5 lessonsAbout 30 minutes
ALW stages and roles
Five short lessons on the path from a first question to enrollment in the Assisted Living Waiver (ALW), and on keeping eligibility, the waitlist, a released slot, a facility’s participation, an opening and placement apart.
- Given a family’s or a referrer’s question, separate the published criteria, waitlist status, a released slot, facility participation, a current opening and enrollment, and state none of them as done before it is.
- Given a common ALW question, name who decides it (DHCS, the CCA, CDSS, the home or another provider) and send it to that owner.
5 lessonsAbout 32 minutes
Reporting duties after an incident
Five short lessons on what to report after an event: safety first, then each separate duty (abuse reporting, licensing, the ALW program, workplace safety and privacy), with the sources linked.
- When someone may be in danger, act on safety first, using the site’s emergency process and 911 when it applies, before any form.
- For one event, name each reporting branch that may apply and check each one on its own, not as one form.
5 lessonsAbout 32 minutes
Change in condition and handoff
Five short lessons on turning "something is off" into a clear description of the change, a handoff with a clear request and a confirmed next step, without diagnosing.
- Describe a change in a resident’s condition by comparing it with the person’s usual pattern, with when it began, and without naming a cause.
- Raise a change the way the person’s plan and the site’s procedure say: the emergency process and 911 first when they apply, and the approved backup when the named contact does not answer.
5 lessonsAbout 30 minutes
Joining ALW as a facility
Five short lessons for owners and administrators weighing the Assisted Living Waiver (ALW): what it pays and does not pay, the three DHCS steps, what a participating facility provides, a readiness check, and what enrollment does not guarantee.
- When an owner or a family asks about cost, separate what ALW pays the facility for care from what the resident pays for room and board, using the 2026 figures exactly as DHCS and CDSS state them.
- For a facility planning to apply, put the three DHCS steps in order, name both applications and the verification visit, and promise no date.
5 lessonsAbout 34 minutes
Dementia care rules
Five short lessons on the California rules behind dementia care in an RCFE: the training hours the law requires, reading a behavior as a message, exits and wandering, night supervision, and where the current rules live.
- For a new hire or a certified nurse assistant, state the dementia-care hours owed before independent work, within four weeks and each year, exactly as sections 1569.625 and 1569.626 set them.
- When a resident with dementia acts in a new way, check and report the physical signs section 87705 names, and leave diagnosis and medicine to the licensed professional.
5 lessonsAbout 34 minutes
Medication help and condition limits
Five short lessons on the California rules around medications and health conditions in an RCFE: assisting without administering, the training a medication helper must have, PRN orders and records, the allowable, restricted and prohibited conditions, and hospice residents.
- Sort a medication task on shift as assistance or administration, without forcing, hiding or overriding a refusal.
- Check a medication helper's training against section 1569.69: the hours for the home's licensed size, the exam, the yearly in-service and the repeat rules.
5 lessonsAbout 35 minutes
Person-centered ALW service plan
Five short lessons for CCA care coordinators on the person-centered Individual Service Plan (ISP): who leads the plan, goals and preferences, assessed needs and services, risks and back-up plans, and how to modify a setting right, then sign, share, review and update the plan.
- Set up an ISP meeting the participant leads, with the people the participant chooses, plain-language information and an informed choice of setting, services and providers.
- Write strengths, goals and preferences that come from the participant, each goal with its supports and who provides them, whatever the person's age or diagnosis.
5 lessonsAbout 32 minutes
ALW candidate screen
Five short lessons for hospital and SNF discharge planners and case managers: the published Assisted Living Waiver (ALW) criteria, Medi-Cal and level of care, the waitlist and its institutional-transition priority, what a referral can and cannot promise, and who decides each question.
- Given a patient's chart, sort each published ALW criterion as matches, open or does not match as written, without deciding eligibility.
- Given a Medi-Cal or level-of-care question, send it to its owner (the county, the CCA or DHCS) and record it as open until that owner answers.
5 lessonsAbout 34 minutes
An ALW referral that moves
Five short lessons for discharge planners, case managers and community referrers: ask the person first and share only what the next step needs, keep every choice with the person, send the documents a home and a Care Coordination Agency commonly ask for, explain who does each next step without promising a date, and close the loop on every referral.
- Before any record leaves your desk, confirm that the person wants the referral and send only what the receiving agency or home asked for.
