Utah assisted living facility license: Type I, Type II and the size classes

Who needs a Utah assisted living license

Utah’s threshold is low. Under R432-270-4, anyone who “offers or provides care to two or more unrelated individuals in a residential facility” must be licensed as an assisted living facility if the residents stay more than 24 hours and you provide or arrange help with one or more activities of daily living (ADLs) ⁠¹. The rule lists medication administration, bathing and dressing among the ADLs, so helping a second unrelated adult with their pills already puts you in licensed territory ⁠¹.

The statute defines a resident as a person 21 or older who needs assisted living services because of physical or mental limitations or age, and who “does not require intensive medical or nursing services as provided in a hospital or nursing care facility” ⁠⁵.

Utah has no separate adult foster home or adult family home license for older adults. A house serving two to five residents is licensed under the same rule as a 100-bed building, as a “limited capacity” assisted living facility ⁠¹. Two related licenses are often confused with this one:

• Adult day care. A licensed ALF can run a day program without a second license (see below). A stand-alone day program is licensed separately as adult day care.
• In-home services. Care delivered in a client’s own home is licensed as a personal care agency or a home health agency, not an ALF.

Two decisions that set every other rule: type and size

Type I or Type II

The type depends on how residents leave the building in an emergency. You must license as Type I “if each resident can exit the facility without the assistance of another person,” and as Type II if each resident “can exit the facility only with the limited assistance of one person” ⁠¹. The statute describes Type I as assistance with ADLs and social care for people who “require protected living arrangements.” It describes Type II as “a home-like setting” offering coordinated personal and health care services “available 24 hours per day” ⁠⁵.

Sources: R432-270-6, -10, -14 and -15 ⁠¹.

Neither type may provide skilled nursing care. The rule calls nursing “skilled” when it can be performed safely only by, or under close supervision of, a licensed professional, or when it is needed to prevent deterioration or keep a resident’s current abilities ⁠¹.

Size class

R432-270-4(8) puts every facility in one of three classes: large (17 or more residents), small (6 to 16) and limited capacity (2 to 5) ⁠¹. The class matters mostly for construction and for the administrator’s qualifications.

The building: occupancy class, sprinklers and plan review

Building code occupancy by type and size

R432-6 assigns an International Building Code occupancy to each combination ⁠²:

The bottom-right cell catches many people converting a house. A limited capacity facility that houses Type II residents “shall either have an approved sprinkler system, or provide a staff to resident ratio of one to one on a 24-hour basis,” and residents “shall be housed on floors at grade level” ⁠².

Changing license class later, for example from Type I to Type II, counts as new construction. So does remodeling more than 50 percent of a building, wing or floor ⁠².

Local approvals the state requires you to collect

The Office of Licensing does not enforce local codes itself. It requires you to get documentation of compliance from the local authority and submit it. That means local zoning, the International Building, Plumbing, Fire and Mechanical Codes, and the National Electrical Code (NFPA 70) ⁠². You also need a certificate of occupancy from the local building official and a certificate of fire clearance from the fire marshal having jurisdiction. Copies go to the department before residents move into new construction, additions or remodels ⁠². Where the rules and a local code conflict, “the most restrictive requirement applies” ⁠².

Plan review

The department must approve new buildings and remodeled areas before they are occupied ⁠². The sequence in R432-6-7 through -10:

1. Conference first

   “Prior to submitting documents for plans review, the facility architect and licensee must schedule a conference with Department representatives” ⁠².

2. Submit four items

   A functional program, schematic drawings, design development drawings, and working drawings with specifications. Working drawings must carry the seal of a Utah licensed architect ⁠². The functional program describes the license category, services, contracted services, and the physical, mental and ambulatory condition of the residents you intend to serve ⁠².

3. Review clock

   Review starts only when all documents and fees are in. Within 30 days the department sends a written report of required changes ⁠².

4. Keep moving

   Plan approval expires 12 months after the approval letter if construction has not started. After that you resubmit and pay a new plan review fee ⁠².

5. Final inspection

   When the project is finished and furnished, you schedule a final inspection before residents move in ⁠².

For an existing building with no plans, you submit a functional program and a report of the changes needed to meet construction rules. The department answers within 30 days. You pay the inspection fee before the final inspection ⁠². Building without approval does not stop licensure, but you pay the full plan review and inspection fees and correct every deficiency against as-built drawings ⁠².

Space minimums

Room areas exclude toilets, closets, wardrobes, alcoves and vestibules ⁠². A Type II facility must have a resident call signal system; limited capacity homes may use one that sounds an alarm to summon staff. In Type I, a signal system is required for large facilities, for bedrooms on more than one floor, and when staff are not always on the same level as residents ⁠².

Administrator qualifications

Every administrator must be at least 21, pass the R432-35 background screening and “know applicable laws and rules” ⁠¹. The education or experience bar depends on type and size:

• Type I, any size: an associate degree or two years of experience in a health care facility ⁠¹.
• Type II small or limited capacity: an associate degree in a health care field, one year as a licensed health care professional, or two or more years of health care management experience ⁠¹.
• Type II large: an associate degree plus four years of health care management experience; a health care bachelor’s degree with management training or one year of management experience; any bachelor’s degree with management training or a year of management, plus a year in health care; or a Utah health facility administrator license ⁠¹.

