Cal. Code Regs. Tit. 22, § 87155 - Application for License
(a)
Any individual, firm, partnership, association, corporation or governmental
entity desiring to obtain a license shall file with the licensing agency an
application on forms furnished by the licensing agency. The licensee shall
cooperate with the licensing agency in providing verification and/or
documentation as requested by the licensing agency. The application and
supporting documents shall contain the following:
(1) Name or proposed name and address of
facility.
(2) Name and address of
the applicant and documentation verifying completion by the applicant of
certification requirements as specified in Section
87406, Administrator Certification
Requirements.
(A) This section shall apply to
all applications for license, unless the applicant has a current license for
another residential care facility for the elderly which was initially licensed
prior to July 1, 1989, or has successfully completed an approved certification
program within the prior five years.
(B) If the applicant is a firm, partnership,
association, or corporation, the chief executive officer or person serving in a
like capacity or the designated administrator of the facility shall meet the
requirements of this section.
(3) If the applicant is a partnership, the
name, signature and principal business address of each partner.
(4) If the applicant is a corporation or
association, the name, title and principal business address of each officer,
executive director, and member of the governing board. The application shall be
signed by the chief executive officer or authorized representative. In
addition, a copy of the Articles of Incorporation, Constitution and By-laws,
and the name and address of each person owning more than 10 percent of stock in
the corporation shall be provided.
(5) 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 the directors, executive director or an
officer.
(6) Procedures as required
pursuant to Section 1569.175 of the Health and Safety Code.
(7) Name and address of owner of facility
premises if applicant is leasing or renting.
(8) The category of facility to be
operated.
(9) Maximum number to be
served.
(10) The name, residence
and mailing addresses of the facility administrator, a description of the
administrator's background and qualifications, and documentation verifying the
required education and administrator certification.
(11) Copy of the current organizational chart
showing type and number of positions and line of authority. However, facilities
for less than sixteen persons may furnish, in lieu of an organization chart, a
list of positions and the periods of time that persons in these positions will
be providing services at the facility.
(12) Evidence pursuant to Health and Safety
Code, section 1520(b).
(13) A
financial plan of operation on forms provided or approved by the Department.
Start-up funds shall be sufficient to meet a minimum of three (3) months
operating costs. In addition:
(A) Where
construction is anticipated to meet the requirements for a license, sufficient
financing for the construction shall be available.
(B) The scope of the applicant's services
shall be such that an adequate quality of service will be permitted from
available funds. The licensing agency shall have the right to verify the
availability of these funds.
(14) When there is a change of licensee, the
required documentation shall include the information specified in Section
87217(k).
(15) Information concerning insurance carried
by the applicant relating to the operation of the facility.
(16) A plan of Operation as specified in
Section 87208, Plan of
Operation.
(17) The fee for
processing the application for the requested capacity as specified in Section
87156, Licensing Fees.
(18) Name, address and telephone number 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 facility is located.
(19)
Such other information as may be required by the licensing agency for the
proper administration and enforcement of the licensing law and
regulations.
(b) An
application shall be filed with the licensing agency which serves the area in
which the facility is located.
Notes
Note: Authority cited: Sections 1569.23, 1569.30 and 1569.616, Health and Safety Code. Reference: Sections 1569.1, 1569.2, 1569.10, 1569.15, 1569.151, 1569.1515, 1569.16, 1569.17, 1569.185, 1569.19, 1569.20, 1569.21, 1569.22, 1569.23, 1569.24, 1569.312, 1569.45, 1569.60, 1569.616 and 1569.62, Health and Safety Code.
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