Orange County Child Care Association

Provide, Promote and Support Quality Licensed Family Child Care

 

    State Forms

j0289525Maintaining forms and records is an important part of being in compliance with state regulations. Community Care Licensing is no longer mailing out updated forms to licensees. It is therefore the provider’s responsibility to ensure they have the most recent information and forms.

 

In an effort to assist our members we have provided a list of some of these required forms. This list is an aid to LIC 311D – Forms/Records to Keep in Your Family Child Care Homes. Please make a habit of researching and checking the Department of Social Services (DSS) web sit and ours for updates.

 

 

Thank You

 

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About Us

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General Meetings

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Health & Wellness

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State Licensing Forms

School Readiness Programs

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Resources & Links

Interviews

SIDS: Sudden Infant Death Syndrome & SBS: Shaken Baby Syndrome

Privacy Policy

 

 

 

DO YOU HAVE THE MOST-UP-TO DATE FORMS?

 

Children’s Forms/Records

Acknwldgmnt of Receipt of Licensing Reports (LIC 9224) 08/08

Additional Children in Care (LIC 9150) 08/08

Affidavit Regarding Liability Insurance (LIC 282) 08/08

Caregiver Background Check Process (LIC 995E) 10/09

Children’s Pre-Admission Health History (LIC 702) 08/08

Consent for Medical Treatment (LIC 627) 09/08

Consent for Administration of Medications (LIC 9221) 08/08

Consent/Verification for Nebulizer Care (LIC 9166) 02/01

Consumer Awareness Information (LIC 9212) 10/05

Identification and Emergency Information (LIC 700) 08/08

Notification of Parent’s Rights (LIC 995A) 08/08

Notification of Parent’s Rights Remove/Exclude (LIC 995B) 08/08

Notification of Parent’s Rights Reinstatement (LIC 995C) 08/08

California School Immunization Card (PM 286B) 01/02

Unusual Incident/Injury Report (LIC 624B) 08/08

 

Facility Forms/Records

Personnel Records per Title 22, Div. 12, Ch. 3, Section 102416.1

Child Care Roster (LIC 9040) 10/05

Notice of Employee Rights (LIC 9052) 03/03

Report Suspected Child Abuse (LIC 9108) 03/05

Property Owner/Landlord Consent Form (LIC 9149) 02/05

Property Owner/Landlord Notification Form (LIC 9151) 03/05

 

Information to be Posted in your Facility

ALL posting shall be in a location visible to clients

Emergency Disaster Plan (LIC 610A) 06/05

Facility Sketch (LIC 999A) 02/05

Earthquake Preparedness Checklist (LIC 9148) 09/00

Notification of Parent’s Rights Poster (PUB 394) 12/06

Facility License (LIC 203)

 

Cite Visit Postings

Title 22, Section 1596.8595 (a) (2) a family day care home shall post a copy of any licensing report pertaining to the facility that documents either a facility visit or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. It shall be posted immediately, adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days. (b) (2) Posting shall remain during hours when clients are present.

 

Additional Forms/Documentation

Live Scan Fingerprint Request (LIC 9163)

CPR/First Aid Certification – current

Never Shake A Baby (PUB 271) 05/05

Applicant/Licensee Rights (LIC 9058) 08/05

License Addendum – If license states capacities of 8 or 14

Pre-admission Health  History (LIC 702)

Consent for Admin. Of Medication (LIC 9221) 01/08

 

Other Items to be Maintained

Fire Extinguisher, annually serviced

Fire & Disaster Drill Log, Title 22,  Section 102417 (9) (A)

 

Guides and Helpful Tools

Self-Assessment Guide – English

Self-Assessment Guide – Spanish

Waivers & Exceptions Guide – English

Waivers & Exceptions Guide - Spanish

Disaster Planning Guide – English

Disaster Planning Guide - Spanish

 

 

 

 

Updated

February 10, 2010

 

 

NEW

To receive notifications via E-mail from DSS contact:

linette.villalobos@dss.ca.gov

Request to be added to the DSS Notification Dist. List

 

To access CCL web site go to: http://www.ccld.ca.gov

 

 

WANT TO BECOME A LICENSED PROVIDER?

Click here for an application

 

Need to go on an “inactive” status?

Click here for an Request Form

 

Title 22 Regulations

Division 12, Chapter 3 (09/28/06)

 

Office of Regulations Development

 

Child Care Advocacy

LIC 9223 (03/07)

Holly Daasnes

 

Basic Learning Requirements

Homeowner’s Associations

Landlord and Tenant Issues

Zoning Issues for Large Facilities

 

CCL Updates

October 2009

 

CCL Manual Letter

Title 22 Updates

No. CCL-06-07 Dec. 8, 2006

No. CCL-06-06 Sept. 27, 2006

 

Common Citations

Fingerprinting at age 18  – When a licensed provider has anyone in the household who is 18 years and older, state law requires fingerprinting of that person. The person MUST have reached his/her 18th birthday before fingerprinting can be done, then within 31 days the processing should be completed and records maintained in your facility files.

 

LIVE SCAN  LOCATIONS

LIVE SCAN REQUEST FORM

 

Assistant Transfer –Assistants who have a clearance to work in child care for one facility cannot work at another facility without the proper transfer documentation.

 

Email Notification

Notifications for members

when we post regulation updates and other important information related to family child care.

 

Stay up-to-date

To keep up-to-date please Email us with your Email address and advise us if you change your email address.

 

Fire Extinguishers

Come to a General Meeting and get your annual servicing done for only $15

(price subject to change)

 

Fire & Disaster

Drill Log

Do you need a log?

 Click here for your FREE copy

 

 

 

Orange County Child Care Association

PO Box 26769

Santa Ana, CA 92799

714.893.0390

949.348.6988