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LIC 610E: Emergency and Disaster Plan for Residential Care Facilities for the Elderly
By Sevana Care · Checked against cdss.ca.gov and Title 22 on
- When it is due
- A new applicant submits the plan with the initial license application [3][1].A licensed home reviews it "annually" and updates it as necessary, trains each staff member on it at hire and annually, and runs a drill at least quarterly for each shift [3].
- Who fills it out
- The licensee or administrator.The "Administrator Statement" has a row for each review or update, with date, name and title, and signature [1]. The form also asks for a named staff member and title for each assignment during an emergency [1].
- Where it is kept
- "Maintained on file at the facility" [1].The plan is made available on request to residents onsite, any responsible party for a resident, the local long-term care ombudsman and local emergency responders [3]. Title 22 § 87212(c) says "Emergency exiting plans and telephone numbers shall be posted" [4].
LIC 610E is the California Department of Social Services (CDSS) Emergency and Disaster Plan for Residential Care Facilities for the Elderly. The form says a licensee "is required to have an emergency and disaster plan that includes all of the elements on this form" under Health and Safety Code (HSC) § 1569.695 and Title 22 § 87212, and that "This form is provided as a courtesy to applicants and licensees" [1]. The statute names no form [3]. CDSS's license application instructions list it as "RCFE only LIC 610E" [6], and CDSS's records list names it [5].
Who fills it out
The licensee or administrator. HSC § 1569.695(d): "The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary" [3]. The form's Administrator Statement reads in part "As licensee or administrator of this facility, I assume responsibility for and have reviewed this plan", with REVIEWED and UPDATED boxes, a date, a name and title, and a signature on each line [1].
The form asks for [1]:
- the facility name, license number, administrator, address and phone numbers
- emergency names and numbers "in addition to 9-1-1," including the CCL Adult and Senior Care Regional Office, the local long-term care ombudsman and Adult Protective Services
- the staff member and title for each assignment: emergency supplies, utility shut-off and any backup generator, transportation, directing evacuation and the person count, supervising residents, and contacting agencies, residents' representatives and hospice providers
When it is due
New applicants. HSC § 1569.695(h): "An applicant seeking a license for a new facility shall submit the emergency and disaster plan with the initial license application" [3]. The form says the same, and CDSS's application instructions list it among the forms an RCFE applicant files [1][6]. The facility license guide covers the application.
Review. "A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served" [3]. The statute says "annually" and sets no calendar date.
Training. "A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster" [3].
Drills. "A facility shall conduct a drill at least quarterly for each shift." The type of emergency "shall vary from quarter to quarter." An actual evacuation is not required, and a facility "shall not require any resident participation." The documentation "shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill" [3].
Licensing visits. CDSS "shall confirm, during annual licensing visits, that the emergency and disaster plan is on file at the facility and includes required content" [3].
Where it is kept
The form says the plan is "maintained on file at the facility" [1]. CDSS's records list, dated 4/05, names "Emergency Disaster Plan (LIC 610E) posted emergency disaster plan" under "Administrative Records" [5].
Posting. Three sources speak of posting. Title 22 § 87212(c): "Emergency exiting plans and telephone numbers shall be posted" [4]. The form: "Emergency numbers must be posted at the facility" [1]. LIC 311F: "posted emergency disaster plan" [5]. HSC § 1569.695(g) says the plan is available "upon request" [3].
Who may ask for a copy. HSC § 1569.695(g): "residents onsite, any responsible party for a resident, the local long-term care ombudsman, and local emergency responders." Resident and employee information "shall be kept confidential" [3]. A facility "is encouraged" to give a copy to the medical health operational area coordinator [3]. The form calls this "encouraged, but not required" [1].
Resident information. The form lists four items that must be "readily available to facility staff during an emergency" and located in the facility: a roster with each resident's date of birth, an appraisal of resident needs and services, a medication list for residents with centrally stored medications, and contact information for the responsible party and physician [1][3].
