How to start a home care agency in Colorado (Class B license, 2026)

Governing body or designated individual

Either convene a governing body with legal authority for the agency, or designate one individual responsible for every Part 7.1 task. At least one member or the designee knows HCA operations.

Bylaws or governing document

Keep bylaws or a governing document that names the programs and services offered, reviewed and revised as needed.

Designate and employ an HCA manager

The governing body or designee designates, employs and appoints an HCA manager to supervise services.

Adopt policies, review them every year

Develop and adopt policies and procedures for operating and administering the agency; review them annually and revise as needed.

Services follow the service plan and policy

Every program or service, direct or under arrangement, follows the consumer’s service plan and agency policy.

Annual review of operations and minutes

Review the agency’s operations at least annually and keep minutes of all governing body meetings.

Keep minutes

Keep minutes of all meetings of the governing body (or designee decisions).

Fixed office in Colorado

Provide a fixed office in Colorado that protects consumer confidentiality and is a safe place to work, able to run day-to-day business.

Written organization and lines of authority

Set out in writing how services are organized, administrative control and lines of authority down to the consumer care level.

Comprehensive annual evaluation

At least once a year, evaluate the whole operation; use the findings to check policies are followed, find problems and revise policies, including the quality management program’s findings.

Ongoing policy and administrative review

Run ongoing process improvement and policy review covering scope of services, arrangements with others, admission and discharge policies, supervision and service plans, urgent care, service records and personnel qualifications.

Consumer input mechanism

Have an ongoing way, set by agency policy, for consumers to comment on services; report findings and consumer input to the governing body at least annually.

Four evaluation criteria

Judge each part of the program on appropriateness, adequacy, effectiveness and efficiency.

Document the evaluation

Record who carried out the evaluation (names and titles), the criteria and methods used and the actions taken.

Quarterly consumer record review

At least quarterly, qualified staff review a representative sample of active and closed consumer records to check policies are followed and service quality is appropriate.

Manager qualifications

The manager is 21 or older with a high school diploma or GED and one year of documented supervisory experience in personal care (or the degree-plus-experience alternatives), communicates effectively, and knows the applicable laws.

Manager course and 12 hours a year

Keep proof that the manager completed an approved 8-hour manager course (or documented equivalent) and 12 hours of related training in the first year and every year after; file the certificate.

Manager: compliance, reports and liaison

The manager ensures legal compliance, completes and submits CDPHE reports and records, and liaises with the governing body or designee, staff and community.

Current organizational chart

Keep a current organizational chart showing lines of authority down to the consumer.

Manager keeps records and policies

The manager maintains personnel, bookkeeping and administrative records and the agency’s policies and procedures.

Orientation and in-service education

Ensure new personnel get orientation and that regular in-service education and continuing education opportunities are provided.

Written designation of an alternate

Designate in writing the qualified staff member who acts when the manager is absent.

Manager or designee available during all service hours

The manager or a designee is available for all hours that personnel are providing services.

Accurate marketing

Marketing, advertising and promotional material accurately represents the agency and only the care and services it can provide directly or by contract (no skilled services for Class B).

Agency-wide infection prevention program

Maintain a coordinated, agency-wide infection prevention and control program that is part of the quality management program.

Worker training program

The manager implements and monitors the training program for homemakers and personal care workers, managing or delegating training and development.

Homemaker initial training and competencyif the agency employs homemakers (every personal care worker must also meet Part 7.3)

Homemakers complete interactive initial training (duties and incident and mandatory reporting; non-medical rules; homemaker vs personal care; consumer rights; basic health and safety; assignment and supervision; communication; needs of the populations served; homemaking skills competency) and pass a competency evaluation with visual observation before serving consumers.

Validating outside trainingif the agency uses an outside training provider

If another organization trains staff, check the program meets the Part 7.3(C) topics and file proof of completion in the personnel record.

Orientation on hire

Orient all personnel on hire to agency policies and procedures, emergency response policies, emergency contact numbers for the agency and each assigned consumer, and a description of the agency’s services.

