South Carolina community residential care facility (CRCF) license: DPH rules and steps

One license from two beds to two hundred

South Carolina regulates every kind of residential care for adults under a single license. The Department of Public Health (DPH) defines a community residential care facility as one that “offers room and board and which, unlike a boarding house, provides/coordinates a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older, not related to the licensee within the third degree of consanguinity.”⁠¹ The statute behind it, S.C. Code section 44-7-260(A), uses the same two-person line: a CRCF that cares for two or more unrelated people may not operate without a license.⁠⁴

What the rule means in practice:

• No separate assisted living license. DPH says these facilities “may be referred to as ‘assisted living’ provided they meet the above definition of community residential care facility.”⁠¹⁠² A building marketed as assisted living without a CRCF license is unlicensed.
• No small-home category. South Carolina has no adult foster home or small-home license: a three-bed house and a 120-bed building hold the same license and follow the same regulation. The rule does scale some requirements by size (fire alarms at 6 beds, kitchen equipment at 16, extra square footage above 10), covered below.
• Personal care is the trigger. The rule defines personal care as helping with or directing activities of daily living, knowing a resident’s general whereabouts, and monitoring residents’ activities on the premises.⁠¹ Medication administration is on the rule’s list of activities of daily living.⁠¹ A boarding house gives room and board and gives personal care to no more than one person.⁠¹
• Mental health and disability homes are included. The definition covers any facility other than a hospital that offers or advertises “a beneficial or protected environment specifically for individuals who have mental illness or disabilities.”⁠¹

If DPH finds room, board and personal care being given to two or more unrelated adults without a license, “the owner shall cease operation immediately” and must keep the occupants safe. The rule adds that past or current violations “may jeopardize the issuance of a license for the facility or the licensing of any other facility.”⁠¹ You may not advertise or market as a CRCF before you are licensed, and you may not admit a resident before the license’s effective date.⁠¹

South Carolina’s certificate of need program applies to nursing homes, not CRCFs (S.C. Code section 44-7-160).⁠⁴ You don’t need state approval of community need before building.

Where the CRCF ends and other licenses begin

A CRCF may not admit or keep anyone who needs hospital or nursing home care. It also may not keep anyone who needs the continuous daily attention of a licensed nurse, beyond short intermittent nursing of up to 14 consecutive days during recovery.⁠¹ If your residents need that level of care, the license you need is a nursing home license, which does require a certificate of need.⁠⁴ Daytime-only programs are licensed as day care facilities for adults; see our South Carolina adult day care guide. Personal care delivered in clients’ own homes falls under the in-home care provider license, and skilled visits under the home health agency license.

A CRCF license covers one site. Facilities on non-adjoining property need separate licenses. A road does not split a property unless it is a limited-access road such as an interstate. A different facility type on the same premises, such as a nursing home wing, is licensed separately.⁠¹

The administrator license comes first

Regulation 60-84 defines the administrator as the person in charge of all of the facility’s functions who “is appropriately licensed as a community residential care facility administrator by the S.C. State Board of Long Term Health Care Administrators.”⁠¹ The DPH application form says you “MUST provide a copy of license,” with its number and expiration date.⁠³

The board, part of the Department of Labor, Licensing and Regulation (LLR), issues a CRCF administrator license to an applicant who meets these requirements under S.C. Code section 40-35-40(B):⁠⁵

• is at least 21;
• has no conviction relevant to running a CRCF, “including financial misconduct or physical violence,” and is of reputable character and sound health;
• meets one of these education and experience combinations, with the experience gained on site under a licensed CRCF administrator, including supervisory and direct resident care duties:

• passes the board’s examination and pays the fees.

