Starting a care business in California

CDSS's Community Care Licensing Division is split into programs by client group, and each has its own application route. The Child Care Licensing Program handles both family child care homes and child care centers. The Senior Care Licensing Program licenses residential care facilities for the elderly, the Adult Care Licensing Program licenses adult day programs, and the Home Care Services Branch licenses home care organizations. Every one of these licenses is non-medical. Skilled nursing at home belongs to CDPH.

Child care thresholds are generous at the bottom and strict above it. You may care for your own children plus one other family's without a license, and relatives are exempt; a second unrelated family requires a Family Child Care Home license. A small home takes up to 8 children and a large home up to 14 with an assistant, counting your own children under 10, and state law makes either one a residential use that a city cannot zone out or charge a business tax on. Anything outside a provider's home is a center, which since January 1, 2024 holds a single license with infant, toddler, preschool and school-age components. The 2026 budget trailer bills add 16 hours of health and safety training for all caregiving staff by October 1, 2027 and 12 hours of continuing education a year after that, and centers need a new emergency and disaster plan from January 1, 2027.

California has no separate license for small adult homes. A six-bed house caring for people 60 and older holds the same RCFE license as a large assisted living building, and a home serving six or fewer is treated as a family dwelling for zoning, with no conditional use permit allowed. The barrier is preparation rather than size: the applicant or administrator must complete an 80-hour certification program and pass a state exam, and CDSS will not take an application without a specific property and proof of three months of operating funds. Adults 18 to 59 with disabilities who need 24-hour care are served under a different CDSS license, the Adult Residential Facility, whose administrator takes a separate 35-hour certification program.

Adult day care runs on two tracks. A non-medical Adult Day Program needs a CDSS license at any size, with fees from $182 to $1,513 depending on capacity. A program offering skilled nursing and therapy is an Adult Day Health Care center, a CDPH health facility license with an $8,830 fee for 2026-27, and most such centers also seek Medi-Cal CBAS certification from the Department of Aging, which says that process may take 18 to 24 months. In home care, CDSS licenses the employer model: a Home Care Organization costs $5,603 for two years, requires $1 million/$3 million liability insurance, workers' compensation and a $10,000 dishonesty bond, and may send only aides listed on the Home Care Aide Registry. AB 152 switches HCOs to a $2,802 annual fee from January 1, 2029.

The biggest blocker is in home health. SB 164 has barred CDPH from issuing new home health agency licenses or adding branches since June 29, 2026, until no later than 90 days after CDPH's revised home health regulations take effect. During the freeze an applicant can only file a written exception request and must win a CDPH finding of unmet need in the proposed service area. Unmet need also becomes a permanent licensing condition, and a new licensee cannot sell the agency for five years without CDPH's consent. On top of the state freeze, CMS has refused new Medicare enrollments of home health agencies nationwide since May 13, 2026, under a six-month moratorium.