Patient & Caregiver Guide: Choosing the Right RCFE in California for Dementia

This guide is designed for families placing a loved one with dementia into assisted living or Board/Care (RCFE) in California.

Step 1: Understand what an RCFE is (and isn’t)

RCFE = assisted living (not a nursing home), board/care, personal care home

They provide:

• Medication assistance
• Supervision
• Help with bathing, dressing, meals
• Dementia supervision

They do NOT provide:

• 24/7 skilled nursing care
• Intensive medical care

RCFEs are licensed and regulated by the California Department of Social Services Community Care Licensing Division (CCLD), which conducts inspections and enforces safety standards.

A board and care is a subtype of RCFE, and are largely subject to the same state regulations. Board and cares tend to be smaller, usually six beds, and are often less expensive due to fewer administrative costs.

Step 2: Use the OFFICIAL California licensing database

This is the single most important site:

Official California RCFE licensing lookup:

https://www.cdss.ca.gov/inforesources/community-care-licensing/facility-search-welcome

-Scroll down and click “Search for a facility”
-Then Scroll down and click “Elderly Assisted Living”
-You should get this page:
 

Can search by county or zip code if you do not yet have specific facilities in mind

This site includes:

• Licensing status
• Inspection reports
• Complaint investigations
• Violations and citations
• Ownership information

Step 3: How to interpret violations and citations

When you open a facility, look for:

Type A violations — RED FLAG

These are serious violations posing immediate risk to residents.

Examples:

• Falls due to poor supervision
• Medication errors causing harm
• Abuse or neglect
• Residents wandering unsupervised

Avoid facilities with multiple or repeat Type A violations. Even one recent type A violation can be a red flag. You can also go into individual reports to see if the recent ones had Type A violations.

Type B violations — caution

These are less severe but still concerning.

Examples:

• Staffing shortages
• Medication documentation errors
• Training deficiencies

Complaint findings — extremely important

Look for:

Substantiated complaints → proven violations

• Abuse
• Neglect
• Medication errors
• Falls due to supervision failure

Substantiated complaints mean the allegation was proven true by investigators. You can also see the actual reports.

Step 4: Check the Long-Term Care Ombudsman

This is an independent watchdog.

They:

• Visit facilities
• Investigate complaints
• Advocate for residents

Call your local ombudsman and ask:

• "Do you have concerns about this facility?"
• “Would you place your own family member here?”

To reach them, you can use 
1) https://www.aging.ca.gov/programs_and_services/long-term_care_ombudsman 
2) Or simpler, call the state ombudsman hotline and ask to connect to your local ombudsman: 
1‑800‑231‑4024

Step 5: Consider if facility has dementia care capability

Ask directly:

• Do you provide:
• Memory care unit?
• Secured unit?
• Wandering prevention?
• Staff trained in dementia care?

Not all RCFEs are appropriate for dementia. Smaller board and care facilities usually will not be able to handle persons with behaviors that can pose a risk to themselves or others.

Step 6: Visit the facility IN PERSON (non-negotiable)

Visit at least 3–5 facilities.

Visit at different times of the day, if possible, as staffing varies dramatically by time.

Step 7: What to look for during your visit (Quality Indicators)

#1 Staff-to-resident ratio (critical)

Ask for actual staffing, don't trust a brochure:

Good ratios for dementia care:

• Daytime: 1 staff : 6–8 residents
• Evening: 1 : 8–12 residents
• Overnight: 1 : 12–20 residents

#2 Observe residents carefully

Residents should be:

• Clean
• Groomed
• Calm
• Engaged

Red flags:

• Residents unattended
• Residents calling for help unanswered
• Residents slumped or sedated excessively

#3 Observe staff behavior

Staff should be:

• Calm
• Patient
• Respectful

Avoid facilities where staff:

• Ignore residents
• Rush care
• Appear overwhelmed

#4 Smell test

Facility should NOT smell strongly of urine or feces.

Strong odor = poor care.

#5 Ask about falls

Ask directly:

"How many falls per month occur in the memory care unit?"

Lower is better.

#6 Ask about wandering prevention

Look for:

• Secured doors
• Alarmed exits
• Enclosed outdoor space

#7 Ask about hospital transfer rates

Ask:

"How often do residents go to the hospital?"

Frequent transfers = poor management.

Step 8: Important Questions to Ask

Ask administrator:

Staffing:

• What is your staffing ratio day/evening/night?
• How many staff on memory care overnight?

Training:

• Are staff trained in dementia care?
• How often is training updated?

Safety:

• How do you prevent falls?
• How do you prevent wandering?

Medical:

• Who manages medications?
• How do you monitor health changes?

Turnover:

• How long have your caregivers worked here?
• High turnover = red flag.

Step 9: Check license status and ownership stability

Avoid facilities with:

• License probation
• License revocation history
• Frequent ownership changes

Step 10: Large corporate facilities may have poor staffing 

Smaller facilities often have better, more stable staffing and more individualized care.

Large facilities may be fine—but verify staffing ratios carefully. Do not trust marketing brochures, ask directly and trust your eyes.

Step 11: Special considerations for Smaller Board and Care Homes (6 beds or fewer)

Small board-and-care homes can provide a quieter environment, more personalized care, and more consistent caregivers than larger facilities. Often the cost is lower as well. However, quality varies greatly, so careful evaluation is essential.

When visiting, ask:

• Who owns and operates the home? Homes where the owner is regularly present often have closer oversight than those managed remotely.
• How long has the home been under the current owner? Frequent ownership or administrator changes can be a warning sign.
• Who provides the care? Is there an awake caregiver overnight, or is staff sleeping? How many caregivers are present during the day and at night?
• How experienced are the caregivers? Ask how long they have worked there and what dementia-specific training they have received.
• What happens if the caregiver calls out sick? With only a few staff members, backup coverage is especially important.
• Are residents ever left alone? Ask what happens if a caregiver needs to accompany a resident to the emergency department or leaves to run errands.
• Can they manage dementia behaviors? Ask about their experience with wandering, agitation, nighttime confusion, falls, and incontinence. 
• Can they care for residents as dementia progresses? Some homes cannot safely manage people with advanced dementia or increasing care needs. Ask what are the symptoms and indicators that would necessitate a transfer to a higher level facility.
• How is medical care coordinated? Ask who manages medications, communicates with physicians, and responds to emergencies.
• Talk with current families if possible. Ask whether communication is good and whether they would choose the home again.

Finally, trust your observations. In a well-run board-and-care home, residents should appear clean, comfortable, and engaged, caregivers should know each resident well, and the atmosphere should feel calm, respectful, and home-like.

Sources

California Department of Social Services (CDSS) – Community Care Licensing Division
https://www.cdss.ca.gov/inforesources/community-care-licensing

California Department of Social Services – Evaluator Manual for Residential Care Facilities for the Elderly

California Health and Safety Code, Division 2, Chapter 3.2 – Residential Care Facilities for the Elderly

California Department of Aging – Assisted Living Consumer Information
https://www.aging.ca.gov

California Long-Term Care Ombudsman Program
https://www.aging.ca.gov/programs_and_services/long-term_care_ombudsman

National Institute on Aging – Residential Care and Assisted Living
https://www.nia.nih.gov/health/residential-care-and-assisted-living

Alzheimer’s Association – Residential Care Options and Memory Care
https://www.alz.org/help-support/caregiving/care-options/residential-care