Oklahoma adult day care center license: OSDH rules, the 180-day first license and the 1:8 ratio

When Oklahoma requires the license

Under the Adult Day Care Act, an adult day care center is a facility that provides “basic day care services to unrelated impaired adults for more than four (4) hours in a twenty-four-hour period” ⁠¹. The law defines basic day care services as supervised health, social supportive and recreational services in a structured daytime program for functionally impaired adults who still live in their own homes, usually with help from family caregivers ⁠¹. The rules define a functionally impaired adult as anyone aged 18 or older who needs care or supervision, which takes in younger adults with disabilities as well as older people ⁠².

Neither the statute nor the rule sets a minimum number of participants. The tests are the type of people served (unrelated, impaired adults), the service (basic day care) and the time (more than four hours a day) ⁠¹. Under 63 O.S. § 1-873(B), “centers to be licensed shall include all adult day care centers,” and you need a separate license for each site ⁠¹.

The center must also be a distinct entity. It can be freestanding or a separate program of a larger organization, but it needs its own staff, space, budget and participant record system that can be verified separately ⁠¹. The rules split this into two kinds. A free-standing center shares no staff, licensed space, equipment, dietary, security, maintenance or utilities with any other organization. An associated day care program is physically attached to another organization, such as a nursing facility, but has its own designated space and staff on top of what that host already needs for its residents ⁠². If you put a center inside a building with another OSDH-licensed program, each program must meet its own licensing rules ⁠². Your floor plan has to show that separation ⁠³.

Who is outside the Act

• Retirement centers and senior citizen centers are excluded from the definition ⁠¹.
• PACE organizations (Programs of All-Inclusive Care for the Elderly, 42 C.F.R. § 460.6) have been excluded since Laws 2024, c. 294, which took effect on an emergency basis on May 13, 2024 ⁠¹. A PACE day center operates under its federal PACE agreement, not this license.
• Sheltered workshops and senior recreational centers that charge participants no fees do not need a license ⁠¹. If you start charging participants, this exemption no longer applies.

Advertising alone can break the law. Under 63 O.S. § 1-878(A), it is unlawful to advertise or hold yourself out as providing adult day care services without a license under either the Adult Day Care Act or the Continuum of Care and Assisted Living Act ⁠¹. The license is required “regardless of other licenses held by the operator” ⁠¹, so an assisted living center license or a home care agency license does not cover a day program.

Neighboring Oklahoma licenses

A continuum of care facility combines a nursing facility with assisted living or adult day care under one license. Its adult day component is still subject to the Adult Day Care Act ⁠¹, and OSDH charges an additional $75 when a continuum of care application includes adult day care ⁠⁴. If people stay overnight, you are no longer running a day program. Look instead at the assisted living center license (two or more unrelated residents who need personal care or nursing supervision) or the residential care home license. Care in clients’ own homes falls under Oklahoma’s home care agency licensing or the companion/sitter agency license.

The agency, and a license that starts at six months

Adult day care licensing is handled by OSDH’s Health Facility Systems office in Protective Health Services. The same office licenses assisted living centers, residential care homes and nursing facilities ⁠⁴. You apply on paper. The contact details printed on ODH Form 712 are PO Box 268823, Oklahoma City, OK 73126-8823; phone (405) 426-8175; [email protected] ⁠³.

The law ties the license to the operator and the address. It cannot be transferred or assigned, it covers only the premises named in the application, and it must be posted where people can see it ⁠¹. A new center’s first license expires 180 days after issuance. Each renewal after that runs 36 months ⁠¹. The three-year term dates from Laws 2021, c. 94, effective November 1, 2021. The same law let OSDH issue licenses of 12 to 36 months in the cycle after that date so expiration dates would be spread across the calendar ⁠¹.

Building, zoning and fire approvals come first

Form 712 does not let you file and fix the building later. The initial packet must include a statement from your city or local zoning authority saying the address is zoned appropriately for an adult day care center, and that letter must state the center’s maximum participant capacity (occupancy load). It must also include a copy of the local building and fire inspector’s report or the State Fire Marshal’s inspection form ⁠³. So the local approvals are your first real milestone.

State law sets how local codes treat these centers: “Local health, fire and building codes relating to adult day care centers shall be classified as an education use group” ⁠¹. Bring that citation when you talk to a building official who has not handled an adult day center before.