- Present the waiver, the agency and the home as the person's own choices, using the DHCS lists, without naming a favorite.
5 lessonsAbout 35 minutes
RCFE health-condition decisions
Five lessons for RCFE leaders and referrers on whether a home may accept or keep a person with a given health condition: incidental medical services, what a restricted condition requires, the prohibited conditions and relocation, exceptions and the hospice route, and reading the medical assessment.
- Place a health condition named in a referral or a medical assessment as allowable, restricted, prohibited or a question for licensing, and name the section that decides it.
- Before a person with a restricted condition moves in, list what the home must have in place: the physician's documentation, the professional who performs the procedure, talks with other providers, hands-on training and any Department approval.
5 lessonsAbout 35 minutes
Required staff training and records
Five short lessons for RCFE administrators and licensees on the training California requires of staff: the forty starting and twenty yearly hours, the dementia and special-conditions hours inside them, medication-helper training, who may teach and what counts, and the personnel and training records to keep, and for how long.
- Plan a new direct-care hire's first four weeks so that twenty hours, with six dementia hours and four special-conditions hours inside them, are done before she works independently with residents.
- Set each staff member's yearly training to the statutes: twenty hours with eight dementia and four special-conditions hours, plus eight medication in-service hours for each medication helper.
5 lessonsAbout 36 minutes
Hospice care in an RCFE
Five short lessons for hospice and home-health partners and RCFE leaders on working together when a resident elects hospice: the home's hospice care waiver and its conditions, the hospice care plan as the shared document, the staff training before care begins, the records and medications, the reports, and where the ALW care coordination agency fits.
- Check, before the first hospice visit in an RCFE, that the home's waiver, the resident's own hospice contract and an agreed written care plan are all in place.
- Review a draft hospice care plan against section 87633 and name each missing or improper part, including the home's duties and the staff training.
5 lessonsAbout 34 minutes
The HCBS settings rule in an ALW home
Five short lessons for facility leaders and CCA staff on the federal home and community-based settings rule in an ALW home: the qualities every setting must have, rights in daily life, the person's own unit and written agreement, how a right is modified through the person-centered plan, and how the state checks compliance.
- Check an ALW home against the five qualities of a home and community-based setting, and name the settings the rule presumes to be institutional.
- Judge a house rule or routine against the rights to control one's schedule, food at any time, visitors at any time, privacy, and freedom from coercion and restraint.
5 lessonsAbout 34 minutes
2025 dementia regulations
Five short lessons for RCFE administrators on the dementia-care regulations in effect since January 1, 2025: where the standards moved, the plan of operation and dementia programs, training and staffing, the medical assessment (LIC 602A) and the appraisals, and the notices CDSS issued.
- Given a policy or plan written before 2025, name each dementia rule that moved, changed or was repealed, and the current Title 22 section that holds it.
- Check a plan of operation against section 87208, and against section 87706 when the home advertises dementia care, and list every missing item.
5 lessonsAbout 35 minutes
ALW paperwork for the facility office
Five short lessons for facility office, admissions and billing staff and CCA staff: the Freedom of Choice, Amenity and Informing Notice forms, the assessment and the Individual Service Plan, the home's own admission paperwork, notices when something changes, and how a participating home bills Medi-Cal for ALW care.
- Given a new ALW resident's file, name each DHCS form and the ISP, who completes it and where its copy belongs, naming no form the sources do not name.
- Given a move-in, line up the home's own admission paperwork with the ALW enrollment date, with the admission agreement signed by both sides within seven days.
5 lessonsAbout 36 minutes
Evictions, notices and transfers
Five lessons for RCFE leaders and CCA staff on involuntary moves: the lawful reasons to evict, the written notice and what it must say, three-day notices and other urgent moves, relocation planning and a safe move, and the roles of the Long-Term Care Ombudsman, Community Care Licensing and the ALW care coordinator.
- Test a proposed eviction against the five reasons in section 87224 and the admission agreement, and stop one that rests on no listed reason.
- Check a draft notice to quit for the notice period, the specific facts, the effective date, the resources, the complaint contacts and the exact court statement, and route the copy and the five-day report.
4 lessonsAbout 20 minutesFamily guide, no test
What ALW is
A short guide for families and representatives in four lessons: what the Assisted Living Waiver (ALW) pays for and what it does not, who may qualify by the published criteria, how the waitlist works, who decides each step, and what a care coordination agency does.
