LIC 421BG - Civil Penalty Assessment Caregiver Background Check

Form LIC 421BG is a specific civil penalty assessment form related to caregiver background checks in licensed facilities in California. The form is completed by the California Department of Social Services (CDSS) to inform the facility operator or licensee about the assessed civil penalty for non-compliance with caregiver background check requirements. It includes details of the violation(s), the amount of the penalty, and instructions for payment. By utilizing this form, the CDSS ensures enforcement of background check regulations and promotes the safety and well-being of individuals receiving care in licensed facilities.