Forms and documents
LIC 9119 Facility Inspection Checklist Group Homes
Form LIC 9119 is an inspection checklist specific to group homes in California.
LIC 9118 - Facility Inspection Checklist Checklist Child Care Centers
Form LIC 9118 is an inspection checklist specific to child care centers in California.
LIC 9112 - Facility Compliance Plan
Form LIC 9112 is used to develop a facility compliance plan for licensed facilities in California. The form assists facility operators in creating a comprehensive plan to address identified deficiencies, violations, or areas of non-compliance with licensing regulations.
LIC 9106A - Short-Term Residential Therapeutic Program
Form LIC 9106A is specific to short-term residential therapeutic programs (STRTPs) in California. The form provides instructions for completing the program statement required for STRTP licensure.
LIC 9106 - Group Home Program Statement General Instructions
Form LIC 9106 provides general instructions for completing the program statement required for group homes in California.
LIC 9102TV - Advisory Notes - Technical Violation
Form LIC 9102TV is used to provide advisory notes specifically addressing technical violations in licensed facilities in California. The form contains detailed guidance, recommendations, or corrective actions related to violations identified during inspections or investigations.
LIC 856B - Complaint Determination Notification - Substantiated
Form LIC 856B is used to notify licensed facilities in California when a complaint has been substantiated.
LIC 856A - Complaint Intake Notification
Form LIC 856A is used to notify licensed facilities in California of the intake of a complaint.
LIC 622B - Psychotropic Medication Administration Record
Form LIC 622B is a specialized medication administration record used for psychotropic medications in licensed facilities in California. The form is completed by authorized staff members who administer psychotropic medications to residents or participants.
LIC 622A - Medication Administration Record
Form LIC 622A is a medication administration record used in licensed facilities in California. The form is completed by authorized staff members responsible for administering medications to residents or participants.