AGING AND DISABILITY SERVICES ADMINISTRATION
Boarding Home Applications
Residential Care Services (RCS) recently convened a workgroup comprised of representatives from boarding home associations and past customers of the application process to focus on revising, updating, and streamlining the application process. The following products are the result of their work. See related letter to providers.
Note: All application materials are in Word format. A free viewer for Word documents is available.
APPLICATION PACKETS *
The following types of application packets are downloadable, in full, by clicking on the corresponding link. Please note that for each application type, you must also print, complete and submit the 2-page background authorization form, found below under "Related Materials".
- Initial License (38 pages)
- Change of Licensee "Full" (39 pages)
- Change of Licensee "Partial" (38 pages)
- Change of Licensee "Mini" (38 pages)
- Contract (3 pages)
- Nursing Home Conversion (39 pages)
Not sure which type of application you need? See application types.
RELATED MATERIALS
Download the following individual forms or informational handouts by clicking on the corresponding link:
- Policies & Procedures Attestation (1 page)
- Instructions (1 page)
- Information for Medicaid Contractors Regarding Liability Insurance (PDF Format)
- Background Authorization (2 pages) *
- Lease or Operating Agreement Attestation (3 pages)
- Management Agreement Attestation (4 pages)
- Resource Information for Licensed BH Providers (3 pages)
- Administrator Attestation (1 page)
- BH Frequently Asked Questions (5 pages)
- RCS Regional Contacts (1 page)
- Application Types (1 page)
* Applicants who have resided in the State of California within the past 3 years should contact the applications unit for the requirements and process for out-of-state (California only) background checks. This will help to avoid an unnecessary delay in processing your application.
If you are unable to view these documents online or require materials in hard copy format, please contact the Residential Care Services Business and Applications Analysis Unit at (360)725-2420.
If you have difficulty printing these documents, please read the Print Troubleshooting guide.
