How to start a home care agency in California (the HCO license, 2026)

A home care organization is "an individual, 18 years of age or older, firm, partnership, corporation, limited liability company, joint venture, association, or other entity that arranges for home care services by an affiliated home care aide to a client, and is licensed pursuant to this chapter" (HSC § 1796.12(j)). An affiliated home care aide is someone 18 or older "who is employed by a home care organization to provide home care services to a client and is listed on the home care aide registry" (§ 1796.12(a)). Our reading: companion-only and housekeeping-only work is covered when the client, because of age or disability, cannot do it themselves, because those services are on the statute’s list (§ 1796.12(n)).

The statute lists 14 kinds of provider that are not HCOs (§ 1796.17(b)). The ones founders ask about most:

• IHSS. "A person who performs services through the In-Home Supportive Services program pursuant to Article 7 (commencing with Section 12300)" is not an HCO (§ 1796.17(b)(4)). IHSS is a public program for eligible aged, blind and disabled people who have a Medi-Cal eligibility determination; a county social worker assesses need, and the recipient usually hires and employs their own provider. CDSS’s page tells recipients: "If you are approved for IHSS, you must hire someone (your individual provider) to perform the authorized services. You are considered your provider's employer" (CDSS IHSS page). These are program rules, not HCO license rules.
• Home health agencies. "A home health agency licensed under Chapter 8 (commencing with Section 1725)" is not an HCO (§ 1796.17(b)(1)). A home health agency provides or arranges skilled nursing services in the home, meaning "services provided by a registered nurse or licensed vocational nurse" (HSC § 1727).
• Referral (employment) agencies. "An employment agency, as defined in Section 1812.5095 of the Civil Code, that procures, offers, refers, provides, or attempts to provide an independent home care aide who provides home care services to clients" is not an HCO (§ 1796.17(b)(7)). Independent home care aides are aides listed on the registry who work through a direct agreement with a client (§ 1796.12(p)). Under the Civil Code, an employment agency is not the employer of a domestic worker it refers if all of the listed factors fit, among them a signed contract, the worker free to accept or reject work and to negotiate pay, "The domestic worker does not receive any training from the employment agency with respect to the performance of domestic work", and no direction, control or supervision of how the work is done (Civil Code § 1812.5095(b)). Our reading: a referral agency should meet every one of those factors; if you employ, train or supervise the caregivers, plan on the HCO license.
• Licensed facilities. Licensed health facilities, hospices, community care facilities, residential care facilities for the elderly, child care facilities and clinics are not HCOs either (§ 1796.17(b)), and the director may name others providing similar services (§ 1796.17(b)(14)). We found nothing in the Act about agencies that supply staff to such facilities; ask CDSS if that is your model.
• Regional center vendors. An organization vendored or contracted through a regional center or the Department of Developmental Services is not an HCO when DDS funds the services and "more than 50 percent of the recipients of the home care services provided by the organization are persons with developmental disabilities" (§ 1796.17(b)(6)).
• Hiring your own carer. "This chapter shall not prohibit an individual from employing an individual not listed on the home care aide registry to provide home care services." (§ 1796.15)

Names, advertising and other states

Unless licensed (IHSS providers and referral agencies aside), a business may not present itself as an HCO, imply it is licensed for these services, mention employee bonding, or "use the terms “home care organization,” “home care,” “in-home care,” or any combination of those terms, within its name" (§ 1796.34(a)). An HCO based in another state must "Have an office in California" and keep all pertinent records of its operation there, and an out-of-state company must also register with the Secretary of State to do business in California (§ 1796.36(a)-(b)). "Each home care organization shall be separately licensed." (§ 1796.17(a))

Penalties for unlicensed care

CDSS sends a written notice of noncompliance and must "assess a civil penalty of nine hundred dollars ($900) per day for each calendar day of each violation", copying the notice to the Attorney General or the district or city attorney (§ 1796.35(b)-(c)). Violating the Act is also a misdemeanor, with a fine of up to $1,000, up to 180 days in county jail, or both (§ 1796.58).

The statute lets CDSS issue a license to an applicant that meets the requirements of the Act, among them: a complete application with the fee, proof of liability insurance, workers’ compensation and a dishonesty bond, a background check, CDSS’s orientation, no outstanding fees or civil penalties, disclosure of other CDSS-licensed facilities, and "any other information as may be required by the department for the proper administration and enforcement of this chapter" (HSC § 1796.37(a)). Our reading: that last item is the basis for most of the documents CDSS asks for, such as job descriptions, personnel policies, the training plan and the program description, which the statute does not list.

