Virginia adult day center license: VDSS rules, the 1:6 ratio and a fee that starts at $14

Who needs a VDSS license, and who is outside it

Virginia defines an adult day center as a facility that “is either operated for profit or that desires licensure” and that gives supplementary care and protection during only part of the day to four or more adults who are aged, infirm or have disabilities and who live somewhere else ⁠¹. Section 63.2-1701 of the Code of Virginia then requires every person who operates an adult day center to hold a license from the Commissioner of Social Services ⁠².

Read the definition closely, because it decides whether you are regulated at all:

• Profit status matters. A for-profit center serving four or more qualifying adults must be licensed. The definition reaches other centers only if they want a license ⁠¹. VDSS repeats the same wording on its program page ⁠⁹. The Code’s definition of “person” who must hold a license includes local governments and any other legal entity that operates an adult day center ⁠². None of the VDSS pages or rules checked says how a nonprofit or local-government center that does not request a license is treated, so if you are organizing as a nonprofit, ask the regional licensing office for its position in writing before you open without one.
• Multiple sites are added together. Two or more locations owned, operated or controlled by one entity count as one center when their combined total reaches four or more adults ⁠¹. You cannot avoid the threshold by splitting three participants into each of two buildings.
• PACE-only centers are exempt. No license is needed for a center that serves only people enrolled in a Program of All-Inclusive Care for the Elderly run under an agreement among the provider, the Department of Medical Assistance Services (DMAS) and CMS ⁠².
• Other licensing agencies and relatives. The definition excludes facilities or parts of facilities licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services, and the home of someone who cares only for relatives by blood or marriage ⁠¹.
• Residential care is a different license. The adult day center rules cover part-day care for adults who live elsewhere ⁠¹. VDSS describes assisted living facilities as congregate residential settings giving 24-hour supervision to four or more adults, and those fall under the assisted living facility license instead ⁠⁹.

Participants must be 18 or older ⁠¹. Section 63.2-1705 also requires every building to be licensed for either ambulatory or nonambulatory participants. Ambulatory means someone who can evacuate without another person’s help, even with a wheelchair, walker or a single verbal command ⁠⁴. The Program Addendum asks whether you will serve nonambulatory participants, participants who need medication given at the center, and participants who wander ⁠¹¹. Those three answers shape your building classification, staffing and policies, so settle them before you sign a lease.

The building comes first: occupancy, plan review and inspections

Under 22VAC40-80-150, a valid certificate of occupancy is a prerequisite for licensure. It must classify the building for its licensed purpose under the Virginia Uniform Statewide Building Code use group ⁠⁷⁠⁴. If the building has never been used as an adult day center, or you are renovating, VDSS must also approve its “functional design features” ⁠⁷:

1. Submit floor plans before construction

   Send VDSS floor plans that show how each space will be used, before construction or renovation begins ⁠⁷.

2. Completeness check

   VDSS tells you within 10 working days if the plans are incomplete ⁠⁷.

3. Preliminary Approval Statement

   Within 20 days of a complete plan, VDSS issues a Preliminary Approval Statement or a letter explaining its disapproval. A copy goes to the local building official ⁠⁷.

4. On-site check after the work

   Once construction is finished, licensing staff inspect for compliance and send the findings to you and the building official ⁠⁷.

The regulation warns that architects, contractors and building officials “may not be thoroughly familiar with these functional design requirements” and urges applicants to bring plans to VDSS before signing contracts ⁠⁷. A Preliminary Approval Statement does not promise a license, and it depends on approval from fire, health and building officials ⁠⁷.

You need three outside sign-offs at the time of application, and the fire and health reports again at least annually ⁠⁷⁠¹:

• A Certificate of Use and Occupancy from the local building official ⁠⁷.
• A fire inspection report under the Virginia Statewide Fire Prevention Code (13VAC5-51). The center rules require at least an annual inspection by the fire official and two years of retained reports ⁠⁷⁠¹.
• A health inspection report covering general sanitation and, where applicable, water supply, sewage and food service ⁠⁷. If you use a caterer or contract food service, the local health department must approve it ⁠¹.

