Form LIC 9106. Group Home Program Statement General Instructions - California

Form LIC 9106 is used in California by applicants or licensees operating group home programs to provide general instructions and guidelines regarding the completion of the Group Home Program Statement (GHPS). The main purpose of this form is to assist individuals or entities in accurately and comprehensively completing the program statement.

The form consists of sections where the California Department of Social Services provides detailed instructions, explanations, and examples for each section of the GHPS. It may include information on licensing requirements, specific program components, staffing ratios, policies and procedures, and any other relevant considerations. The form may also have a section for the applicant or licensee to acknowledge receipt of the general instructions.

Important fields on this form include clearly outlining the requirements and expectations for completing the GHPS, providing clear instructions for each section, and offering examples or guidance to ensure completeness and accuracy. It is essential for the applicant or licensee to carefully follow these instructions to fulfill licensing requirements and provide a comprehensive overview of their group home program.

Application Example: A nonprofit organization in California plans to open a group home program for foster youth. The organization receives Form LIC 9106, which provides general instructions for completing the GHPS. The form explains the required information about the program's philosophy, services offered, staff qualifications, and admission and discharge criteria. By following the instructions provided, the organization can ensure that its GHPS accurately represents the program and meets the licensing standards.