The physical-plant rules in OAC 310:605, Subchapter 15 add the following ⁠²:

• Space: at least 40 square feet per participant, excluding hallways, storage areas, offices, restrooms and kitchens. You also need office space and space for special therapies and private conversations.
• Accessibility: a newly licensed center, or one that undergoes design changes or construction, must meet Chapter 11 of the 2003 International Building Code.
• Exits: at least two exits that can serve as disaster escape routes.
• Toilets: at least one toilet and hand-washing facility for every 12 participants, close to the activity areas and private. Hot water at fixtures used by participants may not exceed 115°F.
• Climate: room temperature between 68°F and 85°F. Portable space heaters are banned, and heating pipes and radiators in participant areas must be covered.
• Rest and illness: at least one bed in a quiet space away from activities, plus a separate room or partitioned area for isolating a participant who becomes ill.
• Fire safety: smoke detectors throughout; fire-resistant draperies, upholstery and decorations; no extension cords or temporary wiring; and an agreement with the local fire service or access to 911.
• Site: outside lighting at entrances and on the grounds, parking for drop-off and pickup, secured floor coverings (throw rugs are prohibited) and non-slip stairs.

The occupancy load in your zoning and fire paperwork can come out lower than these numbers. The participant count you put on Form 712 has to match all of these documents ⁠³.

Who you have to hire

Required positions

Every center must have a director, an activity director, a social services coordinator or case manager, and a dietary supervisor ⁠². If your food comes from a larger parent organization or an outside contractor, the dietary supervisor can be part time. One person can fill more than one position only if they meet the minimum qualifications for each ⁠².

The Tier 2 administrator question

The Long-Term Care Administrator Licensing Act (Laws 2023, c. 271) defines a “Tier 2 long-term care administrator” as a person licensed or certified to serve as administrator of, among other settings, an adult day care center. It also makes it unlawful to serve as a long-term care administrator without a license or certificate ⁠¹. The Act bars OSDH from requiring a four-year degree for Tier 2 ⁠¹. OSDH now offers a Tier 2 Adult Day Care Administrator license. To get it, you apply through the OSDH portal before you start training, complete an approved training program, pass the Oklahoma State Standard exam and the NAB Core exam, and keep up 16 continuing education hours a year. No internship is required, and licenses expire every December 31 ⁠⁵. The Act also says that until OSDH adopts its rules, the existing licensure and certification processes stay in place ⁠¹.

Neither OAC 310:605 nor Form 712 says the director must hold the Tier 2 license, and the OSDH program page sends applicants to OAC 310:679 for licensure requirements without saying when a center must have a licensed administrator ⁠³⁠⁵. Ask Health Facility Systems whether the director you name on Form 712 must hold the Tier 2 license before you hire.

Ratio

You need “a minimum of one full time equivalent direct care staff person for every eight (8) participants who are present and one (1) additional direct care staff person for a major portion of eight (8) additional participants present” ⁠². The count is based on participants actually present, not your licensed capacity. Paid staff and volunteers both count as direct care staff if they are assigned to participants’ direct needs ⁠². Separately, at least two responsible persons must be at the center whenever participants are present, and one of them must be a staff member ⁠². A volunteer counted in the ratio must be qualified for the written job description and needs a personnel file ⁠².

Aides, screening and health

Oklahoma treats a personal-care aide in a day center like a nurse aide in a nursing home. State law bars an adult day care center from employing anyone as a nurse aide who is not a certified nurse aide in good standing. OSDH may grant a temporary emergency waiver to a center that shows it could not otherwise meet its staffing needs ⁠¹. Before an aide starts, you must check the OSDH nurse aide registry for confirmed findings of abuse, neglect or misappropriation ⁠², and arrange the criminal history background check required by the Long-term Care Security Act ⁠¹. Every paid staff member needs an employment exam, including a tuberculosis test under the CDC’s 2019 guidelines, within 72 hours of hire ⁠². Direct care paid staff must be at least 18 ⁠².

Training is set by the rules. Every staff member and volunteer gets a general orientation on the program, policies, fire, safety and emergency procedures before starting work, and in-service training every quarter. You must keep records of attendance and content ⁠². At least one staff member trained in CPR must be on duty at all times ⁠².