The 2026 General Assembly passed SB 677/HB 840, effective July 1, 2026. It exempts adult day centers that care for 12 or fewer adults in a home from restaurant requirements. VDSS says the law writes existing practice into statute, and questions about eligibility go to the local health department ⁠¹³.

Space and physical plant

Stairways and ramps need nonslip surfaces, sturdy handrails and contrast or warning strips at changes in level. Open-flame lighting is prohibited, and working flashlights or battery lanterns must be on hand ⁠¹. The floor plan you submit must show large-group, small-group and individual activity areas, privacy space, dining, restrooms, any bathing facilities and the rest area ⁠¹¹.

The director and the licensee

The license goes to one business entity, and a license cannot be issued in the name of more than one ⁠¹. The licensee must be of good character and reputation and must appoint a qualified director in writing. It must also keep a statement of purpose and scope, including whom the center will and will not serve, a staffing plan with a schedule, an organizational chart and volunteer policies ⁠¹. Every policy, plan and procedure the chapter requires must be written down and carried out ⁠¹.

Under 22VAC40-61-130, the director or a qualified assistant director runs the program and must be present at least 51% of the center’s weekly hours ⁠¹. The director must ⁠¹:

• be at least 21 years old;
• hold a bachelor’s degree from an accredited college or university and have two years of experience working with older adults or people with disabilities (part-time, volunteer work and internships count as equivalents), or
• hold a current nursing home administrator or assisted living facility administrator license from the Board of Long-Term Care Administrators, or
• hold a current Virginia RN license plus the same two years of experience;
• complete 24 hours of continuing education every year. At least 2 hours must cover infection control, and at least 4 must cover mental impairment when the center serves participants with mental impairments.

A narrow grandfather clause covers people continuously employed as director or assistant director in a center licensed before July 1, 2000 ⁠¹. If you plan to direct the center yourself, you must meet these qualifications, and the written appointment must say so ⁠¹.

Staffing, training and background checks

Ratio and coverage. You need at least one staff person giving direct care and supervision for every six participants “or portion thereof,” at the center and on field trips. The ratio is counted across the whole center, not room by room ⁠¹. At least two staff must be on duty whenever even one participant is present, and one non-volunteer staff member must be in charge during all operating hours ⁠¹. Seven participants therefore need two direct-care staff. A volunteer counts toward the ratio only if they meet staff qualifications and each counted volunteer is matched by a counted staff member ⁠¹.

Direct-care qualifications. Ratio staff must be 18 or older unless they are Virginia-certified nurse aides. Within two months of hire, each direct-care worker must meet one of these ⁠¹:

• Virginia Board of Nursing nurse aide certification, or completion of a Board-approved nurse aide program;
• completion of the DMAS personal care aide training used for waiver adult day health care;
• a geriatric assistant, home health aide or nurse aide program from a hospital, nursing facility or school that VDSS approves on request;
• the department-approved 40-hour Assisted Living Facility Direct Care Staff Training curriculum;
• at least 40 hours of training taught by a licensed health care professional (or nationally accredited online) covering set topics such as aging, dementia, ADLs, transfers and safety.

Licensed health care professionals working within their scope are exempt from this training requirement ⁠¹.

Training clock. All staff must complete orientation on participant rights, fire and emergency duties, abuse reporting as mandated reporters, and confidentiality before working with participants. A second block of training must be finished within three weeks of hire (six weeks for part-time staff), with supervised work until it is complete ⁠¹. Direct-care staff then need 12 hours of training every year, including 2 hours on infection control and 4 on mental impairment where relevant ⁠¹.

First aid and CPR. Each direct-care worker needs adult first aid certification issued within the past three years, or must get it within 60 days of hire. Nurses are exempt ⁠¹. At least one first-aid-certified person must be on the premises at all times unless an RN or LPN is on duty. Two direct-care staff with current adult CPR certification must be on the premises at all times, and a first aid and CPR holder must go on every off-site activity ⁠¹.

