We have been completing License Applications for ARF RCFE and Group Home for over 15 years. We guarantee our work and will make any changes requested by Community Care Licensing.
Upload your documentation here:
To begin working on your License Application we will need the following items: Certificate of Completion of Initial Administrator Certification Course
Current State of California Administrator Certificate
HIV AIDS TB Course
Proof of 4 Hour HIV AID TB Course Completion for the administrator.
register for HIV AIDS TB online course here Online HIV Course
Fist AID Certificate (cannot be an online course)
For licensee and each and all staff
Control of Property ( lease or title)
Component I Orientation Certificate
To register for Online ARF Orientation
Articles of Incorporation along with bylaws.
We will also need the following forms completed by the licensee. Consider providing services to non-ambulatory clients. Many Regional Center homes with a vendored capacity of 4 have 2 non-ambulatory.
License Application LIC 200
Applicant Information LIC 215 (for you as the licensee, not staff)
Administrative Organization LIC 309
Financial Information Release and Verification LIC 404
The following forms must be completed by the licensee and each staff.
Health Screening Report Facility Personnel (LIC 503)
Criminal Record Statement LIC 508
Personnel Record LIC 501
Part I and II must be completed if you are a sole proprietor. If you are a corporation with financial history complete Part II only.
Supplemental Financial Information LIC401a
Complete this form only if you are a sole proprietor.
Balance Sheet LIC 403a
LIC 999 Sketch of House ( we are happy to complete your sketch – ask us how)
Drawing of inside house and lot. Must easily identify the Electric Panel, Gas Shut Off and Water Shut OFF. Also, specify resident and staff rooms and how many clients in each room. Also which room will be for non-ambulatory/ambulatory. Specify, exits, windows, living and dining room, kitchen, bathrooms, garage, driveway, gates, fence, walkways, storage garage cans and outside the area. Dimensions must be specified for each room along with front, side and backyard.
Two Relocation Sites (to be completed by applicant)
Acceptable relocation sites are a hotel like Holiday Inn. Another ARF home, Red Cross or a Church will not work. You will need to get two letters on letterhead from two hotels indicating the hotel will accept your clients in an emergency. A sample letter follows:
Independent Living ARF is an Adult Residential Facility licensed by California Department of Social Services. I agree that my Best Western Hotel located at Adams Blvd in Los Angeles will be used as a relocation site for Independent Living ARF in case of an emergency.
Signed by owner or manager.
Name of Your Facility
Note: The name of your business can be separate from the name of your facility. A good idea is to name your facility in a way that identifies it’s location. For example Sepulveda House North. Religious names may be heartfelt and meaningful to you but may be a turn off to family and others considering placement.