LIC 421IM - Civil Penalty Assessment Immediate $500 And Repeat Violations

Form LIC 421IM is a civil penalty assessment form used by the California Department of Social Services (CDSS) to address immediate and repeat violations in licensed facilities. The form is completed by the CDSS to notify the facility operator or licensee about the assessed civil penalty, which involves an immediate fine of $500 due to recurring violations. It includes information about the specific violation(s), the amount of the penalty, and instructions for payment. By utilizing this form, the CDSS emphasizes the urgency of compliance with regulations, discourages repeated violations, and ensures the safety and well-being of individuals served by licensed facilities.