West Virginia assisted living residence license: OHFLAC rules, fees and steps

Four residents is the line

West Virginia’s definition of an assisted living residence (ALR) depends on how many residents you serve and what they need. An ALR is any “living facility, residence, or place of accommodation, however named, available for four or more residents” that offers personal assistance or supervision, paid or not, to people “dependent upon the services of others by reason of physical or mental impairment.”⁠¹ Personal assistance means help walking, bathing, dressing, eating or getting in and out of bed, or supervision needed because of age or mental impairment.⁠¹

Below four, a different law applies. Someone who gives personal assistance to one to three residents for more than 24 hours registers with OHFLAC as a legally unlicensed health care home. Registration is free, and one provider may run only one such home.⁠¹⁴⁠¹⁷ Taking in a fourth resident moves you into ALR licensure. If you plan to grow beyond three, budget for the ALR building standards from the start. The small-home route is covered in our legally unlicensed health care home guide.

These arrangements fall outside the definition:⁠¹

• Relatives. Care in a household of people related by blood or marriage, within the degree of second cousin to the head of household or their spouse.
• Room and board only. Hotels, boarding homes and similar places that give guests only a room and meals.
• Other institutions. Hospitals, state institutions, residential care homes run by the federal government or the state, alcohol treatment institutions, physician offices, and fraternal order homes.

A residential care community is a separate license under article 16B-9. It applies to a group of 17 or more apartments that are part of a larger independent living community.⁠¹⁵ 71CSR21 does not apply to residential care communities.⁠⁶ OHFLAC uses one application form for both. You tick the box for a small ALR, a large ALR or a residential care community.⁠⁹

Landlords who own the building but have no role in care, advertising, admissions, transportation or other ongoing operations do not need a license. The licensee, though, must have “complete control of the operation and premises.” OHFLAC may review your leases and on-site service contracts.⁠²

Running an unlicensed ALR is a misdemeanor. The first offense carries a fine of up to $100, up to 90 days in jail, or both. Later fines go up to $250, and each day after conviction counts as a separate offense.⁠⁵ The rule adds civil money penalties: up to $20,000 for knowingly operating an unlicensed ALR, and up to $5,000, then up to $5,000 per day after 10 days’ notice, for a licensed owner who also runs an unlicensed home.⁠⁶

Small or large: what the bed count changes

The statute has a single license type, but OHFLAC’s application splits ALRs into small (4 to 16 beds) and large (17 or more beds).⁠⁹ 71CSR21 attaches different requirements to each:

Sources: 71CSR21 §§ 3.12.2, 4.3.1, 10.2.2⁠⁶; OHFLAC Life Safety fees⁠⁸.

A large residence whose administrator was approved before August 15, 1996 may keep an administrator with a high school education.⁠⁶ OHFLAC sets your licensed bed capacity when it approves your plan of operation, and adding beds later requires its written approval first.⁠⁶

The nursing ceiling

The definition caps the nursing care an ALR may provide at “limited and intermittent,” meaning hands-on nursing care for someone who needs no more than two hours a day for no more than 90 consecutive days per episode.⁠¹ That care must be given by or under the supervision of a registered nurse.⁠¹ Nursing care that runs longer than 90 consecutive days counts as ongoing nursing care.⁠⁶

You may not admit anyone who needs ongoing or extensive nursing care.⁠⁶ There are two exceptions. The time limits do not apply to a resident who later enrolls in a licensed hospice, or to home health services from a Medicare-certified home health agency.⁠¹ And if a resident’s condition declines after admission and a hospice or certified home health agency is coordinating their care, they may stay. In that case the residence must have a backup generator for any equipment that needs power.⁠⁶ Once needs exceed what you are licensed for, you must tell the resident in writing, help find another placement, and send a transfer summary with them.⁠⁶

Every ALR needs an RN responsible for nursing oversight. You can employ the RN, contract with one, or use a nursing service or home care agency that meets the rule.⁠⁶ For each resident with nursing needs, the RN must:⁠⁶

• complete a nursing assessment within 24 hours of admission
• write a nursing service plan within seven days
• see the resident at least weekly and record a progress note
• take part in admission and discharge decisions.

