Training RCFE Staff to Work with LIC 602A: How to Avoid the Risks of Outdated Forms
AI-generated image of frontline staff being trained to recognize outdated LIC 602A forms, created for illustrative and educational purposes.
By 2025, the world of senior care in California changed more than many administrators expected. For Residential Care Facilities for the Elderly (RCFE), it is no longer just about “having a doctor’s form in the file.” The state now looks closely at which form you use, what is written on it, and how your team handles it.
At the center of these changes is the updated medical assessment form LIC 602A (Physician’s Report, Rev. 4/25) and several key Provider Information Notices (PINs). The older form LIC 602A (Rev. 8/11) is no longer acceptable. Continuing to use it is not a minor paperwork error. It can lead to citations, civil penalties, and serious questions about your license.
This article explains, in plain language, why the new form matters so much and how to train frontline staff so outdated 602A forms simply stop appearing in your intake process.
Who Sets the Rules and What Exactly Do They Expect?
Community Care Licensing Division (CCLD): more than a “resource”
Community Care Licensing Division (CCLD) is the enforcement arm of the California Department of Social Services for RCFE. It does not just “support providers”; it:
sets standards for RCFE operations
inspects facilities and reviews resident files
issues deficiencies and citations
imposes civil penalties
can suspend or revoke licenses
CCLD communicates changes through Provider Information Notices (PINs). Many staff still treat PINs like newsletters. In reality, they function as written instructions from the regulator.
For LIC 602A, two PINs are critical:
PIN 25-05-ASC cancels the old LIC 602A (Rev. 8/11) and introduces LIC 602A (Rev. 4/25) as the required form.
PIN 24-09-ASC updates dementia and neurocognitive care standards and requires more precise information about cognition and behavior.
If staff do not read and act on PINs, the facility automatically drifts into non-compliance.
Title 22 §87458: why the form must be current
Section 87458 of Title 22 says that before admission the RCFE licensee must obtain a medical assessment signed by a qualified health professional.
Section 87458(b) adds an important condition: the licensee must obtain an updated assessment when required by the Department.
Issuing a new version of LIC 602A through a PIN is exactly such a requirement. That means:
Admitting a resident on LIC 602A (8/11) after the release of the 4/25 version is a direct violation of §87458(b).
During an inspection this almost guarantees a deficiency related to documentation.
LIC 602A as a legal document, not just an intake checklist
Many frontline employees see LIC 602A as a handy checklist for move-in. Training has to reset that mindset.
In practice, LIC 602A is:
a legal statement about the resident’s condition at the time of admission
evidence that the resident is appropriate for RCFE level of care (non-medical, no ongoing skilled nursing)
the foundation for the Needs and Services Plan (LIC 625) required under §87463
If the form is outdated, it simply lacks required questions and fields. In a complaint investigation or lawsuit, the facility can easily appear as if it “chose not to know” important facts about the resident’s condition. That is a weak position in front of CCLD, families, and courts.
Old vs. New LIC 602A: How Staff Should Spot the Difference in Seconds
Training should give staff not only legal context, but also simple visual rules. They should be able to look at a form for five seconds and know whether it can be used.
First filter: the revision date in the footer
The quickest test is at the bottom of the page.
In the lower left corner (footer) of every page you will see a revision date:
Outdated form:
LIC 602A (8/11)Current form:
LIC 602A (4/25)
If you see (8/11), the form is not acceptable. Do not scan it, do not file it, do not continue admission. Return it to the physician and request the 4/25 version.
This should become a reflex: open the PDF or fax, glance at the footer, decide “stop” or “go.”
Cognitive conditions: beyond “forgetful”
The older 8/11 form treated mental status in a very general way. It used vague boxes like “confusion” or “disorientation.” A physician could write “memory loss” without describing the level of impairment.
