LIC 308 Form PDF Details

Navigating the operational requirements of state-licensed facilities in California can be complex, particularly when it comes to ensuring continuity of authority and responsibility during operational hours. The Lic 308 form plays a crucial role in this context, serving as a mandatory instrument for licensed facilities to delegate authority to an appointed staff member who will represent the facility during the licensee's absence. This form, issued by the California Department of Social Services Community Care Licensing, requires detailed information about the facility, including its name, address, and contact information, alongside the designation of a responsible individual. This designated person gains the authority to accept licensing reports and handle various regulatory documents, an essential component for maintaining the facility's compliance with state regulations. The form also stipulates that additional documentation, such as board resolutions, may be required for corporate licensees, illustrating the state's emphasis on formalizing the delegation of authority. Furthermore, the form is tailored to accommodate specific regulations applicable to different types of facilities, such as Residential Care Facilities for the Elderly and Child Care Centers, ensuring that the delegation of responsibility aligns with specialized legal standards. The necessity for licensees to promptly inform the licensing agency of any changes to this designation underscores the dynamic nature of operational management and the state's commitment to maintaining active oversight of licensed care facilities.

QuestionAnswer
Form Name LIC 308 Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names california lic308, lic308, lic 308 facility, lic 308 designation of facility responsibility

Form Preview Example

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

DESIGNATION OF FACILITY RESPONSIBILITY

Licensed facilities are required to have an authorized person continuously present at the facility during operational hours to represent the facility and to accept licensing reports. Licensees shall use this form to delegate the above authority to appropriate staff. Applicants/licensees who are corporations shall attach board resolutions authorizing this delegation.

Facility Name _______________________________________________________________ Date ____________________________

Facility Number _____________________________________________________________

Facility Address _____________________________________________________________ Phone ___________________________

City ______________________________________________________________________ County __________________________

In the event of my absence I designate ___________________________________________________________________. He/She is

NAME

authorized to receive any documents including reports of inspections and consultations, accusations and civil and administrative processes on my behalf at the above-named facility.

When delegating authority to appropriate staff, Residential Care Facilities for the Elderly shall comply with CCR Title 22, Division 6 Section 87564. Child Care Centers shall comply with CCR Title 22, Division 12 Section 101215.1 and other licensed facilities shall comply with CCR Title 22, Division 6 Section 80064.

I (We) shall notify the licensing agency, in writing, within 10 days of any change in the above authorization.

________________________________________

Signature of applicants/licensees

_____________________________________________

Title

_____________________________________________

Address

_____________________________________________

City

County

Zip

LIC 308 (11/02) (PUBLIC)

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