You also need a written plan for 24-hour contact between the residence, the RN and emergency services.⁠⁶ The application asks for the supervising RN’s name and license number.⁠⁹ Medication administration must follow article 16B-10 and the approved medication assistive personnel (AMAP) rule, 71CSR17.⁠⁶

Plan the building with OHFLAC before you build

West Virginia reviews construction before the work starts, so building first and applying later is risky. Building or renovating without following section 3.12 of the rule is a listed ground for refusing a license.⁠⁶ The construction requirements apply in full to every proposed ALR. For an existing residence that adds or renovates, only the parts OHFLAC finds applicable apply.⁠⁶

Before construction begins:

• Drawings. Send architectural, structural and mechanical drawings and specifications to OHFLAC and the State Fire Marshal for approval. If substantial construction does not start within a year of final approval, you need written confirmation that the approval is still valid.⁠⁶
• Site inspection. OHFLAC inspects every proposed site before work starts. The site must sit above the 100-year flood plain, drain well, and have a safe water supply sized for both residents and the sprinkler system, from a public system or a well that meets the well rules. Sites near railroads, freight yards, traffic arteries or airports need safety precautions. Questionable soils, high walls or runoff need review by a soils engineer.⁠⁶
• Codes. The residence must meet State Fire Commission rules, the 2003 International Building Code, the Fire Code (87CSR1), the ADA and ANSI standards, and any local building or zoning code that is stricter. Keep signed compliance evidence from local fire, building and zoning officials on site.⁠⁶

The rule sets these design minimums for proposed residences:⁠⁶

• Bedrooms: 100 sq ft per resident in a single room and 90 sq ft per resident in a double. No more than two people per room, a vertical window to the outside, and no below-ground bedrooms without written approval. At least three feet between beds.
• Bathrooms: at least two, with no fewer than one toilet and sink for every six residents. At least one bathing room per floor and one for every 10 residents. Grab bars must be anchored to hold 250 pounds, and bathroom doors must swing outward and unlock from outside.
• Common space: 15 sq ft per resident for dining and 15 sq ft for leisure, or 30 sq ft per resident if the two are combined.
• Site: an all-weather hard-surface road connecting directly to a highway, parking for all staff on duty plus one space per five beds, and 36-inch concrete walks at the exits.
• Systems: a call system reachable from every bed, one service sink per floor, heat to at least 72°F, and cooling that keeps the inside at or below 80°F.

When construction is substantially complete, you file a substantial completion form signed by all parties and an inspection request. OHFLAC must approve the work before any resident moves in.⁠⁶ Inspection request forms are on OHFLAC’s assisted living page.⁠¹¹ A residence that has not received the State Fire Marshal’s recommendation for licensure can be refused a license.⁠⁶

The application packet

OHFLAC’s initial and change-of-ownership application is a seven-page PDF. It must carry your notarized signature, and the signature also authorizes OHFLAC to check references, credit and background.⁠⁶⁠⁹ Its checklist and the statute together call for:⁠²⁠⁹

• the application fee, by check or money order payable to OHFLAC
• a preliminary statement of operations: a proposed budget with projected monthly income and a balance sheet covering owner pay, lease payments and the monthly rates you plan to charge⁠⁶
• the names, addresses and occupations of everyone with a 10% or larger ownership interest, every officer, director and trustee, and the officers and directors of any corporation holding 25% or more. The same disclosure is required for the owner of the premises if that is a different person
• a signed copy of the lease if you lease the building, and facility photographs
• the proposed bed count with private and semi-private rates, and an organizational plan listing each position with full-time and part-time numbers (the form says check marks are not accepted)
• the administrator’s name and proof of education, and the supervising RN’s name and license
• the services you will offer and any extra charge for each
• your West Virginia business license number and FEIN
• proof that the criminal background check was completed.

