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RCFE Project Tracker — rcfe.tdgrm.com

Opening Two Premium
Care Facilities

Phase 1: Oklahoma — Edmond / Nichols Hills (6 beds · Q4 2026) Phase 2: California — Southern CA TBD (6 beds · 2027) Started March 2026 ◌ Connecting...

Business Model & Licensing Snapshot

As captured from planning sessions

Business Model

Client profileSelf-pay, 50+, high-end
Target monthly rate$7,500–$15,000 / bed
Medicaid billingNone — self-pay only
CA facility size≤6 beds (small RCFE)
OK facility size6 beds (RCH)
Est. net margin~55% at full occupancy
Year 1 occupancy (realistic)50–70%

Licensing Path

CA training hours80 hrs ICTP
CA exam pass score70% minimum
CA exam fee$100
CA cert application fee$120
CA orientation fee$54.85
CA surety bond$1,000 minimum
OK license fee formulaBeds × $10 × 0.5

Project Timeline

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Licensing Checklist

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California — RCFE

0 / 11

Oklahoma — RCH

0 / 10

Market Intelligence

Evaluated zip codes — both states
California Markets

Ladera Heights

90056 — Los Angeles County
Avg household income$200,304
65+ population20.4%
Median home value$1.59M
Property identifiedYes — scouting
PRIMARY TARGET — Proceed

Canyon Crest / Woodcrest

92506 / 92508 — Riverside
Median household income$120K–$144K
High-income households22–28%
Median home value$584K–$700K
Best for premium?Moderate fit
ALTERNATE — If Ladera not viable

Temecula

92592 — SW Riverside County
Median household income$134,313
High-income households25.6%
Median home value$697K
Best for premium?Strong fit
STRONG ALTERNATE — Scale location
Georgia Markets — Future Expansion

Sandy Springs / Johns Creek

Atlanta Metro — Fulton County
Assisted living avg cost$5,500–$8,000/mo
Market characterAffluent, fast-growing
Senior population61,000+ in metro
Licensing fitPCH (≤24 beds) — lighter reqs
TimingYear 3 — after CA stable
FUTURE TARGET — Year 3 expansion

Buckhead

Atlanta — Fulton County
Market characterOld money, established
Premium pricing15–30% above city avg
Competition levelHigh — large operators present
Differentiation neededBoutique vs. institutional
TimingYear 3+ — after CA stable
MONITOR — High competition, strong wealth

Alpharetta

Atlanta Metro — North Fulton County
Market characterTech wealth, growing senior base
Competition levelLower than Buckhead
Income demographicsStrong — newer affluence
Best for premium?Good fit
TimingYear 3 — after CA stable
BEST ATLANTA ENTRY POINT — Less competition
Tulsa — Oklahoma Phase 2 Target

Midtown Tulsa

74114 — Utica Square Area
Median HHI$95,000+ with high-income outliers
Wealth typeOld oil and gas money — Williams, Kaiser family networks
NeighborhoodHistoric, established, large homes — boutique conversion potential
Referral anchorSaint Francis Health System — largest hospital in Oklahoma
CompetitionAlmost no boutique premium competition
TimingPhase 2 — mid-2027 after OKC opens
PRIMARY TULSA TARGET — Old money, zero boutique competition

South Tulsa / Maple Ridge

74137 — Southern Hills Area
Income demographicsStrong professional and executive community
Property costs$400,000–$700,000 for suitable residential
NeighborhoodEstablished, quiet residential — excellent for boutique care
Hospital proximitySaint Francis, Saint John, Hillcrest all within 15 minutes
License typeOklahoma RCH — 6 beds — same as OKC model
Rate target$7,000–$8,000 per bed per month
STRONG ALTERNATE — Lower property cost, same demographics
Illinois Markets — Long-Term Watch

Chicago North Shore

Winnetka / Lake Forest / Kenilworth
Avg assisted living cost$7,040/mo (city avg)
Market characterGenerational wealth, deep pockets
New state licensing requiredYes — 4th regulatory framework
Property taxesVery high — Cook County
TimingYear 4+ — national scale only
LONG-TERM ONLY — Wrong timing now