Homemaker annual trainingif the agency employs homemakers

Homemakers complete at least four of the initial training topics every 12 months (from hire date or calendar year, as policy sets), prorated for months worked.

Special diet instructionif meals are preparedRecommended practice

Where meal preparation is in the service contract, instruct the homemaker on any special diet (the rule says "should").

Workers report changes and hazards

Workers report environmental concerns and any observed or stated changes in the consumer’s physical, cognitive or developmental status to the agency.

Service notes with time in and out

Workers complete a signed, dated and timed service note for every visit confirming services provided and time in and out, in the form agency policy sets.

Personal care worker training

Personal care workers complete the homemaker topics plus personal care vs nurse aide and health care; observing, reporting and documenting; non-medical ADL help (bathing to protective oversight); medication reminders; and any adaptive equipment they will use, then pass a competency evaluation and skills validation with visual observation.

Competency before assignment

Ensure workers are competent for all assigned tasks; before assignment, the manager or supervisor completes a proof of competency evaluation on ADL help, medication reminders, adaptive equipment and other hands-on tasks.

Annual training for workers and supervisors

Supervisory and direct care staff complete at least six topics every 12 months (prorated), including behavior management, dignity and rights with abuse and neglect prevention and reporting, disaster and emergency procedures, infection control with universal precautions, and basic first aid and home safety.

Personal care worker duties

Workers maintain a safe home environment per the service plan, report status changes, and give non-medical ADL help and other tasks only as included in the service plan.

Personal care task limits

Keep personal care within the task limits for skin care, ambulation, bathing, dressing, exercise, feeding, hair, mouth and nail care, positioning, shaving, toileting, transfers, medication, respiratory care, accompaniment, protective oversight and respite; refer higher needs to skilled care.

Support stocking competencyif workers apply support stockings

Workers who apply support stockings are trained by a qualified individual and pass a proof of competency evaluation before applying them and every year.

Over-the-counter medicated shampoo competencyif workers use over-the-counter medicated shampoos

Workers using over-the-counter medicated shampoos are trained by the agency, with a proof of competency evaluation before use and every year.

Transfer equipment trainingif workers use transfer equipment or lift devices

Adaptive equipment, gait belts and lift devices are used in transfers only by workers trained in them (lift devices with demonstrated competency), and only where the consumer can assist or direct the transfer.

Medication reminders

Medication help is limited to pre-filled, clearly marked medication minders (asking, prompting, handing over, opening if the consumer cannot); irregularities are reported immediately to the supervisor.

Oxygen tank changesif workers change oxygen tanks

Only specifically trained workers with demonstrated competency set oxygen flow, by written instruction, when changing tanks.

Wandering and redirectionif the agency serves consumers who wander

Workers giving protective oversight to prevent wandering are trained in intervention and redirection.

Prohibited tasks

Do not allow personal care workers to perform skilled services, set up medications, or do anything agency policy, regulation or law prohibits.

Training exemptionsif the agency uses a training exemption

Apply the training exemptions only as the rule allows: returning employees within a year (with all four conditions), transfers between offices with the same training, and licensed or certified workers (still oriented and competency-checked).

Training and competency records

Document all training, competency testing and skills validation with date, length, trainer or provider, a short content description and the worker’s signature or proof of attendance, and keep it with certificates in each personnel file.

Supervisor qualifications in policy

Supervisors are 18 or older, have completed personal care training, and have the home care experience or training the agency’s policy specifies.

Supervisor available at all times

Supervision is done by an agency employee qualified under 7.7, in a designated supervisory role and available to the worker whenever care is given.

Supervision every three months

Supervise each worker at least every three months, in person or by telehealth, assessing consumer satisfaction, the worker’s competence and adherence to the service plan.

Annual in-person evaluation

Evaluate each worker in person once a year in a consumer’s home, observing tasks and the relationship with the consumer.

Supervision records in the consumer record

Document every supervisory activity in the consumer’s record: date, time, method, location, people present, tasks evaluated and outcome, and any retraining or support given.