- Explain to a relative, in one sentence, that ALW pays for care services and the person pays the home for room and board.
- Check a loved one's situation against the published ALW criteria and name which ones are still open, without deciding eligibility.
4 lessonsAbout 20 minutesFamily guide, no test
Choosing a home
Four short lessons for families and representatives: the difference between an RCFE and an ARF, how to check a home's license and record on the CDSS Facility Search, what to look at and ask on a visit, and how the choice works when the person uses ALW.
- Pick the kind of home to look for, RCFE or ARF, from the person's age and needs, before the search starts.
- Check a home on the CDSS Facility Search for its type, license status, complaints and citations, and know when to call the Regional Office.
4 lessonsAbout 20 minutesFamily guide, no test
Rights in an RCFE
A short guide for families and representatives in four lessons: the personal rights every resident of a Residential Care Facility for the Elderly (RCFE) has, the added protections for people in the Assisted Living Waiver (ALW), where to take a concern, and the protection from being punished for speaking up.
- Find the rights form your loved one signed at move-in and name the rights it gives in daily life, choices, money and safety.
- Check a house rule against the ALW protections for visitors, food, schedule and a lockable door, and know that any limit must be written in the ISP with the person's consent.
3 lessonsAbout 16 minutesFamily guide, no test
ALW and money
A short guide for families and representatives in three lessons: what ALW pays for and what the person pays the home, how the 2026 SSI/SSP amounts split between the home and the person, and which extra charges a home may make for a resident on SSI/SSP.
- Explain to a relative, before a move, that ALW pays the home for care services and the person pays the home for room and board from their own income.
- Read the 2026 CDSS SSI/SSP amounts for a person in a licensed care home and say which part goes to the home and which part the person keeps.
3 lessonsAbout 18 minutesFamily guide, no test
The care plan meeting
A short guide for families and representatives in three lessons: what the ALW care plan (the Individualized Service Plan, or ISP) is and who writes it, how your loved one leads the plan meeting and who they invite, what to bring and ask, how often the plan is reviewed, and what to do if the plan does not fit.
- Explain to a relative what the ALW care plan is, who writes it, and that it starts from your loved one's own goals and preferences.
- Help your loved one get ready for the plan meeting: who leads, who they invite, a time, place and language that suit them, and what to bring.
3 lessonsAbout 18 minutesFamily guide, no test
A notice to move out
Three short lessons for families and representatives of a person in an RCFE: what a written notice to move out must say, how much time it must give and when it can be shorter, and who can help: the Long-Term Care Ombudsman, Community Care Licensing, the ALW care coordinator and, when it is needed, a lawyer.
- Read a written notice to move out and list what the rules say it must contain, and what is missing from it.
- Check how much time the notice gives, and tell when a shorter notice needs licensing's written approval first.
5 lessonsAbout 35 minutes
Resident rights on shift
Five short lessons for RCFE and ARF caregivers on residents' personal rights as they meet them on shift: the state rights list, the added setting rights for people in the Assisted Living Waiver (ALW), privacy in personal care, consent and choice in daily routines, and what to do when a right seems to be at risk.
- Find the rights form that applies to a resident (LIC 613C-2, LIC 613C or LIC 613) and name the right a shift task touches.
- Check a routine or house rule against the ALW setting rights, and send any limit that is not written in the ISP to the supervisor the same day.
5 lessonsAbout 36 minutes
Personal care and physical needs
Five short lessons for RCFE caregivers: how aging changes daily care, help with bathing, dressing, grooming and toileting with dignity and choice, skin care and early signs of skin breakdown, falls prevention and safe moves, and eating, drinking and when to report a change.
- Give help with bathing, dressing, grooming or toileting that keeps the resident's privacy, dignity and choices, and lets the resident do each step they can.
- Spot early signs of skin breakdown during daily care and report them early through the facility procedure, without treating the skin or naming a stage.
5 lessonsAbout 35 minutes
Postural supports, restricted conditions and hospice teams
Five lessons for RCFE caregivers on the topics of section 1569.696: what a postural support is and how it differs from a restraint, the restricted health conditions and what trained staff may do for each, and working with the hospice team when a resident gets hospice care in the home.
- Judge a device on shift as a postural support or a restraint, using the physician's order, quick release, the hands-and-feet rule and the bed-rail rule.
- Name the tasks you may and may not do for a resident with a restricted health condition, from her record of care and the training you have completed.
