Form LIC 9122A. Facility Inspection Checklist Small Family Home - California

Form LIC 9122A serves as a Facility Inspection Checklist specifically designed for Small Family Homes in California. This checklist is used during inspections conducted by representatives from the California Department of Social Services to evaluate the compliance of Small Family Homes with state regulations and licensing requirements.

The form consists of various sections that cover different areas 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, Small Family Home 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: A Small Family Home in California undergoes an inspection using Form LIC 9122A. The home ensures accurate documentation of staff qualifications, provides comprehensive resident care, follows proper medication management protocols, implements appropriate health and safety measures, maintains a suitable physical environment, keeps comprehensive records, and meets all necessary documentation requirements. By utilizing the checklist, the Small Family Home can identify any deficiencies and make necessary improvements to maintain compliance with state regulations.