There is no official PDF of California Title 22. The California Code of Regulations, Title 22 spans hundreds of chapters covering health care facilities, community care licensing, Medi-Cal, environmental health, and more, and the Office of Administrative Law updates the text weekly, so a consolidated download would be out of date almost immediately. The authoritative version lives on OAL’s online California Code of Regulations database, where you can search by section number or browse by division.1Office of Administrative Law. California Code of Regulations (CCR) Cornell’s Legal Information Institute mirrors the full code and is a convenient alternative for reading individual sections.
Anyone working from a PDF found elsewhere on the internet is working from a snapshot. For licensing decisions, citations, or compliance, the online database is the version that governs.
What Title 22 Contains
Title 22 carries the heading “Social Security,” but that name understates its reach. It holds the operating rules for licensed care facilities, public health programs, and social services administered by several California agencies. The divisions people search for most often are:
- Division 1: Employment Development Department
- Division 1.8: California Department of Aging
- Division 2: Department of Social Services and Department of Health Services
- Division 3: Health Care Services, including Medi-Cal
- Division 4: Environmental Health
- Division 4.5: Health Planning and Facility Construction
- Division 5: Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies
- Division 6: Licensing of Community Care Facilities
- Division 9: Prehospital Emergency Medical Services
- Division 12: Child Care Facility Licensing Regulations
The California Department of Public Health enforces Division 5 for hospitals, skilled nursing facilities, and similar health care settings. The California Department of Social Services enforces Division 6 through its Community Care Licensing Division, overseeing residential care facilities for the elderly, adult residential facilities, and group homes. Because the enforcing agency depends on the division, finding the right division is the first step.
Finding the Section You Actually Need
The database is organized by Title, Division, Chapter, and Section. If you already have a section number from a citation letter, a legal filing, or a training document, type it in and go straight there. If you are researching a topic cold, browsing by division is faster. Division 5 is the entry point for hospital and skilled nursing rules. Division 6 covers community care facilities. Division 3 is where Medi-Cal lives.
Community Care Facility Rules Under Division 6
Division 6 sets licensing standards for facilities like Residential Care Facilities for the Elderly and Adult Residential Facilities. These are not medical facilities. The regulations focus on daily living support, safety, and resident dignity.
Administrator Certification
Every RCFE administrator must hold a valid certificate before starting work. Obtaining that certificate requires completing an Initial Certification Training Program and passing a written examination.2Legal Information Institute. California Code of Regulations Title 22, 87406 – Administrator Certification The training covers regulatory requirements, facility operations, and caring for residents with dementia. Operating without a certified administrator is a straightforward path to a citation.
Resident Rights
Division 6 guarantees personal rights for every resident, including the right to privacy, the right to file grievances without retaliation, and the right to keep and use personal belongings.3Legal Information Institute. California Code of Regulations Title 22, 87468 – Personal Rights of Residents Facilities must inform residents of these rights in writing, and violations can trigger enforcement action.
Physical Space Standards
Each resident must have an individual adult bed with a mattress, pillow, and clean linens, plus at least eight cubic feet of dresser space for personal belongings.4Legal Information Institute. California Code of Regulations Title 22, 87307 – Personal Accommodations and Services Facilities with a capacity of seven or more must post a current activity calendar, and outdoor areas must be furnished and include shade. The Community Care Licensing Division’s pre-licensing checklist covers items down to hot water temperature and locked storage for medications and cleaning supplies.5California Department of Social Services. Pre-Licensing Facility Evaluation Checklist – Adult Residential Facility
Health Care Facility Rules Under Division 5
Division 5 covers general acute care hospitals, skilled nursing facilities, home health agencies, and clinics. The standards are more clinically detailed than Division 6 because these facilities deliver medical treatment.
Medical Record Retention
Health records for discharged adult patients must be completed and filed within 30 days of discharge, then kept for at least seven years.6Legal Information Institute. California Code of Regulations Title 22, 72543 – Patients Health Records That retention period matters if you need to request records for a legal claim, insurance dispute, or continuing care. Facilities must also maintain systems for prompt retrieval and protect records from unauthorized access.
Nurse-to-Patient Ratios
Section 70217 sets specific licensed nurse-to-patient ratios by unit type. In a critical care or intensive care unit, the ratio must be one nurse to two or fewer patients at all times. In medical and surgical units, the ratio is one nurse to five or fewer patients.7Legal Information Institute. California Code of Regulations Title 22, 70217 – Nursing Service Staff These are floor ratios, not shift averages. The ICU ratio also applies to intensive care newborn nurseries.