5 lessonsAbout 35 minutes
Fire safety and emergencies
Five short lessons for RCFE staff on the California rules behind emergencies: the emergency and disaster plan and your part in it, the fire clearance, evacuating residents who need help by day and at night, drills and fire devices, and power outages, heat and when to call 911.
- Name your assignment in the home's emergency and disaster plan, and find the exits, assembly points, shut-offs, keys and resident information it lists, before an emergency.
- Spot a resident change that may affect the fire clearance, such as a new walker, a bedridden resident or a resident who does not react to the alarm, and tell the administrator right away.
5 lessonsAbout 34 minutes
Psychosocial needs and cultural competency
Five short lessons for RCFE caregivers: noticing loneliness and signs of depression and reporting what you see, meaningful activity and choice, respecting culture, language and faith, the rights of LGBT residents under California law, and using a resident's chosen name and pronouns and raising a concern.
- Describe and report a lasting change in a resident's mood, interest, sleep, eating or social contact in plain words, without naming a diagnosis, and treat talk of suicide as urgent.
- Plan a resident's day around the person's own interests and choices, including free time and the right to say no.
5 lessonsAbout 32 minutes
Medication words, orders and routes
Five short lessons for RCFE staff who help residents take their own medications: the words the rules define, reading a prescription label and a Drug Facts label, PRN and over-the-counter orders, routes and who handles each one, and when to stop and ask.
- Read the medication words on an order or label (assist, administer, PRN, OTC, skilled professional) and say what each one asks of staff, without guessing at a short form you do not know.
- Check a prescription label and a Drug Facts label against the resident and the order, and stop and report a mismatch without changing the label.
5 lessonsAbout 32 minutes
Centrally stored medications
Five short lessons for RCFE medication helpers and administrators: when a medication must be centrally stored, how it is stored, the centrally stored medication record (CDSS form LIC 622), counts, refills and running out, and what happens to medications that leave the home or are no longer needed.
- Decide whether a resident's medication must be centrally stored, using the three reasons in section 87465(h)(1), and leave each finding to the person the rule names: the physician, the administrator or the Department.
- Keep centrally stored medications in a safe, locked place, in their original labeled containers, and report a key, label or container problem without fixing it yourself.
5 lessonsAbout 33 minutes
Side effects, errors and psychotropics
Five short lessons for RCFE staff who help residents take their own medications: noticing and describing a possible side effect, what to do and write down after a medication error, what the training laws say about psychotropic medicines for residents with dementia, the resident's right to say no, and reporting through your facility's procedure.
- Describe a possible side effect on shift in plain, timed facts and pass it to your supervisor, without naming a cause or changing a medicine.
- Respond to a medication error by checking on the resident first, telling your supervisor at once and writing the facts, without making up for it with another dose.
5 lessonsAbout 35 minutes
Assessment and care tiers
Five short lessons for CCA care coordinators and nurses on the ALW Assessment Tool: what it measures, who completes it and when, how its score sets a tier from 1 to 5, what a tier changes and what it does not, and how to explain a tier without promising one.
- Given an upcoming assessment, name who may complete the ALW Assessment Tool, when it is due and who makes the final determination, as the waiver states.
- Given a participant's assessed needs, explain how the tool's score sets a tier from 1 to 5, including the Tier 5 criteria, without choosing a tier by hand.
5 lessonsAbout 35 minutes
Monitoring, reassessment and tier changes
Five short lessons for CCA care coordinators and nurses on keeping an ALW plan current: the monthly contact the waiver requires, what to look for and record at each visit, the six-month reassessment and its packet, when a change in condition calls for an earlier reassessment, and how a tier change is assembled, decided and shared with the home and the participant.
- Plan each participant's monthly contact so it meets the waiver: with the participant or responsible parties, in person or by a telehealth visit the participant chose, and recorded in the ISP's monitoring section.
- Run a monthly visit that checks every ISP service, finds new risks, verifies Medi-Cal and reports abuse, neglect or other problems at once to the right agencies.
5 lessonsAbout 34 minutes
ALW incidents and quality assurance
Five short lessons for ALW care coordinators: what the waiver counts as an incident, who reports it to whom and how fast, follow-up and records, the participant's safety plan, and the quality-assurance measures the waiver lists.
- Decide whether an event a home reports is an ALW incident, using the waiver's list, the DHCS checklist and the DHCS priority levels.
