Form LIC 9112. Facility Compliance Plan - California

Form LIC 9112 serves as a Facility Compliance Plan for various licensed facilities in California. This form is used to outline a comprehensive plan that ensures compliance with the relevant regulations and requirements governing the operation of the facility. The main purpose of this form is to demonstrate the licensee's commitment to maintaining a compliant and safe environment for individuals receiving services.

The form consists of different sections addressing specific aspects of compliance. These sections may include personnel qualifications, health and safety measures, emergency preparedness, documentation protocols, incident reporting procedures, and policies related to client rights and grievances.

Important fields on this form include providing detailed information about the facility's policies and procedures, specifying staff qualifications and training requirements, outlining health and safety protocols, and documenting the facility's emergency preparedness plans. Licensees must ensure that all sections of the form are completed accurately and comprehensively to demonstrate their commitment to maintaining compliance with the regulations set forth by the California Department of Social Services.

Application Example: A residential care facility in California updates its Facility Compliance Plan by completing Form LIC 9112. The form includes detailed information about the facility's policies on medication management, staff training requirements, fire safety protocols, and incident reporting procedures. By submitting the updated form, the facility demonstrates its commitment to maintaining a compliant environment and ensuring the well-being and safety of its residents.