South Carolina day care facility for adults license: R.60-75 rules, fees and Medicaid

Who needs this license in South Carolina

South Carolina’s health facility licensing statute lists “day care facilities for adults” among the facilities that may not be established, operated or maintained without a license if they provide care for two or more unrelated persons ⁠². That threshold is lower than in most states. Regulation 60-75 itself sets no headcount; it applies the statute’s definition ⁠¹.

The statute defines a daycare facility for adults as a facility for people 18 or older that ⁠²:

• offers, in a group setting, a program of individual and group activities and therapies;
• provides community-based care for people who need a supportive setting for less than 24 hours a day, to prevent unnecessary institutionalization; and
• operates a minimum of 4 and a maximum of 14 hours a day.

The regulation adds that services are delivered through an Individual Plan of Care with measurable goals or behaviorally stated objectives, designed to help participants keep or regain functional independence ⁠¹. A drop-in senior center with no care plans and no supervision of impaired adults is a different thing; a program that supervises and cares for frail or cognitively impaired adults during the day is what this license covers. DPH can investigate, by inspection or otherwise, whether an operation needs a license ⁠².

The license also restricts marketing. No person or organization may “represent, advertise, or market itself” as a Day Care Facility for Adults without a license, and you may not enroll anyone before the license’s effective date ⁠¹. If DPH finds care being given at an unlicensed location, the owner must stop operating immediately ⁠¹.

The statute’s exemptions are narrow and do not describe ordinary adult day businesses: student infirmaries at private schools, community housing sponsored by the Office of Intellectual and Developmental Disabilities, and small Office of Mental Health homeshare programs ⁠².

Neighboring licenses you might confuse it with

• Overnight care. If participants sleep there, you need a residential license instead. See the community residential care facility guide.
• Care in the client’s home. Personal care in private homes is an in-home care provider license; skilled nursing visits need a separate home health agency license.
• Two facility types on one site. If you run an adult day program inside or beside another licensed facility, each type needs its own license even under one owner ⁠¹.

What South Carolina does not require

There is no certificate of need for adult day care. Since 2023, Section 44-7-160 requires a CON only for nursing homes and, until its repeal on January 1, 2027, for new hospitals and hospital bed changes ⁠². Adult day facilities are not on either list.

There is also no separate state “adult day health” license tier. DPH issues one license under R.60-75. The adult day health care rules that add nurses and longer hours come from the Medicaid program, not from licensing (see the Medicaid section below) ⁠⁶.

The building: plan this before you sign a lease

R.60-75 is written for a commercial-grade building, and most of its physical requirements are rated Class I or Class II violations ⁠¹. Check a candidate site against this list before committing.

Sources: ⁠¹.

New construction and renovations must follow the codes adopted by the South Carolina Building Codes Council and the State Fire Marshal ⁠¹. If a facility closes, loses or surrenders its license and later reapplies at the same site, DPH treats it as a new building and applies the codes in effect at that time ⁠¹.

Plan review and construction inspections

DPH reviews plans for new construction and for any project that affects how a space functions, accessibility, structure, fire safety systems (including kitchen hoods), doors, walls, ceilings, exit corridors, life safety systems, or that increases occupant load or licensed capacity ⁠¹. The rules ⁠¹:

• Plans must be prepared by an architect and/or engineer registered in South Carolina and submitted at the schematic, design development and final stages, unless DPH directs otherwise.
• Construction may not start before DPH approves the plans, and the owner must employ a registered architect or engineer to observe construction.
• You must get every local permit. DPH will not inspect a project built without proper permits.

Converting an existing building often counts as a project that changes function or occupant load, so ask DPH early whether your build-out needs plan review.

Owner and administrator qualifications

The applicant can be an individual, partnership, corporation, LLC or government unit. A business entity must be registered with the South Carolina Secretary of State if state law requires it ⁠¹. The application form also asks for officers’ names, every owner with 5% or more, and anyone who can claim liabilities of the licensee or facility ⁠⁴. A licensee’s past violations, at this facility or any other DPH-licensed facility, can put the license at risk ⁠¹. If you already hold a DPH license, that facility must be in substantial compliance before DPH licenses a new one ⁠¹.