The 4/25 form changes this completely. It:
adds a separate “Cognitive Conditions” section
introduces two key categories:
Mild Cognitive Impairment (MCI) – mild cognitive changes, not normal aging but not full dementia
Major Neurocognitive Disorder (Major NCD) – significant cognitive decline
asks for the specific type of disorder (for example, Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia)
Why this matters:
It determines whether the resident can be placed in a memory care or secured unit.
It influences staffing, supervision levels and environmental safety measures.
It shapes the Needs and Services Plan.
If a resident with serious dementia is admitted on an 8/11 form that only says “forgetful,” the facility officially has no record of a Major NCD. In an elopement or injury case, this looks like the facility never recognized the real risk.
“Behavioral expressions” instead of “problem behavior”
New standards shift the language from blaming the resident to understanding their needs.
Instead of “problem behavior,” the 4/25 form uses “behavioral expressions”. The physician is asked to:
describe known patterns such as wandering, resistance to care, aggression, or exit-seeking
indicate how much support the resident needs to manage these behaviors
This gives the facility practical information for staffing, care planning, and safety. The 8/11 form simply did not ask for this level of detail.
Electronic signatures and TB updates
The new LIC 602A also includes:
clear language that an electronic signature is legally equivalent to a handwritten one
an updated tuberculosis (TB) section that reflects current public health guidance
If an old form is used, CCLD can easily argue that TB documentation and signature standards are out of date.
What Happens When a Facility Uses the Old Form?
Type A and Type B citations: two levels of trouble
CCLD classifies deficiencies into two main types.
Type A Citation – a violation that either created, or was likely to create, an immediate threat to health, safety, or personal rights.
Example: A resident with severe dementia and strong wandering tendencies is admitted using an 8/11 form. There is no Major NCD recorded, no clear behavior section, and no enhanced supervision. The resident leaves the building and is injured. During the investigation, the analyst sees:
an outdated LIC 602A (8/11)
no documentation recognizing the true level of cognitive risk
This is a classic Type A scenario.
Type B Citation – a violation that may pose a threat if not corrected, but has not yet led to harm.
Example: During a routine visit, the Licensing Program Analyst (LPA) reviews recent admissions and finds several residents admitted in 2025 using the 8/11 form. Residents are currently safe, but the documentation does not meet current state requirements. That is Type B. Repeated Type B citations can escalate penalties.
Civil penalties: how one mistake multiplies
Civil penalties can add up quickly when outdated forms appear in multiple files. A single facility-wide practice (for example, always printing an old template from a shared folder) can turn into several citations and multiple penalty days.
Besides direct costs, all citations are publicly visible. Families and referral sources can see them and start to question the facility’s professionalism and risk management.
Improper admission and forced eviction
The 4/25 LIC 602A includes an updated list of Restricted Health Conditions — situations that may be allowed only under strict conditions, or not allowed at all under a particular license.
If an outdated 8/11 form does not capture, for example:
complex catheter care
advanced pressure injuries
complex diabetes management
the facility could admit a resident whose needs exceed its license or capabilities. Later, when the real condition becomes clear, the facility may have to start a stressful eviction process with 30-day notice, appeals, and family complaints.
The whole point of the updated LIC 602A is to catch such situations before admission, not after.
Building an Effective Training Program for Frontline Staff
A good training program is not one webinar. It is a simple, repeated system that tells each role:
what to look for
what to do next
how this protects residents and the facility
Module 1 – “Clean Sweep”: removing old forms from the system
Goal: eliminate outdated LIC 602A files from all devices and shared drives.
Steps:
Workstation audit
Each staff member checks:desktop
“Downloads” folder
“Sent Items” in email
shared network folders
They look for файлы with names like
LIC602A.pdf,PhysicianReport.pdf, etc.Delete all versions before 4/25
Any blank form with revision 8/11 is deleted permanently. No “just in case” copies.One source of truth
New rule: blank forms are not stored on desktops. For every new request, staff download LIC 602A (4/25) from:the official CDSS website, or
an internal intranet folder that is maintained and updated centrally.
