What is Title 22?

Title 22 of the California Code of Regulations governs the licensing and operation of Adult Residential Facilities (ARFs). It is administered by the California Department of Social Services (CDSS), Community Care Licensing Division (CCLD). As a licensed ARF administrator, your facility must comply with Title 22 at all times.

ARFs are licensed to provide 24-hour non-medical care and supervision to adults (ages 18+) who are unable to provide for their own daily needs due to a physical, mental, or social disability.

Licensing Requirements

Every ARF must hold a valid license issued by CDSS. Key licensing requirements include:

• The facility administrator must hold a current ARF Administrator Certification
• The facility must meet all fire safety, physical plant, and zoning requirements
• Facility capacity is set by the license and may not be exceeded
• Any change of ownership, address, or capacity requires prior CDSS approval
• The license must be posted in a visible location inside the facility

Staffing Standards

Title 22 requires that ARFs maintain adequate staffing to meet resident needs. Requirements include:

• At least one staff person must be awake and on duty at all times when residents are present
• Staff must be at least 18 years old, in good health, and have a criminal record clearance
• New employees must complete orientation and initial training before working independently with residents
• All staff must receive ongoing in-service training appropriate to their role
• Administrators must complete required continuing education hours for license renewal

Resident Rights Under Title 22

Title 22 guarantees each resident specific rights that the facility must protect and uphold:

• Right to be treated with dignity and respect
• Right to privacy in sleeping areas, phone calls, mail, and personal matters
• Right to manage their own money (or have it managed with written consent only)
• Right to receive and refuse visitors
• Right to file a complaint without fear of retaliation
• Right to participate in planning their own care and services
• Right to be free from physical, chemical, or psychological restraint or abuse

Inspections and Compliance

CDSS conducts unannounced inspections of licensed ARFs. During an inspection, the licensing analyst may review:

• Resident files, including Individual Service Plans (ISPs) and health records
• Staff files, including criminal clearances, training records, and certifications
• Facility records, including medication logs, incident reports, and fire drill records
• Physical plant conditions (cleanliness, safety, accessibility)
• Resident rights postings and complaint procedures

Overview of Title 17

Title 17 of the California Code of Regulations governs the provision of services to individuals with developmental disabilities (DD) in California. It is administered by the California Department of Developmental Services (DDS) and the 21 regional centers across the state. Title 17 works alongside Title 22 — both apply to ARFs serving individuals with DD.

Developmental disabilities under the Lanterman Act include intellectual disability, cerebral palsy, epilepsy, autism, and other conditions closely related to intellectual disability that originate before age 18.

The Lanterman Act and Regional Centers

The Lanterman Developmental Disabilities Services Act (Welfare & Institutions Code 4500+) gives individuals with DD the legal right to the services and supports necessary to live more independent, productive, and normal lives. Key points:

• Regional centers are the local agencies that coordinate services for individuals with DD
• Each client served by your ARF has a regional center service coordinator (case manager)
• The regional center funds many services, including placement in your ARF
• Vendors (including ARFs) must have a current vendor agreement with the regional center
• The facility must cooperate with regional center staff and allow reasonable access to clients

Individual Program Plans (IPPs)

Every regional center client has an Individual Program Plan (IPP) — also called an Individual Service Plan (ISP) at the facility level. As a facility administrator, you must understand and implement these plans:

• The IPP is developed by the regional center team with the client and their support network
• It identifies the client's goals, desired outcomes, and needed services
• The ARF is responsible for supporting the client in working toward their IPP goals daily
• Staff must be informed of each client's IPP goals and document progress regularly
• IPP meetings must include the client and may include family, advocates, and facility staff

Rights Under Title 17

Title 17 Section 50510 establishes specific rights for individuals with developmental disabilities receiving services. These rights include:

• The right to be treated with dignity, respect, and consideration
• The right to participate in planning and making decisions about their own life
• The right to live in the least restrictive environment appropriate to their needs
• The right to be free from harm, including abuse, neglect, and exploitation
• The right to privacy in all personal matters
• The right to make choices about daily activities, personal relationships, and the future
• The right to access their records

Incident Reporting Requirements

Under Title 17, certain incidents involving regional center clients must be reported to the regional center and, when applicable, to CDSS and law enforcement:

• Unexpected death or serious injury
• Any allegation of abuse, neglect, or exploitation
• Hospitalization or emergency room visits
• Unauthorized absence (elopement)
• Any use of behavioral interventions that cause injury
• Medication errors with clinical significance

What is the HCBS Final Rule?

The Home and Community Based Services (HCBS) Final Rule was published by the Centers for Medicare & Medicaid Services (CMS) in 2014. It establishes standards that settings providing Medicaid-funded HCBS must meet to ensure they are truly community-integrated and person-centered — not institution-like.

