LIC 624 is the unusual incident/injury report form of California's Community Care Licensing Division. A residential care facility for the elderly uses it to send the written report of an unusual incident to the licensing agency.
Facilities licensed by Community Care Licensing — among them residential care facilities for the elderly (RCFEs) — report unusual incidents and injuries of residents in writing. In an RCFE the report is usually prepared by the administrator from what the caregiver on shift saw and did, and it goes to the licensing agency and to the resident's responsible person.
Under Title 22, § 87211(a)(1), the written report is due within seven days of the event — for example a death, an injury that needs medical treatment or an unusual incident that threatens a resident's welfare. Outbreaks, poisonings, catastrophes and major accidents that threaten the welfare, safety or health of residents are reported within 24 hours under § 87211(a)(2), and suspected abuse has its own 24-hour reporting duties. The current text of the regulation and the form instructions are published by the California Department of Social Services.
The report identifies the resident and the facility, gives the date, time and place of the event, describes what happened and who was present, the immediate action taken and who was notified, the physician's findings and treatment if there were any, and how the matter was followed up or resolved. A clear, factual description written soon after the event is easier to defend at the next licensing visit than a summary put together days later from memory.
Most of what the LIC 624 asks for is already in the caregiver's shift note: the time, what was seen, what was done and whom the caregiver called. The work for the administrator is to turn the note into the report, add the follow-up and keep the note and the report together in the resident's file.
In the service, a shift note that describes an incident is flagged for the administrator, and a draft LIC 624 is prepared from it with the resident, the date and time, the description, the action taken and the people notified filled in. The administrator reviews it, adds the follow-up and sends the report; the deadline is shown until the report is marked as sent.
See also: Unusual incident reports for small RCFEs
I need thisService in preparation · No payment is accepted on this page