Why Chicago is deferred

Honest assessment — March 2026
4th state licensingToo much complexity now
IL regulatory scrutinyIncreasing staffing mandates
Labor costsHigh — union pressure
Market fundamentalsStrong — revisit at scale
Priority orderCA → OK → Atlanta → Chicago
DEFERRED — File for year 4+

Expansion priority order

Strategic sequencing — on record
Phase 1Oklahoma — 6-bed pilot facility (Q4 2026)
Phase 2California — flagship 6-bed RCFE (2027)
Phase 3Georgia — Atlanta metro (Year 3+)
Phase 4Illinois — Chicago North Shore (Year 4+)
RationaleMaster one before scaling next
CONFIRMED SEQUENCE — Do not skip phases
Oklahoma Markets

Nichols Hills

OKC Metro — Oklahoma County
Median household income$203,750
Median home value$967,003
Market characterOld money, established
Best for premium?Highest fit
TOP PICK — Strongest demographics

Edmond

OKC Metro — Oklahoma County
Avg household income$143,053
Population96,825
Richest city in OK (5K+)Yes
Best for premium?Strong fit
RECOMMENDED — Best volume market

Forest Park

73121 — Original selection
Median household income$103,929
Median age58.2 yrs
Population913 — very small
Distance to OKC5 miles
RECONSIDER — Edmond/Nichols Hills stronger

Key Decisions Log

Strategic conclusions from planning sessions
Business Model

Self-pay only — no Medicaid

Eliminates billing complexity, rate caps, and audit burden. Allows premium pricing $7,500–$15,000/bed/month. Referral strategy focuses on estate attorneys, financial advisors, and concierge physicians.

California Market

Ladera Heights (90056) — Strong candidate but not yet committed

Avg household income $200,304. 20%+ residents 65+. Median home values $1.59M. Neighbor operating as care facility confirms zoning precedent. Verify neighbor on ccld.ca.gov before finalizing. Alternatives under evaluation: Baldwin Hills, Pasadena, Long Beach (Bixby Knolls), Temecula. Property decision deferred until California license is closer to issuance.

California Market

Riverside 92503 dropped — demographics do not support model

Median income $91,523. Young population (median age 33). Working-class market cannot sustain $7,500+/month self-pay rates. Replaced with 92506/92508 or Temecula 92592 as alternates.

Oklahoma Market

Shifted from Forest Park to Edmond / Nichols Hills

Forest Park population is only 913 people — too small for referral pipeline. Edmond: avg income $143K, 97K population. Nichols Hills: median income $203,750, strongest demographics in OKC metro.

Timeline Reality

CA provisional license realistically Q4 2026 or early 2027

June 1 training → July exam → August certificate → Aug–Sep application → CDSS review/inspection → provisional license Q4 2026. First residents likely early 2027. Plan finances accordingly.

Property Intelligence

Adjacent care home at Ladera Heights is a positive signal

Licensed care facility next door confirms zoning permits RCFE use. Not a hospital — a 4-bedroom residential care home. Check their CDSS record for citations at ccld.ca.gov.

Revenue Planning

Stress-test at 4 residents, not 6, for year one

Premium self-pay clients require longer decision cycles. 90% occupancy at opening is unrealistic. Budget for 50–70% year-one occupancy. Need 6–12 months operating reserves before opening.

Your Advantage

Real estate background significantly accelerates property search

Understanding markets, reading neighborhoods, evaluating buildings — months of advantage over typical first-time RCFE operators. Key risk is zoning compatibility — verify this first on every property.

Atlanta — Future Expansion

Atlanta is a yes — but not until California is open and stable

Sandy Springs and Buckhead charge $5,500–$8,000/month for assisted living — close to target pricing. Strong wealth demographics and growing senior population. However, Buckhead is already saturated with large operators (Belmont Village, Sunrise, Brighton Gardens). Best entry point is Sandy Springs, Johns Creek, or Alpharetta where competition is lower. Fits Georgia licensing path already explored. Target as Phase 3 expansion after California is operational and profitable.

Atlanta — Market Detail

Alpharetta is the recommended Atlanta entry point

Lower competition than Buckhead, strong income demographics from tech and professional wealth, growing senior base, and newer housing stock suitable for boutique RCFE conversion. Georgia PCH license (≤24 beds) is the right vehicle — lighter administrator requirements than ALC tier. Administrator licensing requires 1 year experience + 14-hour program + NAB RCAL exam + $110 application fee.

