Form LIC 9216. Complaint And Type A Violation Log - California

Form LIC 9216 is used in California to document complaints and Type A violations related to licensed facilities regulated by Community Care Licensing. This form is completed by individuals or entities responsible for licensing and oversight to record and track reported complaints and violations.

The form consists of sections that require detailed information about the complaint or violation, including the date, nature of the incident, parties involved, actions taken, and resolution. It also provides space to record any corrective measures implemented to address the issue. Important fields include the description of the complaint or violation, identification of the facility involved, and a summary of the actions taken by the licensing authority. Accurate and comprehensive documentation is critical for tracking and addressing complaints and violations promptly and ensuring compliance with regulatory requirements.

An application example of this form would involve a licensing authority completing Form LIC 9216 when a complaint or Type A violation is reported regarding a licensed facility. They would document the details of the incident, parties involved, actions taken to investigate or resolve the issue, and any corrective measures implemented. By maintaining an organized log through this form, the licensing authority can effectively address complaints and violations, track patterns or trends, and improve the overall quality of care and services provided by licensed facilities.