Documenting this “clean sweep” is useful. It shows CCLD that the facility took proactive, system-wide action.
Module 2 – “Footer First”: a 5-second visual check
Goal: create a simple habit that blocks outdated forms at the door.
Rule for all intake staff:
When a LIC 602A arrives (fax, email, paper scan), look first at the lower left footer.
If it says (8/11) – stop the process, do not file, do not create a resident record based on this form.
If it says (4/25) – proceed to full content review.
Training tools:
print sample pages of both versions
hang a small poster in the intake office:
“Footer First: 8/11 = STOP, 4/25 = OK”
Module 3 – Cognitive Conditions: MCI vs Major NCD
Goal: teach staff to recognize when the cognitive section is incomplete.
Training scenario:
Staff receive a mock LIC 602A (4/25) where the physician has checked “yes” for a cognitive condition but has not specified whether it is MCI or Major NCD and has left the diagnosis line blank.
They should learn the correct response:
This form is not complete.
Admission cannot be finalized based on this information.
A polite request goes back to the physician:
On simple examples, trainers can show how this affects:
supervision levels
room assignment (secured vs non-secured)
staffing plans and care tasks
Module 4 – Restricted Health Conditions: matching form to license
Goal: help staff connect what is on the form with what the facility is legally allowed to do.
In training, staff review cases where the physician has checked boxes for:
oxygen use
certain stages of pressure injuries
insulin-dependent diabetes
catheter care, and so on
For each case, staff practice:
checking the facility’s license and policies
confirming whether trained staff and procedures are in place
verifying that the LIC 602A clearly answers questions about the resident’s ability to self-manage (where applicable)
This module reduces the chances of admitting residents whose needs cannot be safely met in that RCFE.
Role-based training matrix
To keep the program organized, it helps to define learning goals by role.
Intake Administrator / Move-In Coordinator
Recognize old vs new forms (8/11 vs 4/25) at a glance
Use scripts when asking physicians to replace or complete forms
Explain to families why the facility cannot proceed without the correct form
Wellness Nurse / Director of Health Services
Interpret cognitive and behavioral sections
Evaluate restricted health conditions
Translate form details into staffing and care plans
Marketing / Family Liaison
Understand why refusing an outdated form protects the resident
Communicate calmly with families about delays caused by incomplete medical paperwork
Administrator / Executive Director
Oversee regular file audits
Ensure training is repeated and documented
Demonstrate to CCLD that the facility has a system, not just a one-time training
Working with Physicians: Saying “No” Without Burning Bridges
Even if your internal process is perfect, outdated forms often arrive from physician offices.
Why physicians keep sending 8/11
In many clinics, especially large group practices, LIC 602A is embedded inside the electronic medical record system:
the 8/11 template was built years ago
it auto-fills basic patient data
IT departments may take months to update external forms
So physicians simply print what the system offers. It is not intentional non-compliance, but the risk for the RCFE is still very real.
A proactive tactic: always attach the correct form yourself
Best practice:
Every time your facility requests a medical assessment, you attach a blank LIC 602A (4/25).
In the cover message you briefly explain why this specific version is required.
Sample language:
“Attached is the updated Physician’s Report LIC 602A (Rev. 4/25), required for Residential Care Facilities for the Elderly in California. The 2011 version is no longer used because of new requirements for documenting neurocognitive conditions. Please complete this form so we can admit your patient without delays.”
This reduces the chance that the office will pull an outdated template from its EMR.
How to decline an old form in a respectful way
When a physician does send the 8/11 form:
Do not file it and do not create a final admission package based on it.
Reply with a polite but clear explanation:
“Thank you for sending the Physician’s Report. Unfortunately, the Department of Social Services now requires the updated LIC 602A (Rev. 4/25). The 2011 version does not include the cognitive and behavioral fields we must have in order to accept a resident. I’ve attached the current form and highlighted the sections that are new. Could you please transfer the information to this version so we can move forward?”
