Skip to content
Sevana
Book a demo

Forms library

SOC 341A: Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders

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

When it is due
Before the person starts work.Welfare and Institutions Code (WIC) § 15659(a) says a care custodian, "prior to commencing his or her employment and as a prerequisite to that employment, shall sign a statement on a form that shall be provided by the prospective employer" [3].
Who fills it out
The new employee signs, and the employer provides the form and a copy of WIC § 15630 [3].The form has lines for name, position and facility, and a signature and date [1].
Where it is kept
The form says "RETAIN IN EMPLOYEE/VOLUNTEER FILE" [1].WIC § 15659(a) says "The signed statement shall be retained by the employer" [3].
How long to keep
Neither § 15659 [3] nor the form [1] gives a period.Section 87412(h) sets three years after employment ends for personnel records, and § 87412(a) does not list this statement [11].

SOC 341A is the California Department of Social Services (CDSS) form "Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders." WIC § 15659(a) says a person who starts work as a care custodian must sign a statement that they know WIC § 15630 and will comply with it, on a form the employer provides [3]. Residential care facilities for the elderly are on the care custodian list [4]. The statute names no form. CDSS's Provider Information Notice (PIN) 21-27-ASC says licensees and staff "may use" SOC 341A to meet the requirement, and that it "is provided as a courtesy to licensees" [7].

Who fills it out

The employee signs. The employer provides the form. WIC § 15659(a) says [3]:

  • "The employer shall provide a copy of Section 15630 to the employee."
  • "The statement shall inform the employee that he or she is a mandated reporter and inform the employee of his or her reporting obligations under Section 15630."

WIC § 15610.17 defines a care custodian as "an administrator or an employee of any of the following public or private facilities or agencies, or persons providing care or services for elders or dependent adults, including members of the support staff and maintenance staff." The list includes "residential care facilities for the elderly, as defined in Section 1569.2 of the Health and Safety Code" [4]. WIC § 15630(a) names "administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian" among mandated reporters [5].

Volunteers. The form says: "As an employee or volunteer at a licensed facility, you are one of those persons - a 'mandated reporter'" [1]. Section 15659(a) speaks of a person who "enters into employment" [3].

What the employee writes. The form has lines for NAME, POSITION and FACILITY at the top. It ends with: "I, ____, have read and understand my responsibility to report known or suspected abuse of dependent adults or elders. I will comply with the reporting requirements." Below that are SIGNATURE and DATE [1]. The form does not say who fills in the top lines.

The employer's duty under § 15659 has a limit. Section 15659(f) says: "The retention of statements required by subdivision (a), and the delivery of statements required by subdivision (b), shall be the full extent of the employer's duty pursuant to this section." It adds that a failure to report "shall be the sole responsibility of that person" [3].

When it is due

Before the first day of work. The statute says the person signs "prior to commencing his or her employment and as a prerequisite to that employment" [3]. The form does not give its own deadline [1].

Training is separate. WIC § 15655(a)(3) says employees of a residential care facility hired on or after July 1, 2002 "shall be trained within 60 days of their first day of employment" [6]. PIN 21-27-ASC lists the employee statement and the training under separate headings [7]. The form says nothing about training [1].

No second signing date. Neither § 15659 [3] nor the form [1] gives a date to sign again.

Where it is kept

In the employee's file. The form's top note reads: "NOTE: RETAIN IN EMPLOYEE/VOLUNTEER FILE" [1]. WIC § 15659(a): "The signed statement shall be retained by the employer" [3].

Not in the list of personnel record contents. Section 87412(a) lists what each personnel record "shall contain," in 13 items, and the statement is not one of them [11]. CDSS's list of records an RCFE keeps, dated 4/05, does not list SOC 341A [12].

How long to keep it. Neither the form [1] nor § 15659 [3] gives a period. Section 87412(h): "All personnel records shall be retained for at least three (3) years following termination of employment" [11]. Section 87412 does not name SOC 341A [11].

What the record must show

The record is the signed statement: the employee's name, position and facility, a signature and a date [1]. By statute the statement must show that the person has knowledge of § 15630 and will comply with it [3].