The Administrator-in-Residency (AIR) program is the board’s alternative to the experience requirement.⁠⁷ You need a board-approved preceptor, a $25 application fee (check or money order), official transcripts sent directly to the board, and a notarized lawful-presence form. Programs start on the first of a month, and the complete application must reach the board by the 15th of the month before.⁠⁷ Under rules the board adopted effective May 22, 2026, what was called the Administrator-in-Training program is now the Administrator in Residency, and administrator licenses are biennial.⁠⁹

Applicants also need SLED and FBI fingerprint reviews and a current credit report before initial licensure.⁠⁵ The examination has two parts. The national part is the NAB Core of Knowledge (CORE) exam plus the Residential Care and Assisted Living (RC-AL) line-of-service exam. The state exam is based on Regulation 60-84 itself.⁠⁸ Since January 1, 2026, NAB limits candidates to four attempts per exam in each July-June cycle.⁠⁶ LLR lists the license as expiring June 30 of even-numbered years, with a biennial active renewal fee of $300.⁠⁶ LLR also notes it verifies lawful presence, and that DACA recipients cannot receive a professional license in South Carolina.⁠⁶

Once you are open, name a staff member in writing to act when the administrator is absent.⁠¹ If the administrator leaves, tell DPH by phone or email within 72 hours. Then send the new administrator’s name in writing within 10 days.⁠¹

Owners: the fingerprint bar

S.C. Code section 44-7-264 applies only to nursing homes and CRCFs. Everyone who must sign the CRCF license application has to pass a state (SLED) and national (FBI) fingerprint-based criminal records check.⁠⁴ The form lists the signers: the owner if an individual, the head of an LLC, two officers of a corporation, or the head of a government department.⁠³

DPH must not issue the license, and may revoke one already issued, if a signer is on the sex offender registry or has been convicted of:⁠⁴

• abuse, neglect or exploitation of a child or vulnerable adult;
• any violent crime as defined in section 16-1-60;
• any other drug-related felony;
• forgery, embezzlement, or breach of trust with fraudulent intent; or
• a similar offense in another state or under federal law.

A pardon does not automatically clear the way. DPH may still weigh the pardoned conviction and its circumstances in deciding whether you are fit to hold a CRCF license.⁠⁴

Staff are screened separately. Every staff member and direct care volunteer needs a criminal background check under section 44-7-2910 before being hired, and no staff member, volunteer or private sitter may have a conviction or no-contest plea for abuse, neglect or exploitation of a child or vulnerable adult.⁠¹ If you cannot verify that an applicant lived in South Carolina for the past 12 months, run a state check before hiring and start a federal check after.⁠⁴

The building: plan review before construction

Regulation 60-84 treats a building licensed as a CRCF for the first time like new construction. You must submit plans and specifications to DPH for “buildings being licensed for the first time” and “buildings changing license type,” as well as for new construction, additions and capacity increases.⁠¹ Final plans must be prepared and sealed by an architect or engineer registered in South Carolina. Unless DPH directs otherwise, you submit at the schematic, design development and final stages, and “construction work shall not commence until a plan approval has been received from the Department.”⁠¹ During construction you must employ a registered architect or engineer to observe and inspect, and DPH inspects periodically.⁠¹ All local permits come first: DPH will not inspect construction done without proper local permits.⁠¹ The statute says DPH “may charge an inspection fee,”⁠⁴ but neither Regulation 60-84 nor the application form states a plan review or construction inspection fee for a CRCF. Ask the Bureau of Health Facilities Licensing for the amount before you submit drawings.

Design must meet the codes adopted by the South Carolina Building Codes Council and the State Fire Marshal for CRCFs.⁠¹ Beyond the codes, the regulation sets its own space and fixture minimums:⁠¹

Each resident needs a real single bed; “roll-away type beds, cots, bunkbeds, and folding beds shall not be used”. Each also needs a closet or wardrobe, a three-drawer bureau, a nightstand and a chair.⁠¹ Live-in staff, family and the public need bathrooms separate from residents’. The building must have facilities for handicapped persons even if no current resident needs them.⁠¹ Only residents, staff, volunteers, owners and the owner’s immediate family may live in the building, and no one but residents may use resident bedrooms.⁠¹

Fire alarm at six beds. A facility with six or more licensed beds needs a supervised fire alarm system that transmits automatically to a third party and gives audible and visual alarms on every floor.⁠¹ All facilities need emergency power for exit lighting, egress lighting and any required alarm system.⁠¹

