| Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below:
Residential Care Facility for the Elderly (RCFE)
LIC 308 Designation of Facility Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 500 Personnel Report
LIC 610E Emergency And Disaster Plan For Residential Care Facilities For The Elderly
LIC 9020 Register of Facility Clients/Residents
Copy of current Liability Insurance
Copy of current Administrator Certificate
Alternate contact information including name, telephone number, & email address.
Please submit the above forms/information to Fresno CCL by: 06/08/2026
As an operator of a Community Care Licensed facility, it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.
LPA reviewed staff and residents’ files. No deficiencies were observed and cited during this visit.
AD granted Staff 1 (S1) - Johanna Lorio authorization to sign report.
Exit interview conducted. Report was signed and Copy of this report was provided to S1 for facility records.
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