In-person visit for care complaints

Make an in-person supervisory visit to evaluate a complaint about staff care that cannot be resolved by audiovisual connection.

Telehealth supervision standardsif the agency supervises by telehealth

Telehealth supervisory visits use an interactive audiovisual connection with worker and consumer, are documented by the supervisor, and meet the same standards as in-person visits.

Branch notice and same servicesif the agency opens a branch office

Tell CDPHE in advance before opening a branch (services, area within the parent’s area, daily supervision plan); a branch offers only the parent’s services.

Branch supervision and coverageif the agency has a branch office

The parent supervises the branch daily, provides backup coverage, visits it on site as policy sets, keeps a qualified supervisor available during all branch hours and stays aware of branch staffing and census.

Policies and records at branchesif the agency has a branch office

Each branch keeps a copy of all agency policies readily accessible to staff, and consumer records are accessible to all staff giving care.

Rights statement to all staff on hire

Give every new hire a complete statement of consumer rights, including the right to complain to CDPHE.

Rights policy minimum contents

Policies state that consumers are told their rights effectively, that care is not conditioned on or discriminated by personal, cultural or ethnic preference, disability or advance directive status, and that the agency protects and promotes these rights.

Respect, safety and confidentiality rights

Protect the rights to exercise rights without retaliation, respect for person and property, freedom from neglect, exploitation and abuse, staff identity on request, trained staff, freedom from restraint and confinement, to complain, and to confidentiality.

Policy on disclosing clinical information

Have, and tell consumers about, the agency’s policies on disclosure of clinical information and records.

Informing consumers in advance

Tell the consumer in advance about the care, method of delivery and services, and any changes, so they can give informed consent; respect refusals and explain consequences.

Right to refuse telehealth

If a consumer refuses a change from in-person to telehealth delivery, continue services in person.

Participation in planning care

Offer the consumer the right to take part in developing the plan, with instruction and education on it, and advise them of this right in advance.

Prompt care

Provide care promptly in line with the care plan.

Notice of billing changes

Give 30 days’ written notice of a scheduled rate increase to all consumers, and explain individual billing changes orally and in writing within 5 business days of learning of them.

No power of attorney or property for services

Never take power of attorney or guardianship, require checks endorsed to the agency, or take loans, interests or property in exchange for future services.

State hotline information

Tell consumers in writing, on acceptance, about the state’s toll-free home care hotline: its number, hours and that it takes complaints and questions, including about advance directives.

Ownership disclosure and change of owner notice

On request, give consumers a written list of everyone with ownership or controlling interest; a new owner after a change of ownership writes to every consumer naming the owners and offering continued service or help transferring.

Documentation of rights compliance

Keep documentation showing the agency met the consumer rights and notice requirements.

Admit only needs the agency can meet

Accept consumers only with reasonable assurance the agency can meet their needs at home.

Agreed days and times, updated yearly

Document the agreed days and times of service based on the consumer’s needs, and update at least annually.

Referrals for unavailable services

If needed services are not available at referral, tell the consumer and primary care provider, and admit only if both agree the services can be delayed or discontinued.

Discharge plan in every record

Keep a specific discharge plan in each consumer record with ongoing discharge planning; document when no improvement or discharge is expected.

Help finding another provider

Help consumers who still need care find another agency and document due diligence on continuity of care.

Efforts before discharge, and notice

Do not discontinue or refuse services without documented efforts to resolve the problem; tell the consumer verbally and in writing of the intent to discharge and why.

Notify CDPHE of unsafe discharges

Notify CDPHE before discharging a consumer who needs and wants continuing paid care with no transfer arranged; report emergency discharges made to protect staff within 48 hours.

Agency disclosure notice

Within one business day of starting services, give a signed disclosure notice (CDPHE form) stating who is responsible for employment, liability, wages, taxes, insurance, supervision, scheduling, duties, hiring and firing, supplies and training; get it acknowledged, or document a verbal explanation if the consumer will not sign.

