Health Care Facility Licensing and Certification

Contact Us

Phone: (916) 552-8632
Email: CAB@cdph.ca.gov

For application status requests, please include the following in your email:

Application ID (if applicable)
Name of Facility or Agency
License or Facility/Agency # (if applicable)
Address
Facility or Provider Type
Date Documentation Sent
Contact Number

Adult Day Health Center
Initial Application Packet

A State license is required to operate as an Adult Day Health Center in California. Adult Day Health Center or Adult Day Health Care Center means “a licensed facility that provides adult day health care,” pursuant to Health and Safety Code (HSC) section 1570.7(b). Adult Day Health Care means “an organized day program of therapeutic, social, and skilled nursing health activities and services provided pursuant to this chapter to elderly persons or adults with disabilities with functional impairments, either physical or mental, for the purpose of restoring or maintaining optimal capacity for self-care. Provided on a short-term basis, adult day health care serves as a transition from a health facility or home health program to personal independence. Provided on a long-term basis, it serves as an alternative to institutionalization in a long-term health care facility when 24-hour skilled nursing care is not medically necessary or viewed as desirable by the recipient or his or her family,” pursuant to HSC section 1570.7(a).

To apply for an Initial license, you must complete the required application packet. Refer to Title 22 of the California Code of Regulations (CCR) sections 78001 through 78609 and HSC sections 1570 through 1596.5 for information regarding licensure requirements.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process.

Please refer to the following links to get started:

Provider Instructions (PDF)
Provider Checklist

Application Packet Forms

HS 200 - Licensure and Certification Application (PDF, 1.5MB)
HS 215A - Applicant Individual Information (PDF)
HS 309 - Administrative Organization and Organizational Structure (PDF)
CDPH 322 - Transmittal Application for Criminal Background Investigation (PDF)
CDPH 325 - Criminal Record Clearance Submissions (PDF)
HS 602 - Transfer Agreement (PDF)
CDPH 609 - Bed or Service Request (PDF)
DHCS 1051 - Civil Rights Compliance Review (PDF)
CDA ADH 0006 - Staffing/Services Arrangement (PDF)
CDA ADH 0007 - Proposal to Share Space (PDF)
CDPH 5000 - Program Flexibility Request (PDF)
CDA IMS 33 - Balance Sheet (PDF)
CDA IMS 35 - Cash Flow Forecast (PDF)
CDA IMS 37 - Operating Budget (PDF)
STD 850 - Fire Safety Inspection Request (PDF)

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377

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