The application form is still dated June 1, 2014, and refers to fingerprinting through Morpho Trust. 71CSR21 now requires every employee to be screened under the West Virginia Clearance for Access: Registry and Employment Screening (WV CARES) Act and rule 71CSR11. The administrator must hold an eligibility fitness determination or a variance.⁠⁶ OHFLAC’s assisted living page still lists the licensure application under the same form name.⁠¹¹ The sources do not say how an applicant now documents WV CARES fingerprinting with it, so ask OHFLAC at 304-558-0050 which background-check proof it wants with the application and which current form to use.

OHFLAC will not renew a license if the business’s workers’ compensation or unemployment compensation account is in default.⁠⁹

OHFLAC judges whether each owner and officer is “responsible and suitable” based on financial capacity, business or professional experience, compliance history, and no license revocation in the past five years.⁠² The rule’s grounds for refusal include insufficient capital or delinquent accounts, an ineligible WV CARES result without a variance, a license denied or revoked in any jurisdiction in the last five years, and submitting false information.⁠⁶

Fees as published

The statute sets the renewal fee at $6 per bed and lets OHFLAC raise fees each year by the Consumer Price Index, which is why the published figure is $10.42. The prior schedule, effective June 1, 2025, listed $10.16.⁠²⁠⁷⁠¹⁹ The rule says the yearly increases are posted on OHFLAC’s website.⁠⁶ The statute describes the initial inspection charge as the average direct cost of the last 10 initial licensures, scaled to bed capacity.⁠² OHFLAC does not publish that average, so ask for an estimate before you commit. Residential care communities pay $75.00 initially and $7.76 per bed at renewal.⁠⁷

From first contact to license: the order that works

1. Confirm the license type

   Four or more residents with impairments who need personal assistance or supervision means an ALR. Apartments inside an independent living campus may instead fit the residential care community license.⁠¹⁠¹⁵

2. Settle the certificate-of-need question

   West Virginia lists “assisted living facilities and services” among services exempt from certificate of need. The statute says that, to get this exemption, a person files an exemption application with the West Virginia Health Care Authority.⁠¹³ The sources do not say whether the Health Care Authority expects a new ALR to file that application in practice, so ask the Authority, and OHFLAC, whether an exemption filing is needed before you apply for the license.

3. Get the site inspected and the drawings approved

   Request OHFLAC’s site inspection and send drawings to OHFLAC and the State Fire Marshal before any construction or renovation.⁠⁶⁠¹¹

4. Hire the administrator and arrange RN oversight

   Both go on the application, and both must clear WV CARES.⁠⁶⁠⁹

5. File at least 90 days before opening

   Send the notarized application, the $65 fee and the preliminary statement of operations. The application form recommends certified mail.⁠⁶⁠⁹

6. Finish construction and request inspections

   OHFLAC inspects only after the application is complete and your documents show the building is ready.⁠⁶ The State Fire Marshal carries out the fire and safety inspections.⁠⁴

7. Correct deficiencies

   OHFLAC sends a written report within 15 days of an inspection. You return a signed plan of correction within 15 working days. Violations that pose an immediate and serious threat must be fixed at once, and others within 60 days unless OHFLAC allows more time.⁠⁶

8. Pay the inspection bill and receive the license

   The license states the maximum bed capacity, the issue date and the expiration date, and must be posted where residents and visitors can see it.⁠²⁠⁶

Staffing: a formula tied to resident needs

West Virginia’s minimum staffing depends on how many residents have high care needs. Every ALR needs at least one direct care worker on duty 24 hours a day who can read and write. On top of that, you add workers for residents with two or more “special care needs”: dependence on staff for eating, toileting, moving between locations, bathing, dressing, repositioning, oral hygiene or grooming, or behaviors that reasonably require extra staff.⁠⁶

Someone with current first aid and CPR training must be on duty at all times. A multi-story building needs at least one awake staff member on each floor while residents sleep, unless a physician or psychologist certifies that the residents do not need supervision during sleep and an emergency call system reaches the awake staff.⁠⁶ If a resident has a poor outcome because of too little supervision, OHFLAC can order you to add staff.⁠⁶

Training requirements:⁠⁶

• Orientation before an employee works unsupervised, and within 15 days of hire at the latest. It covers emergency and disaster plans, policies, resident rights, confidentiality, abuse reporting, the ombudsman’s role, complaints, individual care needs, activities and infection control.
• Alzheimer’s and dementia training of at least two hours within 15 days of hire and every year after.
• Annual in-service training on resident rights, abuse prevention, infection control, fire safety and evacuation, and related topics.
• Administrator training of eight hours a year on operating a residence.
• Tuberculosis screening for every employee before hire and every year after. Personnel records must be kept for three years after an employee leaves.