You must employ a full-time administrator with either ⁠¹:

• a bachelor’s degree, or
• at least two years of college or technical school plus at least four more years of experience in nursing, social services, sociology, psychology, or a field closely related to health and social development for older adults.

Name a staff member in writing to act when the administrator is absent. If the administrator changes, tell DPH in writing within 72 hours, with the new administrator’s name, start date and proof of qualifications ⁠¹. The initial application must include a copy of the administrator’s qualifications ⁠⁴.

Staffing, screening and training

Sources: ⁠¹.

Criminal record checks. Adult day facilities are “direct care entities” under Section 44-7-2910, so every direct caregiver needs a check before hire. This includes anyone who works in the building or may have participant contact, not only aides and nurses ⁠². If the applicant can verify 12 months of South Carolina residency, a state check is enough; if not, run a state check before hire and start a federal check after hire ⁠². Checks go through the State Law Enforcement Division (SLED) or a private business using SLED or FBI records, and fingerprints are submitted with the application ⁠². For a state and federal check, DPH’s background check page has you email a signed Verification of Application and Authorization form to [email protected]. DPH then issues a service code, and fingerprints are taken at an approved vendor such as IdentoGO. SLED requires a valid relationship with the applicant when they are fingerprinted ⁠⁷. Staff and volunteers may not have a conviction or no-contest plea for unlawful conduct toward a child, or abuse, neglect or exploitation of a vulnerable adult ⁠¹. DPH checks your compliance before each renewal, and violations carry civil fines of $100, then $500 for each later violation, which must be paid before renewal ⁠².

Program and participant rules that shape your intake

These are operating rules, but they affect who you can enroll and what you must have ready on opening day ⁠¹:

• Enrollment limits. Adults only. No one who is bed-confined. If you cannot meet someone’s needs, or their condition or behavior makes continued attendance unsafe, they may not stay beyond 30 days.
• Physical exam. By a physician or other authorized provider within 60 days before enrollment, covering activity limits, diet and medications, then at least every two years.
• Care planning. A documented enrollment assessment, an Individual Plan of Care within 30 days of enrollment reviewed at least every six months, and progress notes at least quarterly.
• Written agreement. Signed by the participant or responsible party, explaining services and disclosing all fees.
• Rights. Post the Statement of Rights of Adult Day Care Participants, get a signed acknowledgment, and include DPH’s email address and phone number in your grievance procedure.
• Activities. A posted monthly activity schedule and a daily attendance census kept for 12 months.
• Medications. Locked storage. Prescription medication may be given only by a licensed nurse or an authorized healthcare provider, and the same person must prepare and give each dose.
• Meals. At least one meal for anyone attending 4 or more hours and two meals for 10 or more hours, plus snacks at no extra charge, with a week of menus posted. An on-site kitchen is permitted and inspected under Regulation 61-25 (Retail Food Establishments); catered food must come from a graded establishment under a written contract.

On the application, DPH asks whether food is catered (attach the contract) and asks for a Certified Food Protection Manager certificate on initial applications ⁠⁴.

Alzheimer’s special care programs

If you offer or advertise an Alzheimer’s special care unit or program, the Alzheimer’s Special Care Disclosure Act requires you to put in your policies, and disclose to families, what makes the care suited to people with Alzheimer’s: admission, transfer and discharge criteria, care planning, staffing patterns, staff training, physical environment, activities, the family’s role, and any extra costs ⁠⁵. R.60-75 repeats this in its required policies ⁠¹, and the application asks you to attach the special care unit policies and disclosure statement if you answer yes ⁠⁴.

