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LIC 603A: Resident Appraisal

By Sevana Care · Checked against cdss.ca.gov and Title 22 on

When it is due
Before admission [3].The pre-admission appraisal "shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first" [5].
Who fills it out
The licensee, or the employee responsible for admissions, interviews the prospective resident and the responsible person, if any, before admission, and the prospective resident or the responsible person must be involved in developing the appraisal [3].The form has a signature line for the applicant or responsible person and one for the licensee or designated representative, each with a "Date completed" [1].
Where it is kept
In the resident's record, kept in the facility or in a central administrative location readily available to facility staff and licensing staff [4].
How long to keep
At least three years after service to the resident ends: § 87506(e) sets this for resident records, and § 87506(b)(15) puts the pre-admission appraisal in the resident's record [4].Section 87506 does not mention LIC 603A by name [4].

LIC 603A is the California Department of Social Services (CDSS) form titled "Resident Appraisal", with the subtitle "Residential Care Facilities For The Elderly" [1][7]. Title 22 § 87457, "Pre-Admission Appraisal", names no form [3]. It covers the appraisal you complete before admission and says the appraisal must document the person's functional capabilities, mental condition and social factors [3]. CDSS lists LIC 603A as the Resident Appraisal in the records an RCFE keeps [2].

Who fills it out

The licensee, or the employee responsible for admissions, interviews the prospective resident and the resident's responsible person, if any, before admission [3]. The prospective resident or the responsible person must be involved in developing the appraisal [3].

The form says: "This information may be obtained from the Prospective Resident, or his/her responsible person" [1]. It has two signature lines, each with a "Date completed": "Signature of applicant or responsible person" and "Signature of licensee or designated representative" [1].

The form is not the medical assessment. Its note reads: "This form is not a substitute for the Physician's Report (LIC 602)" [1]. The note names LIC 602, not LIC 602A. CDSS lists LIC 602 as the Physician's Report for Community Care Facilities and LIC 602A as the Medical Assessment for Residential Care Facilities for the Elderly [7]. For an RCFE, CDSS's records list names the Physician's Report as LIC 602A [2]. Title 22 § 87458 requires a medical assessment before a person is accepted as a resident. It says the assessment includes "information applicable to the pre-admission appraisal" [6]. See LIC 602A.

When it is due

Before admission. Title 22 § 87457(c) says: "Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs" [3]. No one may be admitted without their consent and agreement, or that of their responsible person [3].

Then update it. The pre-admission appraisal "shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first". The update is called the reappraisal [5], and neither § 87457 nor § 87463 names LIC 603A for it [3][5].

Where it is kept

In the resident's record. The record must contain "the admission agreement and pre-admission appraisal" [4]. The record is kept in the facility or in a central administrative location readily available to facility staff and licensing staff [4]. CDSS's list puts LIC 603A under "Residents Records", which must be "kept in the facility complete and current, and readily available for review" [2].

How long to keep it: at least three years after service ends. Title 22 § 87506(e) says original records or photographic reproductions "shall be retained for a minimum of three (3) years following termination of service to the resident" [4]. Section 87506(b)(15) puts the pre-admission appraisal in the resident's record [4]. Section 87506 does not mention LIC 603A by name [4].

What the record must show

Section 87457(c)(1) says the appraisal must document, at a minimum [3]:

  • an evaluation of the prospective resident's functional capabilities, mental condition and social factors
  • whether the prospective resident's or other residents' safety would be at risk if the person is allowed access to any of the items in §§ 87307 (Personal Accommodations and Services) and 87309 (Storage Space and Access)

The form has headed sections for health, physical disabilities, mental condition, health history, social factors, bed status, tuberculosis information, ambulatory status, functional capabilities and services needed [1]. The form is dated 7/99. It has no section on the second item above, which § 87457 gained in an amendment that took effect on 1-1-2025 [1][3].

If an appraisal shows a service need the facility's general program does not meet, § 87457(c)(2) says to get advice from a physician, social worker or other consultant on whether the home can meet the need. If it can, the licensee and the consultant develop a plan of action. The plan has objectives with a time frame, plans for meeting them, who is responsible, and a method of evaluating progress [3]. CDSS's list puts "Appraisal Need and Services Plan, when applicable (LIC 625)" in the same list item as LIC 603A [2]. See LIC 625.

Questions

Do RCFEs use LIC 603A?

CDSS lists "Resident Appraisal RCFE (LIC 603A)" in its records list for residential care facilities for the elderly, and the form's subtitle names RCFEs [1][2]. Title 22 § 87457 sets what the appraisal covers and does not name a form [3].

Is LIC 603 the same as LIC 603A?

They are separate CDSS forms. CDSS lists LIC 603 (6/22) as "Preplacement Appraisal Information" and LIC 603A (7/99) as "Resident Appraisal" [7]. CDSS's RCFE records list names LIC 603A and does not name LIC 603 [2]. Title 22 does name LIC 603 in one narrow place. When a resident asks to review a health condition relocation order, § 87638(g)(3)(A) says "The licensee shall be permitted to use the form LIC 603 (Rev. 6/87), Preplacement Appraisal Information, to document the appraisal or reappraisal" that goes with the request [8].

Is the pre-admission appraisal the same thing as the admission agreement?

No. Section 87506(b)(15) names both in one item of the resident's record, as two documents [4]. See LIC 604A.

How Sevana Care keeps this record

Is the pre-admission appraisal on file? In Sevana Care, each resident's admission file has a place for the pre-admission appraisal. It shows Missing until you add a photo or a file, then On file. We don't write the appraisal. Open the sample home to see the screen, though uploads are switched off there.

More in Admission and the resident file

  • LIC 9172: The checklist of what a new resident can do for themselves
  • LIC 613C-2: The personal rights a resident signs at admission
  • LIC 601: The form with a resident's contacts, doctor, hospital and emergency details
  • LIC 627C: The signed consent for emergency medical or dental care
  • PUB 325: The brochure on medical care decisions that you give each resident on admission

Sources

  1. CDSS, LIC 603A (7/99), Resident Appraisal, Residential Care Facilities For The Elderly (PDF)
  2. CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)
  3. California Code of Regulations, Title 22, § 87457, Pre-Admission Appraisal (Westlaw)
  4. California Code of Regulations, Title 22, § 87506, Resident Records (Westlaw)
  5. California Code of Regulations, Title 22, § 87463, Reappraisals (Westlaw)
  6. California Code of Regulations, Title 22, § 87458, Medical Assessment (Westlaw)
  7. CDSS, Forms and Publications (I-L)
  8. California Code of Regulations, Title 22, § 87638, Resident Request for Review of Health Condition Relocation Order (Westlaw)