CDSS’s instructions, form HCS 281, set out the packet. "The application fee and all Section A forms and Section B documents should be completed and sent to CDSS as a packet." (HCS 281) "An application is not considered complete and review of your application will not begin until the application package (Section A forms), supporting documents (Section B documents), and non-refundable application fee are received by CDSS." (HCS 281)

Section A: the forms

HCS 200 (the application), HCS 215 (applicant information, one for each individual applicant, partner, chief executive officer, owner of 10% or more and manager of a manager-managed LLC), HCS 308 (designation of responsibility), HCS 309 (organization structure, for entities), HCS 402 (employee dishonesty bond), LIC 508 (criminal record statement) and HCS 9165 (board of directors statement, if you have a board) (HCS 281, Section A).

• Business hours. The HCS 200 asks for the days and hours you are open to the public, and CDSS says: "CDSS will conduct visits and unannounced inspections during this time. If the Home Care Organization is by appointment only, CDSS will still conduct visits and unannounced inspections." (HCS 281, HCS 200)
• A designee. The HCS 200 names the person who will directly supervise the HCO in the licensee’s absence, and HCS 308 can name more. CDSS’s instructions say HCOs "are required to have a licensee or designee continuously present during business hours to represent the Home Care Organization and perform administrative processes", and every person on HCS 308 needs a background clearance or exemption (HCS 281, A1 and A3).
• The bond. "The Employee Dishonesty Bond must have a minimum limit of ten thousand ($10,000) dollars." The State of California must be named as beneficiary, with effective and expiration dates (HCS 281, A5).

Section B: the supplemental documents

This is where CDSS asks for written material. In CDSS’s words, the table "outlines the documents required to be completed by the applicant for initial licensure" (HCS 281, Section B):

• Other employment laws. CDSS notes that other agencies enforce laws such as minimum wage and fair employment practices, and says "CDSS does not enforce other agencies’ laws." It asks applicants to check their practices against them (HCS 281, B3).
• Dementia from 2027. SB 412 adds dementia care to the annual training topics from January 1, 2027 (HSC § 1796.44(c)(6)). CDSS’s PIN 26-02-HCS says: "Applicants who apply for an HCO license on or after January 1, 2027, must include the special care needs of clients with dementia in the annual training plan submitted as part of their HCO application." CDSS says it "will not prescribe a specific curriculum but will verify that submitted training materials meet the statutory intent and cover essential dementia care competencies" (PIN 26-02-HCS).
• Keep a copy. "You are required to keep a copy of the application package in your Administrative Records. These documents may be inspected during your unannounced inspection." (HCS 281)

After you apply

The analyst’s introductory letter gives your pending license number, contact details and instructions for orientation and Live Scan (CDSS application steps). The orientation "is a scheduled, virtual session with HCSB staff and is not available on demand", and CDSS charges a nonrefundable $50 for it (CDSS’s fee) (step 5). The analyst then checks your compliance history with other licenses and verifies the entity, and CDSS decides once every step is complete (steps 7 and 8). On timing, CDSS says only that it "can vary depending on different factors" (CDSS application steps).

• Insurance. You must "maintain proof of general and professional liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate", and keep a workers’ compensation policy covering your aides (HSC § 1796.42(b), (d)).
• The bond. You must "maintain and abide by an employee dishonesty bond, including third-party coverage, with a minimum limit of ten thousand dollars ($10,000)" (§ 1796.42(c)).
• Renewal. The renewal fee must be "postmarked on or before the expiration of the license" (§ 1796.37(b)(1)), and CDSS mails a renewal notice at least 60 days ahead (§ 1796.37(c)). In 2022, CDSS recommended postmarking it at least 10 working days before the license expires (PIN 22-03-HCS). Since July 10, 2023, renewal no longer asks for the HCS 200 or proof of insurance, workers’ compensation or the bond (PIN 23-04-HCS), but you must still keep them.
• If the license lapses. "If the license expires the HCO must cease operation or a civil penalty of $900 per day shall be assessed for operation as an unlicensed HCO." (PIN 22-03-HCS)
• From 2029. AB 152 (2026), as summarized in the Legislative Counsel’s digest (the new section text operative in 2029 is not yet published on CDSS’s pages), moves renewal to every year from January 1, 2029, with an annual license fee of $2,802 (California’s fee) and new late, payment processing and probation monitoring fees (AB 152, Legislative Counsel’s digest).
• Costs we cannot price. CDSS’s fee page does not list Live Scan fees; it sends those questions to its Care Provider Management Branch (CDSS fees page). Insurance and bond premiums are set by your insurer.

