California LIC 9020 is the Register of Facility Clients/Residents, a form published by the California Department of Social Services (CDSS) that licensed residential care facilities must keep on-site with current information about every person in their care. The current version was revised in May 2017 and can be downloaded from the CDSS forms page under the I–L alphabetical listing.1California Department of Social Services. Forms and Publications (I-L) It stays in the facility at all times and must be complete, current, and available whenever a licensing evaluator arrives.
Which Facilities Have to Keep One
LIC 9020 applies to residential facilities licensed by the Community Care Licensing Division (CCLD): adult residential facilities, residential care facilities for the elderly (RCFEs), group homes, small family homes, and similar programs governed by Title 22, Division 6 of the California Code of Regulations.2California Department of Social Services. Community Care Licensing Regulations Residential CCLD policy under Section 80071 identifies LIC 9020 as the form available to licensees for maintaining their required client register.3California Community Care Licensing Division. Regulation Interpretations and Procedures for Community Care Facilities
The CDSS records checklist for RCFEs, Form LIC 311F, specifically lists the Register of Facility Clients/Residents among the documents that must be kept in the facility, complete and current, and readily available for review.4California Department of Social Services. Records to Be Maintained at the Facility – Residential Care Facility for the Elderly If your facility falls under a different chapter of Title 22, check the equivalent records checklist for your license category; the register requirement applies broadly across residential community care facilities.
What Information the Form Captures
The header asks for your facility name, facility number, licensee name, and the date of the most recent update. Enter the facility name and license number exactly as they appear on your CDSS license certificate, because evaluators cross-reference them. The licensee’s name is the legal name of the individual or entity that holds the license.
Below the header, each row documents one resident. The fields are:
- Room or bed identifier for the resident.
- Client or resident full legal name, not a nickname.
- Ambulatory status: whether the person can move independently, needs assistance, or is non-ambulatory. This affects fire-safety planning and staffing.
- Physician name, office address, and a working phone number.
- Responsible person: the family member, conservator, or other contact authorized to make decisions or receive information, with their relationship to the resident and a current phone number.
- Restricted conditions: medical conditions, allergies, dietary restrictions, or behavioral considerations staff need to know, such as food allergies, fall risk, elopement risk, oxygen use, or behavioral triggers.
How to Fill It Out
Fill one row completely for each resident. Many facilities use shorthand for ambulatory status, such as “A” for ambulatory, “NA” for non-ambulatory, and “SA” for semi-ambulatory. Whatever notation you pick, keep it consistent and understandable to any staff member or evaluator who reads it.
The physician entry should carry enough detail that someone could reach the doctor in an emergency. Restricted conditions should be factual and brief. Every entry on the register has to match what is in the resident’s individual file. If the register lists Dr. Smith but the care plan lists Dr. Jones, that discrepancy will be flagged during an inspection.
Keeping the Register Current
LIC 9020 is a living document. Update it the same day a new resident moves in, and cross out or remove the row for any resident who leaves. The CDSS maintenance standard requires that the register be complete and current at all times.4California Department of Social Services. Records to Be Maintained at the Facility – Residential Care Facility for the Elderly A stale register, one that lists residents who left months ago or omits someone currently living there, is the kind of finding that turns a routine visit into a citation.
Update the form whenever a resident’s ambulatory status changes, their physician changes, or a new responsible person is designated. Some operators print a fresh copy quarterly and rebuild it from scratch; others maintain a single copy with pen corrections. Either approach works as long as the result is legible and accurate. The register stays in your on-site facility files and is not mailed to a regional CCLD office.
What Inspectors Check
CCLD licensing evaluators conduct both scheduled and unannounced visits. During an inspection, the evaluator will typically ask to see the LIC 9020 and then walk the facility, comparing the names on the register against the residents actually present. They check whether ambulatory-status entries match what they observe, whether physician information is current, and whether every resident in the building appears on the form.
A resident physically present who does not appear on the register, or a listed resident with outdated medical information, can produce a deficiency finding. For serious deficiencies that go uncorrected past the deadline in the notice, penalties start at $50 per violation per day and can reach $150 per day.5New York Codes, Rules and Regulations. 22 California Code of Regulations 87761 – Penalties If a resident becomes sick, is injured, or dies because of a deficiency, the penalty is an immediate $150 per day.6California Department of Social Services. Civil Penalty Assessment
Not a Staff Form
LIC 9020 tracks residents, not personnel. Staff information belongs on separate CDSS forms, and putting employee data on the client register is a common mistake. The staff roster is LIC 500 (Personnel Report), which lists facility personnel, other adults residing in the facility, volunteers, and the licensee if serving as administrator or director.7California Department of Social Services. LIC 500 Personnel Report Individual employment records go on LIC 501, and the sworn criminal history statement for anyone subject to background checks is LIC 508.8New York Codes, Rules and Regulations. 22 California Code of Regulations 101170 – Criminal Record Clearance Keep those records in each employee’s personnel file; none of that information belongs on LIC 9020.