Orange County

Child Care Association

​www.orangecountychildcareassociation.org

HELPFUL RESOURCES

FOR YOUR FAMILY HOME CHILD CARE

MAILING ADDRESS
P.O. Box 26769, Santa Ana, CA 92799

MEETING LOCATION
Orange County Department of Education
200 Kalmus Dr. Costa Mesa, AS  92626

E-mail us at: contactus@orangecountychildcareassociation.org

STATE FORMS

LIC 311 D 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 site and ours for updates.

Children’s Forms/Records

LIC 9224 Acknowledgment of Receipt of Licensing Reports 


LIC 9150Additional Children in Care


LIC 282 Affidavit Regarding Liability Insurance 


LIC 995 E Caregiver Background Check Process


LIC 702 Children’s Pre-Admission Health History 


LIC 627 Consent for Medical Treatment


LIC 9221 Consent for Administration of Medications


LIC 9166Consent/Verification for Nebulizer Care 


LIC 9212 Consumer Awareness Information 


LIC 700 Identification and Emergency Form 


LIC 995 ANotification of Parent’s Rights 


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


LIC 995 C Notification of Parent’s Rights Reinstatement 


PM 286 B California School Immunization Card 


LIC 624 B Unusual Incident/Injury Report


Facility Forms/Records


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


LIC 9040 Child Care Roster 


LIC 9052 Notice of Employee Rights 


LIC 8572 Report Suspected Child Abuse 


LIC 9108 Acknow Req to Rpt Suspected Child Abuse 


LIC 9149 Property Owner/Landlord Consent Form


LIC 9151 Property Owner/Landlord Notification Form
 


Information to be Posted in your Facility

ALL posting shall be in a location visible to clients


LIC 610 AEmergency Disaster Plan


LIC 999 A Facility Sketch


LIC 9148 Earthquake Preparedness Checklist 


PUB 394 Notification of Parent’s Rights Poster 


LIC 203 Facility License
 


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

LIC 9163 Live Scan Fingerprint Request 


CPR/First Aid Certification – current


PUB 271 Never Shake A Baby


LIC 9058 Applicant/Licensee Rights (LIC 9058) 08/05


License Addendum – If license states capacities of 8 or 14


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


Guides in other languages can be found here