Title 22 Explained: What California Assisted Living Operators Need to Know

What Is Title 22 and Why Does It Matter for Assisted Living in California?

If you’re running or opening an assisted living facility in California, understanding Title 22 of the California Code of Regulations (CCR) is not optional, it’s essential. 

Title 22 is the regulatory foundation for assisted living facilities in California, including Residential Care Facilities for the Elderly (RCFEs) and Adult Residential Facilities (ARFs), managed by the California Department of Social Services (CDSS).

These rules ensure your facility operates safely, ethically, and in the best interest of residents. Failing to comply can result in citations, fines, or even license revocation.

Who Does Title 22 Apply To?

Title 22 applies to any California-based facility licensed to care for adults who are not related to the licensee, including both RCFEs (serving older adults) and ARFs (serving adults with developmental disabilities, mental health needs, or other conditions).

Key Title 22 Requirements for California Operators

Here are the five most important areas of Title 22 that every California operator needs to understand:

1. Licensing and Certification

Operators must apply for and maintain a license through CDSS. Title 22 outlines:

• Facility types and designations (RCFE vs. ARF)
• Application and renewal procedures
• Physical plant and safety requirements
• Staffing and financial disclosure requirements

? Synkwise Tip: Synkwise helps organize documentation and track key renewal and compliance deadlines so nothing slips through the cracks.

2. Staffing Ratios and Ongoing Training

Title 22 enforces minimum staffing levels and mandates that staff receive regular training in resident care, safety, and emergency procedures.

You’ll need:

• Administrators with certified training
• Direct care staff with specific onboarding and annual training
• Night staffing that meets resident needs

? Synkwise Tip: Use training tracking tools to log completed modules, schedule refreshers, and stay ready for inspection.

3. Resident Rights and Grievance Procedures

All residents have protected rights under Title 22, including:

• The right to dignity, privacy, and respect
• The right to access their records
• And the right to file complaints without retaliation

Facilities must also maintain proper grievance reporting and response logs.

? Synkwise Tip: Built-in resident records and progress notes help document complaints, follow-ups, and outcomes which is vital during audits.

4. Health, Safety, and Medication Management

This includes:

• Sanitation and infection control
• Food service and nutrition
• Medication storage, administration, and logging
• Facility safety standards (fire drills, exit signage, etc.)
  

? Synkwise Tip: With a robust eMAR, automated med passes, and safety documentation, Synkwise helps ensure health protocols are followed and auditable.

5. Resident Assessments and Care Planning

Every resident must have:

• A pre-admission appraisal
• A needs and services plan
• Periodic updates based on reassessments

Failing to keep these plans current is one of the most common violations.

? Synkwise Tip: Synkwise makes it easy to create and update assessments, with reminders for reassessment timelines and staff notes in one place.

How to Stay Compliant with Title 22 in California

Title 22 is detailed and it’s updated regularly. To stay compliant, you should:

• Bookmark the California DSS Title 22 Portal
• Monitor for regulatory updates or notices
• Keep digital records audit-ready
• Regularly train and retrain your staff
• Use a platform like Synkwise that’s built to support California operators
  

How Synkwise Helps California Assisted Living Facilities Stay Compliant

Synkwise is designed for assisted living providers who want to stay organized, audit-ready, and confident in their compliance with Title 22 and beyond.

From medication administration to assessments, staff training to emergency drills, Synkwise turns compliance into a manageable daily workflow, not a last-minute panic before surveys.

And because we work closely with providers across California, Synkwise already includes:

• Built-in LIC forms required by California
• State-specific documentation tools to help meet licensing standards
• Flexible customization options so communities can adapt forms to their workflows

Title 22 Compliance Doesn’t Have to Be Overwhelming

Operating in California means navigating some of the most detailed assisted living regulations in the country. But when you have the right systems in place, compliance doesn’t have to be overwhelming.

Whether you’re preparing to open your first RCFE or managing multiple ARFs, understanding and implementing Title 22 is the key to delivering excellent care and staying in business.

? Want to see how Synkwise supports compliance for California providers? Schedule a free demo