Tuberculosis. Every staff member, and every volunteer counted in the ratio, needs a TB evaluation between 30 days before and seven days after starting, then an annual screening using the Virginia Department of Health risk assessment ⁠¹.

Background checks. Under § 63.2-1720, you may not hire or keep anyone convicted of an offense in clause (i) of the barrier-crime definition in § 19.2-392.02. The one exception is a single misdemeanor barrier crime not involving abuse or neglect, after five years have passed ⁠⁶. Each applicant gives a sworn statement or affirmation, and you must obtain an original criminal record clearance or Central Criminal Records Exchange history within 30 days of employment ⁠⁶. Volunteers may serve only with the permission or under the supervision of a cleared person ⁠⁶. The implementing regulation, 22VAC40-90, was amended effective August 15, 2025. VDSS says the amendments added no new requirements. They do bar employees from working directly with participants until their record is received, unless a cleared employee directly supervises them ⁠¹⁵.

Medication. If staff give medications, each person must be licensed to do so, be a registered medication aide, or complete a Board of Nursing-approved program accepted for adult day centers. The 68-hour medication aide program also qualifies. Unlicensed staff need 4 hours of medication refresher training every year ⁠¹.

Participants, program and records

Before or on the day of admission, the director, a director-qualified staff member or an employed licensed health care professional must complete a written assessment. It covers medical and functional condition, mental status, social environment, communication, interests and preferences, and must be reviewed at least every six months ⁠¹. A preliminary plan of care is due by admission, a review within 30 days, and further reviews at least every six months and at each significant change ⁠¹. Each participant needs a physical exam by a licensed physician within the 30 days before admission ⁠¹.

Meals and snacks must be provided by the center through its own kitchen, a caterer or a contract food service. Each participant gets at least 45 minutes per meal, with at least two hours between scheduled meals and snacks. Weekly menus are posted and kept for two years ⁠¹. If you transport participants, vehicles must have a ramp or lift whenever someone stays in a wheelchair during the ride ⁠¹.

Major incidents must be reported to the regional licensing office within 24 hours, followed by a signed written report within seven days ⁠¹. The emergency preparedness plan must document initial and annual contact with your local emergency coordinator. The fire and emergency evacuation plan must be approved by the fire official, and evacuation drills must be unannounced ⁠¹. You must carry public liability insurance for bodily injury of at least $1 million per occurrence or $1 million aggregate ⁠¹.

The application, in order

1. Watch the VDSS videos

   VDSS asks prospective applicants to watch “Introduction to Licensing” and then “Introduction to Adult Day Centers” before applying ⁠⁹. Licensing staff are available for consultation throughout the process ⁠⁷.

2. Lock down the building

   Get VDSS functional design review if needed, the certificate of occupancy, the building evaluation signed by the building official, the fire inspection and the Department of Health sanitation inspection ⁠⁷⁠¹¹.

3. Form the entity

   Partnerships, corporations, LLCs and business trusts attach their State Corporation Commission filings ⁠¹⁰.

4. Assemble Part I

   Include three character reference letters dated within 12 months from unrelated people who have known you at least a month, an annual operating budget, and one credit reference ⁠¹⁰. Submitting a budget and a credit reference keeps VDSS from inspecting your financial records ⁠³⁠⁷.

5. Assemble the Program Addendum

   Attach the program description, any forms that differ from VDSS model forms, and the floor plan. Add all policies and procedures, the management organization chart, any management company name, the Staff Information Sheet, a two-week menu, a monthly activity schedule, and proof of the $1 million liability policy. If you transport participants, add vehicle insurance or the contractor’s name ⁠¹¹.

6. Submit in VELA

   Since October 20, 2022, VDSS has accepted initial applications, uploads and fees through the Virginia Enterprise Licensing Application (VELA). The portal is for initial applications only, not renewals ⁠¹². File at least 60 days before your planned opening ⁠⁷⁠¹⁰.