Medication

If staff will give medications, someone on duty must be an RN, an LPN, a certified medication aide (CMA) or a medication administration technician (MAT) trained in a course OSDH approves. A center that relies on a CMA or MAT also needs a monthly consultation from an RN or LPN ⁠². The rules encourage participants to keep and take their own medications. When a participant cannot, the center stores the drugs locked in the pharmacy containers and gives them only on a physician’s order. Only a licensed nurse may take a phone order, and the physician must sign it within three working days. Refrigerated medications are kept locked at 36°F to 48°F, Schedule II drugs go in a locked box, each dose is documented within one hour, and a licensed nurse reviews the medication system at least every three months ⁠².

Program rules OSDH will inspect

OAC 310:605 is specific about the program itself ⁠²:

• Required services: supervision, help with activities of daily living, planned activities, social services, nutritious meals, and emergency and first aid services.
• Activities: planned activities for at least half of daily operating hours and never less than four hours. Post the monthly calendar before the first day of the month and display the daily schedule.
• Meals: at least one meal a day, meeting one-third of the adult recommended dietary allowance, for anyone who attends four or more hours. Write menus on at least a two-week cycle if you cook on site, provide therapeutic diets when a physician orders them in writing, and have a qualified dietitian available for staff consultation. Food must be handled under the State Board of Health’s food service establishment rules.
• Admission: a signed application plus medical information from or verified by the participant’s physician, a physician’s medical assessment within five days of entry, and an individualized written plan of care within ten days, reviewed at least every six months. An RN’s nursing assessment can substitute only for a participant who has no physician and takes no medications.
• Discharge: at least two weeks’ notice before ending services, unless the participant’s continued attendance threatens others’ safety. Write an aftercare plan before a planned discharge and a detailed report after every unplanned one.
• Emergencies: a written emergency plan posted where people can see it, drills at least every three months, and every fire reported to OSDH within 72 hours (immediately if anyone is hurt or killed).
• Records: keep participant and employee records for at least five years after discharge or termination. Electronic records are allowed if they can be accessed on site and are backed up.
• Transportation (if offered): a seat for every rider, accommodation for mobility devices, and a rest stop on any ride longer than one hour.
• Pets: resident animals are limited to dogs, cats, fish and birds, with no more than two dogs or cats unless OSDH approves, and you need veterinary documentation for each animal.

You must have written policies covering enrollment criteria (including turning away people whose needs exceed what your program can handle), hours, rates and fee-based extras with public disclosure, the services you offer, medication, admission and discharge, personnel, records and emergencies ⁠². Participants’ rights, such as freedom from restraint except on a physician’s order in the care plan and access to a telephone, are listed in OAC 310:605-3-1 ⁠².

Filing the application

1. Settle the site

   Get the zoning letter with the maximum participant capacity, then the local building and fire inspection report or a State Fire Marshal inspection ⁠³. Draw the floor plan, showing the separate space if you share a building ⁠³.

2. Prepare the ownership and staffing forms

   Complete the Disclosure Statement (ODH Form 953-B), its Detail Attachment (953-C) and Affirmation Attachment (953-D), and the Staffing Projection and Professional Certification (953-E). The operating entity itself must complete the 953-D ⁠³. An individual applicant also files ODH Form 301, the Affidavit of Lawful Presence ⁠⁴.

3. Assemble the business documents

   Include a complete description of your programs and services, the applicant’s financial statement, and a projected budget of revenues and expenses for the first month of operation ⁠³. The statute separately requires a statement of ownership and a financial statement ⁠¹.

4. Answer the Alzheimer’s question

   Item 7 on Form 712 asks whether you market care for people with Alzheimer’s disease or related disorders in a special unit or program. If you do, you must file the special care disclosure ⁠³. OSDH now takes it as a digital form ⁠⁴.

5. Sign before a notary and mail with the fee

   Form 712 must be complete, signed and notarized. Send it with a $75 check payable to the Oklahoma State Department of Health to the PO box above ⁠³.

6. Wait for the license before opening

   “Application for initial license must be filed, and a license must be obtained, before operation begins” ⁠³. Neither the form nor the rules give a processing time.

Operating without a license is a misdemeanor, each day counts as a separate violation, and OSDH can impose administrative penalties of up to $500 a day ⁠¹.