The administrator, or an employee designated in writing, must be present and in charge at all times. You must tell OHFLAC within 10 days of a permanent change of administrator or supervising RN, and you may not operate more than 30 days without either one unless OHFLAC grants an extension.⁠⁶

Dementia care needs a second license

A facility that will “advertise, market, or otherwise promote” a dedicated unit or program for Alzheimer’s or dementia care must first get an additional license under 71CSR19. The application is made before operation and again with each annual renewal.⁠¹² The rule requires an average of at least 2.25 hours of direct care staff time per resident per day, and at least two direct care staff present whenever more than five residents are in the unit or program. On-call staff do not count toward the minimum.⁠¹² 71CSR19 took effect May 28, 2025, when the former 64CSR85 was renumbered under the Office of Inspector General.⁠¹²

Contracts, resident money and day programs

Before admission you must give each prospective resident a written list of every cost they may be charged. Residents are not liable for any cost you did not disclose.⁠³ The admission contract must state the population you serve, the health and nursing services you provide (including CPR), the monthly or annual price, which changes in care needs raise the price, your refund policy, discharge criteria and how to file a complaint.⁠⁶

If you handle resident money, you must post a surety bond of at least $2,500. This does not apply if you handle less than $25 per resident and less than $500 for all residents in a month.⁠³ Table 71-21 A in the rule raises the bond with the average monthly balance, for example $5,000 for balances of $3,901 to $4,000. A resident’s personal funds over $200 go in an interest-bearing account.⁠⁶ Your name and advertising may not use “clinic,” “hospital,” “nursing home,” “residential care community” or any other word suggesting a different facility type.⁠⁶

To run an adult day program alongside the residence, you need OHFLAC’s approval first. You tell OHFLAC how many day participants you will serve beyond your licensed beds, and they must have the same health screening as residents.⁠⁶ A stand-alone day program is licensed separately. See our medical adult day care center guide.

Renewal, inspections and ownership changes

The license runs for up to one year. The renewal application is due at least 90 days before expiration, with your fiscal-year balance sheet, statement of operations, and any changes to ownership or management.⁠²⁠⁶ A renewal is granted only if you are in substantial compliance and meet every Class I standard. Class I standards are the rule’s most serious tier.⁠⁶ If the timely renewal application and fee are in, the old license stays in effect until the new one is issued, for up to one year.⁠² OHFLAC can issue a provisional license for up to one year. It cannot be renewed and is not available while Class I violations remain uncorrected.⁠²⁠⁶

After licensure, OHFLAC makes periodic unannounced inspections, and the State Fire Marshal handles fire safety.⁠⁴⁠⁶ Major incidents such as a serious fall injury, a missing resident at risk, or an assault causing injury must be reported to OHFLAC by the next business day.⁠⁶

A license covers only the named owner and location and cannot be transferred. Give OHFLAC 30 days’ written notice before changing the name or address. A new owner must notify OHFLAC within 10 days and apply right away, and that application works as a license for three months.⁠²⁠⁶ Failing to apply after a change of ownership can bring a civil money penalty of up to $5,000.⁠⁶

How residents pay

Plan on residents paying privately. West Virginia’s main Medicaid home and community-based program for older adults, the Aged and Disabled Waiver, is described by the state as in-home care that lets a person “remain at or return home instead of receiving nursing home care.”⁠¹⁶ The Bureau for Medical Services’ Chapter 501 states that ADW services may not be provided in assisted living residences, group residential facilities or provider-owned or leased settings of paid caregivers.⁠¹⁸ The sources found do not identify another Medicaid program that pays for services in a licensed ALR, so ask the Bureau for Medical Services whether one applies before you plan around it. Your renewal financial statements and the cost disclosure rules apply either way.⁠²⁠³