7. Answer the completeness review

   VDSS notifies you in writing within 15 days if the application is incomplete. If you do not cure it within 30 days, VDSS returns everything except the nonrefundable fee ⁠⁷.

8. Initial inspection and investigation

   A licensing representative inspects the site and investigates the applicant’s character, reputation and financial responsibility, and that of officers and agents for entities ⁠³⁠⁷. Findings are discussed with you, and you submit a plan to correct any noncompliance ⁠⁷. You can ask for a variance from a standard that creates a special hardship ⁠⁷.

9. Decision

   VDSS notifies you of its decision. A denial letter states the reasons and your appeal rights ⁠⁷.

A new center may first receive a conditional license of up to six months to demonstrate compliance. When it ends, the center must substantially meet the standards or be denied ⁠⁷.

Fees

The fee depends on licensed capacity and the length of the license. VDSS bills it annually for each year of the term, and it is not refundable ⁠⁸.

Scroll the table sideways to see every column.

The regulation’s own example: a center licensed for 55 participants on a 24-month license owes $210 for the term, billed $105 at the start of each year ⁠⁸. No fee is charged directly after a conditional license is issued ⁠⁸. The initial application lists the one-year amounts. It asks for payment to “Treasurer of Virginia” and adds a $50 charge for a returned check ⁠¹⁰. In March 2026 the State Board of Social Services opened a periodic review of the fee regulation, with public comment from March 9 to March 30, 2026. Its outcome was not published on VDSS pages checked October 12, 2026 ⁠¹⁴.

License terms, inspections and renewal

Licenses run up to three years, and each license states the maximum number of participants ⁠². VDSS sets the term by compliance history: three years when a center routinely exceeds minimum standards, two years when it consistently meets them, and one year when compliance is inconsistent ⁠⁷. The term also sets the minimum number of inspections ⁠⁵:

VDSS may also make other announced or unannounced visits ⁠⁵. A July 29, 2026 memo reminds licensees to give inspectors immediate access when an inspection starts, to keep staff present during operating hours, and to keep records organized and available ⁠¹⁷.

VDSS sends a renewal application before the license expires. A renewal counts as complete only when any civil penalty from a case decision is paid. If you file a complete renewal before expiration, your license stays in effect while VDSS decides ⁠⁷. Under SB 937, effective July 1, 2025, a center given a provisional license must complete corrective action acceptable to the Commissioner before it can appeal ⁠¹⁶.

Getting paid through Virginia Medicaid

Medicaid funds adult day health care (ADHC) as a covered service of the Commonwealth Coordinated Care Plus (CCC Plus) Waiver for people who meet long-term services and supports screening criteria ⁠¹⁸. To enroll, a center must hold a VDSS adult day center license and show it to DMAS before enrollment ⁠¹⁹. The waiver adds staffing on top of 22VAC40-61 ⁠¹⁹:

• an RN, employed or contracted, present at least eight hours a month. The RN evaluates each waiver participant’s nursing needs at least every 90 days;
• a qualified activities director, with at least 48 semester hours in recreational therapy, occupational therapy or a related field plus one year of related experience;
• an ADHC coordinator who writes 30-day progress notes and reviews daily records weekly;
• program aides who meet the DMAS training rules.

A billable ADHC day is at least six hours. Centers without professional nursing staff on site may not admit waiver participants who need skilled care such as tube feedings or sterile dressing changes ⁠¹⁸. For centers serving Medicaid participants, § 63.2-1720 lets you tell DMAS whether an employee’s background check is complete and whether they are eligible to work ⁠⁶. The waiver rule also lets the care coordinator, DMAS or the managed care organization meet with waiver participants for the annual experience survey ⁠¹⁹. The rules and VDSS pages checked do not describe how an adult day center contracts with Medicaid managed care plans, so ask DMAS and the plans serving your area about provider enrollment and billing before you count on Medicaid revenue.

