Form LIC 9099. Complaint Investigation Report - California

Form LIC 9099 is used in California by the Department of Social Services to document the investigation of complaints filed against licensed facilities or programs. The main purpose of this form is to gather information, record findings, and determine the appropriate actions or resolutions regarding the complaint.

The form consists of sections where the investigator records details about the complainant, the nature of the complaint, the timeline of events, interviews conducted, evidence collected, and the final conclusion or recommendations. It may also include sections for documenting any actions taken or sanctions imposed as a result of the investigation.

Important fields on this form include accurately capturing the details and nature of the complaint, conducting thorough interviews and collecting relevant evidence, and providing a clear and comprehensive analysis of the findings. It is crucial for the investigator to follow established procedures and ensure impartiality, fairness, and confidentiality throughout the investigation process.

Application Example: The Department of Social Services receives a complaint about alleged neglect in a residential care facility for the elderly. An investigator conducts an investigation and compiles Form LIC 9099, documenting the complainant's statement, interviewing staff and witnesses, reviewing records, and summarizing their findings. This form serves as a comprehensive record of the investigation and supports the department's decision-making on any necessary actions or interventions.