A Type II administrator must also complete an Office of Licensing-approved national certification program within six months of hire ⁠¹. Each year, every administrator needs four hours of core competency training that includes dementia and Alzheimer’s content. On top of that, they need six hours of continuing professional education, at least five of them in person, counting 50 minutes as an hour. Courses must be approved by the Utah Assisted Living Association, the Utah Health Care Association or Beehive Homes ⁠¹. The administrator must designate in writing an acting administrator, also 21 or older, for times they cannot be reached ⁠¹.

A corporate licensee must keep a functioning governing body. Every licensee must run a quality assurance committee that includes at least the administrator and a health care professional and meets at least quarterly ⁠¹.

Staffing, nurses and training

R432-270 sets no fixed staff-to-resident ratio for the residential side. Instead, qualified direct-care staff must be “on-site 24 hours a day” in numbers that meet each resident’s assessed needs ⁠¹. Fixed points:

• Age. Staff giving personal care must be at least 18, or a certified nurse aide ⁠¹.
• Nursing. A Type I facility must hire or contract a registered nurse to provide or delegate medication administration for residents who cannot self-medicate. A Type II facility must have an RN providing or supervising nursing services, including general health monitoring of each resident. A Type II facility must also have at least one CNA on duty 24 hours a day ⁠¹.
• First aid. At least one person on every shift must have CPR, basic first aid, emergency procedures and Heimlich training ⁠¹.
• Kitchen. Anyone preparing or serving food needs a food handler’s permit. Menus must be approved and signed by a certified dietitian ⁠¹.

Training has three layers. Within 30 days of hire, each employee gets an orientation that includes OL-approved core competency training, resident rights, abuse reporting, and the fire and disaster plan ⁠¹. Each direct-care employee also gets a skills demonstration and 16 hours of one-on-one training with a direct-care worker who has at least three months of experience. That training cannot be carried over from another facility ⁠¹. Certified nurse aides are exempt from the 16 hours, and any direct-care worker supplied by a staffing agency must be a CNA ⁠¹. Ongoing in-service training must cover twelve listed subjects, including dementia, medication assistance and safe bath temperatures ⁠¹.

Employees must be tested for tuberculosis within two weeks of hire, by the Mantoux method or an FDA-approved blood test ⁠¹.

Background screening

Background checks run through the Direct Access Clearance System (DACS). The owner or applicant must be cleared before the Office of Licensing issues a provisional license ⁠⁴. Each covered employee must be entered into DACS before they start and must submit fingerprints within 15 working days ⁠⁴. In a residential setting, that includes every non-resident household member aged 12 or older ⁠⁴. Listed felonies and class A misdemeanors within the past 10 years bar direct patient access ⁠⁴.

Who you can admit and keep

Before admission you must interview the person and their responsible party. A licensed health care professional must complete a signed assessment on an OL-approved form and state that the person meets the facility’s admission criteria. The assessment is repeated at least every six months ⁠¹. A service plan is due within seven calendar days of admission ⁠¹.

• Type I may accept people who have stable health, can take life-saving action in an emergency on their own, and need total help with no more than three ADLs ⁠¹.
• Type II may accept people who need total help with more than three ADLs, as long as they can evacuate with the limited help of one person and staffing meets their needs ⁠¹.
• Neither may admit or keep someone with active tuberculosis, someone whose behavior is assaultive, suicidal or a danger to others, or someone who needs 24-hour nursing care that will last more than 15 calendar days ⁠¹.

Hospice residents are allowed under conditions. A Type I facility may keep hospice residents who cannot exit on their own only if a trained worker is assigned to each of them around the clock, and they may not exceed 25% of the census ⁠¹. You may not refuse admission only because the person wants a monitoring device in their room ⁠¹.

The signed admission agreement must cover charges, refund procedures, any mandatory shared-room policy and 30 days’ notice before any change in charges ⁠¹. Discharge notices must be served by hand or certified mail at least 30 days ahead, except in listed urgent situations. They must include the long-term care ombudsman’s contact details and the resident’s right to request a conference within five calendar days ⁠¹.

Applying, in order

Licensing procedure is set by R380-600, which applies to all DHHS licenses ⁠³. Health facility licensing sits within the Division of Licensing and Background Checks ⁠⁶. The division publishes its health facility rules and descriptions on its website ⁠⁶. The sources checked here do not name the application form or online portal for an assisted living license, so ask the Office of Licensing for the current application packet and how to submit it, and which policies it wants with the first filing.

1. Pick type and size

   Your type and size class decide the IBC occupancy, administrator qualifications and nursing model. Changing them later can mean meeting new-construction standards ⁠¹⁠².

2. Clear zoning and start plan review

   Hold the plan review conference, then submit the functional program and drawings, or the existing-building report ⁠².