Fees

Oklahoma has no certificate of need for adult day care. OSDH’s certificate of need program covers nursing facilities and specialized facilities ⁠⁴.

Inspections, renewal, changes and closing

OSDH inspects every center at least once a year and whenever it sees a need. By applying, you consent to entry, and refusing entry is grounds for denial or revocation ⁠². After a cited inspection, you have 10 days from receiving the notice of violation to submit a plan of correction, and the plan can allow no more than 30 calendar days to fix the problems ⁠². As part of these inspections, OSDH also reviews employee files for the required background checks ⁠¹.

Renewal: file Form 712, the 953-B disclosure, your most recent financial statement and the $225 fee at least 45 days before the expiration date ⁠¹⁠³. Because the first license lasts only 180 days, your first renewal is due 135 days after the license is issued.

Capacity changes: to serve more participants, refile Form 712, Forms 953-B through 953-E, and a building and fire inspection report showing the approved occupancy load. To serve fewer, refile Form 712 and Form 953-E. Send a new floor plan for any design or construction change. These filings go to the OSDH street address, 123 Robert S Kerr Ave, Suite 1702, Oklahoma City, OK 73102-6406, and the form says not to send fees there ⁠³.

Enforcement: OSDH gives 30 days’ written notice before suspending or revoking a license. If participants’ health and safety are threatened, it can act immediately and close the center. You have 10 days to request a hearing ⁠². A licensee may surrender the license instead of paying a fine, but is then “forever barred” from getting it reissued ⁠¹.

Closing: notify participants in writing at least 30 days before closing. Unless the license is being revoked, notify OSDH 30 days ahead as well. Surrender the license as soon as you close ⁠¹.

Medicaid: the ADvantage waiver

Oklahoma’s Medicaid ADvantage Program waiver lists adult day health among its services. A provider must be certified by the ADvantage Administration and hold a signed SoonerCare (Medicaid) contract with the Oklahoma Health Care Authority ⁠⁶. Certification checks licensure, training, business practices and financial stability, and financial certification is re-evaluated at least once a year ⁠⁶. Oklahoma Human Services’ Community Living, Aging and Protective Services (CAP) audits adult day health providers. A provider that needs a plan of correction can be dropped from the referral list until the plan is approved and a follow-up review is done ⁠⁶. Your OSDH license comes first: ADvantage certification checks that you hold it.

What changed recently

• May 13, 2024: PACE organizations were removed from the definition of adult day care center (Laws 2024, c. 294) ⁠¹.
• May 22, 2023: the Long-Term Care Administrator Licensing Act created the Tier 2 tier that includes adult day care center administrators ⁠¹⁠⁵.
• November 1, 2021: licenses moved from annual terms to 36 months, and the renewal fee was set at $75 per year of licensure (Laws 2021, c. 94) ⁠¹. OAC 310:605 was amended to match, effective September 11, 2022 ⁠².
• September 11, 2020: the TB screening rule began citing the CDC’s 2019 health care guidelines ⁠².

The OSDH-posted copy of OAC 310:605 lists the September 11, 2022 amendment as its latest ⁠². It does not say whether later changes are pending, so ask Health Facility Systems for the current rule text before you finalize your policies.

Sources

1. 1
   Oklahoma Legislature, Oklahoma Statutes, Title 63: Adult Day Care Act (63 O.S. §§ 1-870 to 1-878) and Long-Term Care Administrator Licensing Act Checked 12 Oct 2026 · Back to text ↑
2. 2
   Oklahoma State Department of Health, Oklahoma Administrative Code, Chapter 310:605: Adult Day Care Centers Checked 12 Oct 2026 · Back to text ↑
3. 3
   Oklahoma State Department of Health, Adult Day Care License Application, ODH Form 712 (revised 9/28/2021) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Oklahoma State Department of Health, Health Facility Systems Checked 12 Oct 2026 · Back to text ↑
5. 5
   Oklahoma State Department of Health, Long Term Care Administrator Licensing Program Checked 12 Oct 2026 · Back to text ↑
6. 6
   Oklahoma Health Care Authority, OAC 317:30-5-761: ADvantage Program eligible providers (revised 09-01-24) Checked 12 Oct 2026 · Back to text ↑

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