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LIC 621: Client/Resident Personal Property and Valuables
By Sevana Care · Checked against cdss.ca.gov and Title 22 on
- When it is due
- Health and Safety Code (HSC) § 1569.153(d) says a "written resident personal property inventory is established upon admission" [3].Later items are added or removed at the written request of the resident, the family, a responsible party or a person acting for the resident [3]. Neither the statute nor the form gives a number of days [3][1].
- Who fills it out
- The licensee or administrator and the resident sign each entry, and the form says to "Explain why, if client/resident does not sign" [1].The initial inventory "shall be completed by the licensee and the resident or the resident's representative" [5].
LIC 621 is the California Department of Social Services (CDSS) Client/Resident Personal Property and Valuables form [1]. Page 1 is a log of items entrusted to the facility and items removed [1]. Page 2 is headed "RESIDENTIAL CARE FACILITIES FOR THE ELDERLY ONLY." It reprints HSC §§ 1569.152 to 1569.154 and has a signature line for the resident's receipt of them [1]. CDSS lists LIC 621 in the records an RCFE keeps [2]. HSC § 1569.153(d) requires a written personal property inventory for RCFE residents and names no form [3]. None of the cited sources says LIC 621 is that inventory [1][2][3].
Who fills it out
Page 1 of the form says the "Licensee/Administrator is responsible for maintaining a record of personal property/valuables entrusted to and removed from the facility." It says "Licensee/Administrator and client/resident must sign each entry. Explain why, if client/resident does not sign" [1]. Each entry has a signature line for the client or resident, which says "(or if 'None' explain)," and one for the licensee or administrator [1].
The law says who completes and witnesses the personal property inventory. Title 22 § 87218(a)(1): "The initial personal property inventory shall be completed by the licensee and the resident or the resident's representative" [5]. HSC § 1569.153(d): inventories "shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated" [3].
Page 2 has a second signature block. The resident or responsible person signs under the statement "I have received a copy of Health and Safety Code Sections: 1569.152, 1569.153, and 1569.154," with a title and a date. The form also has a line for the licensee or designated representative and a "date completed" [1].
When it is due
At admission. HSC § 1569.153(d): a "written resident personal property inventory is established upon admission and retained during the resident's stay" [3].
When items change. "Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident's family, a responsible party, or a person acting on behalf of a resident" [3]. The form says to explain the reason for each removal and enter the removal date [1].
At discharge. HSC § 1569.153(e) calls for "Inventory and surrender of the resident's personal effects and valuables upon discharge to the resident or authorized representative in exchange for a signed receipt" [3]. Title 22 § 87217(i) also requires surrender, to the resident or "his responsible person," of property "entrusted to the licensee," and says "A signed receipt shall be obtained" [4].
At death. HSC § 1569.153(f) calls for "Inventory and surrender of personal effects and valuables following the death of a resident to the authorized representative in exchange for a signed receipt." It also calls for "Immediate written notice to the public administrator of the county upon the death of a resident whose heirs are unable or unwilling to claim the property" [3]. Title 22 § 87217(j) says the resident's property "shall immediately be safeguarded." Then "The executor or the administrator of the estate shall be notified by the licensee, and the cash resources, personal property, and valuables surrendered to said party." If no executor or administrator has been appointed, "the responsible person shall be notified, and the cash resources, personal property, and valuables shall be surrendered to said person in exchange for a signed itemized receipt" [4].
The statute gives no number of days for the inventory. Other duties in the same section have clocks: documentation of lost or stolen property worth $25 or more "within 72 hours of the discovery," and a report to local law enforcement "within 36 hours" when the administrator has reason to believe property worth $100 or more has been stolen [3]. CDSS lists a Resident Theft and Loss Record (LIC 9060) separately, "when applicable" [2].
Where it is kept
The form says to "Provide a copy to the client/resident and maintain a copy in client's/resident's file" [1]. CDSS's list puts the "record of each resident's personal property and/or valuables entrusted to facility, Client/Resident Personal Property and Valuables (LIC 621)" under "Residents Records" and says these records "must be kept in the facility complete and current, and readily available for review" [2]. That list is dated 4/05.
Section 87506(a) requires a record for each resident, in the facility or at a central administrative location readily available to facility and licensing staff. Item (b)(16) lists "Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables" [6].
Receipts. Section 87217(b) says the licensee "shall give the residents receipts for all such articles or cash resources." Under (g)(2), the records "shall include a copy of the receipt furnished to the resident" [4].
How long to keep it. HSC § 1569.153(d) says the inventory is "retained during the resident's stay" [3]. Section 87506(e): "Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident" [6]. Section 87506 does not name LIC 621 or an inventory. Item (b)(16) names records of cash resources [6]. None of the cited sources gives a retention period for the inventory after the stay ends.