3. Build or remodel, then collect local sign-offs

   You need the certificate of occupancy, fire clearance, and documentation of compliance with zoning and the building, plumbing, fire, mechanical and electrical codes ⁠².

4. File the application

   It includes the OL application, fees for each license category, background checks for covered individuals, required policies and procedures, every owner and decision-maker, fire and business license documentation, and the architectural plans and functional program ⁠³. The application fee must be paid before OL does any site visit or document review ⁠³.

5. Write the policies the rules require

   These include admission, retention and transfer; nursing services; infection control; personnel health; medication disposal; and an emergency and disaster plan covering the 58°F cold-temperature trigger, semi-annual disaster drills and quarterly fire drills on every shift ⁠¹.

6. Final inspection and license

   The department issues a license only once the facility meets construction rules and has every required clearance ⁠².

Until the license is approved you may not “accept any fee,” enter into any service agreement or provide any service ⁠³. An application not completed within six months must be filed again with fees under R380-600-3(10). R380-600-5(2) separately requires a new fee after 12 months ⁠³. A denied applicant must wait at least three months to reapply ⁠³.

Fees

R380-600 sets how fees are charged: an initial application fee for each license category at each site, a capacity fee based on approved beds, renewal fees, and extra fees for follow-up inspections when the same rule is cited again ⁠³. Plan review and construction inspection fees are separate ⁠².

The dollar amounts are set in the division’s annual health facility fee schedule, which could not be opened for this review, so no figures are quoted here. Ask the Office of Licensing for the schedule in effect for your application date, covering the application fee, the per-bed capacity fee, any new-provider charge, and plan review and construction inspection fees.

Add-on services without a second license

• Respite. An ALF may offer respite care with no additional license. Each stay is limited to 14 days; a longer stay counts as a regular admission. OL must approve your respite policies first ⁠¹.
• Adult day care. An ALF may run adult day services without a separate license after OL approves its policies. The program needs a designated director and 50 square feet of indoor space per participant, not counting halls, offices, kitchens or bathrooms. Staffing is one staff per eight participants, or one per six when half or more have a dementia diagnosis ⁠¹.
• Secure units. Only a Type II facility with approved secure units may admit residents with Alzheimer’s or dementia into a locked setting. Requirements include a signed consent to controlled egress and a wander-risk agreement. At least 4 of each worker’s 16 one-on-one training hours must be in the unit, and one direct-care worker must be there at all times. No more than 30 residents may live in one smoke compartment with controlled egress ⁠¹.

Medicaid: the New Choices Waiver

Utah Medicaid’s New Choices Waiver serves people “residing long term in a nursing facility, licensed assisted living facility, licensed small health care (Type N) facility” or another licensed medical institution. Participants must meet nursing facility level of care, and each setting has a minimum length-of-stay requirement ⁠⁷. Licensed ALFs are among the settings where waiver participants can live and receive services ⁠⁷. To enroll, a provider completes an Attachment B for each residential level of care it is licensed to provide (for example, one for ALF Type I and II and a separate one for a secure memory care unit) and uploads the signature page to PRISM. Waiver providers also complete a Settings Rule self-attestation, quiz and survey ⁠⁷. The page says each setting has a minimum length-of-stay requirement but does not state it; ask the New Choices Waiver Program at (800) 662-9651, option 6 ⁠⁷.

Renewal, inspections and changes

A license runs one year and expires at midnight on the last day of the month it was issued. Renewal requests and fees are due at least 30 days before expiration ⁠³. After two consecutive license periods in good standing, a health care provider may apply for a two-year license by paying twice the annual fee ⁠³. Licenses cannot be transferred ⁠³.

Changes in capacity or administrator need a program change application 30 days in advance. A new location, a new population or a transfer of 50% or more of ownership needs a full new application 30 days in advance ⁠³. Inspections may be announced or unannounced. Citations are posted on the division website for at least 36 months ⁠³. Critical incidents must be reported to OL within one business day ⁠³.

Rule versions: R432-270 was last changed November 13, 2025; R432-6 on August 20, 2018; R380-600 on May 8, 2025; R432-35 on January 20, 2026 ⁠¹⁠²⁠³⁠⁴.

Sources

1. 1
   Utah Office of Administrative Rules, Utah Admin. Code R432-270, Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Utah Office of Administrative Rules, Utah Admin. Code R432-6, Assisted Living Facility General Construction Checked 12 Oct 2026 · Back to text ↑
3. 3
   Utah Office of Administrative Rules, Utah Admin. Code R380-600, General Licensing Provisions Checked 12 Oct 2026 · Back to text ↑
4. 4
   Utah Office of Administrative Rules, Utah Admin. Code R432-35, Background Screening Checked 12 Oct 2026 · Back to text ↑
5. 5
   Utah State Legislature, Utah Code 26B-2-201, Health care facility definitions Checked 12 Oct 2026 · Back to text ↑
6. 6
   Utah DHHS, Division of Licensing and Background Checks, Health Facilities: Rules and Descriptions Checked 12 Oct 2026 · Back to text ↑
7. 7
   Utah Medicaid, New Choices Waiver Checked 12 Oct 2026 · Back to text ↑

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