Get Lic 9099

The Lic 9099 is an important document used in the investigation of complaints related to community care facilities in California. This guide provides a clear and comprehensive walkthrough of how to fill out the form online, ensuring a smooth and accurate submission process.

Follow the steps to fill out the Lic 9099 online effectively.

1. Click the ‘Get Form’ button to obtain the Lic 9099 and access it in your preferred digital format.
2. Fill in the complaint control number in the designated space at the top of the form.
3. Enter the date the complaint was received in the specified area, ensuring it is accurate and up to date.
4. Complete the evaluator's name section, including the full name of the individual conducting the investigation.
5. Provide the facility name and facility number that the investigation pertains to.
6. Input the facility's address as designated on the form, being mindful of accuracy.
7. Select the facility type from the available options to classify the facility appropriately.
8. Fill in the name of the facility representative and their telephone number for any necessary follow-up.
9. Document the capacity of the facility and the census at the time of the investigation.
10. Enter today’s date in the corresponding field, ensuring the date aligns with the completion of the report.
11. Clearly outline the allegations related to the complaint in the designated area of the form.
12. Document investigation findings by selecting one of the four resolution codes: Substantiated, Inconclusive, Unfounded, or Needs Further Investigation.
13. If applicable, provide an estimated number of days required for the completion of the investigation.
14. Use the Lic 809 form for all citations that need to be documented during this process.
15. Ensure the licensing analyst signs the form and records the time out and their telephone number.
16. The name of the supervisor overseeing the investigation should be completed along with their contact information.
17. Distribute the report according to the instructions at the bottom of the page, ensuring proper channels are followed.
18. Users should acknowledge receipt of the form by signing and dating in the designated sections, which indicates understanding of appeal rights.
19. Finally, review the entire form for accuracy and completeness before saving, downloading, printing, or sharing as necessary.

Complete the Lic 9099 form online today to ensure compliance and timely follow-up.