Get Ca Lic 809 2015-2026

Filling out the CA LIC 809 form online is essential for facilities undergoing evaluation by the California Department of Social Services. This guide will provide a clear, step-by-step approach to complete the form accurately and effectively.

Follow the steps to successfully fill out the CA LIC 809 online.

1. Click ‘Get Form’ button to access and open the CA LIC 809 form in the online editor.
2. Begin by entering the facility's name, director's name, facility number, address, and telephone number in the designated fields.
3. Specify the capacity of the facility and the date of the visit. Additionally, select the type of visit performed by checking the appropriate box, such as office, pre-licensing, management annual, or follow-up.
4. In the deficiency information section, identify the facility type and indicate who was met during the visit. Record the time the visit began and completed, noting whether it was announced or unannounced.
5. Address civil penalty information by checking if any deficiencies were cited. Include comments or deficiencies found and whether a penalty was assessed or cleared.
6. Complete the plan of corrections (POC) section by providing a detailed plan for each deficiency noted, specifying due dates to ensure timely correction.
7. Obtain signatures from the licensing evaluator and the facility representative, along with their respective dates.
8. Once all sections are completed, ensure to save changes, and you can choose to download, print, or share the form for record-keeping purposes.

Complete the CA LIC 809 form online today to ensure compliance and proper documentation.