Policies and plans DPH expects before approval

DPH must find the proposed facility in substantial compliance before it issues the first license ⁠¹, so the written program has to exist before the inspection. R.60-75 requires written policies and procedures on ⁠¹:

1. Staffing and training
2. Reporting incidents, closure and zero census
3. Participant records
4. Participant care and services
5. Participant rights
6. Medication management
7. Admissions and discharge
8. Fire prevention
9. Housekeeping
10. Infection control
11. Alzheimer’s special care, if offered

Policies must be reviewed at least every two years and signed by the administrator. You also need a disaster and evacuation plan, a plan to continue essential services during power or water outages or staff shortages, a fire and evacuation plan developed with your fire department, and a written water-disruption plan ⁠¹. If the site is outside a public fire department’s service area, you need a written agreement with the nearest fire department and must give DPH a copy ⁠¹.

The application, in order

1. Pick and vet the site

   Check the space, exit, canopy, alarm and call-system rules above, and confirm with DPH whether your build-out needs plan review ⁠¹.

2. Get plan approval and local permits, then build

   Submit SC-registered architect or engineer drawings at each stage, pay the plan and site inspection fees, and pull local permits ⁠¹.

3. Form and register the entity

   Register with the Secretary of State if required. Choose a name that is not the same as or similar to any other South Carolina licensed facility; chains must include their geographic area in the name ⁠¹.

4. Hire the administrator and core staff

   Run background checks, health assessments and TB screening, and finish orientation and training before anyone has participant contact ⁠¹⁠².

5. File Form 3287-ENG-DPH

   Include proof of ownership or a lease, administrator qualifications, the number of participants you want licensed, ownership disclosures, the food service contract or food protection manager certificate, and special care documents if they apply. The verification page is signed by the owner(s), two officers of a corporation or the head of an LLC, and must be notarized ⁠¹⁠⁴. Email is the preferred method: [email protected]. By mail: Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171. Phone: 803-545-4370 ⁠⁴. Proof of payment must accompany every application ⁠⁴.

6. Pass the initial inspection

   DPH inspects before initial licensing ⁠¹. If it cites deficiencies, you submit a written plan of correction by the date on the report, stating the fix, how you will prevent recurrence and completion dates ⁠¹.

7. Receive and post the license

   Post it in a public area. Enroll participants only from its effective date, and never above the capacity printed on it ⁠¹.

Neither R.60-75, Form 3287-ENG-DPH nor DPH’s adult day page states a processing time for initial applications, so ask the Bureau of Health Facilities Licensing at 803-545-4370 or [email protected] how long review and scheduling of the initial inspection are running before you sign a lease ⁠¹⁠³⁠⁴.

Fees

Sources: ⁠¹.

As a worked example from the published schedule, a new 40-participant facility pays a $120 license fee and a $625 initial inspection fee ($225 + 40 × $10) before any construction review fees ⁠¹. All fees are non-refundable and paid by check or credit card ⁠¹.

Renewal, changes and enforcement

Section 44-7-260 says licenses expire one year after issuance or annually on uniform dates, or as the regulation otherwise prescribes ⁠². R.60-75 only says a license is effective for a period set by DPH and stays in effect until DPH notifies the licensee of a change ⁠¹, and the renewal application asks for the license’s expiration date ⁠⁴. Check the expiration date printed on your license. To renew, file an application and the fee before expiration. You cannot have pending enforcement actions ⁠¹. If the fee and late fee are not paid within 30 days after expiration, the facility becomes unlicensed ⁠¹. The current licensee must renew on time even if an ownership change or capacity change is still pending ⁠⁴.

• Amended license before moving, changing the name or address, or changing licensed capacity ⁠¹.
• New license before any change in controlling interest or change of legal entity (for example, sole proprietor to LLC), because licenses cannot be transferred ⁠¹.
• Separate licenses for facilities on non-contiguous properties. Buildings on the same or adjoining grounds offering one level of care can share a license ⁠¹.
• Closures. Notify DPH in writing at least 15 days before a temporary closure, or within 48 hours if it is an emergency. Report zero census lasting 90 days or more no later than day 100. Closures or zero census lasting over a year mean reapplying as a new facility ⁠¹.
• Incidents. Report crimes, abuse, neglect or exploitation, elopement, medication errors, fractures, injuries needing medical care, suicide attempts and fires to DPH within 24 hours, with a written investigation report within 5 calendar days ⁠¹.

