West Virginia legally unlicensed health care home: registering a 1-to-3 resident care home
If you will give room and personal assistance for more than 24 hours to one, two or three adults who are not your relatives, West Virginia requires you to register with the Office of Health Facility Licensure and Certification (OHFLAC) as a legally unlicensed health care home (LUH). Registration is free and there is no license, but you and every adult in the household must clear a WV CARES fingerprint check first. A fourth unrelated resident makes the home an assisted living residence that needs a full license.
Contents15 sections
Key takeaways
- Registration, not a license: anyone giving personal assistance for more than 24 hours to one to three unrelated adults must register with OHFLAC, and the statute forbids charging a fee.12
- Relatives within the degree of second cousin do not count as residents, but OHFLAC wants a notarized Declaration of Relationship with documents for each one.167
- You, every household member over 18 and every caregiver must get a WV CARES fitness determination before OHFLAC approves you.345
- One provider, one home; a married couple counts as one provider; the registration dies if you sell the home.236
- Residents may need no more than limited and intermittent nursing care (two hours a day, 90 days per episode) supervised by a registered nurse.13
- Housing a fourth unrelated resident brings a $50 per day civil penalty for each extra resident and puts you in assisted living territory.813
Quick facts
| Agency | OHFLAC Assisted Living Program/LUH Program, Office of Inspector General |
|---|---|
| Capacity | 1 to 3 residents not related to you or your spouse |
| Registration fee | $0; the statute bars a fee (as published on 2026-10-12) |
| Background checks | WV CARES registry prescreen plus fingerprints for you and every adult in the home |
| Homes per provider | One |
| Governing law | W. Va. Code §§ 16B-6-1 to 16B-6-6; 71CSR22 (effective May 28, 2025) |
From W. Va. Code Chapter 16B, Article 6, 71CSR22 and OHFLAC LUH documents dated 11/2021, checked 2026-10-12.
A registration, not a license
West Virginia does not license care homes with fewer than four residents. Instead, Chapter 16B, Article 6 of the Code makes the person running such a home a “service provider” who must register with the director of OHFLAC.2 OHFLAC lists the legally unlicensed health care home as a registered facility type handled by its Assisted Living program, with no license and no certification attached.17 The Legislature’s stated purpose is to identify where these homes are and to check that residents get care appropriate to their needs, while encouraging noninstitutional settings for older adults.1
The statute is short and the money side is simple: “No fee may be charged for registration.”2 The registration is valid only for the individual who applied and the building named in the application, and it cannot be transferred or assigned.3
Who has to register
You must register if you are the individual administratively responsible for providing personal assistance, for more than 24 hours, to one to three residents, whether or not you are paid.1 “Personal assistance” covers help with walking, bathing, dressing, feeding, getting in and out of bed, or supervision needed because of age or a physical or mental impairment.1 Residents may also need limited and intermittent nursing care, and the definition expressly includes people receiving services coordinated by a licensed hospice.1
Three exclusions shape the count:
- Relatives. A person related to you or your spouse by blood or marriage within the degree of second cousin is not a “resident.”1 OHFLAC asks for a Declaration of Relationship for every such relative in the household: a notarized statement plus documents such as birth certificates and marriage licenses that trace the family line.57 The FAQ says your census should never exceed three, even temporarily, unless the fourth person is a relative.6
- VA Medical Foster Homes. A home approved and reviewed each year by the U.S. Department of Veterans Affairs under 38 CFR 17.73 and caring only for three or fewer veterans is outside Article 6 altogether.11
- Adult Family Care homes. 71CSR22 does not apply to adult family care providers approved and monitored by the Department of Human Services.3 That is a separate program, described below.
