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CA LIC 500 2003-2024 free printable template

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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICESINSTRUCTIONS:PERSONNEL REPORTNAME OF FACILITYThis form is intended for keeping a current roster of all
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Show insurance policies. [E.g., Health Services insurance, and Workers Compensation insurance).] Include name, address, insurance number & license number of other staff members (facilitates) working in facilities. [E.g., Dental/Health Services staff and other staff/s working in health facilities.] Show staffing level, hours of work and staffing requirements. [Example: 1 hour/one visit] (NOTE: To complete this report, you MUST fill out each of the above items, and print the completed report in the preferred format above.) FURTHER NOTE: This report is to be submitted no later than 15 July of the previous year. IMPORTANT: PLEASE CLICK HERE to review the current California Health and Safety Code: Section 1350.16. FACILITIES AND PERSONNEL POLICIES ALL FACILITIES OPERATED BY CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICESINSTRUCTIONS: PERSONNEL POLICY, STANDARD PRACTICES AND DEFINITIONS: Standards and Practices: A checklist is to be completed by each coordinator. This checklist details the facility's policies and practices for the care and treatment of their residents. This checklist is designed to assist facility staff in effectively operating the facilities while protecting the rights of its patients. Example of a standard practice Example of an example of a standard practice DEFINITIONS:  Assessor. The person responsible for identifying the state of repair for each individual resident and reporting it to the Department of Health Services, as required by law. [Note: Assessing a resident's damage is different from caring for the resident. In the latter, it is the department's job to ensure residents' health care needs are met.] Behavior Analysis. A clinical evaluation of a resident designed to identify and understand their needs, behaviors and coping strategies. “Behavior Analysis” is a type of treatment in which a specific behavior by an individual is observed, understood and managed in the hopes of altering that behavior in the resident's favor. Example of a behavior analysis: The resident, a young patient with dementia, complains of “being too tired and having a headache.

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