How to Choose a Board and Care Home: 10 Questions to Ask Before You Decide

1. Is the facility licensed by the California Department of Social Services, and can I see the license?

This should be the very first thing you confirm. Every legitimate board and care home and assisted living facility in California operates under a license issued by the CDSS Community Care Licensing Division, and that license should be posted and visible in the home.

If a facility can't show you a current license or gets evasive about it, that's your cue to leave. You can also look up any licensed RCFE in California on the CDSS website and see their inspection history, any citations, and when they were last reviewed. It takes about two minutes and tells you a lot. If the term RCFE is new to you, here's a plain-English explanation of what an RCFE is and how California regulates these homes.

2. What is the staff-to-resident ratio, and does it change at night or on weekends?

The daytime ratio during a weekday tour will always look its best. What you really want to know is what overnight coverage looks like, and whether staffing changes on weekends when management may not be around. A small board and care home with six residents and two overnight caregivers is very different from a 60-person community with two overnight staff. Press for specifics and don't let a vague answer slide.

3. How is medication managed, and who is responsible for it?

Medication errors are one of the most common and serious issues in senior care. Ask who actually handles medications. Is it a dedicated staff member, or is it whoever happens to be on shift? How are medications stored and tracked? What happens if a dose is missed or a prescription changes? A well-run facility will have a clear, consistent answer to all of this. A hesitant or vague answer is a red flag worth taking seriously.

4. What happens if my loved one's care needs increase over time?

This is one of the most important questions on the list, and it's one families rarely think to ask until they're in the middle of a crisis. Care needs change, sometimes gradually and sometimes quickly. You want to know whether the facility can accommodate increasing needs, what that process looks like, and under what circumstances they would ask a resident to leave. Knowing this upfront protects your family from a very painful and disruptive situation down the road.

5. Can I visit at any time, or are there set visiting hours?

A quality facility will welcome family visits at any reasonable hour, not because they're performing for you, but because they're confident in what you'll see. Rigid visiting hours can sometimes indicate that a facility is more comfortable when family isn't around. That's a dynamic you want to understand before committing.

Also ask whether you can do an unannounced drop-in visit before signing any agreements. Most reputable homes will say yes without hesitation.

6. What is included in the monthly rate, and what costs extra?

We covered this in more detail in our post on assisted living costs in Carlsbad, but the short version is this: always ask for a written breakdown of what's included and what carries an additional fee. Incontinence supplies, transportation, specialized programming, private rooms. These can add up quickly at some facilities while being included at others. The monthly rate you're quoted on a tour is not always the monthly rate you'll pay.

7. How long has the administrator been here, and how long have the caregivers stayed?

Staff turnover is one of the clearest indicators of how a facility actually operates. High turnover almost always reflects problems with management, culture, or working conditions, and it directly affects the quality of care residents receive, because consistency matters enormously for seniors.

A caregiving team that's been together for years knows residents deeply, while a team that's constantly rotating never builds that connection. Don't just ask management; if you can, have a brief conversation with one of the caregivers directly. How they talk about their residents tells you everything.

8. What does a typical day look like for residents?

This question is less about logistics and more about culture. You're listening for whether the answer is warm and specific, like "Mr. Rodriguez likes to do his crossword after breakfast and we always make sure he has the paper," or generic and institutional. A good facility doesn't just house residents; it knows them, and the answer to this question will tell you which kind of place you're looking at.

9. How do you handle a medical emergency?

Every facility should have a clear, practiced protocol for medical emergencies. Ask what happens step by step. Who calls 911, who notifies the family, who stays with the resident, how the on-call system works at 2 a.m. You're not being difficult by asking this. You're being a responsible advocate for someone you love, and a well-prepared facility will walk you through it without hesitation.

10. Can I speak with the families of current residents?

This is the question that separates genuinely confident facilities from ones that are better at marketing than caregiving. A facility that's proud of what it does will connect you with families who are happy to talk. They may not give you a direct referral due to privacy considerations, but they can let families know you'd like to connect and facilitate it. If a facility deflects this question entirely, that tells you something worth paying attention to.