Kitchen at five and sixteen beds. If you cook on site, DPH must approve the kitchen and it is graded under the retail food regulation, R.61-25.⁠¹ A facility licensed for 16 or more beds needs kitchen equipment meeting R.61-25. A facility of five or fewer beds may use a household dishwasher plus a two-compartment sink instead of a three-compartment sink.⁠¹ Catered meals must come from a graded food establishment under a written contract.⁠¹ The initial application asks for the name and certificate of your certified food protection manager.⁠³

Fire department and location. If you are outside a public fire department’s service area, you need a written agreement with the nearest fire department, and DPH gets a copy.⁠¹ The site must be served by roads passable at all times, have parking, and give firefighting equipment access around the building.⁠¹

Locked doors. Residents may not be locked in or out of their rooms, common areas or the building. Exit doors may be locked only with DPH’s written approval and as the codes allow.⁠¹ A secured dementia unit therefore needs DPH sign-off; see the dementia section below.

Plans DPH wants before it licenses you

The regulation requires written policies and procedures covering each section of Regulation 60-84, including any special care you offer, such as for Alzheimer’s disease or developmental disabilities.⁠¹ Two items have to be in DPH’s hands before the first license:

• Disaster and evacuation plan. You develop it with your county emergency preparedness agency, and “prior to initial licensing of a facility, the completed plan shall be submitted to the Department for review.” It must name the sheltering facilities your residents would move to and state your bed capacity and average occupancy.⁠¹
• Fire and evacuation plans, written with your supporting fire department or disaster preparedness agency.⁠¹

Applying to DPH, in order

1. Line up the administrator

   Recruit a licensed CRCF administrator or get licensed yourself; the application cannot be completed without a license number.⁠³⁠⁵

2. Settle the site and name

   Your facility name may not match or resemble any other licensed facility in South Carolina, and chains must add their geographic area to the name.⁠¹

3. Get plan approval and local permits

   Submit sealed plans to DPH at each required stage, obtain local permits, and build or renovate only after DPH approves the plans.⁠¹

4. Write the plans and policies

   Prepare the policy manual and send the county-coordinated disaster plan to DPH for review.⁠¹

5. File Form 0217-ENG-DPH

   The July 2025 form asks for your bed count and buildings, whether you offer Alzheimer’s special care services or a special care unit, and whether you are part of a continuing care community. It also asks for your administrator’s license and food protection manager certificate. For the owner, attach Secretary of State documents, a list of officers, everyone holding 5% or more ownership, and anyone with a claim on the licensee’s liabilities.⁠³ The signature page must be notarized, and “proof of payment is required for all applications submitted.” DPH prefers email to [email protected]. The mailing address is Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171, and the phone number is 803-545-4370.⁠³

6. Fingerprint checks for the signers

   through SLED and the FBI.⁠³⁠⁴

7. Pass the initial inspection

   DPH inspects before initial licensing and issues an initial license only once you show “substantial compliance with the licensing standards.”⁠¹ Deficiencies require a written plan of correction signed by the administrator, giving the corrective action, how recurrence will be prevented, and completion dates.⁠¹

8. Post the license and admit residents

   Post it in a public area. Admit no one before its effective date, and never more residents than the bed count on the face of the license.⁠¹

If you already hold a DPH license for another facility, that facility must be in substantial compliance before DPH will license a new one.⁠¹ DPH does not publish a processing time for CRCF applications in the regulation or on the form.

