LIC 421FC - Civil Penalty Assessment Failure To Correct And Repeat Violations

Form LIC 421FC is a civil penalty assessment form used by the California Department of Social Services (CDSS) to address repeated violations and failure to correct deficiencies in licensed facilities. The form is completed by the CDSS to inform the facility operator or licensee about the assessed civil penalty due to non-compliance with corrective actions and recurrence of violations. It includes details of the specific violation(s), the amount of the penalty, and instructions for payment. By utilizing this form, the CDSS emphasizes the importance of prompt and effective correction of violations, ensuring the provision of safe and quality care in licensed facilities.