The ceiling: three residents, then assisted living
An assisted living residence is any facility or residence, however named, available for four or more residents who need personal assistance or supervision and no more than limited and intermittent nursing care.13 So the fourth unrelated resident is the line where you need an assisted living residence license from OHFLAC instead. If a complaint investigation finds more than three residents in a registered home, OHFLAC must assess a civil penalty of $50 per day for each resident over three, counted from the day you receive the written statement of deficiencies.8
The cap also applies to you as a person. A provider may operate no more than one legally unlicensed home.23 OHFLAC reads this strictly: you cannot keep residents in a second house and also in your own home, and a husband and wife count as one provider and cannot run separate residences.6 Adding houses means moving to a licensed assisted living model.
Adult Family Care: the subsidized alternative for the same size home
A founder looking at a three-bed home should know West Virginia has a second, separate track. The Bureau for Social Services certifies Adult Family Care (AFC) homes, also called adult foster care homes, for up to three adults; relatives and private-pay residents count toward the three.14 AFC providers go through fingerprinting, references and a home study, must complete at least six hours of face-to-face training before accepting clients, and receive a state subsidy for eligible clients.1415 To qualify for the subsidy, a client needs liquid assets under $2,000, among other conditions.15
The LUH registration form asks whether you are an approved AFC home,4 and the LUH rule does not apply to AFC providers.3 Which track fits depends on who your residents are and how they pay: LUH registration carries no state payment, while AFC is the route that comes with a subsidy and a home study.
Who can be a provider: the WV CARES requirement
The rule requires that you, every member of your household (other than residents) and every caregiver have a personal history free of abuse, neglect, fraud, repeated violations in running a care facility or caring for dependent people, and relevant criminal convictions, as shown by an eligibility determination from WV CARES (West Virginia Clearance for Access: Registry and Employment Screening).3 The Inspector General may also deny registration to an operator listed on the state abuse registry.10
OHFLAC’s FAQ puts the scope as all household members over 18 plus anyone with direct access to or providing care for residents. Each must pass a prescreen of the registries on the WV CARES website, then a criminal background check with fingerprints, and receive an eligibility letter.6 Fingerprints are captured by a State Police contractor and run through the State Police and the FBI.18 Copies of every fitness determination go to OHFLAC and must also be kept in the home.6 The registration instructions are blunt: WV CARES checks “must be completed prior to being approved as a LUH provider.”4 WV CARES can be reached at (304) 558-2018 or [email protected].4
The registration is free, but the background checks may not be. OHFLAC’s LUH documents and the OIG WV CARES page publish no fee for LUH providers, so ask WV CARES at (304) 558-2018 what prescreening and fingerprinting charges apply to you and each adult in your household before you start.
Registering with OHFLAC, step by step
OHFLAC’s “Process to Open a Home” sets this order:5
Get the forms
Call OHFLAC at 304-558-0050 or download them from the LUH page on the OHFLAC site; OHFLAC will mail them if you do not have a computer.5
Send the registration form
It asks for your name, home and cell numbers, the physical address where care is given, mailing address, county, email, the total number of people in your care including relatives, whether you are an approved AFC home, any resident’s designated legal representative, and driving directions from Charleston.4 By law the form must cover your contact details, where services are given and to how many residents, and what services (personal assistance, nursing care) you provide.2 You can give the information by phone, but registration does not count until your signature is on the form.2
Get your LUH identification number
OHFLAC issues one after it receives the form.5
Open a WV CARES account
using that number.5
Run the checks
on yourself and everyone over 18 who lives or works in the home: registry prescreen first, then fingerprints.5
Send OHFLAC the WV CARES fitness determination letters
5
Read the Adult Protective Services policy
linked from the LUH page.5
Complete a Declaration of Relationship
for each relative in the household within the degree of second cousin.57
Submit everything
to OHFLAC Assisted Living Program/LUH Program, 408 Leon Sullivan Way, Suite 120, Charleston, WV 25301, by mail, by fax to 304-558-2515, or by email to the program manager listed on the form.5
Receive the registration letter
OHFLAC sends it once it has the registration form, any declarations and WV CARES letters for everyone living or working in the home.5
OHFLAC may deny registration if you knowingly give false information or leave out required information.2 It publishes no processing time. After you register, you must tell OHFLAC if you stop caring for residents, move the home, or change the home’s name or your phone number.34 OHFLAC publishes a list of registered providers at least once a year,12 and its online facility search lets the public filter by county for “Legally Unlicensed” homes.6
Naming and advertising the home
The name of the home and its advertising may not use “clinic,” “hospital,” “nursing home,” “personal care home,” “residential board and care home,” or any other word suggesting a different type of facility.3 OHFLAC’s registration instructions add “assisted living residence” to that list.4
The house itself
Article 6 and 71CSR22 contain no square-footage, bathroom-ratio or sprinkler standard. What the rule requires is short:3
- electric power and hot and cold running water adequate for residents, household members and employees;
- a clean, safe, sanitary home in good repair inside and out;
- no smoking or open flames in a room where oxygen is used or stored;
- a separate bed for each resident, in a bedroom, plus a chair, a reading light and clothing space for each.