April 2026 — Strategic Update

Oklahoma capped at 6 beds — same as California

Original plan allowed up to 16 beds for Oklahoma RCH. Decision: cap at 6 beds for both states. Reasons: (1) Operational consistency — same systems, policies, and staffing model in both facilities. (2) Lower capital requirement — 6-bed property in Edmond $350K–$700K vs larger property for 16 beds. (3) Simpler management — 6 beds is manageable as owner-operator without a large management layer. (4) Proves the model cleanly before any scale decision.

April 2026 — Strategic Update

California property decision deferred — evaluating multiple submarkets

Not committed to Ladera Heights. Multiple Southern California submarkets under evaluation: Baldwin Hills/View Park (same demographic, lower cost), Pasadena/Altadena (older established wealth, Huntington Hospital referrals), Long Beach Bixby Knolls (lower entry cost, growing market), Temecula (wine country positioning, strong self-pay demographics, lower property cost). Decision will be made when California license is closer to issuance — Q3/Q4 2026.

April 2026 — Financial Model

Two 6-bed facilities combined financial projection

Oklahoma at full occupancy ($7,000/bed × 5, Maxwell property): $420,000/yr gross + $108,000 add-ons = $528,000 total. Zero debt — cash purchased at $450,000. California at full occupancy ($12,000/bed × 6): $864,000/yr gross. Combined total revenue: $1,248,000–$1,392,000/yr at full occupancy. Oklahoma net estimate: $241,000–$338,000/yr. Year one OK realistic: $140,000–$170,000 during ramp. Oklahoma cash flow fully funds California startup. Oklahoma property confirmed: Maxwell, Forest Park — $450,000 cash, zero debt.

April 2026 — Niche Strategy

High-return niche options identified — decision pending

Top niche candidates evaluated: (1) Concierge Dementia Care — highest rates ($12K–$18K/bed), longest stays (4–8 yrs), lowest turnover. Requires §87706 advertising compliance. (2) Post-Acute Luxury Recovery — short stays at premium daily rates ($400–600/day), one referral relationship fills beds. (3) Cultural Affinity (Black community) — Ladera Heights specific, no competition, lowest marketing cost. (4) Executive and Professional Transition Care — highest rate ceiling, most differentiated. (5) Oil and Gas Retirees — Oklahoma specific, royalty income is non-depletable, old money Nichols Hills. Niche selection decision pending property confirmation.

April 2026 — Phase 1 Confirmed

Forest Park Maxwell property confirmed — Oklahoma Phase 1 facility

Cash purchase and full renovation completed at $450,000 — zero debt. 4,000 sq ft total: 2,700 main floor (4 bedrooms) + 1,300 finished basement (1 bedroom, full kitchen, bath, private patio with hot tub). 5 total resident beds. Zoning confirmed for RCH use. Large elevated deck with fire pit, dining, and chaise lounge zones. 3-car garage for operations. No debt service — all revenue goes to operations and net income. Estimated net at full occupancy: $241,000–$338,000 annually. Break-even at 3 residents.

April 2026 — Financial Model Update

5-bed Oklahoma model — shift staffing, no debt, revised projections

5 residents @ $7,000/bed = $420,000 gross/yr base. Add-on target $108,000/yr ($1,800/resident/month). Labor: shift model 3 caregivers/day 24/7 @ $16/hr + 20% burden = $168,000–$175,000/yr. Overhead $35,000–$45,000/yr. Zero debt service. Net estimate: conservative $241,000/yr, target $338,000/yr. Year 1 realistic $140,000–$170,000 during ramp. Cash-on-cash return at target: 75% on $450,000 investment. Break-even: 3 residents. Stress test at 3 residents: $107,000 net — still 23.8% return.

April 2026 — Client Qualification

Minimum financial qualification standard — 36 months at full rate

Never accept a resident whose assets cover less than 36 months at full rate. This is the minimum financial qualification standard. Pre-qualification questions: (1) What is the source of monthly funds — pension, investment income, rental income, or home sale? (2) Has family consulted financial advisor or elder law attorney? (3) Has family modeled total cost of care? Natural wealth screens: trust beneficiary referrals via estate attorneys, oil and gas royalty recipients in Oklahoma, pension income residents (military, federal, CalSTRS), home equity from $1.5M+ home sale.