"An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client." (HSC § 1796.14(b)) And the HCO must "ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients" (§ 1796.43(a)).

• Who. "A registered home care aide shall be 18 years of age or older." (§ 1796.21)
• How. Aides apply in CDSS’s Guardian portal or by mail on form HCS 100, and "Home Care Organizations can submit applications on behalf of Home Care Aides using their Guardian account". The aide then takes a Live Scan form to a Live Scan vendor for fingerprints (CDSS Home Care Aide Application Process).
• Fee. $35 to register and $35 to renew (CDSS’s fees) (CDSS). "To remain on the home care aide registry, a registered home care aide shall renew his or her registration every two years." (§ 1796.31(a))
• What the public sees. The registry shows each aide’s registration status, expiration date and, for an affiliated aide, the HCO (§ 1796.29(a)(1)).
• When an aide leaves. "Immediately notify the department when the home care organization no longer employs an individual as an affiliated home care aide." (§ 1796.43(a)(3))
• Transfers. An HCO can bring in an aide already on the registry by sending CDSS a clearance or exemption transfer form with a copy of the aide’s photo ID (CDSS Resources for HCOs).
• Independent aides. Aides who are not employed by an HCO may join the registry, but do not have to (§ 1796.14(a)).
• Who oversees aides. "Other than maintaining the home care registry, the department shall have no oversight responsibility regarding registered home care aides." (§ 1796.52(d)) Our reading: CDSS oversees the HCO, not individual aides, so supervising your aides falls to you (CDSS’s instructions ask each job description to show lines of supervision, HCS 281 B2).

"A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section." (HSC § 1796.44(a))

• Population specific. The annual training must "relate to core competencies and be population specific", and the list is a minimum: it "shall include, but not be limited to" those areas (§ 1796.44(c)).
• Online is allowed. "The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program." (§ 1796.44(d))
• Records are inspected. CDSS reminds licensees that "Home Care Aide (HCA) training hours, proof of registration, and tuberculosis (TB) clearances records remain subject to inspection" (PIN 22-03-HCS). The training plan and sample log you send with the application (Section B4) set out how you will meet this.
• No set curriculum. The statute sets hours and topics, not a course, and names no trainer qualifications (our reading); CDSS’s instructions ask your plan to say who will conduct the training (HCS 281, B4).

Each aide applicant "shall submit their fingerprints to the Department of Justice by electronic transmission", and the Department of Justice uses them "to search state and Federal Bureau of Investigation criminal offender record information" (HSC § 1796.23). By mail, the aide takes the Request for Live Scan Service (LIC 9163) to a Live Scan vendor (CDSS).

• Office staff and volunteers too. The HCO must "ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information that may pose a risk to the clients’ health and safety has met the requirements of Section 1796.23, 1796.24, 1796.25, 1796.26, and 1796.28 before there is contact with clients or prospective clients or access to confidential client information" (§ 1796.43(a)(1)).
• Owners. All applicants and anyone with a 10% or greater ownership stake complete the check before licensing (CDSS application steps; § 1796.33).
• No conditional start. Aides are cleared on the registry before direct contact with clients (§ 1796.43(a)). We found no provision for working while a check is pending.
• Clearance or exemption. "If the department finds that the home care aide applicant or the registered home care aide has been convicted of a crime, other than an infraction, the department shall deny the home care aide application, or revoke the registered home care aide’s registration unless the department grants an exemption" (§ 1796.25(a)(1)). CDSS’s background check page says "the CDSS is prohibited by law from granting exemptions to individuals convicted of serious crimes such as robbery, sexual battery, child abuse, elder or dependent adult abuse, arson or kidnapping." (CDSS background checks).
• After clearance. The Department of Justice keeps registered aides’ records updated and tells CDSS of later reports (§ 1796.28(a)). Someone who already holds a CDSS clearance, such as an employee of a CDSS-licensed facility or a registered TrustLine provider, may transfer it instead of being fingerprinted again (§ 1796.23(d)).
• Exclusion orders. CDSS may order a person removed from contact with clients, and "A licensee’s failure to comply with the department’s exclusion order after being notified of the order shall be grounds for disciplining the licensee pursuant to Section 1796.38." (§ 1796.54)

"Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease." (HSC § 1796.45(a)) CDSS’s application instructions go further: "Home Care Aides are required to be registered on the Home Care Aide Registry, obtain TB clearance, and complete 5 hours of entry-level training before providing services to clients." (HCS 281) Our reading: get the TB clearance before an aide’s first client, which meets both.

• The test. A test for tuberculosis infection recommended by the CDC and licensed by the FDA and, if positive, a chest X-ray. "The aide shall not work as an affiliated home care aide unless the licensee obtains documentation from a licensed medical professional that there is no risk of spreading the disease." (§ 1796.45(b))
• Every two years. An aide whose test is negative is examined at least once every two years. Once an aide has a documented positive test followed by an X-ray, the exam is no longer required (§ 1796.45(c)).
• On file. After each exam, the HCO keeps the examining practitioner’s certificate showing the aide was found free from active TB, and the exam is "a condition of initial and continuing employment" (§ 1796.45(d)-(e)).
• Transfers. An aide moving between HCOs can use a certificate from the past two years, or the former HCO can confirm it holds one and give the new HCO a copy before the aide starts (§ 1796.45(f)).

The licensee must "report any suspected or known dependent adult or elder abuse as required by Section 15630 of the Welfare and Institutions Code and suspected or known child abuse as required by Section 11164 to 11174.3, inclusive, of the Penal Code", and "A copy of each suspected abuse report shall be maintained and available for review by the department during normal business hours." (HSC § 1796.42(e))

• Who reports. Under the elder and dependent adult abuse law, "A person who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult, whether or not they receive compensation", along with care custodians, health practitioners and the administrators, supervisors and licensed staff of facilities that care for elders or dependent adults, is a mandated reporter (WIC § 15630(a)). Our reading: HCO caregivers and managers who serve elders or dependent adults are mandated reporters.
• When. By phone or the confidential online tool, "immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an internet report shall be made through the confidential internet reporting tool established in Section 15658, within two working days." (WIC § 15630(b)(1)).
• Where. For a client living at home: "the report shall be made to the adult protective services agency or the local law enforcement agency." (WIC § 15630(b)(1)(C)). Child abuse is reported under the Penal Code (HSC § 1796.42(e)).
• What CDSS does. When CDSS receives an abuse report from an HCO, it cross-reports to local law enforcement and Adult Protective Services (adults) or Child Protective Services (children), and is not required to investigate the abuse itself (§ 1796.52(e)).
• In your paperwork. CDSS’s instructions ask for abuse reporting procedures in your personnel policies, and your annual training must cover how to report, prevent and detect abuse and neglect (HCS 281, B3; § 1796.44(c)).
• Complaints about an HCO. Since January 2, 2024, these go to CDSS’s Centralized Complaint and Information Bureau: (844) 538-8766 or letusno@dss.ca.gov (PIN 24-01-HCS).

"The department shall verify through random, unannounced inspections that a home care organization meets the requirements of this chapter and the rules and regulations promulgated pursuant to this chapter." (HSC § 1796.52(b)) CDSS staff may "enter a home care organization during posted business hours, with or without advance notice" (§ 1796.53), and "A home care organization’s refusal to make records, books, or premises available shall constitute cause for the revocation of the home care organization’s license." (§ 1796.52(c))