OHFLAC adds that two residents may share a bedroom if there is ample room for both beds and their belongings.6 Any equipment that would need auxiliary electrical power during an outage cannot be used unless the home has a backup generator.13
The fire-safety rule is about where people sleep rather than how the house is built. Residents incapable of self-preservation, meaning they cannot at least get themselves out of imminent danger such as a fire, may be housed only on a ground floor with a door that exits directly outside.13 OHFLAC’s FAQ applies this to every resident who cannot walk or uses a wheelchair.6 The rule also requires you to follow any applicable state and local laws,3 so check your city or county before you register; the LUH documents do not list local approvals.
Running the home day to day
Supervision. You or a responsible individual must be available in the home to help residents at all times.3 OHFLAC treats leaving residents alone or without adequate supervision as neglect.6
Meals. Offer at least three meals a day, seven days a week, plus snacks and special diets that keep each resident at a normal weight.3 Therapeutic diets follow written instructions from the resident’s physician or dietitian, and you must keep a daily record of the food actually served at each meal.3 OHFLAC recommends weighing residents monthly.6
Medications. Medicines are given or self-administered according to physician orders. Each prescription stays in its original, legibly labeled pharmacy container, and if directions change the container must be relabeled by a pharmacist or backed by a signed, dated physician document.3 All medications go in a locked cabinet.3 OHFLAC says you need a copy of the physician’s order for each medication you give, and you may not use pill minders.6
Records. Keep resident information in a secure area in the home and open it to OHFLAC during an inspection.3
Restraints. Physical restraint is allowed only when all seven conditions in the rule are met at once: a physician’s order, an emergency, staff trained in their use, cloth vests or soft belts only, release every two hours for at least 10 minutes, a call for professional help, and use only until that help arrives, never beyond 24 hours.3 OHFLAC lists locking a resident in a room, blocking an exit and bed side rails as prohibited restraints.6
Changes in condition. Tell the resident’s family, legal representative and physician about any change in appearance, health or well-being; the physician must be told of any major incident or significant change, and it goes in the resident’s record.3
How much nursing a resident can need
The home may serve residents who need limited and intermittent nursing care: hands-on nursing of no more than two hours a day, for no longer than 90 consecutive days per episode.1 That care is allowed only when the resident asks to stay, has been told about other facilities that could treat the condition, and the need comes from a medical pathology or normal aging.13 OHFLAC’s examples include Foley catheters, feeding tubes, wound care and injections.6
You must arrange for a registered professional nurse to supervise that care, provide enough nursing support staff working under that nurse, and carry out the nurse’s recommendations on care and staff training.3 Nothing about a resident’s medication, diet, procedures or treatment may be started, changed or stopped without an order from a lawfully authorized health care professional.3
You may not admit anyone who needs extensive nursing care (a life-threatening, unstable condition) or ongoing nursing care (expected to last more than 90 days with little or no improvement), and you must arrange a transfer for a resident who develops those needs.3 If a resident’s nursing is not being supervised by a registered nurse, OHFLAC says the resident must be discharged to a facility that can provide it.6
Residents’ rights and what you must hand out at admission
At admission, give each resident the name, address and phone number of OHFLAC, the state long-term care ombudsman and Adult Protective Services, and tell them both orally and in writing that they can file complaints with those offices.13 Residents keep the right to receive visitors (relatives and clergy at any time, with the resident’s consent), to voice grievances without reprisal, to take part in planning their care, and to use the physician of their choice.3