DPH can inspect at any time without notice. When everyone is out, you must post a notice at the entrance saying when people will return, with a contact phone number that is not the facility’s ⁠¹. Violations are Class I, II or III. Under the regulation’s schedule, a first Class I violation carries a penalty of $500 to $1,500, and repeat violations of any class can reach $5,000 ⁠¹. DPH may also deny, suspend or revoke the license ⁠¹.

How South Carolina adult day programs get paid by Medicaid

Medicaid funding comes through the South Carolina Department of Health and Human Services (SCDHHS) home and community-based services program as Adult Day Health Care (ADHC). An ADHC provider must hold a current DPH adult day care license ⁠⁶. SCDHHS then adds requirements the license does not:

• Hours and billing unit. The center must be open at least 8 hours a day, Monday through Friday, within 7:00 a.m. to 6:00 p.m. A billable day is at least 5 hours in the center, not counting transportation ⁠⁶.
• Nursing. On top of the DPH 1:8 ratio, an RN must be present for set minimum hours based on the number of waiver participants: 2 hours for 1 to 10 participants, rising to 6 hours for 36 to 44. From 45 participants, additional RNs, LPNs or a case manager are required ⁠⁶. If the RN position becomes vacant, SCDHHS must be notified by the next business day ⁠⁶.
• Siting. Under the federal HCBS settings rule, the center cannot be on the grounds of or next to a public institution, on a parcel with more than one state-licensed facility, or in a building that provides inpatient institutional care ⁠⁶.
• Included services. The daily rate covers items such as daily nursing oversight and one meal plus a snack, with the meal meeting one-third of the daily recommended dietary allowances. Staff must also be checked against the CNA registry before hire and every two years ⁠⁶.
• Transportation. Transportation is reimbursed through the Medicaid non-emergency transportation broker system ⁠⁶.

If Medicaid participants are part of your plan, check the siting rule before you choose a building. A site next to a nursing home or on a campus with another licensed facility may pass DPH licensing but not qualify for waiver payment ⁠⁶.

Recent changes to watch

• The regulation was last revised in the State Register on May 23, 2025 (Document 5352), after a 2022 update ⁠¹. DPH’s adult day page was updated November 10, 2025 ⁠³, and the application form is the July 2025 version ⁠⁴.
• Agency name. The regulation and DPH’s page name the South Carolina Department of Public Health as the licensing agency ⁠¹⁠³. The statute text still says “Department of Health and Environmental Control” ⁠², and the SCDHHS ADHC policy still cites the rule by its former number, “Regulation 61-75” ⁠⁶. All of these refer to the same license.
• CON repeal. The hospital CON requirement in Section 44-7-160(B) ends on January 1, 2027 ⁠². Adult day care was already outside CON.

Sources

1. 1
   South Carolina Department of Public Health, Regulation 60-75, Standards for Licensing Day Care Facilities for Adults Checked 12 Oct 2026 · Back to text ↑
2. 2
   South Carolina Legislature, South Carolina Code of Laws, Title 44, Chapter 7 (Sections 44-7-130, 44-7-160, 44-7-260, 44-7-2910 to 44-7-2950) Checked 12 Oct 2026 · Back to text ↑
3. 3
   South Carolina Department of Public Health, Day Care Facilities for Adults Checked 12 Oct 2026 · Back to text ↑
4. 4
   South Carolina Department of Public Health, Licensure Application for Day Care Facilities for Adults, Form 3287-ENG-DPH (07/2025) Checked 12 Oct 2026 · Back to text ↑
5. 5
   South Carolina Legislature, South Carolina Code of Laws, Title 44, Chapter 36 (Alzheimer's Special Care Disclosure Act, Sections 44-36-510 and 44-36-520) Checked 12 Oct 2026 · Back to text ↑
6. 6
   South Carolina Department of Health and Human Services, HCBS Provider Policy, Scope of Services: Adult Day Health Care (July 1, 2024) Checked 12 Oct 2026 · Back to text ↑
7. 7
   South Carolina Department of Public Health, Background Checks for Direct Caregivers Checked 12 Oct 2026 · Back to text ↑

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