Loading
Get Ca Lic 604 2005-2026
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CA LIC 604 online
Filling out the California LIC 604 form is crucial for establishing a clear admission agreement between a residential care facility and its clients or residents. This guide will help users navigate through the form efficiently and understand the necessary information required for completion.
Follow the steps to successfully complete the CA LIC 604 form online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering the facility information. Fill in the name of the facility, type of facility, address, city, state, zip code, and telephone number, as these details establish the identity of the residential care facility.
- Provide the basic services that the licensee will offer to the client or resident. This includes entering the name of the client or resident, their optional Social Security number, and their birthdate.
- Detail the basic general services to be provided, such as lodging type, food services, laundry, cleaning, and transportation arrangements. Ensure that all applicable services are checked off and clearly described.
- Specify the basic monthly rate for services. Enter the amount or select the appropriate government-funded rate option, and indicate the payment schedule (in advance or in arrears).
- If there are any optional services, list them, including time intervals, service descriptions, rates, and payment schedules. Calculate the total monthly rate for these optional services and enter it.
- Summarize the total monthly rate that combines both basic and optional services to provide a clear overview of the financial obligations.
- Review the eviction procedures section and fill in any specific policies relevant to the facility, ensuring users understand the tenant rights and responsibilities.
- Outline the facility's visiting policy and include any relevant details. Make sure this section enhances transparency for clients and their families.
- Complete the refund policy and any relevant admission agreement terms. Highlight the key policies on resource handling and other resident responsibilities.
- Lastly, ensure all parties sign the agreement in the designated areas, including the client or resident, the licensee or administrator, and any authorized representatives. Review the document for completeness before saving.
- Save changes, download, print, or share the completed form as required.
Complete your CA LIC 604 form online today to ensure compliance and clarity in your admission agreements.
Assisted living facilities in California are regulated by the Department of Social Services, specifically the Community Care Licensing division. Agencies issue the CA LIC 604 license and ensure these facilities comply with state regulations. Their role is vital in protecting residents and ensuring they receive appropriate care.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.