April 2026 — Entity Structure

Recommended structure: S-Corp holding company + one LLC per facility

TDM Oklahoma Holding LLC (existing) owns all real estate. TDM Residential Care LLC (new — S-Corp election) operates all three facilities and leases properties from TDM Oklahoma Holding LLC. TDM Community Services Inc. (new nonprofit) operates free food service program in Oklahoma only. Each entity is completely separate with its own bank account, EIN, and books. Liability at any one facility cannot reach real estate assets in TDM Oklahoma Holding LLC. Estimated annual tax savings from S-Corp election: $50,000–$100,000 at full three-facility occupancy.

April 2026 — Entity Structure

Why one LLC per facility — liability isolation is non-negotiable

A lawsuit, regulatory action, or financial problem at one facility cannot reach assets of the other two when each operates as a separate LLC. This is especially critical in healthcare where a single resident incident can trigger significant liability. Each LLC also has clean books — essential if a facility is ever sold independently. Three facilities in two states with regulatory licenses in each location requires this structure. One entity across all facilities creates unacceptable cross-facility liability exposure.

April 2026 — Entity Structure

Why Wyoming or Nevada for the holding company

No state income tax, strongest asset protection laws in the US, lowest annual fees ($50–$100), no requirement to publicly list member or officer names, and no requirement to register in Oklahoma or California if operations run through the state LLCs. The holding company does not operate facilities — it owns the LLCs. This keeps the holding company clean, simple, and outside the tax reach of both California and Oklahoma. CPA must confirm this structure does not trigger nexus in either operating state.

April 2026 — Entity Structure

Immediate entity formation sequence

Step 1: Engage healthcare CPA and business attorney this week. Step 2: Form TDM Residential Care LLC in Oklahoma. Step 3: File IRS Form 2553 S-Corp election within 75 days — cannot be missed. Step 4: Obtain EIN for TDM Residential Care LLC. Step 5: Open TDM Residential Care LLC bank account. Step 6: Execute lease agreement between TDM Oklahoma Holding LLC and TDM Residential Care LLC for Forest Park property. Step 7: Register TDM Residential Care LLC as foreign entity in California when CA facility is ready. Step 8: Form TDM Community Services Inc. nonprofit. Do NOT commingle funds between any entities at any time.

April 2026 — Expansion Update

Three-facility plan confirmed — OKC, Tulsa, Southern California

Revised expansion: Phase 1 — OKC Forest Park (Q1 2027 first residents). Phase 2 — Tulsa Oklahoma (mid-2027). Phase 3 — Southern California (late 2027–early 2028). Two Oklahoma facilities generating cash flow before California opens. Combined three-facility net at full occupancy: $881,000–$1,218,000 annually. OKC and Tulsa fund California acquisition. Georgia remains Phase 4 after all three are stable.

April 2026 — Licensing Strategy

Dual ARF + RCFE certification — California and Oklahoma

Pursuing four administrator certifications: CA ARF, CA RCFE, OK ARF equivalent, OK RCH. CA ARF exam scheduled end of April 2026. CA RCFE training complete November 2026. Both CA certifications target November–December 2026. Oklahoma training taken jointly with facility employee who will serve as OK administrator of record. BLOCKING: Must confirm OK license types and training requirements with OKSDH (405-271-6868) and OKDHS (405-521-3571) before enrolling in OK training.

April 2026 — Oklahoma Staffing

Employee as Oklahoma licensed administrator of record

Owner takes Oklahoma training alongside designated facility employee. Employee obtains Oklahoma administrator certification and serves as administrator of record for OK facilities. This allows Oklahoma facilities to operate under employee license while owner focuses on California licensing and property. Employee manages day-to-day operations in both OKC and Tulsa. Owner retains ownership, oversight, and strategic control. Critical: employee background check must clear before training investment.

April 2026 — Construction Update

Forest Park Maxwell — new construction completing July 2026

Property is new construction not renovation — completion target end of July 2026. Cannot open until OK administrator training complete November 2026 and license issued. Gap period July–November 2026: property complete but not yet operational. Oklahoma OKSDH application submitted Q4 2026 after training completion. First residents realistically Q1 2027. Gap period options: final facility preparation, staff recruitment and training, referral network outreach, marketing development.

