Provider Screening Questionnaire

Screening and a basic listing are free — compare listing options. Every provider listed on wecarela.app must serve the LGBTQ+ community. This questionnaire is how we build and maintain that database — it documents your training, policies, and everyday practices so families can trust who we refer them to.

1. Complete the questionnaire

Six short sections covering licensing, staff training, written non-discrimination policy, and day-to-day affirming practices.

2. We verify your answers

Our team reviews your responses and follows up by email for supporting documentation, a document review, or a site visit.

3. Tier rating & listing decision

Verified providers receive a tier rating and are considered for listing in the WeCareLA provider database.

What we look for

Services are available to LGBTQ+ older adults and their chosen families without exception.

A written non-discrimination policy names sexual orientation and gender identity.

Staff receive LGBTQ+ cultural competency training, not one-time awareness only.

Chosen family is recognized for visitation and care participation.

Chosen name and pronouns are used and recorded.

Residents and clients have a real way to raise concerns and see them resolved.

Providers still building these practices are encouraged to apply. Answer honestly — “in development” is a valid answer, and we would rather help you improve than list a provider a family cannot rely on.

Before you start

Which listing are you interested in?

Screening and review are free either way. This only tells us how to follow up — there is no payment step in this form. Compare listing options.

Listing interest

Section 1

Organization & licensing

Tell us who you are and how you are licensed to operate in Los Angeles County.

Legal organization name

DBA / doing-business-as name

Organization type

License type

License number

Year established

Street address

City

ZIP code

County

Website

Licensed bed capacity

Current census / clients served

Section 2

Primary contact

Who should we work with on verification and follow-up?

Contact name

Title / role

Phone

Section 3

LGBTQ+ staff training

How your team is prepared to care for LGBTQ+ older adults.

Training program name

Training provider organization

Percent of staff trained

Training frequency

Trainer credentials

LGBTQ+ content in new-hire orientation

Topics covered in training (select all that apply)

Pronouns and chosen name use

Chosen family and support networks

Transgender and non-binary health

LGBTQ+ aging and social isolation

End-of-life and bereavement care

Legal protections and advance directives

Dementia care and LGBTQ+ identity

Cultural humility and implicit bias

Section 4

Non-discrimination policy & accountability

Written protections and how concerns are resolved.

Written non-discrimination policy

Policy explicitly covers sexual orientation

Policy explicitly covers gender identity

Policy explicitly covers gender expression

Grievance process available to residents/clients

How the grievance process works

Staff accountability measures

Section 5

Affirming care practices

Day-to-day practices that determine whether LGBTQ+ elders feel safe in your care.

Preferred name & pronoun practice

Pronouns recorded in the client record

Chosen family recognition

Visitation rights for chosen family

Transgender-inclusive care protocol

Gender identity captured in records

LGBTQ+-affirming materials visibly displayed

LGBTQ+ support groups offered

Staff with LGBTQ+ specialization available

Roommate request policy

Privacy protections for LGBTQ+ residents/clients

Anything else we should know

Section 6

Attestation

Confirm the accuracy of your responses so our team can begin verification.

Name of person completing this form

Title

I confirm that the answers above are accurate to the best of my knowledge, that our organization serves LGBTQ+ older adults and their chosen families, and that WeCareLA may contact us to verify this information and request supporting documentation.

Please do not include any resident, patient, or client health information in this form. Completing this questionnaire does not guarantee a listing on wecarela.app — all responses are verified by our team first.

This questionnaire is for organizations, not for individuals seeking care. If you or a family member needs help finding care, please request an assessment instead. This site is informational and is not a substitute for emergency services — in an emergency, call 911.