Notice of consumer rights

Within one business day of starting services, give the CDPHE-format rights notice in a way the consumer understands, including options if rights are violated and how to reach the agency’s complaint contact.

Advance directives policy

Within one business day of starting services (and before care), inform the consumer of the agency’s advance directives policies, including a description of Colorado law.

Payment information

Within one business day of starting services, tell the consumer orally and in writing what insurance or other sources may pay and what the consumer may owe.

Complaint investigation and resolution

Policies cover investigating complaints about services or lack of respect, documenting existence, investigation and resolution, and telling the complainant the results and the plan to resolve issues.

Substantiated complaints feed quality

Feed substantiated complaint findings into the quality assurance program for systemic changes.

No retaliation statement

State explicitly that the agency does not discriminate or retaliate against consumers for complaining.

Complaint log

Keep a separate complaint log of all activity, investigation and resolution for at least two years, available for inspection.

Posted complaint notice

Post a clear notice in a public location that complaints may be made to the agency, CDPHE and the relevant DORA board, and give contact details on request.

Client grievance mechanism plan (capacity 51+)if the agency’s client capacity is 51 or more (CDPHE to confirm how capacity is measured for home care)

Agencies with a client capacity of 51 or more need a written grievance plan with a client care advocate (acknowledge in 3 working days, written response in 15 business days, final outcome in 30 days), filed with CDPHE. How "capacity" applies to home care is unclear; ask CDPHE.

Occurrence reporting to CDPHE

Report occurrences (unexplained or suspicious deaths, serious injuries, missing consumers, abuse, neglect, misappropriation, drug diversion, equipment malfunction) to CDPHE through COHFI within one business day.

Coroner-reportable deaths policy

Have a policy defining deaths reportable to the county coroner, consistent with the local coroner’s policy.

Employees report occurrences to the agency

Have a policy requiring employees to report occurrences to the agency.

No retaliation against reporters

Never discharge, discriminate or retaliate against anyone (clients, staff, relatives) for a good-faith occurrence report or for giving evidence.

Investigating occurrences, abuse and misconduct

Policies cover timely investigation of alleged neglect, abuse or staff misconduct; investigation of every reportable occurrence with preventive measures; protecting consumers during investigations; and documentation for CDPHE, with a findings report available within 5 working days.

Protecting consumers during investigations

Set administrative steps to protect consumers while an investigation is under way (for example, removing the accused worker from their care).

Prevent, detect, investigate and respond to abuse

Have policies to prevent (adequate staffing, screening, protection during investigations), detect (a reporting system and staff training), investigate and respond to abuse or neglect, with corrective action.

Report abuse of at-risk persons to law enforcement

Staff caring for at-risk persons report suspected physical or sexual abuse, exploitation or caretaker neglect to law enforcement within 24 hours (mandatory by statute for at-risk elders 70+ and adults with IDD).

Report child abuseif the agency serves children

Staff caring for children report suspected abuse or neglect immediately to the county department, local law enforcement or the child abuse hotline (1-844-CO-4-KIDS); the statute’s required reporters, such as nurses, follow up promptly in writing.

Staff know the reporting rules

Make sure all personnel know the mandatory reporting requirements, and report the incident to CDPHE as an occurrence where applicable.

Define competence and qualifications per service

Define the competence, qualifications and experience required of personnel in each program or service.

Staff access to policies

Ensure all personnel can access and know the agency’s policies and procedures.

Personnel record contents

Personnel records hold references, employment and separation dates and reason, current qualifications and licensure (experience, skills, training, education, observed competency evaluation and supervised written testing), orientation, job descriptions and annual performance evaluations.

Observed competency and written testing

Qualifications include a detailed, observed competency evaluation and written testing overseen by someone with the same or higher validated qualifications.

Job descriptions and annual evaluations

Keep job descriptions for every position and an annual performance evaluation for each employee.

Annual performance evaluation

Evaluate each employee’s performance every year and file it.

Criminal history check for applicants

Require every job applicant to submit to a criminal history record check (at least a Colorado search) no more than 90 days before employment; the agency or applicant pays.