Chicago — Deferred

Chicago is a strong market but wrong timing — defer to year 4+

Chicago average assisted living cost is $7,040/month — well above national median. North Shore suburbs (Winnetka, Lake Forest, Kenilworth) have generational wealth ideal for self-pay model. However: Illinois is a 4th state requiring completely separate licensing framework, property taxes in Cook County are among the highest in the US, labor costs are high with increasing union pressure, and regulatory scrutiny on staffing is increasing. Market fundamentals are real — revisit at national scale. Priority order confirmed: California → Oklahoma → Atlanta → Chicago.

Expansion Strategy

Oklahoma opens first as pilot — California opens second as flagship

Oklahoma is now Phase 1. Lower capital requirement ($350K–$700K property), simpler regulatory path, faster time to revenue. Oklahoma cash flow funds California startup costs. California is Phase 2 — flagship facility with proven systems from Oklahoma. Both facilities capped at 6 beds for operational consistency. Do not open both simultaneously — master one before scaling to two.

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Practice Exam

California RCFE State Exam — Title 22

RCFE California State Exam Prep

100 questions across 13 categories based on Title 22, Division 6, Chapter 8.
Select categories to focus on, or leave all unselected for a mixed exam. Pass score is 70%.

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Study Guide

Title 22 · Division 6 · Chapter 8 — California RCFE Exam Prep

Critical numbers — memorize these

60
Minimum age for elderly person (§87101)
75%
Minimum % of residents who must be 60+ (§87101(r)(4))
80 hrs
Initial administrator certification training (§87406)
70%
Minimum passing score on state exam
3 months
Minimum start-up operating funds required (§87155)
6 months
Terminally ill — life expectancy threshold (§87101(t)(1))
10 days
Address change notification (§87114)
60 days
Change of ownership notice to residents (§87109)
30 days
Change of licensee/location notice (§87109)
48 hrs
Corporate change notification (§87161)
6 months
Standard provisional license maximum (§87162(c)(1))
12 months
Extended provisional license — extenuating circumstances
60 days
Emergency Approval to Operate (EAO) maximum (§87111)
10 days
Complaint on-site inspection deadline (§87106)
1 year
Wait after license denial before re-applying (§87157)
2 years
Wait after license revocation before re-applying (§87157)
15 sec
Max delayed egress — standard dementia unit
30 sec
Max delayed egress — Alzheimer's facility
$100
Unlicensed operation penalty per resident/day
$200
Doubled penalty — refuses licensure or denied
20 days
Designee must apply after licensee death (§87111(c)(4))
5 days
Buyer must apply after offer accepted (§1569.191)

Licensing fees — capacity schedule (§87156)

CapacityInitial FeeAnnual Fee
1–3$495.60$495.60
4–6$990.00$495.60
7–15$1,486.80$742.80
16–30$1,980.00$990.00
31–49$2,476.80$1,238.40
50–74$2,972.40$1,448.00
75–100$3,469.20$1,734.00
Other fees: Relocation = 50% of app fee · Capacity change = $25 · Orientation = $50 · Late payment = +50% of annual fee · Plan of correction = $200 · All fees NON-REFUNDABLE

Core roles & people (§87101)

TermDefinitionKey Detail
Elderly PersonPerson 60 years of age or olderMinimum age for RCFE admission
AdministratorIndividual designated by licensee to manage facilityLicensee and administrator can be same person
LicenseeIndividual, firm, partnership, or corporation operating licensed facilityHas authority AND responsibility
ConservatorPerson appointed by Superior Court (Probate Code §1800)Cares for adult person, estate, or both
GuardianPerson appointed by Superior Court (Probate Code §1500)Cares for person/estate of a CHILD
Significant OtherPerson sharing committed partnership with resident prior to RCFE placementIncludes same-gender partners
Responsible PersonRelative, health care surrogate, or placement agency assisting residentAssists in placement or assumes responsibility
DietitianEligible for registration by American Dietetic AssociationNOT the same as Nutritionist
NutritionistMaster's degree in food/nutrition, dietetics, or public health nutritionOr county health dept. employee

