Admin CDSS LIC 311C - Administrative Records CDSS On-line Forms and Publications
A. Employment of or evidence of regular consultation from a nutritionist, dietician, or home economist if facility
is licensed for 50 or more residents.
B. Dated weekly employee time schedule posted in facilities for 16 or more residents.
C. Documentation of actual hours worked by staff.
D. Current and valid driver's license for each staff member transporting clients.
E. Surety Bond, if appropriate (LIC 402).
F. Menus for the most recent 30-day period.
G. Posted emergency phone numbers and addresses.
H. Emergency Disaster Plan (LIC 610D) evidence that disaster and emergency drills are conducted every
six months. Documentation of the drills shall be maintained for a year.
I. Notices of planned activities for facilities of seven or more clients, posted in a central location. Copies
of such notices shall be retained for at least six months.
J. A current written program of activities which is planned in advance and is readily available to clients
and authorized representatives in facilities of 50 or more clients.
K. Documentation of approved Exceptions and Facility Waivers: Facility Waiver Request (LIC 956)
and Exception/Exemption Request (LIC 971)
L. For facilities licensed for seven or more clients, posted facility license (LIC 203).
M. Provider/Licensee Rights, Appeals Procedure (LIC 9058).
N. Designation of Facility Responsibility (LIC 308), if applicable
O. Affidavit Regarding Client/Resident Cash Resources
P. Accounting Record for Change of Licensee, if applicable
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This calendar is not realtime, and updates daily.