How to Fill Out Form LIC 9213

Form LIC 9213 at a glance

What it is: Form LIC 9213 is the Notice of Site Visit by a Child Care Licensing Office Representative.

A filled-in Form LIC 9213 example: a site visit with a Type B violation

Form LIC 9213 example filled out, example: a site visit with a Type B violation
A licensing representative fills out Form LIC 9213 after a site visit. Violations were issued during the visit, none is Type A and one is Type B. The picture shows the filled notice, and its names and figures are sample values.

How to fill out Form LIC 9213, box by box

Name of Facility, License Number and Date of Visit

Form LIC 9213 example filled out, name of Facility, License Number and Date of Visit

Enter the Name of Facility, the License Number and the Date of Visit of the site visit or complaint investigation.

Regulatory violations issued during this visit

Form LIC 9213 example filled out, regulatory violations issued during this visit

Mark Yes or No: Were regulatory violations issued during this visit?

Type A violations

Form LIC 9213 example filled out, type A violations

If regulatory violations were cited, mark Yes or No: would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)?

Type B violations

Form LIC 9213 example filled out, type B violations

If regulatory violations were cited, mark Yes or No: could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.

Posting the notice and the Regional Office Contact Person

Form LIC 9213 example filled out, posting the notice and the Regional Office Contact Person

Only visit reports documenting Type A violations and corrections of violations must be posted in the child care facility for 30 consecutive days.

This notice must be posted for 30 days.

Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office.

Enter the Regional Office Contact Person and the Contact Person Telephone Number.

Sources

[1] Form LIC 9213 (1/04), Notice of Site Visit by a Child Care Licensing Office Representative, California Department of Social Services (the Official source link on this page).

Form Lic 9213 PDF Details

In the realm of child care services within California, the oversight and regulation by the California Department of Social Services play a crucial role in ensuring the safety and welfare of children. Integral to this oversight are the procedures and documentation mandated by the state, among which the LIC 9213 form serves as a fundamental instrument. This document, officially titled "Notice of Site Visit by a Child Care Licensing Office Representative," records the findings of either a routine site visit or a complaint investigation conducted at a child care facility. It details whether any regulatory violations were identified, categorizing them based on the level of risk they pose to children—either immediate risk (Type A) or potential risk if unaddressed (Type B). Furthermore, the LIC 9213 form outlines the mandatory posting of the visit report in the facility if Type A violations are found, for a duration of 30 consecutive days, thereby ensuring transparency and accountability. This process not only informs facility operators of their compliance status but also empowers parents and guardians by providing them access to critical safety information. This requirement for a public display of the findings, alongside the availability of the report upon request from the local Child Care Regional Office, underscores the commitment of the California Department of Social Services to uphold high standards of child care and protect the rights and safety of children.

QuestionAnswer
Form NameForm Lic 9213
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCONSECUTIVE, contacting, todays, recordkeeping