Resident records are confidential, and the licensee is responsible for storing them and safeguarding what they contain [6].
What the record must show
What the form asks. Page 1 has the resident's name and Social Security number. Part A is "Personal property/valuables entrusted to facility," and part B is "Personal property/valuables removed." Each part has columns for number, description, date and location, plus the two signatures [1]. The form says "Under 'Number', enter the quantity of items entrusted," and "Under 'Location', enter where items are stored" [1].
What HSC § 1569.153(d) asks. The inventory is written in ink, witnessed, dated, and a copy goes to the resident or the person acting for the resident. Additions are made in ink, witnessed and dated. A current copy is available "upon request to the resident, responsible party, or other authorized representative" [3].
What page 1 leaves out. Page 1 has no instruction to write in ink and no line labelled "witness" [1]. The statute asks for both [3]. The sources do not say whether the form's two signatures meet "witnessed."
Items the statute lets the resident leave off. The resident, family or a responsible party "may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from the facility" [3]. The facility "shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory" [3].
Marking. The statute also calls for "Establishment of a method of marking, to the extent feasible, personal property items for identification purposes upon admission and, as added to the property inventory list" [3]. The form says "marking articles by names or numbers may aid identification" [1].
Questions
Does an RCFE have to use LIC 621?
HSC § 1569.153(d) requires the inventory and names no form [3]. CDSS lists LIC 621 in the records an RCFE keeps [2], and a CDSS forms request for RCFEs, LIC 183B (10/03), also lists it [11]. Section 87102, the Chapter 8 list of forms, does not include LIC 621 [10].
Is LIC 621 the personal property inventory in HSC § 1569.153(d)?
No source says so. The statute calls it a "written resident personal property inventory" [3]. LIC 311F lists LIC 621 as the "record of each resident's personal property and/or valuables entrusted to facility," in the same item as the cash resources record, LIC 405 [2]. The form's own text is about items "entrusted to and removed from the facility" [1].
Is any home exempt from the inventory?
HSC § 1569.153(m): "Only those residential units in which there are no unrelated residents and where the unit can be secured by the resident or residents are exempt from the requirements of this section" [3].
Is the back page required?
The form says it "may be completed and retained in Residential Care Facilities for the Elderly to meet the notice requirements of Health and Safety Code Section 1569.153(k)" [1]. Section 1569.153(k) reads: "A copy of this section and Sections 1569.152 and 1569.154 is provided by a facility to all of the residents and their responsible parties, and, available upon request, to all of the facility's prospective residents and their responsible parties" [3]. The form's reprint of (k) reads "this section and Sections 1569.152, 1569.153 and 1569.154" [1].
Can the admission agreement limit what the home owes for a resident's belongings?
HSC § 1569.154: "No provision of a contract of admission ... shall require or imply a lesser standard of responsibility for the personal property of residents than is required by law" [9]. Title 22 § 87218(a)(3) says nearly the same: a contract of admission "shall not require or suggest a lesser standard of responsibility for the personal property of residents than the law requires" [5]. See LIC 604A.
What does the statute say about a home that loses a resident's property?
HSC § 1569.152(a): a home that "fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value." The home "shall be presumed to have made reasonable efforts" if it "has shown clear and convincing evidence of its efforts to meet each of the requirements specified in Section 1569.153." The presumption "shall be a rebuttable presumption" [8]. The inventory is item (d) of § 1569.153 [3].
How Sevana Care keeps this record
Belongings come and go. Each resident has a place in Sevana Care for the LIC 621. File a scan of the signed copy. It shows Missing, then On file, then Expiring for its last 30 days, then Stale once the signed date is 12 months old. Sevana Care sets that 12 months; the form and the law don't. Keep the paper original too. We don't fill out the LIC 621. A resident's documents in the sample home hold the Personal Property Inventory.
More in Resident money and belongings
- LIC 9059: The CDSS guidelines form for how a home handles resident property, theft and loss
Sources
- CDSS, LIC 621 (4/99), Client/Resident Personal Property And Valuables (PDF)
- CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)
- California Health and Safety Code § 1569.153 (leginfo)
- California Code of Regulations, Title 22, § 87217, Safeguards for Resident Cash, Personal Property, and Valuables (Westlaw)
- California Code of Regulations, Title 22, § 87218, Theft and Loss (Westlaw)
- California Code of Regulations, Title 22, § 87506, Resident Records (Westlaw)
- CDSS, Forms and Publications (I-L)
- California Health and Safety Code § 1569.152 (leginfo)
- California Health and Safety Code § 1569.154 (leginfo)
- California Code of Regulations, Title 22, § 87102, Descriptions of Forms (Westlaw)
- CDSS, Notice of Form Change No. 04-064 (2/27/2004), with LIC 183B (10/03) Forms Request, Residential Care Facilities For The Elderly (PDF)