Form LIC 9200. Pre-Licensing Facility Evaluation Checklist - California

Form LIC 9200 is a pre-licensing facility evaluation checklist used in California to assess the readiness of a facility for obtaining a license from Community Care Licensing. This form is completed by individuals or organizations seeking to establish a new facility and obtain a license.

The form consists of sections that cover various aspects of the facility, including physical environment, safety measures, staffing, programs/services offered, and documentation requirements. It provides a comprehensive checklist of items to be reviewed and evaluated during the pre-licensing inspection. Important fields include detailed information about the facility's physical environment, safety protocols, staff qualifications, and documentation of policies and procedures. It is important to carefully review and address each item on the checklist to ensure compliance with licensing standards prior to the actual licensing process.

An application example of this form would involve an individual or organization completing Form LIC 9200 as part of the process to establish a new facility. They would go through each section of the checklist, gather necessary documentation, and ensure that the facility meets all the required standards. By successfully completing this form and addressing any identified deficiencies, the applicant can demonstrate their commitment to providing a safe and suitable environment for the intended services and increase the chances of obtaining a license from Community Care Licensing.