Form LIC 9119 CCH. Facility Inspection Checklist Community Crisis Home - California

Form LIC 9119 CCH serves as a Facility Inspection Checklist specifically designed for Community Crisis Homes (CCH) in California. This checklist is utilized during inspections conducted by representatives from the California Department of Social Services to assess the compliance of Community Crisis Homes with state regulations and licensing requirements.

The form consists of various sections that cover different aspects of operation, including staffing requirements, client eligibility criteria, safety measures, emergency preparedness, program activities, recordkeeping practices, and documentation requirements. It is crucial for Community Crisis Home operators to carefully review and complete each section of the checklist to ensure compliance with the regulations set forth by the California Department of Social Services.

When filling out the form, Community Crisis Home operators should focus on accurately documenting their staffing ratios and qualifications, ensuring that clients meet the eligibility criteria, implementing appropriate safety measures, maintaining an effective emergency preparedness plan, providing suitable program activities, and maintaining comprehensive records. By utilizing this checklist, Community Crisis Homes can identify areas for improvement and maintain compliance with the California Department of Social Services' regulations.

Application Example: A Community Crisis Home in California conducts regular self-inspections using Form LIC 9119 CCH. The home reviews its staffing ratios and qualifications, verifies the eligibility of its clients, checks the effectiveness of safety measures, evaluates the adequacy of the emergency preparedness plan, assesses the suitability of program activities, and ensures proper recordkeeping. By utilizing the checklist, the Community Crisis Home can proactively identify any deficiencies and make necessary improvements to maintain compliance with the state's regulations.