If your interested in license application for ARF or RCFE see below.
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.
In order for us to complete your license application please complete this simple form and complete the forms as indicated below.
The following forms need to be completed and emailed.
Applicant Information LIC 215 (for you as the licensee not staff)
Supplemental Financial Information LIC401a (complete only if you are a sole proprietor)
Balance Sheet LIC 403a
Financial Information Release and Verification LIC 404
Health Screening Report Facility Personnel (LIC 503) (for all staff including licensee/owner)
Criminal Record Statement LIC 508 (for all staff including licensee/owner)
Personnel Record LIC 501 (for all staff except licensee)
LIC 999 Sketch of House (to be completed by applicant)
Drawing of house that identifies Electric Panel, Gas Shut Off and Water Shut OFF . Also specify resident and staff rooms, exits, windows living and dining room, kitchen, bathrooms, garage, driveway, gates, fence, walkways, storage garage cans and outside area. Does not have to be to scale. A reasonable drawing will do.
Two Relocation Sites (to be completed by applicant)
Acceptable relocation sites are 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. 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 on 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.
Proof of attendance at Community Care Licensing Orientation Component I Orientation
To register for Online ARF Orientation
Other Critical Items
Certificate of Completion of Initial Administrator Certification Course
Current State of California Administrator Certificate
Proof of 4 Hour HIV AID TB Course Completion (for Administrator only – register for HIV AIDS TB online course here Online HIV Course
Proof of First AID Course Completion. (for owner/licensee and all staff – online course is not acceptable)
Control of Property ( lease or title)
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.