Recent changes

• 2024: Senate Bill 300 placed assisted living licensure in chapter 16B under the Office of Inspector General. Statutes and forms written before then cite the former article 16-5D and the Department of Health and Human Resources.⁠¹⁠⁹
• June 1, 2025: The Office of Inspector General’s fee schedule took effect, with renewal at $10.16 per bed.⁠¹⁹
• May 28, 2025: The dementia special care rule was reissued as 71CSR19.⁠¹²
• June 1, 2026: A new Office of Inspector General fee schedule took effect, with renewal at $10.42 per licensed bed.⁠⁷
• May 1, 2026: The amended 71CSR21 took effect under House Bill 4215. It sunsets August 1, 2031.⁠⁶

OHFLAC can be reached at 304-558-0050, State Capitol Complex, Building 6, Suite 825, Charleston, WV 25305. The 2014 application form shows an older street address.⁠⁹⁠¹⁰

Sources

1. 1
   West Virginia Legislature, W. Va. Code § 16B-5-2 (Assisted living residences: definitions) Checked 12 Oct 2026 · Back to text ↑
2. 2
   West Virginia Legislature, W. Va. Code § 16B-5-6 (License required; application; fees; duration; renewal) Checked 12 Oct 2026 · Back to text ↑
3. 3
   West Virginia Legislature, W. Va. Code § 16B-5-7 (Cost disclosure; surety for residents' funds) Checked 12 Oct 2026 · Back to text ↑
4. 4
   West Virginia Legislature, W. Va. Code § 16B-5-9 (Inspections) Checked 12 Oct 2026 · Back to text ↑
5. 5
   West Virginia Legislature, W. Va. Code § 16B-5-15 (Unlawful acts; penalties) Checked 12 Oct 2026 · Back to text ↑
6. 6
   West Virginia Secretary of State, 71CSR21, Assisted Living Residences (legislative rule, effective May 1, 2026) Checked 12 Oct 2026 · Back to text ↑
7. 7
   West Virginia Office of Inspector General, Facility Fee Schedule (effective June 1, 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Office of Health Facility Licensure and Certification, Life Safety Service Fees Checked 12 Oct 2026 · Back to text ↑
9. 9
   Office of Health Facility Licensure and Certification, Assisted Living Residence Initial or Change of Ownership License Application (revised 06/01/14) Checked 12 Oct 2026 · Back to text ↑
10. 10
    West Virginia Office of Inspector General, Office of Health Facility Licensure and Certification Checked 12 Oct 2026 · Back to text ↑
11. 11
    Office of Health Facility Licensure and Certification, Facility type: Assisted Living Residence (forms and rules) Checked 12 Oct 2026 · Back to text ↑
12. 12
    West Virginia Secretary of State, 71CSR19, Alzheimer's/Dementia Special Care Units and Programs (effective May 28, 2025) Checked 12 Oct 2026 · Back to text ↑
13. 13
    West Virginia Legislature, W. Va. Code § 16-2D-11 (Exemptions from certificate of need which require the submission of information) Checked 12 Oct 2026 · Back to text ↑
14. 14
    West Virginia Legislature, W. Va. Code § 16B-6-3 (Registration of legally unlicensed service providers) Checked 12 Oct 2026 · Back to text ↑
15. 15
    West Virginia Legislature, W. Va. Code § 16B-9-2 (Residential care communities: definitions) Checked 12 Oct 2026 · Back to text ↑
16. 16
    West Virginia Bureau for Medical Services, What is the Aged and Disabled Waiver? Checked 12 Oct 2026 · Back to text ↑
17. 17
    West Virginia Legislature, W. Va. Code § 16B-6-2 (Legally unlicensed health care homes: definitions) Checked 12 Oct 2026 · Back to text ↑
18. 18
    West Virginia Bureau for Medical Services, Chapter 501, Aged and Disabled Waiver (effective May 1, 2023), § 501.17 Checked 12 Oct 2026 · Back to text ↑
19. 19
    West Virginia Office of Inspector General, Facility Fee Schedule (effective June 1, 2025) Checked 12 Oct 2026 · Back to text ↑

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