Facility & health definitions

TermDefinition
AmbulatoryCan leave building without assistance or mechanical aid in emergency — requires BOTH mental and physical capability
NonambulatoryCannot leave building unassisted; includes crutches/walkers/wheelchair users; also those unable to respond to oral fire instructions
Basic ServicesSafe/healthful accommodations, personal assistance, observation/supervision, planned activities, food service, incidental medical/dental arrangements
Healing WoundsCuts, Stage 1–2 dermal ulcers diagnosed by physician, incisions being treated; area returning to normal state
Terminally IllPhysician prognosis of 6 months or less if illness runs its normal course
Transfer TraumaConsequences of stress and emotional shock from abrupt, involuntary relocation of a resident
DementiaLoss of intellectual/cognitive functions; irreversible from disease/injury; MAY be reversible from depression, drugs, alcohol, or imbalances
MCIBetween normal aging and dementia; impaired short-term memory but NO other dementia symptoms affecting daily function
Room and BoardLiving arrangement where care and supervision is NEITHER provided NOR available
Universal PrecautionsTreats all human blood/body fluids as infectious; 4 basics: hand washing, gloves, disinfectant cleaning, proper disposal
Exception vs. Waiver: Exception = individual-specific and non-transferable. Waiver = facility-wide need or circumstance. This distinction is frequently tested!

License basics

  • License is NOT transferable — §87109
  • Must be posted in prominent, publicly accessible location — §87113
  • Address change notification: 10 calendar days — §87114
  • No initial license issued until: on-site survey + fire clearance + full compliance
  • Fees are NON-REFUNDABLE

License forfeiture — by operation of law (§87112)

  • Licensee dies
  • Licensee sells or transfers the facility
  • Licensee surrenders the license
  • Licensee moves facility to new location
  • Licensee abandons the facility
  • Licensee convicted of specified offenses
Abandonment: 1 call/day for 5 consecutive workdays with no response PLUS certified letter unanswered for 7 calendar days.

Exemptions from licensure (§87107)

  • Health facilities (H&S Code §1250) and clinics
  • Care by a family member (spouse, child, parent, sibling)
  • Board and room only — no care/supervision provided
  • Recovery houses for alcoholism/drug addiction
  • Federal housing projects for elderly/disabled

Provisional license (§87162)

ConditionDuration
Normal circumstances — full compliance expected within periodMax 6 months
Circumstances BEYOND applicant's controlMax 12 months
Renewable?NOT renewable under any circumstances
Capacity limitResidents for whom immediate need exists OR facility capacity — whichever is LESS

Administrator certification

RequirementDetails
Initial certification80-hour Initial Certification Training Program (ICTP) + pass state exam (70% minimum)
Classroom hour50–60 minutes of instruction within a 60-minute period. No credit for meal breaks.
Licensee as administratorThe licensee, if an individual, may be the administrator
RecertificationContinuing education required for certificate renewal (40 hours every 2 years)

Criminal record requirements (Article 6)

TermDefinition
Criminal Record ClearanceBOTH California Clearance AND FBI Clearance — §87101(c)(19)
California ClearanceNo felony or misdemeanor convictions per CA DOJ
FBI ClearanceNo felony or misdemeanor convictions per FBI
Arrest without conviction does NOT disqualify an individual from California Clearance or FBI Clearance.

Rehabilitation factors for exemption requests:

Education · Counseling or therapy · Stable employment · Restitution · Remorse · Lifestyle changes · Community service

Admission requirements

RequirementSection
Evaluation of Suitability for Admission§87456
Pre-Admission Appraisal§87457
Medical Assessment§87458
Functional Capabilities assessed§87459
Mental Conditions assessed§87461
Social Factors assessed§87462

Advance health care directives (§87469)

  • Written instruction for health care when individual is incapacitated
  • Includes: Durable Power of Attorney for Health Care, Individual Health Care Instruction, DNR Form
  • DNR Form: Developed by CA Emergency Medical Services Authority
CRITICAL: The licensee or any staff member of the facility SHALL NOT be appointed health care surrogate decision maker for a resident. This is frequently tested.

Resident personal rights (§87468)

  • Dignity and respect in all interactions
  • Privacy in personal care and communications
  • Right to make decisions about their own care
  • Right to manage their own finances (unless conserved)
  • Freedom from abuse, neglect, and exploitation
  • Right to file complaints without retaliation
  • Resident Councils must be supported by facility (§87221)

Health condition classifications

ClassificationDefinitionExample
AllowableConditions licensee CAN care for per regulation or approved exceptionManaged incontinence, diabetes with self-injection
RestrictedConditions allowed only under specific regulatory requirementsRequires specific protocols and monitoring
ProhibitedConditions that CANNOT be cared for in an RCFE — requires inpatient health facility careStage 3–4 pressure ulcers
Healing Wounds = Stage 1 and 2 ONLY. Stage 3 or higher is a prohibited condition requiring immediate relocation.