• Before licensing. CDSS’s eight-step application overview has no inspection step (our reading). Its instructions say your HCO address is where CDSS will make an unannounced inspection (CDSS application steps; HCS 281).
• The checklist. CDSS publishes HCS 9201, a checklist "provided to assist Licensees and their employees in preparing for an unannounced inspection by showing some of the areas reviewed by an Enforcement Analyst": owner checks, the posted license and hours, insurance, bond and workers’ compensation, staff clearances, separation notices, records, and each aide’s registry clearance, TB and training hours (HCS 9201).
• In practice. Of the 2,601 licensed HCOs in CDSS’s download, 1,683 show at least one CDSS visit and 1,228 at least one inspection visit (our count).
• Violations. A written notice names the rule broken and what CDSS may do, "including the requirement of a plan of correction, assessment of a penalty, or action to suspend, revoke, or deny renewal of the license" (§ 1796.55(b)). Our sources name no deadline for a plan of correction. "The department may impose a fine of up to nine hundred dollars ($900) per violation per day commencing on the date the violation was identified and ending on the date each violation is corrected." (§ 1796.55(c))
• After a disaster. A licensee may ask for inactive license status if the HCO is nonoperational because of destruction, significant damage or prolonged closure in an emergency or disaster; the license is not valid while inactive (§ 1796.64).

California’s law is short. Beyond the documents in CDSS’s application, the Act sets duties but says little about how you run care day to day. Our reading of sections 1796.10 to 1796.70: it names no list of written policies, no client contract, care plan or client rights document, and no supervision visits (HSC §§ 1796.10 to 1796.70; HCS 281). The Act also sets no education, experience or training minimum for the licensee or a designee (our reading).

That leaves you to decide, and write down, how you:

• take on clients, agree services and fees, and record what aides do;
• supervise aides in clients’ homes, since CDSS oversees the HCO, not individual aides (§ 1796.52(d));
• keep medication help within the limit: help only with medication the client self-administers, such as "Opening the client’s medication bottle/canister/blister pack" or "Reminding the client to take medication" (CDSS fact sheet), never where it would need administration or oversight by a licensed health care professional (§ 1796.12(n));
• steer clear of medical tasks: CDSS’s examples include insulin shots, catheter care, glucose readings, tube feeding, monitoring vital signs, post-surgery wound care and medication administration (CDSS fact sheet);
• handle complaints, emergencies and records, and keep the posted license, insurance, bond and training and TB records ready for an unannounced visit.

CDSS describes what licensed care means for families: "With licensed care, the HCO employs their caregivers and accepts all employer responsibilities." (CDSS fact sheet) Good written procedures help you show that.

• The regulations were repealed. The HCO regulations, 22 CCR sections 130000 to 130211, were emergency regulations first filed in December 2017 and operative January 1, 2018, refiled in 2018 and 2019. They were emergency rules that lapsed; the repeal was recorded in 2021 (Register 2021, No. 13) (22 CCR § 130000 history notes). CDSS’s Laws and Policies page names only the statute (CDSS), and we found no home care regulations on its regulations page (CDSS, October 8, 2026).
• Inspection regulations are due by 2028. A 2023 law required CDSS to adopt regulations by January 1, 2026 for biennial inspections; AB 152 (2026) moved the deadline to January 1, 2028 (AB 152 digest). Our reading: the “policies” those inspections check are the liability insurance, workers’ compensation and bond policies that renewal used to ask for, not written procedures (Section 29, Ch. 43, Stats. 2023, as quoted in the Department of Finance’s proposed trailer bill language; PIN 23-04-HCS).
• Dementia training from January 1, 2027. SB 412 (2025) adds "The special care needs of clients with dementia" to the annual training topics (SB 412), and CDSS will look for it in new applications’ training plans, at renewal and at inspections (PIN 26-02-HCS). Our suggestion: existing HCOs add it to their annual training plan before January 1, 2027, when CDSS can start checking it.
• Yearly renewal from January 1, 2029. AB 152 makes renewal annual with a $2,802 annual license fee (California’s fee), plus late, payment processing and probation monitoring fees (AB 152 digest). The current license, fee and fine sections say they remain in effect only until January 1, 2029 (HSC §§ 1796.37, 1796.49, 1796.55). We hold the Legislative Counsel’s digest, not the chaptered text, so check the 2029 details with CDSS.

We will email rule-change alerts when CDSS proposes regulations or changes its application (sign up below), and all states’ open changes are on our rule changes page.

CDSS’s statewide Home Care Organization download on October 8, 2026 listed 2,601 HCOs as licensed, 198 as pending and 1,321 as closed. The counties with the most licensed HCOs are Los Angeles (662), San Diego (264) and Orange (261) (CDSS facility data, our count). By first license date, 446 HCOs were first licensed in 2024, 501 in 2025 and 469 in 2026 to early October (our count). You can look up any HCO in CDSS’s Care Facility Search.