Fees as published

Regulation 60-84 sets the annual license fee at “$10.00 per licensed bed or $75.00 whichever is greater,” payable by check or credit card and not refundable.⁠¹ As published on 2026-10-12:

Added beds are prorated for the rest of the licensure year. If an application is denied or withdrawn, DPH may refund part of the fee based on the remaining months of the licensure year, or $75, whichever is less.⁠¹ A renewal filed 30 or more days after expiration may draw a late fee of $75 or 25% of the license fee, whichever is greater.⁠¹ Separately, budget for the administrator’s LLR fees, the SLED/FBI fingerprinting, and any DPH plan-review charges.⁠⁴⁠⁶⁠⁷

Staffing ratios and training

Regulation 60-84 sets a staffing floor for each building:⁠¹

• 7 a.m. to 7 p.m. (“peak hours”): at least one staff member or direct care volunteer per eight residents or fraction of eight. A ninth resident means a second person on duty.
• Overnight: at least one per 30 residents or fraction, and someone must be “awake and dressed at all times.”
• Multi-story buildings over 10 beds: a staff member available on each floor whenever residents are on it.
• Always: a staff member present whenever residents are in the building, plus a CPR-certified staff member or volunteer.

Owners’ children living in the facility count as residents for the ratio.⁠¹ Private sitters hired by residents do not count toward staffing. If your resident agreement allows sitters, you must run a formal sitter program with orientation, health assessments, TB screening and criminal checks.⁠¹ Staff must be able to “speak, read, and write English.”⁠¹

Training is documented and signed by both trainer and trainee. It must happen before resident contact and at least yearly. It covers first aid, communicable disease, medication management, condition-specific care such as dementia or mental illness, restraint techniques, OSHA bloodborne pathogens, confidentiality, and the Bill of Rights for long-term care residents.⁠¹ Fire response and disaster training, along with orientation, are due within 24 hours of a new employee’s first day.⁠¹ Every staff member who has contact with residents, food service included, needs a health assessment with TB testing within 12 months before first resident contact.⁠¹

Unlicensed staff may give routine medications after training by someone licensed to administer medications. They may give injections only for diabetes and for anaphylactic reactions under a medical protocol.⁠¹

Who you can admit and keep

Each resident needs a physical exam within 30 days before admission, and at least once a year after that. Before admission each resident also needs a baseline two-step TB skin test (or a single blood test), unless a documented result from the previous 12 months allows a single test. The rule says periodic repeat testing is not required.⁠¹ Staff must complete a written assessment within 72 hours of admission and an individual care plan within seven days. The plan is reviewed at least every six months.⁠¹

The rule lists people a CRCF may not admit or keep. Among them are people who need:⁠¹

• sliding-scale insulin or other medication needing frequent dose adjustment. Routine insulin once a day or less often is allowed.
• IV fluids, or regular intramuscular or subcutaneous injections by staff;
• urinary catheter, gastrostomy tube or tracheostomy care they cannot manage themselves;
• treatment of stage 2, 3 or 4 pressure ulcers;
• nasogastric tube feeding or suctioning;
• oxygen for the first time where the flow needs adjusting.

You may not keep a resident who has been fully dependent in all activities of daily living for more than 14 consecutive days. On the 15th day you must develop a transfer plan if the resident is not improving.⁠¹

Dementia care and the disclosure law

Regulation 60-84 defines an Alzheimer’s special care unit or program as one that is secured to limit residents’ access outside the area and that advertises or promotes specialized dementia care.⁠¹ The license application asks whether you provide one and how many beds it has.⁠³ Under the Alzheimer’s Special Care Disclosure Act (S.C. Code section 44-36-520), a CRCF offering such a unit must disclose to families what sets its care apart. The disclosure covers admission, transfer and discharge criteria, care planning, staffing patterns, staff training, physical environment, activities, the family’s role, and any extra costs.⁠¹⁰ Remember that locking the unit’s exit doors needs DPH’s written approval.⁠¹

Getting paid through Optional State Supplementation

In South Carolina, public money for low-income CRCF residents flows through Optional State Supplementation (OSS), run by the Department of Health and Human Services (SCDHHS). In its January 8, 2026 bulletin to CRCF providers (MB# 26-001), SCDHHS set the maximum payment to a facility at $1,719 and the net income limit at $1,804, effective January 1, 2026.⁠¹² Facilities must make sure OSS residents keep a personal needs allowance of $85 a month if their only income is SSI, or $105 if they have other income.⁠¹² The earlier September 8, 2023 bulletin (MB# 23-042) states that OSS payments made to CRCFs “are considered payment in full” and that rounding differences cannot be billed to the resident or deducted from the personal needs allowance.⁠¹¹ Ask SCDHHS ([email protected]) which OSS manual and rates apply to your facility before you set private-pay rates.

