DirectCare (directcarehq.com) is an ICF/DD licensing consultant for California. We help owners open ICF/DD-H and ICF/DD-N homes of four to six beds. We prepare the program plan package that the Department of Developmental Services (DDS) approves, the license application that the Department of Public Health (CDPH) reviews, and the records that a surveyor tests. We work on-site within 30 miles of San Jose and remotely everywhere in California.
01 · The licensing path Four agencies decide a new license, and the order is fixed.
A new ICF/DD home needs approval from more than one agency. Each agency checks a different thing. The steps below are the order that the state documents set. We help at each step.
| Step | Agency | What DirectCare does |
|---|---|---|
| Confirm the need for the beds | Regional center resource developer | We prepare the questions and the one-page description of who you will serve. |
| Complete the sixteen hour new provider orientation | An agency that DDS approved | We schedule it early, because proof of attendance goes inside the program plan package.1 |
| Get the program plan approved | DDS Health Facilities | We write or review the program plan, the nine attachments and the medication training plan, and we answer the DDS revision requests.2 |
| Apply for the license | CDPH Centralized Applications Branch | We assemble the HS 200 packet. CDPH asks for a copy of the DDS-approved program plan with it.3 |
| Pass the licensing and certification surveys | CDPH Licensing and Certification | We run a mock survey against your records and your shift routine before the surveyor arrives. |
| Get vendored | Your regional center | We prepare the vendorization documents. Referrals cannot start until the regional center approves you.4 |
Owners often buy or lease a house first. The regional center decides if the beds are needed, and DDS approves the program plan before CDPH accepts the application. Talk to the regional center before you sign for a property.
02 · ICF/DD-H or ICF/DD-N The license type sets your staffing, so decide it on paper first.
California licenses two small home types for people with developmental disabilities. An ICF/DD-H (habilitative) home serves people who need training and support but do not need continuous skilled nursing. An ICF/DD-N (nursing) home serves people who are medically fragile and need skilled nursing care on a recurring basis.5 Both types can hold four to fifteen beds. Most new homes are licensed for four to six.
| Requirement | ICF/DD-H | ICF/DD-N |
|---|---|---|
| Direct care hours per week | 252 | 280 |
| Licensed nursing hours per day | RN visit of one hour per resident per week | 8 minimum |
| QIDP time per resident per week | 1.75 hours | 1.75 hours |
| Medi-Cal per diem, 2026 | $424.66 | $451.20 |
Sources for each figure are in the notes.6 We help you choose the type from the needs of the people you will serve, and then we build the program plan for that type. Our guide to opening an ICF/DD-H home and our guide to opening an ICF/DD-N home walk through each path in detail.
03 · Surveys A survey tests your daily routine, so we prepare the routine, not the binder.
CDPH surveys each certified home at least once every fifteen months, without notice.7 The surveyor compares four things: the written plan, the data, the progress notes and what staff do on shift. Findings come from the gaps between them. We help in three ways.
- Mock survey. We read your records the way a surveyor does and give you a written list of what would be cited.
- Plan of correction. If you receive a statement of deficiencies, we help you write a plan of correction that names the system failure, the fix, the person who checks it and the date.
- Prevention. We set up the documentation habits and digital records that stop a repeat finding.
Our guide on how to pass a California licensing survey for a small ICF/DD home explains the method in full.
04 · What we do not do We cannot guarantee a license, and we tell you that first.
The agencies make the decisions. We prepare you for them. We do not give legal advice, and we do not interpret regulations for an agency. The sixteen hour new provider orientation must come from an agency that DDS approved.1 Qualified intellectual disability professional (QIDP) services come through our sister service, QIDP Consulting.
05 · Where we work On-site near San Jose, remote everywhere in California.
We work on-site within 30 miles of San Jose, which includes Santa Clara, Sunnyvale, Milpitas, Fremont, Campbell, Los Gatos and Morgan Hill. Program plans, applications and survey responses work well by video, so we serve owners in every part of California remotely. On-site work in other areas is available when the client pays the travel cost.
06 · Questions What owners ask before they start.
Who can help me open an ICF/DD-H or ICF/DD-N home in California?
DirectCare is a California consultant that helps owners open ICF/DD-H and ICF/DD-N homes. We help with the regional center conversation, the DDS program plan package, the CDPH license application and readiness for the first survey. The first consultation is free.
Do you help with ICF/DD-N licensing as well as ICF/DD-H?
Yes. We work on both license types. The program plan, the staffing and the medication training plan are different for each type, so we decide the type first and then build the documents for it.
How long does it take to license a new ICF/DD home?
No agency publishes a processing time. The time depends on the regional center, the DDS review of your program plan, the CDPH application and the surveys. When DDS asks for revisions, you must send them back within two weeks. A complete first submission saves the most time.
What does the DDS program plan package include?
For an ICF/DD-H home, the package is the DS 1852 application, the program plan in eight sections, nine attachments and a signed checklist. The attachments include the consultant list, the staff schedule, the floor plan, contracts and credentials, proof of the sixteen hour orientation, the emergency plan, facility operations, a quality assurance plan and the medication administration training plan.
Can you help after we receive a survey deficiency?
Yes. We help you write a plan of correction that names what failed in the system, what changed, who checks it and how often. Then we help you build the habits that stop the same finding at the next survey.
Do you work outside the San Jose area?
Yes. We work on-site within 30 miles of San Jose and remotely everywhere in California. On-site work in other areas is available when the client pays the travel cost.
Planning a new home, or a survey?
Tell us where you are in the process. We will tell you honestly what the next step is and whether we are the right help for it.
Notes and sources
- Health and Safety Code section 1268.6 requires the applicant or a designee to attend a sixteen hour orientation approved by DDS before initial licensure. DDS lists the approved agencies on its New Provider Training page. dds.ca.gov ↩
- DDS ICF/DD-H Program Plan Instructions and Checklist, revised September 2025: package contents, attachments 1 to 9, the medication administration training plan, and the two week resubmission rule. PDF ↩
- CDPH Licensing and Certification, ICF/DD and ICF/DD-H initial and change of ownership provider checklist: the HS 200 application and a copy of the DDS-approved program plan. cdph.ca.gov ↩
- Vendorization requirements and the rule that a regional center cannot refer a consumer before vendorization. California Code of Regulations, Title 17, sections 54302 and 54310. Cornell LII ↩
- Definitions of ICF/DD-H and ICF/DD-N in Health and Safety Code section 1250. public.law ↩
- ICF/DD-N staffing from the DDS staff hours document; ICF/DD-H staffing and RN visits from Title 22, sections 76800 to 76962; the 1.75 hour qualified professional figure from both; 2026 per diems from the DHCS ICF/DD rate page. DDS PDF dhcs.ca.gov ↩
- The state survey agency must survey each ICF/IID no later than 15 months after the previous survey. 42 CFR 442.109. ecfr.gov ↩
Requirements change. Confirm each requirement with DDS, CDPH and your regional center before you commit money to a project. This page is not legal advice.