Activity Programs in Skilled Nursing Facilities
Skilled nursing facilities must maintain activity programs covering social activities that promote group interaction, indoor and outdoor recreation, opportunities to participate in activities outside the facility, creative and educational programming, and exercise.8Legal Information Institute. California Code of Regulations Title 22, 73379 – Activity Program Scope Each resident has the right to attend the religious program of their choice. Paper-only activity calendars are a common deficiency finding during inspector surveys.
Medi-Cal Rules in Division 3
Many people looking up Title 22 are actually after the Medi-Cal regulations. Division 3 contains the California Medical Assistance Program rules, organized into chapters covering eligibility determination and share-of-cost calculations, covered services and their scope, prepaid health plans, and the drug formulary and medical supplies listing.9Legal Information Institute. California Code of Regulations Title 22, Division 3, Subdivision 1 – California Medical Assistance Program These regulations translate the broader Medi-Cal program authorized by the Welfare and Institutions Code into the operational rules that providers and county eligibility workers apply. If your question is about eligibility, provider enrollment, or covered benefits, Division 3 is the right place to search.
Background Checks for Licensing
Before the state issues a license to operate a community care facility, every applicant, administrator, and adult living in the facility who is not a client must obtain a criminal record clearance or an exemption. Fingerprints go electronically to the California Department of Justice, and a second set is forwarded to the FBI for a federal records check.10Legal Information Institute. California Code of Regulations Title 22, 80019 – Criminal Record Clearance Clearance must be obtained before the individual begins working, living, or being present in the facility. Health care facilities under Division 5 have parallel requirements enforced by the California Department of Public Health.
Incident Reporting Deadlines
Title 22 requires facilities to report certain events to the state on tight timelines. The rules differ between health care facilities and community care facilities.
Health Care Facilities
Hospitals, skilled nursing facilities, and similar providers must report epidemic outbreaks, poisonings, fires, major accidents, deaths from unnatural causes, and any other unusual occurrence that threatens the safety of patients, staff, or visitors. The report goes to the local health officer and the Department within 24 hours, by telephone with written confirmation or by telegraph.11Legal Information Institute. California Code of Regulations Title 22, 76551 – Unusual Occurrences Fires and explosions also must be reported within 24 hours to the local fire authority, or to the State Fire Marshal where no organized fire service exists.
Community Care Facilities
Community care facilities follow a tiered timeline based on severity. Suspected physical abuse of an elder or dependent adult resulting in serious bodily injury must be reported within two hours to the local ombudsman, the licensing agency, and local law enforcement. Physical abuse without serious bodily injury must be reported within 24 hours to the same three entities.12Legal Information Institute. California Code of Regulations Title 22, 81061 – Reporting Requirements Other reportable events, including suspected psychological abuse, require notification to the licensing agency by the next working day, followed by a written report within seven days that includes the client’s name, age, sex, date of admission, a description of the event, the attending physician’s findings, and the disposition of the case.
Penalties for Violations
When a facility violates Title 22, the Department can issue citations carrying civil penalties. The amount depends on severity:
- Class A violations carry $1,000 to $5,000 per violation. These are the most serious findings, typically involving direct risk to patient or resident safety.
- Class B violations carry $50 to $250 per violation.
If a facility fails to correct a Class A or Class B violation by the deadline in the citation, the Department adds $50 per day for each day the violation continues. Penalties triple for a second or subsequent violation of the same regulation within any 12-month period when a citation was previously issued and a penalty assessed.13Legal Information Institute. California Code of Regulations Title 22, 73717 – Penalties The trebling provision is where the real financial exposure sits. A facility that repeatedly fails the same standard can see penalties escalate quickly.
License Suspension and Revocation
Beyond monetary penalties, the state can suspend or revoke a facility’s license. Under the Health and Safety Code, grounds for revocation include violating Title 22, aiding or permitting violations, engaging in conduct harmful to the health, welfare, or safety of residents, and criminal convictions of the licensee or associated individuals.14California Legislative Information. California Health and Safety Code 1569.50
Licensees generally have a right to a hearing before their license is revoked. The Director can temporarily suspend a license without a prior hearing when immediate action is necessary to protect residents from physical or mental abuse or any other substantial threat to their health or safety. In that situation, the Director notifies the licensee of the temporary suspension and simultaneously serves an accusation that starts the formal hearing process.15Legal Information Institute. California Code of Regulations Title 22, 87775 – Revocation or Suspension of License The temporary suspension takes effect immediately, and the facility must stop operations until the matter is resolved.