You, and anyone with financial ties to the home, may not serve as a resident’s legal representative.3 OHFLAC spells that out as no power of attorney, medical power of attorney, health care surrogate or guardianship for your own residents.6 If a resident already has a legal representative, you must let that person exercise their authority.3
Complaints, inspections and penalties
The rule is built around complaint investigations rather than scheduled surveys. Anyone may complain to OHFLAC.3 OHFLAC inspectors have the right to enter any place where services are given, see every part of the home and grounds, check food supplies, medications and medical records, and interview residents and staff privately; the director can get a search warrant for a home believed to be operating.9 After an investigation, OHFLAC issues a directed plan of correction with deadlines.3 If a resident who complained suffers discriminatory treatment within 120 days, the law presumes it was retaliation.3
| Trigger | Consequence | Source |
|---|---|---|
| Operating without registering, after certified-mail notice from OHFLAC | Misdemeanor; fine of $500 to $2,500 or 10 to 30 days in jail | 8 |
| Interfering with enforcement | Misdemeanor; fine of $500 to $2,500 or 10 to 30 days in jail | 8 |
| More than three residents found after a complaint | Civil penalty of $50 per day per resident over three | 8 |
| Violations not corrected within 120 days of the investigation | OHFLAC reports the provider and address to the Social Security Administration and gives residents a list of licensed facilities to help them move | 3 |
| Failure to follow a directed plan of correction | Closure order | 310 |
| Substantiated immediate and serious threat | Court petition to close the home, move residents, or appoint temporary management | 9 |
The Inspector General holds sole authority to issue, suspend and revoke registrations.10 Appeals follow the Office of Inspector General’s contested-case procedural rule and the state Administrative Procedures Act.3 Civil actions can be brought in the Kanawha County Circuit Court or the circuit court where the conduct occurred.8
Neither Article 6 nor 71CSR22 sets an expiration date or renewal cycle for a registration.23
OHFLAC’s documents do not say whether it asks existing providers for periodic re-registration or refreshed WV CARES letters. Ask OHFLAC at 304-558-0050 how it handles ongoing eligibility for household members and new caregivers after you are registered.
What changed: new code numbers, same rules
The LUH statute now sits in Chapter 16B, Article 6; its sections carry bill history from Senate Bill 300 of the 2024 regular session.2 The rule followed: on May 28, 2025, legislative rule 64CSR50 was reassigned to 71CSR22 under the Office of Inspector General, with technical updates to citations, agency names and dates.16 71CSR22 took effect May 28, 2025, and is set to expire on August 1, 2030, unless renewed.3
OHFLAC’s registration form, FAQ and process sheet are still the November 2021 versions and cite the old numbers, W. Va. Code §16-5E and 64CSR50.46 The requirements are the same; when you sign the form, you are agreeing to follow what is now 71CSR22.
If you plan to grow past three residents, the next step is an assisted living residence license; if you want to serve adults during the day only, see the medical adult day care center license. Other West Virginia care licenses are on the state page.
Sources
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- 9 West Virginia Legislature, W. Va. Code § 16B-6-5: Inspections; right of entry Checked 12 Oct 2026 · Back to text ↑
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Related guides
West Virginia and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| West Virginia (this guide) | Legally Unlicensed Health Care Home registration | 1 to 3 residents; free registration, 4+ need a license | $0; the statute bars a fee |
| Ohio | Class Two Residential Facility license | Housing and personal care for 3 to 16 unrelated adults | $75, nonrefundable and non-waivable |
| Kentucky | Family Care Home License | No more than 3 unrelated residents; certificate of need exempt | $42 initial and annual |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.