Recent changes to watch

• July 1, 2026: SB 677/HB 840 exempt adult day centers caring for 12 or fewer adults in a home from Department of Health restaurant requirements ⁠¹³.
• July 29, 2026: VDSS memo restating that inspectors get immediate access and that staff must be present during operating hours ⁠¹⁷.
• March 2026: periodic review of the fee regulation, 22VAC40-160, opened for comment ⁠¹⁴.
• August 15, 2025: amended background check regulation (22VAC40-90) took effect ⁠¹⁵.
• July 1, 2025: corrective action required before appealing a provisional license ⁠¹⁶.
• August 14, 2024: the latest amendments to 22VAC40-61, including the definitions, director and staff orientation sections ⁠¹.

Sources

1. 1
   Virginia General Assembly, Virginia Administrative Code, 22VAC40-61, Standards and Regulations for Licensed Adult Day Centers Checked 12 Oct 2026 · Back to text ↑
2. 2
   Virginia General Assembly, Code of Virginia § 63.2-1701: Licenses required; issuance, expiration, and renewal Checked 12 Oct 2026 · Back to text ↑
3. 3
   Virginia General Assembly, Code of Virginia § 63.2-1702: Investigation on receipt of application Checked 12 Oct 2026 · Back to text ↑
4. 4
   Virginia General Assembly, Code of Virginia § 63.2-1705: Compliance with Uniform Statewide Building Code Checked 12 Oct 2026 · Back to text ↑
5. 5
   Virginia General Assembly, Code of Virginia § 63.2-1706: Inspections and interviews Checked 12 Oct 2026 · Back to text ↑
6. 6
   Virginia General Assembly, Code of Virginia § 63.2-1720: Assisted living facilities and adult day centers; employment of persons convicted of certain offenses prohibited Checked 12 Oct 2026 · Back to text ↑
7. 7
   Virginia General Assembly, Virginia Administrative Code, 22VAC40-80, General Procedures and Information for Licensure Checked 12 Oct 2026 · Back to text ↑
8. 8
   Virginia General Assembly, Virginia Administrative Code, 22VAC40-160-10, Fees Checked 12 Oct 2026 · Back to text ↑
9. 9
   Virginia Department of Social Services, Adult Day Centers (ADC) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Virginia Department of Social Services, Initial Application for Licensure of a Child Welfare Agency, Assisted Living Facility, or Adult Day Center (form 032-05-0702-04, 7/24) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Virginia Department of Social Services, Part II: Program Addendum to Application for Licensure of an Adult Day Center (form 032-05-0709-02, 7/24) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Virginia Department of Social Services, Division of Licensing Programs, New Applicants for Licensure: New online initial application for licensure process (October 20, 2022) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Virginia Department of Social Services, Division of Licensing Programs, 2026 Legislation Affecting Adult Day Centers (May 15, 2026) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Virginia Department of Social Services, Division of Licensing Programs, Periodic Review of 22VAC40-160, Fee Requirements for Processing Applications (March 9, 2026) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Virginia Department of Social Services, Division of Licensing Programs, Regulation changes: Regulation for Background Checks for Assisted Living Facilities and Adult Day Centers, effective August 15, 2025 Checked 12 Oct 2026 · Back to text ↑
16. 16
    Virginia Department of Social Services, Division of Licensing Programs, 2025 Legislative Information (May 19, 2025) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Virginia Department of Social Services, Division of Licensing Programs, Statutory and Regulatory Requirements for Inspections, Staffing, and Access to Records (July 29, 2026) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Virginia General Assembly, Virginia Administrative Code, 12VAC30-120-924, Covered services; limits on covered services (CCC Plus Waiver) Checked 12 Oct 2026 · Back to text ↑
19. 19
    Virginia General Assembly, Virginia Administrative Code, 12VAC30-120-935, Participation standards for specific covered services Checked 12 Oct 2026 · Back to text ↑

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