Specific allowable conditions

ConditionSection
Oxygen Administration (gas and liquid)§87618
Colostomy/Ileostomy§87621
Managed Incontinence§87625
Diabetes care§87628
Injections (self or by skilled professional)§87629
Healing Wounds (Stage 1–2 only)§87631
Indwelling Urinary Catheter§87623
Hospice Care (requires Waiver)§87632–87633

Health Condition Relocation Orders

  • Issued when resident has condition outside license limits
  • Resident has right to request review of the order
  • Interdisciplinary Team: Department nurse consultant + social worker with elderly experience
  • Team members shall NOT have been involved in the initial relocation decision

Delayed egress devices — complete rules

RuleRequirement
Who may use themONLY facilities housing residents with Alzheimer's disease or dementia
Required systemsBOTH approved automatic sprinkler AND smoke-detection systems
Activation forceNot more than 15 pounds for 2 seconds
Standard delay max15 seconds
Alzheimer's facility max30 seconds
Required sign text'KEEP PUSHING, THIS DOOR WILL OPEN IN ___ SECONDS, ALARM WILL SOUND' — Letters at least 1 inch high
Re-lockingBy manual means ONLY at the door — no remote re-locking
Auto-deactivationTriggers upon sprinkler/smoke detector activation OR power loss
Egress Alert Device: A wristband or device worn by a resident that triggers a visual or auditory alarm when the resident leaves the facility building or grounds.

Dementia advertising rules (§87706–87707)

Facilities that advertise dementia special care, programming, or environments must comply with specific advertising standards AND training requirements. Advertising dementia care without compliance is a violation.

Penalties & enforcement

ViolationPenalty
Unlicensed operation$100 per resident per day
Unlicensed — refuses licensure or denied and continues$200 per resident per day (doubled)
Plan of correction not implemented on time$200
Late annual fee paymentAdditional 50% of annual fee

Complaint and inspection process

  • On-site inspection required within 10 days of complaint receipt
  • Complainant must be promptly informed of proposed course of action
  • Serious Deficiency: Any deficiency presenting immediate or substantial threat to physical health, mental health, or safety

License revocation grounds

  • Violation of RCFE Act or regulations
  • Conduct inimical to health/welfare/safety of residents
  • Criminal convictions (specified offenses)
  • Financial malfeasance — improper use or embezzlement of client funds

Must-know distinctions — frequently tested

TopicKey Distinction
Exception vs. WaiverException = individual-specific, non-transferable | Waiver = facility-wide
Ambulatory vs. NonambulatoryAmbulatory = can exit independently | Nonambulatory = needs help or mechanical aid
Administrator vs. LicenseeCan be same person | Administrator manages day-to-day | Licensee holds legal authority
Conservator vs. GuardianConservator = adult | Guardian = child (both court-appointed)
CA Clearance vs. Criminal Record ClearanceCA Clearance = CA DOJ only | Criminal Record Clearance = CA DOJ + FBI
Dementia vs. MCIDementia affects daily function | MCI = impaired memory without other dementia symptoms affecting daily function
Allowable vs. Prohibited Health ConditionAllowable = can care for | Restricted = OK with specific protocols | Prohibited = must leave RCFE
Healing WoundsStage 1–2 ONLY | Stage 3+ = prohibited, must relocate
Dietitian vs. NutritionistDietitian = eligible for ADA registration | Nutritionist = master's degree in food/nutrition
Provisional 6 vs. 12 months6 months = normal | 12 months = circumstances BEYOND applicant's control
Staff as surrogate decision makerNEVER — licensee and all staff are prohibited from serving in this role
Delay egress 15 vs. 30 seconds15 sec = standard dementia unit | 30 sec = Alzheimer's facility only
Exam strategy: When unsure, eliminate answers that say "always," "never," "any," or "all" unless you are certain — RCFE regulations have many specific exceptions and conditions.