California Infant Sleep Form LIC 9227: Sections, Log, and Recordkeeping

California’s LIC 9227 Individual Infant Sleeping Plan is a one-time intake form completed when an infant enrolls in licensed care, capturing the child’s sleep habits, rolling ability, and any medical exemption, and signed by a parent or authorized representative. It is not the ongoing record of the state’s required 15-minute sleep checks; that is a separate observation log the facility maintains alongside the plan. Both documents live in the infant’s file and must be produced during inspections by the California Department of Social Services Community Care Licensing Division.¹

You can download the current LIC 9227 from the Department of Social Services forms page under the I–L alphabetical listing.²

Filling Out the LIC 9227 Section by Section

Section A: Infant’s Information

Enter the infant’s full legal name, gender, and date of birth. List the primary and secondary authorized representatives, usually the parents, with phone numbers for each. Match the names exactly to what appears on the rest of the enrollment paperwork so the file reads consistently.

Section B: Sleeping Environment Information

This section records how the infant sleeps at home: whether the child uses a crib, play yard, or other arrangement, the usual sleeping hours, and the typical daytime nap length. There is also a question about pacifier use, including the brand if one is used. The parent provides these details so the provider can keep the child’s routine as consistent as possible, though the facility’s own sleep environment must still meet California’s safe sleep standards regardless of what happens at home.

Section C: Infant’s Ability To Roll

The parent signs and dates this section to confirm when the child became able to roll from back to stomach and back again. This matters for how the provider positions the child. California’s rules require infants to be placed on their backs to sleep, but once an infant can roll independently both ways, the provider is not required to reposition the child each time they turn over.

Section D: Infant’s Ability To Roll in Child Care

If the provider observes the infant rolling both ways at the facility, the provider signs and dates this section. The authorized representative must countersign no later than the next business day after the observation. The dual signature creates a shared record that the milestone was confirmed in both settings.

Section E: Medical Exemption

If an infant has a medical condition that requires a non-supine sleep position, mark this section “Yes” and attach written instructions from a licensed physician. The physician’s documentation must state how the infant should be positioned, how long the exemption lasts, and include the physician’s contact information and signature. The parent also signs to acknowledge the exemption. Keep the physician’s letter attached directly to the LIC 9227 in the infant’s file.

The Separate 15-Minute Sleep Observation Log

California Code of Regulations, Title 22, Section 102425 requires providers to physically check on every sleeping infant at least once every 15 minutes.³ These are hands-on observations at the crib or play yard, not glances across the room. Each check must be documented contemporaneously on an ongoing log that sits alongside the LIC 9227 in the child’s file.

California does not mandate a single form for this log. The California Childcare Health Program at UCSF publishes a sample template many facilities use, and others build their own.⁴ Whatever format you use, each entry must capture:

The exact time of the check
The infant’s name
Whether breathing appeared normal or labored³
Any signs of distress, such as flushed skin, elevated body temperature, or restlessness
The infant’s sleep position, with a note if the child is in any position other than on their back
Any corrective action taken, such as repositioning the infant or removing an item from the crib

Record entries immediately after each check. Backdating or filling in a batch of entries at the end of a nap is one of the things licensing analysts specifically look for, and it can produce a deficiency citation even when the checks were actually performed. Entries should be legible and signed or initialed by the staff member who performed the observation.

If an infant has rolled onto their stomach and does not yet have a documented ability to roll both ways (Section C or D of the LIC 9227), the provider must reposition the child and note what happened on the log. If loose bedding, a stuffed toy, or any other soft item is found in the sleep space, remove it and document the corrective action; the Consumer Product Safety Commission’s guidance against pillows, quilts, bumper pads, and similar items in infant sleep spaces aligns with California licensing standards.⁵

Where To Keep the Records and Who Can See Them

The LIC 9227 form itself directs providers to keep the completed plan, with any attachments, in the infant’s file at the facility. The form cites Title 22, Section 101429(a)(2)(c) for child care centers and Section 102425(c)(2) for family child care homes.³ Store the sleeping plan and the observation logs together, organized by child and by date, so you can produce them without delay.

Licensing Program Analysts from Community Care Licensing conduct both scheduled and unannounced visits, and they will ask to see completed plans and logs on the spot. Parents may review their own child’s records at the facility but not records belonging to other children.⁶ Establish an archiving process for children who leave the program so their records are not accidentally discarded; questions can surface months after the fact.

What a Missing or Sloppy Form Costs

Under Title 22, Section 101195, civil penalties for serious deficiencies at child care centers that are not corrected by the deadline start at $50 per day per violation and can rise to $150 per day. If a child becomes sick, is injured, or dies as a result of a deficiency, the penalty is an immediate $150 per day. Repeat violations of the same regulation within 12 months trigger an immediate $150 assessment followed by continuing per-day penalties.⁷ A facility that fails to correct a deficiency within 90 days of receiving a notice may face license revocation under Health and Safety Code Section 1596.866.⁸

Missing or incomplete sleep documentation is among the easier violations for an analyst to spot during an inspection, and a gap in the log often invites closer scrutiny of the rest of the operation. The two documents are small, but they carry the weight of the entire safe sleep program on the file.

1
California Department of Social Services. Safe Sleep in Child Care
2
California Department of Social Services. Forms and Publications I-L
3
Legal Information Institute. California Code of Regulations Title 22 Section 102425 – Infant Safe Sleep
4
University of California, San Francisco California Childcare Health Program. Sample Infant Sleep Observation Form
5
U.S. Consumer Product Safety Commission. Crib Safety Tips
6
Community Care Licensing Division. Parent Rights in Child Care
7
New York Codes, Rules and Regulations. California Code of Regulations Title 22 Section 101195 – Penalties
8
California Legislative Information. California Health and Safety Code 1596.866