How long to keep it. Section 1569.695, § 87212 and the form give no retention period for the plan or the drill records [3][4][1].
What the record must show
- The statute's list. HSC § 1569.695(a) says the plan "shall include, but not be limited to" [3]:
- evacuation procedures and assembly points on the facility sketch
- a plan to be self-reliant for "not less than 72 hours"
- transportation needs
- a contact list
- "At least two appropriate shelter locations," one "outside of the immediate area"
- utility shut-off locations and instructions
- eight procedures, from emergency power to confirming where each resident is
- The form's sections. Assignments, resident information, utility shut-off, exit doors, assembly points, temporary shelter locations, sheltering in place, evacuation procedures, procedures A to H, and the administrator statement with its review history [1].
- Left off the form. HSC § 1569.695(f) requires an evacuation chair at each stairwell and a set of keys for each shift that opens occupied resident units, facility vehicles, exit doors and the cabinets that hold plan items [3]. The form has no field for either, and only a note about vehicle keys [1]. It has no drill log and no training record [1]. Section 1569.695(a)(7)(A) also asks, for a permanently installed generator, that the plan include "its location and a description of how it will be used" [3]. The form's procedure A asks only for "Provisions for emergency power (could include identifying suppliers of, and obtaining, back-up generators)" [1].
- The older rule. Section 87212(b) lists designation of administrative authority and staff assignments, an evacuation plan and hospice notification [4]. Its last amendment on Westlaw is from 2010, and it does not mention the 72-hour plan, training or drills [4]. Section 87212(b)(2)(A) lists a "Fire safety plan"; the form has no heading by that name [4][1]. We can't say which text controls.
Other forms in the 610 series
From the CDSS forms list [2]:
- LIC 610 (11/23), for child care centers. LIC 610A (01/22), for family child care homes. LIC 610C (10/03), for children's residential facilities.
- LIC 610D (12/21), for adult day programs, adult residential facilities, residential care facilities for the chronically ill and social rehabilitation facilities. The list does not name RCFEs.
- LIC 610 MFHV (6/26), for Medical Foster Homes for Veterans.
Questions
Does an RCFE have to use LIC 610E?
HSC § 1569.695(a) requires a plan with listed content and names no form [3]. The form says it is "a courtesy" [1]. LIC 281 lists "(RCFE only LIC 610E)" and CDSS's records list names it [6][5].
Is LIC 610 the same as LIC 610E?
No. LIC 610 (11/23) is "Emergency Disaster Plan For Child Care Centers" [2]. LIC 610E (12/25) is "Emergency Disaster Plan For Residential Care Facilities For The Elderly" [2]. CDSS's application checklist still asks "Do you have an Emergency Disaster Plan (LIC 610)?", while its row A14 names "(RCFE only LIC 610E)" [6].
Do residents have to join the drills?
No. A facility "may provide an opportunity for residents to participate in a drill" and "shall not require any resident participation" [3].
Does a drill need a real evacuation?
No. HSC § 1569.695(c): "An actual evacuation of residents is not required during a drill" [3].
How Sevana Care keeps this record
Fire drills slip down the to-do list. Sevana Care's Safety area has three pages that cover parts of the LIC 610E plan: Drills, Evacuation and Facility Readiness. On Drills you schedule drills and log each one with its type, date, how long it took, who took part and what to fix. Evacuation covers routes, destinations and transport, and Facility Readiness lists equipment with its condition and last inspection. We don't fill in or print the LIC 610E. All three pages are under Safety in the sample home.
More in Medication, incident reports and safety plans
Sources
- CDSS, LIC 610E (12/25), Emergency and Disaster Plan for Residential Care Facilities for the Elderly (PDF)
- CDSS, Forms and Publications (I-L)
- California Health and Safety Code § 1569.695 (leginfo, as amended by Stats. 2025, ch. 546, effective January 1, 2026)
- California Code of Regulations, Title 22, § 87212, Emergency Disaster Plan (Westlaw)
- CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)
- CDSS, LIC 281 (11/25), Application Instructions for a Facility License (PDF)