If needed, include a short one-page summary from an industry association (such as CALA or LeadingAge) that explains the change.
Training should give staff the exact phrases they can use so they feel confident and respectful when they ask physicians to redo the form.
Audits and Quality Checks: Making Sure Training Sticks
To keep new habits alive, the facility needs simple, repeatable control points.
The “four-eyes” principle for every new LIC 602A
Before admission is finalized, at least two people should review the form:
Intake / Marketing
checks the format (revision date 4/25, signature, legibility)
Wellness Nurse / Director of Health Services
checks the content (cognitive status, behavioral expressions, restricted health conditions, TB section)
Administrator (final sign-off)
confirms that the form is complete and appropriate for the facility’s license before signing the Admission Agreement.
A one-time “general cleanup” of 2025 admissions
At least once, the facility should run a retrospective audit:
list all residents admitted from January 1, 2025 onward
for each file, answer:
is the form 4/25 or 8/11?
is the Cognitive Conditions section properly completed?
are there large blank gaps where there should be information?
is the TB section consistent with current guidance?
If any 8/11 form is found in a current resident’s file:
request a new LIC 602A (4/25) from the physician
file it promptly
record this as a corrective action in the quality improvement plan
Checking templates in EHR/eMAR systems
If the facility uses an electronic health record or eMAR system:
confirm that the stored LIC 602A template is the 4/25 version
if possible, configure the system to:
show a warning or block record creation when a valid LIC 602A is missing
generate a report listing residents without a current medical assessment
Otherwise even well-trained staff may unknowingly select an old template from within the software.
Conclusion: The Form Is the Foundation
The switch from LIC 602A (8/11) to LIC 602A (4/25) is not a cosmetic update. It reflects:
a more precise understanding of cognitive disorders and behavior
a stronger focus on safety and rights for residents with neurocognitive conditions
a clearer way for regulators to see whether a facility understands and manages its risks
For frontline staff, the core message is simple:
An outdated LIC 602A is not a “small paperwork issue.” It is a structural weakness in the entire care system.
To remove that weakness, every RCFE can anchor five straightforward practices:
Clean sweep: remove all old LIC 602A blanks from computers and shared drives.
One source of truth: download blank forms only from approved, updated sources.
Footer first: train all intake staff to check the revision date (4/25 only).
File audits: review all 2025 admissions and replace outdated forms immediately.
Clear scripts: give staff ready-made phrases for requesting the correct form from physicians and explaining the need to families.
The time and effort needed for this training are small compared with the cost, stress, and reputational damage from a serious citation or preventable incident. When the form is solid, the plan of care that rests on it can be solid too.
References
California Department of Social Services (CDSS) – LIC 602A (4/25) – Medical Assessment for Residential Care Facilities for the Elderly
California Department of Social Services (CDSS) – Forms and Publications (I–L): LIC 602A (4/25) – Medical Assessment for Residential Care Facilities for the Elderly
California Department of Social Services – Adult and Senior Care Program – Provider Information Notices (ASC): PIN 25-05-ASC – Updated Medical Assessment For Residential Care Facilities For The Elderly (LIC 602A) Form
California Department of Social Services – Dementia Care Information and Resources – PIN 24-09-ASC – Updated Dementia Care And Miscellaneous Regulations For Residential Care Facilities for the Elderly
Legal Information Institute, Cornell Law School – Cal. Code Regs. Tit. 22, § 87458 – Medical Assessment
California Department of Social Services / Assisted Living Education (сводный текст регуляций) – RESIDENTIAL CARE FACILITIES FOR THE ELDERLY – Title 22 Chapter 8 (Resident Assessments, Fundamental Services and Rights)
LIC602.com – Managing the Full Lifecycle of LIC 602A in RCFEs
LIC602.com – When a Change in Condition Requires a New LIC 602A
CANHR (California Advocates for Nursing Home Reform) – RCFEs: Assessment & Care Planning
A Place for Mom – What California’s Form 602 Is and Why It’s Required