Five factors for convictions

When an applicant has a conviction, weigh the history of convictions or pleas, nature and seriousness, time elapsed, mitigating circumstances and the nature of the position.

Policy on employing people with convictions

Have policies on employing anyone with a felony or misdemeanor conviction so they do not pose a risk to consumers.

CAPS check before direct care

Before employing anyone for direct care, request a CAPS check from CDHS (register with the CAPS Check Unit) and show compliance at application and renewal; recheck if hiring is more than 30 days after the result.

Keep CAPS results confidential

Use CAPS results only in the hiring process and do not release them to anyone not permitted; improper release is a class 2 misdemeanor.

DORA license verification

Before employing anyone for direct care, check with DORA whether they hold any license, registration or certification and that it is in good standing; file a copy of the inquiry.

Written contracts with contracted personnelif the agency uses contracted personnel

Contracts with contracted personnel state that only the agency accepts consumers, the services, conformity with agency policies and qualifications, role in plans, how the agency controls and evaluates services, note and scheduling procedures, and payment.

Personnel policies available to contractorsif the agency uses contracted personnel

Make personnel policies available to all contracted personnel.

Emergency risk assessment

Assess and document the hazards the agency could face (location of office, branches, workstations and consumers; consumer needs; weather, fire, outages, violence, pandemics), reviewed at least annually.

Written emergency preparedness plan

Write and implement an emergency plan based on the assessment to manage consumer care in disasters; review it at least annually and after any emergency response.

Emergency plan training

Train personnel on the plan on hire, at least annually, and whenever procedures or responsibilities change.

Emergency plan contents

The plan covers strategies per identified hazard, responsible staff, contacting staff and consumers, triaging consumers continuously, supply interruptions (water, medicines, PPE), educating consumers and families, protecting and transferring records, and care without record access.

Coordinating with other agencies

Coordinate services with other known home care agencies serving the same consumer and share care information unless the consumer refuses (document any refusal).

Quality management program

Run a quality management program suited to the agency’s size that evaluates quality and safety, with a client safety component (error patterns) and a client well-being component (continuous improvement).

Quality management plan approved yearly

Implement the program through a written quality management plan reviewed and approved yearly by the governing body (or the administrator or designee where there is none).

Quality plan: what is monitored and how

The plan names the errors and potential errors monitored (unexpected outcomes, grievances, deficiencies, occurrences, staff reports), a staff reporting process with training, data collection and trend analysis, reporting to leadership, and how projects and practices are selected.

Quality plan: improvement strategies

For each improvement strategy, document the intervention design, staffing and training, how effectiveness is evaluated, and timelines with tracking.

Infection control training

Train personnel on the written infection prevention and control policies at hire and at least annually.

Annual infection control review

Evaluate the infection control policies at least annually and document any changes.

Pre-employment health and work restrictions

Have written policies on pre-employment physical evaluations and personnel health, including work restrictions for direct care staff who have, or carry, a communicable illness.

Influenza vaccination rate and May 15 report

Aim for 90% influenza vaccination of employees and direct contractors (home care personnel are covered), report the rate to CDPHE by May 15 each year, keep proof of immunization or medical exemptions for three years, and have procedures to prevent spread from unvaccinated workers.

Offer influenza vaccination

Ensure employees and direct contractors are offered the chance to get a yearly influenza vaccine.

Below 90%: assessment and written policyif the agency’s vaccination rate is below 90% for a season

If the agency misses 90% in a season, assess its situation and write or update an influenza policy (records of immunization or exemption; information on benefits, risks, availability and standard precautions).

Infectious disease mitigation, vaccine and treatment planif CDPHE treats home care agencies as "facilities" for Part 12.2.1 (unconfirmed)Recommended practice

Chapter 2 requires "all facilities licensed under this chapter" to keep an infectious disease mitigation, vaccine and treatment plan (vaccine coordinator, vaccine and treatment provider, vaccinating new staff). Whether "facilities" includes home care agencies is unclear; CareRulebook includes a short plan as good practice.

