Form LIC 9120A. Licensed Facility Inspection Checklist Adult Care Facilities - California

Form LIC 9120A serves as a Licensed Facility Inspection Checklist specifically designed for Adult Care Facilities in California. This checklist is utilized during inspections conducted by representatives from the California Department of Social Services to evaluate the compliance of Adult Care Facilities with state regulations and licensing requirements.

The form consists of various sections that cover different aspects of operation, including staffing qualifications, resident care, medication management, health and safety measures, physical environment, recordkeeping practices, and documentation requirements. When filling out the form, Adult Care Facility operators should focus on accurately documenting staff qualifications, providing comprehensive resident care, following proper medication management protocols, implementing appropriate health and safety measures, maintaining a suitable physical environment, keeping comprehensive records, and meeting all necessary documentation requirements.

Application Example: An Adult Care Facility in California conducts regular self-inspections using Form LIC 9120A. The facility reviews its staffing qualifications, assesses the effectiveness of resident care and medication management, evaluates health and safety practices, checks the suitability of the physical environment, ensures the completeness of records, and meets all necessary documentation requirements. By utilizing the checklist, the Adult Care Facility can identify any deficiencies and make necessary improvements to maintain compliance with state regulations.