Cal. Code Regs. Tit. 22, § 82018 - Application for License

(a) Prior to filing an application, the applicant shall attend an orientation designed for the adult day program and provided by the licensing agency.

(1) The orientation shall cover, but not be limited to, the following areas:

(A) Completion of the application for license.

(B) Scope of operation subject to regulation by the Department.

(2) An applicant, who is already licensed to operate an adult day program, shall not be required to attend an orientation if the last orientation attended was for an adult day program and within two (2) years of the next scheduled orientation.

(3) An applicant applying for more than one adult day program license shall be required to attend only one orientation.

(b) Any adult, firm, partnership, association, corporation, limited liability company, county, city, public agency, or other governmental entity desiring to obtain a license shall file with the licensing agency a verified application on form LIC 200 furnished by the licensing agency, and containing the following information:

(1) Name or proposed name and address of day program.

(2) Name, and residence and mailing addresses of applicant.

(3) Name and address of owner of the day program premises if the applicant is leasing or renting.

(4) The category of facility to be operated.

(5) Maximum number of persons to be served.

(6) Hours or periods of day program operation.

(c) Additional documents supporting the application shall contain the following:

(1) If the applicant is a corporation or association, licensing form LIC 309 must be completed and the following information must be provided:

(A) The name, title and principal business address of each officer, executive director and member of the governing board.

(B) The name and address of each person owning more than 10 percent of stock if the applicant is a corporation that issues stock.

(C) A copy of the articles of incorporation, constitution, and bylaws.

(2) If the applicant is a corporation, each member of the board of directors, executive director, and any officer shall list the name of all facilities which they have been licensed to operate, employed by, or a member of the board of directors, executive director or an officer.

(3) Age range, sex or gender, and the categories of persons to be served including, but not limited to, persons with developmental disabilities, mental disorders, or physical handicaps.

(4) Name of administrator.

(5) Information required by Health and Safety Code Section 1520(d).

(6) Information required by Health and Safety Code Section 1520(e).

(7) Licensing form LIC 9054, providing the name, and address of the city or county fire department, the district providing fire protection services, or the State Fire Marshal's Office having jurisdiction in the area where the day program is located.

(8) A plan of operation as specified in Section 82022, Plan of Operation.

(9) Fingerprints as specified in Section 82019, Criminal Record Clearance.

(10) The bonding affidavit as specified in Section 82025(a).

(11) A health screening report on the applicant as specified in Section 82065(g).

(12) The fee for processing the application by the requested capacity as specified in Section 82036, Licensing Fees.

(d) The applicant shall cooperate with the licensing agency in providing verification or documentation as requested by the licensing agency.

(e) The application shall be signed by the applicant.

(1) If the applicant is a partnership, the application shall be signed by each partner.

(2) If the applicant is a firm, association, corporation, limited liability company, county, city, public agency, or other governmental entity, the application shall be signed by the chief executive officer or authorized representative.

(f) The application shall be filed with the licensing agency's Adult Care Program Office that serves the geographical area in which the day program is located.

Notes

Cal. Code Regs. Tit. 22, § 82018

1. New section filed 12-13-2006; operative 1-12-2007 (Register 2006, No. 50).

Note: Authority cited: Sections 1530 and 1530.1, Health and Safety Code. Reference: Sections 1501, 1520, 1520.11, 1522, 1522.1, 1523.1 and 1560, Health and Safety Code.

1. New section filed 12-13-2006; operative 1-12-2007 (Register 2006, No. 50).