The LIC 610D is the California Department of Social Services emergency disaster plan form for adult day programs, adult residential facilities, residential care facilities for the chronically ill, and social rehabilitation facilities. To complete and submit it, download the fillable PDF from the CDSS website, work through the numbered sections (facility information, emergency role assignments, two relocation sites, utility shut-off locations), pair it with the LIC 999 facility sketch, sign the affirmation, and return a signed copy to your local Community Care Licensing Division (CCLD) regional office. Keep a current copy posted at the facility.
What the LIC 610D Covers
CDSS publishes separate emergency disaster plan forms for different facility types, and submitting the wrong version can delay licensing or trigger a deficiency notice during an inspection. The LIC 610D applies specifically to adult day programs, adult residential facilities, residential care facilities for the chronically ill, and social rehabilitation facilities. If you run a child care center, you need the LIC 610 instead; family child care homes use the LIC 610A. All three forms share the same general structure, but the role titles, staffing assumptions, and regulatory references differ.
Where to Download It
The form is a free, fillable PDF hosted on the CDSS forms directory. Download it to your computer rather than filling it out inside a browser tab, because browser-based PDF viewers sometimes fail to save field entries. Once saved locally, you can type directly into the fields, store the completed version, and reopen it when you need to update staff names or site information.
Working Through the Form
Have your facility license, current staff roster, and a local map in front of you before you start. Work the sections in order.
Facility Information
Enter the legal name of your facility exactly as it appears on your state license, the facility address, the administrator’s name, and your California license number. Any mismatch with the CCLD database causes avoidable problems later, so check each entry against the actual license document.
Emergency Role Assignments
The plan requires you to assign specific people to three emergency roles:1California Department of Social Services. Emergency Disaster Plan for Child Care Centers
- Directing evacuation and performing a person count at the assembly point.
- Handling first aid until emergency responders arrive.
- Telephoning emergency numbers, including 911 and family or responsible-party contacts.
Name a primary assignee and at least one backup for each role. Staff turnover is the single most common reason plans go stale, so update names whenever someone leaves.
Two Temporary Relocation Sites
You must list two relocation sites.1California Department of Social Services. Emergency Disaster Plan for Child Care Centers The first should be close by, such as a neighboring building or park, for localized incidents like a gas leak or small fire. The second should be farther away for larger events that affect the surrounding area. Record the name, full address, and a 24-hour contact number for each.
Where possible, obtain a letter of permission from the property owner, renter, or manager of each relocation site and attach it to your plan. A public park won’t offer one, but a church, community center, or private building should.
Utility Shut-Off Locations
List the locations of the main shut-off points for electricity, water, and gas, and mark those same points on your LIC 999 facility sketch.1California Department of Social Services. Emergency Disaster Plan for Child Care Centers Be specific. “East exterior wall, three feet left of the back door” is useful. “Outside” is not. Any staff member on duty should be able to find and operate the shut-offs during an emergency.
The LIC 999 Facility Sketch
The LIC 999 is the companion floor plan and yard sketch. It must show room dimensions, door and window exits, outdoor areas, fences, and hazards such as pools or storage buildings.2California Department of Social Services. Facility Sketch (Floor Plan) Your utility shut-off points carry over from the LIC 610D onto this sketch, so if you haven’t completed the LIC 999 yet, do both at once and make sure they match.
Emergency Supplies the Plan Must Address
Title 22 requires your disaster plan to address the availability of adequate basic utilities and supplies, including water, food, and essential medical materials.3Legal Information Institute. California Code of Regulations Title 22 101174 – Disaster and Mass Casualty Plan The regulation does not specify a minimum duration. FEMA recommends at least one gallon of water per person per day for several days, with a matching supply of non-perishable food, and 72 hours is a widely followed benchmark.4Ready.gov. Build A Kit
Beyond food and water, stock a first aid kit, a battery-powered or hand-crank radio, flashlights with extra batteries, a manual can opener, a wrench or pliers for shutting off utility valves, and basic sanitation supplies such as garbage bags and moist towelettes.4Ready.gov. Build A Kit Include any prescription medications that residents or participants rely on. Document the storage location directly on the LIC 610D so staff can retrieve supplies quickly.
Drill Requirements
Disaster drills must be conducted at least every six months under Title 22, Section 101174(d).3Legal Information Institute. California Code of Regulations Title 22 101174 – Disaster and Mass Casualty Plan Each drill must be documented, and those records stay at the facility for at least one year. The drills do not require you to travel to the relocation site or contact local disaster agencies; practicing your evacuation procedure on the facility’s grounds satisfies the regulation. Your local fire department or CCLD analyst may recommend a higher frequency, but the regulatory floor is twice per year.
Signing and Submitting
The affirmation section is where the administrator signs. By signing, you take responsibility for the plan and confirm that staff and volunteers have been instructed in their duties under it.1California Department of Social Services. Emergency Disaster Plan for Child Care Centers You can sign digitally using a PDF signature tool or print and sign by hand. Add the date next to your signature.
Return a signed copy to your local CCLD regional office. CDSS maintains a directory of regional offices on its Community Care Licensing page; the linked directory PDF lists every office with its address and phone number by county.5California Department of Social Services. Community Care Licensing
Posting and Keeping the Plan Current
Print the signed plan and post it in a prominent location in the facility, near a telephone.1California Department of Social Services. Emergency Disaster Plan for Child Care Centers Any adult on duty, including someone covering a shift for the first time, should be able to find it and act on it.
Update the plan whenever facility information changes. Staff turnover, a new phone number for a relocation site, or a change in utility infrastructure all warrant an update. Even if nothing has changed, review the form at least once a year to confirm everything is still accurate. Outdated plans are among the most common deficiencies flagged during CCLD inspections, and they are entirely preventable.
Penalties for Non-Compliance
A serious deficiency that is not corrected by the date specified in a notice can result in a civil penalty of $50 per day, per violation. That amount increases to $150 per day if a person becomes sick, is injured, or dies as a result of the deficiency.6Legal Information Institute. California Code of Regulations Title 22 101195 – Penalties Repeat violations of the same regulation within 12 months trigger an immediate $150 assessment, with $50 or $150 per day continuing until the problem is fixed. A missing or badly outdated disaster plan is exactly the kind of deficiency that draws a citation during a routine visit, and the amounts accumulate quickly.