LIC 999: Facility Sketch

CARR Initiates Petition To Require Mandatory Liability Insurance for RCFEs

The LIC 999 - Facility Sketch, provides a sketch of all indoor and outdoor space used by residents. It offers specifics such as room dimensions and purpose (i.e. staff rooms, rooms approved for non-ambulatory residents, etc.), utility shut-off locations, and exit routes. This form is supplied to CCL during the application process and maintained in CCL's facility's file.

If the facility is later remodeled as to room configurations or use, or if the facility is expanded to add square footage, a reviewed LIC 999 is required by the CCL. 

To view: http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC999.PDF