- Route an ALW incident within the times the waiver states: 24 or 72 hours from the home, at once from the CCA, and immediately on signs of abuse or neglect.
5 lessonsAbout 33 minutes
ALW waitlist and enrollment timing
Five lessons for Care Coordination Agency staff: how the Assisted Living Waiver (ALW) waitlist works as DHCS describes it, the slot release order and priority groups, the CCA's work from a released slot to enrollment, timing the move with the home and the participant, and keeping people informed without promising what no one controls.
- Given a new waitlist request, screen it, submit it to DHCS and send the written notice within the Policy Letter 24-002 times, and record the placement date.
- Given the requests on a CCA's list, sort each into its priority group, file the proof the first group needs, and explain the release order without quoting a split or a date.
5 lessonsAbout 36 minutes
RN level of care and reassessment
Five short lessons for CCA registered nurses on the ALW level-of-care determination: what nursing-facility level of care means under the waiver and Title 22, the RN's assessment duties, the six-month reassessment and its window, what changes the result and how to document it, and the participant's rights when DHCS changes services.
- Given a referral or a participant's needs, explain nursing-facility level of care as the waiver and Title 22 sections 51120 and 51124 state it, without treating one diagnosis or one task as the answer.
- Before an assessment, confirm that the RN giving the tool meets the waiver's license, experience and DHCS training requirements, and gather the facts from the participant, the family and the records.
5 lessonsAbout 35 minutes
Residential Habilitation and Augmented Plan
Five short lessons for CCA care coordinators and nurses on two ALW services for behavior needs: Residential Habilitation and the Augmented Plan of Care Development and Follow-up. What the waiver says each one is, who it is open to, the DHCS prior approval both need, the documents behind a request, and how a decision or a denial reaches the participant.
- Given a participant's behavior needs, tell Residential Habilitation from the Augmented Plan of Care and name who provides each, as the waiver describes them.
- Given a participant's tier and setting, say which of the two services the waiver opens to them, without treating an open service as approved.
5 lessonsAbout 35 minutes
RCFE basics for visiting clinicians
Five lessons for hospice, home-health and other visiting professionals on what a California RCFE can and cannot do: non-medical care and supervision, what facility staff may do with medications, which restricted-condition tasks stay with you, what you leave in writing, and the handoff and records that follow each visit.
- Sort a task you plan for an RCFE resident as one facility staff may do, one they may do only after your written instruction, or one that stays with the resident or a licensed professional, naming the section that decides.
- Check a PRN order and the physician's written statement against section 87465 before staff help with it, and say what is missing and who completes it.
5 lessonsAbout 34 minutes
Dementia program daily care
Five short lessons for RCFE administrators on the daily side of dementia care under Title 22: hazards, heating devices and water; access to cleaning products, tools and other items; the planned activities program; planning care with the resident and her representative; and the regulated steps when a resident's needs go beyond what the home provides.
- Walk a home's buildings and grounds and say what each hazard needs under sections 87307 and 87219: a barrier when not in use, supervision set by the appraisal, or both.
- Decide whether a resident may keep a cleaning product, tool or other listed item, and what protects the other residents, to the standard of section 87309.
5 lessonsAbout 34 minutes
ARF medication help
Five short lessons for adult residential facility (ARF) administrators and direct-care staff on 22 CCR 80075(b): what help with self-administration is, who may give it, refusals, inhalers and injections, PRN orders and labels, and the three PRN cases with the records each one needs.
- Sort a medication task in an ARF as help with self-administration, and stop before any forcing, hiding, withholding or overriding of a refusal.
- Check that a staff member who helps with inhalers has training from a licensed professional on file, with a yearly review, and keep injections with the client or a person the law allows.
5 lessonsAbout 33 minutes
ARF medication storage and oxygen
Five short lessons for adult residential facility (ARF) administrators and staff on 22 CCR 80075: when a client's medication must be centrally stored, how it is locked, labeled and kept, the centrally stored medication record (CDSS form LIC 622) and the client record, how unused prescription medications are destroyed and recorded, and the licensee's duties when a client uses oxygen.
- Decide whether a client's medication must be centrally stored in an ARF, using the three circumstances in section 80075(j), and leave each finding to the person the rule names: the physician, the administrator or the licensing agency.
- Keep centrally stored medications locked, apart from cleaning products and poisons, in their original labeled containers, and report a key, label or container problem without fixing it yourself.