California's regional center system uses Medi-Cal HCBS funds to support many individuals with DD, meaning ARFs that serve regional center clients must meet HCBS settings requirements.

The Core HCBS Settings Requirements

To be compliant with the HCBS Final Rule, a setting must:

• Be integrated in and support access to the greater community — clients must have opportunities for community participation, not just within the facility
• Ensure individual rights of privacy, dignity, and respect — clients have the right to lock their room, have private phone calls, and manage personal finances
• Optimize individual initiative, autonomy, and independence — clients choose their daily schedule, activities, food, and social interactions
• Facilitate individual choice regarding services, supports, and the setting itself — clients can choose where they live and who provides their services
• Provide opportunities to seek employment and earn competitive wages

Person-Centered Planning

The HCBS Final Rule requires that all services be delivered through a person-centered planning process. This means:

• Plans reflect the individual's preferences, strengths, and goals — not the facility's convenience
• The individual directs their own planning process to the greatest extent possible
• Family, friends, and advocates are included when the individual wants them to be
• Plans are updated whenever circumstances change, not just annually
• Staff support individuals in pursuing their goals — they do not make decisions for them

Settings That Do NOT Meet HCBS Requirements

CMS has identified characteristics that make a setting "institution-like" and non-compliant with the HCBS Final Rule:

• The setting is located on the grounds of, or adjacent to, a nursing facility, institution, or hospital
• Any characteristic of an institution (regimented daily schedule, group activities, limited privacy)
• The setting provides services to individuals with disabilities only (congregate, segregated)
• The setting is designed to provide both residential and non-residential services exclusively to people with disabilities on the same site

HCBS Compliance at Capozzi Residential

To remain HCBS-compliant, Capozzi Residential managers must ensure:

• Residents have access to community activities and outings regularly
• Residents can lock their bedroom doors and have private space
• Residents are not forced to participate in any group activity
• Residents have access to food and snacks outside of set meal times
• Residents can have visitors and make private phone calls without staff supervision
• All rights restrictions are individually justified and documented in the ISP
• Staff never speak on behalf of a resident when the resident can communicate for themselves

The Role of the ARF Administrator

As a licensed ARF administrator, you are legally responsible for the overall operation of the facility. This includes ensuring regulatory compliance, managing staff, maintaining client safety, and preserving the facility's license. Key administrator responsibilities include:

• Maintaining current ARF Administrator Certification (renewal every 2 years)
• Ensuring all staff meet Title 22 hiring, background check, and training requirements
• Overseeing resident admissions, placements, and discharges
• Supervising the development and implementation of each resident's ISP
• Managing facility finances, including resident trust accounts
• Responding to regulatory inquiries, inspections, and citations

Staff Supervision and Leadership

Effective leadership is critical to regulatory compliance. As a manager or administrator, you set the tone for the entire facility culture. Best practices include:

• Conduct regular supervision meetings with Direct Support Professionals (DSPs)
• Document supervision and corrective action in staff personnel files
• Ensure staff receive all required training before working independently
• Lead by example — model respectful, person-centered interactions with residents
• Create an environment where staff can report concerns without fear of retaliation
• Address performance issues promptly and document all disciplinary actions

Medication Management

Medication management is one of the highest-risk areas for ARF compliance violations. As a manager, ensure:

• Only staff who have completed medication training may administer medications
• All medications are stored securely, with controlled substances under double-lock
• Medication Administration Records (MARs) are completed accurately at every administration
• Medication errors are documented in an incident report and reported to the regional center
• Prescription changes are obtained from a licensed physician and documented before implementation
• Expired medications are disposed of properly and documented

Record Keeping and Documentation

Thorough documentation is your best protection during a CDSS inspection or legal challenge. Every ARF must maintain:

• Resident files: Admission agreement, ISP, medical records, incident reports, behavioral documentation
• Staff files: Application, criminal clearance, CPR/first aid, training records, performance evaluations
• Facility records: Fire drill logs, medication logs, maintenance records, visitor logs
• Financial records: Resident trust account ledgers, receipts for resident purchases

Emergency Preparedness

Every ARF is required to have and maintain an Emergency Disaster Plan. As a manager:

• Review and update the Emergency Disaster Plan annually
• Conduct and document fire drills at least quarterly (two per year must be at night)
• Ensure all staff know evacuation procedures and their assigned roles
• Maintain a 3-day supply of food, water, and medications for all residents
• Have a written plan for relocating residents if the facility becomes uninhabitable
• Document all drills, including any deficiencies identified and corrective actions taken