Telling consumers about visits and changes

Have a mechanism, set by policy, for informing consumers about scheduled visits; keep documentation and give schedule changes in advance where possible.

Coverage for illness, vacation, holidays and turnover

Policy covers planning staff coverage for illness, vacation, holidays and sudden resignations or terminations.

Consumer does not answer the door

If the consumer does not let staff in for a scheduled visit, document every attempt to ensure their safety and its outcome.

Making up missed visits

Provide missed services as agreed between the consumer and the agency.

Backup for time-critical care

If consumers need care at set times, employ enough qualified staff or have effective backup plans; backup must not mean calling an ambulance unless one would have been needed anyway.

Information management system

Implement a policy for a paper or electronic information system that captures, stores and retrieves service data, protects privacy, and uses standardized record formats without pre-filled future documentation.

No pre-filled documentation

Standardized formats must not include pre-filled documentation of future care.

Electronic record controlsif the agency keeps electronic consumer records

For electronic records, have policies validating data entry access and changes, and for recovery: contingency plans for outages, an emergency service plan and a data backup system.

Consumer record contents

Keep a complete, accurate record for each consumer that identifies them, supports their condition, justifies services and supports continuity, including communications (calls, emails) and referrals to other providers.

In person or telehealth noted

Record whether each service or visit was in person or by telehealth.

Retention for five years, including after closure

Keep consumer records five years after discharge (longer if law requires); policies provide for retention if the agency closes, including telling the state where records will be; on a change of ownership pass all records to the new owner.

Record corrections

Any change, correction or deletion to a client record notes the date, time, nature, reason and the name of the person making it.

Records access statement

Post, and give each client on admission, a statement of how to obtain records and the right to appeal access grievances to CDPHE.

Record inspection and copies

Let clients inspect their records within 3 business days (10 after discharge) or give a written status update; acknowledge requests in writing; no charge for inspection; copies on request at statutory fees, electronically if kept that way.

Chapter 2 client rights policy

Adopt a client rights policy covering the Chapter 2 rights (participation, refusal, dignity, staff names and credentials, charges and itemized bills on request, consent, complaints, freedom from abuse and restraint, safe care, confidentiality, financial-interest referrals, advance directives) and disclose it before or at admission.

Estimated charges and itemized bills on request

On request, give the estimated average charge before non-emergency care, the general billing procedures, and an itemized bill by date with a billing contact.

Disclose financial interests in referrals

Tell clients whether referrals go to entities the agency has a financial interest in.

Restraint policy statement

An agency that does not use restraint or seclusion says so in a written statement in its policies.

Display the license

Display the license where clients entering the licensed address can see it.

Report changes to CDPHE

Report changes to application information as soon as practicable; give 30 days’ notice and get approval before changing management company, category, scope of services, service area, name, office address or branch details.

Owner conviction notice

Owners, applicants and licensees tell CDPHE of any felony or relevant misdemeanor conviction; failure can mean non-renewal or other sanctions.

Fingerprints within 10 days of a new owner or manager

A new owner, manager or administrator submits fingerprints to CBI within 10 calendar days of the change.

Keep liability insurance in force

Maintain liability insurance (or a surety bond) of at least $100,000 per occurrence and $300,000 aggregate for the whole license period.

Producing records for surveyors

Start producing consumer files and administrative records within 30 minutes of a surveyor’s request, and home-kept documents within 2 hours where the last visit was 14 or more days ago.

Plans of correction

Answer deficiency notices with a signed plan of correction within 10 calendar days: how each deficiency is fixed (with systemic changes), how it is monitored, and a completion date within 30 days.

Temporary closure and zero census

To keep the license through a temporary closure (including any time with zero clients), notify CDPHE in writing 30 days ahead if planned, or within 7 days if unplanned; closures are limited to 90 days.

Permanent closure

On closing, give CDPHE the records storage plan within 10 days before closure, tell every client within 10 days how to get their records, and store records securely.

Accurate information to CDPHE

Give CDPHE accurate and truthful information in inspections, investigations and licensing.