LIC 500: Personnel Report

The LIC 500 form - Personnel Report - Roster of Current Personnel, is intended to record the current roster of all facility personnel, other adults residing in the facility including backup persons and volunteers. 

The purpose of this using this form during the application phase, is to ensure that the facility is adequately planning for the staff coverage necessary to operate the facility in compliance with the regulations. This form lists all planned employee positions, and the days and hours staff are scheduled for duty.  During the application process, many facilities have not yet hired the staff they need, so the placeholder for positions and the designated employee is listed as "to be hired".

CARR's review of the facility files found the LIC 500s are rarely updated following the original date of licensing; 75% of all files reviewed in 2009 contained incomplete reports (Master's Thesis, Murphy,C. 2010).  

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC500.pdf