Renewal, changes and enforcement

The license fee is annual, and the license runs for the period DPH sets. Renewal requires an application and fee, and you may not be under DPH enforcement action. A renewal delayed by enforcement is issued only once the matter is resolved.⁠¹ The form warns that the current licensee must renew before expiration even if an ownership change or capacity change is pending.⁠³

You must get an amended license before a change of ownership, a change in bed count, or a move to a new site; a license “is not assignable or transferable.”⁠¹ Adding beds or occupying renovated space also needs DPH authorization first. Changing the occupant load or capacity sends you back through plan review.⁠¹

DPH can inspect at any time without notice, and inspection reports are public on written request.⁠¹ Violations are Class I, II or III. For a first offense within 36 months, the published penalty ranges are $500 to $1,500 for Class I, $300 to $800 for Class II, and $100 to $300 for Class III. Repeat violations carry higher ranges.⁠¹

Rule history to watch

DPH’s posted copy of Regulation 60-84 lists its most recent State Register amendment as May 23, 2025 (Document 5352).⁠¹ DPH updated its CRCF page on March 30, 2026. The page links the July 2025 application form, a short-form TB risk assessment, and an online administrator change form.⁠² On the administrator side, the LLR board’s regulations effective May 22, 2026 rename the training program to Administrator in Residency, add requirements for dual nursing home and CRCF administrators, and update continuing education for biennial licensing.⁠⁹

DPH’s posted copy of Regulation 60-84 is unofficial; the version published in the South Carolina State Register controls.⁠¹

Sources

1. 1
   South Carolina Department of Public Health, Regulation 60-84, Standards for Licensing Community Residential Care Facilities Checked 12 Oct 2026 · Back to text ↑
2. 2
   South Carolina Department of Public Health, Community Residential Care Facilities Checked 12 Oct 2026 · Back to text ↑
3. 3
   South Carolina Department of Public Health, Licensure Application for Community Residential Care Facility (Form 0217-ENG-DPH, 07/2025) Checked 12 Oct 2026 · Back to text ↑
4. 4
   South Carolina Legislature, S.C. Code Title 44, Chapter 7 (State Certification of Need and Health Facility Licensure Act; criminal record checks) Checked 12 Oct 2026 · Back to text ↑
5. 5
   South Carolina Legislature, S.C. Code Title 40, Chapter 35 (Long Term Health Care Administrators) Checked 12 Oct 2026 · Back to text ↑
6. 6
   South Carolina Department of Labor, Licensing and Regulation, Community Residential Care Facility Administrator (CRCFA) Checked 12 Oct 2026 · Back to text ↑
7. 7
   South Carolina Department of Labor, Licensing and Regulation, CRCFA Administrator-in-Residency (AIR) Program Requirements and Application Overview (Rev. 8/2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   South Carolina Department of Labor, Licensing and Regulation, Examination Information, Board of Long Term Health Care Administrators Checked 12 Oct 2026 · Back to text ↑
9. 9
   South Carolina Department of Labor, Licensing and Regulation, Board of Long Term Health Care Administrators: Final Regulations effective May 22, 2026 Checked 12 Oct 2026 · Back to text ↑
10. 10
    South Carolina Legislature, S.C. Code Title 44, Chapter 36, Article 5 (Alzheimer's Special Care Disclosure Act) Checked 12 Oct 2026 · Back to text ↑
11. 11
    South Carolina Department of Health and Human Services, Medicaid Bulletin MB# 23-042, Optional State Supplementation (OSS) Rate Increases (Sept. 8, 2023) Checked 12 Oct 2026 · Back to text ↑
12. 12
    South Carolina Department of Health and Human Services, Medicaid Bulletin MB# 26-001, SSI COLA Increases and Rebudgeting of Cases (Jan. 8, 2026) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF