agency names.⁠¹⁠²
• Chronic illness endorsement closed. Regulation R043-22 ended the option for new applicants. HCQC says information is still pending for facilities that already hold it.⁠³
• Fee schedule. The NAC 449.016 amounts quoted here are those published on 2026-10-12. Check whether the Board of Health revises them after the reorganization.

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 449.016 fees; NAC 449.156 to 449.27706 residential facilities for groups) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Health Care Quality & Compliance, Nevada Health Authority, Residential facility for groups (adult group care/assisted living) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Health Care Quality & Compliance, Nevada Health Authority, Licensing Checklist for Residential Facilities for Groups (AGC) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Nevada Legislature, Nevada Administrative Code, chapter 654 (Administrators of Facilities for Long-Term Care) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Nevada Legislature, Nevada Revised Statutes, chapter 439A (Planning for the Provision of Health Care) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Nevada Medicaid, Provider Enrollment Checklist for Provider Type 59: HCBS Waiver for the Elderly, Augmented Personal Care (updated 07/31/2024) Checked 12 Oct 2026 · Back to text ↑

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