The form tells the employee [1]:

  • who is a mandated reporter: care custodians, and any person who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult, paid or not
  • to complete form SOC 341, "Report of Suspected Dependent Adult/Elder Abuse," for each report; see SOC 341
  • report deadlines, which the form summarizes in its own words; WIC § 15630(b)(1)(A) sets them [5], and the SOC 341 page quotes it
  • that failure to report "is a MISDEMEANOR CRIME, punishable by jail time, fine or both"
  • that "no supervisor or administrator shall impede or inhibit the reporting duties"
  • that the identity of a person who reports "shall be confidential" and may be disclosed only to the agencies the form lists; the form adds that "Confidentiality may be waived by the reporter or by court order"
  • the legal definitions of physical abuse, serious bodily injury, neglect, financial abuse, abandonment, isolation and abduction

Ages. The form's ages differ from the statute's. The form defines an elder as a person "60 years of age or older (WIC Section 15610.27)" and a dependent adult as a person "between the ages of 18 and 59." Further down page 2 it says "mandatory reporting still only applies to elders age 65 years and older" [1]. WIC § 15610.27 says: "'Elder' means any person residing in this state, 65 years of age or older" [13]. WIC § 15610.23(a) says a dependent adult is a person "between the ages of 18 and 64 years" [14].

Questions

Must an RCFE use SOC 341A?

WIC § 15659(a) requires a signed statement on a form the employer provides, and names no form [3]. PIN 21-27-ASC says licensees and facility staff "may use" SOC 341A and calls it "a courtesy to licensees" [7]. CDSS's Senior Care Licensing page lists SOC 341A under "Mandated Reporter Forms" [10].

Is SOC 341A the same as SOC 341?

No. SOC 341 is the report of suspected abuse. The form tells the employee to complete SOC 341 for each report [1]. CDSS's All County Letter (ACL) 15-33 describes SOC 341A as "a form completed by mandated reporters in licensed facilities" [8]. CDSS lists both under Adult Protective Services program forms [9]. See SOC 341.

Does signing it count as the abuse training?

The form says nothing about training [1], and WIC § 15655(a)(3) sets a separate duty to train within 60 days [6].

Is there a Spanish version?

PIN 21-27-ASC lists "Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders (SOC 341A) in Spanish" [7].

How Sevana Care keeps this record

Where does each new hire's signed statement go? Every staff member's personnel file in Sevana Care has a required place for the mandated reporter acknowledgement, and it shows Missing until a copy is filed. We don't fill in the SOC 341A. Pick a staff member on the Team page in the sample home to see a personnel file.

More in Staff and background checks

  • LIC 500: The roster of staff, volunteers and other adults in the home, with duty hours
  • LIC 503: The health screening and TB result for each staff member
  • LIC 9163: The Live Scan form a person takes to be fingerprinted
  • LIC 9182: The request to move a staff member's active background clearance

Sources

  1. CDSS, SOC 341A (2/24), Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders (PDF)
  2. CDSS, Forms and Publications (Q-T)
  3. Welfare and Institutions Code § 15659, Employee Statement (leginfo.legislature.ca.gov)
  4. Welfare and Institutions Code § 15610.17, "Care custodian" (leginfo.legislature.ca.gov)
  5. Welfare and Institutions Code § 15630 (leginfo.legislature.ca.gov)
  6. Welfare and Institutions Code § 15655 (leginfo.legislature.ca.gov)
  7. CDSS, PIN 21-27-ASC (June 2, 2021), Mandated Reporting Requirements, Employee Statement, and Training Under the Elder Abuse and Dependent Adult Abuse Civil Protection Act (PDF)
  8. CDSS, All County Letter 15-33 (May 4, 2015), Implementation of AB 40 ... Revised Reporting Form SOC 341, and Revised Acknowledgment Form SOC 341A (PDF)
  9. CDSS, Adult Protective Services Program Forms
  10. CDSS, Public Information and Policies, Senior Care Licensing (lists SOC 341A)
  11. California Code of Regulations, Title 22, § 87412, Personnel Records (Westlaw)
  12. CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)
  13. Welfare and Institutions Code § 15610.27, "Elder" (leginfo.legislature.ca.gov)
  14. Welfare and Institutions Code § 15610.23, "Dependent adult" (leginfo.legislature.ca.gov)