Form LIC405 Record of Client's / Resident's Safeguarded Cash Resources - California

California LIC 405 Instructions

The document provides a general understanding of the circumstances that surround handling resident cash resources and illustrates an accounting for resident cash resources. Record the following information in the LIC 405 Form:

1. State the date of the transaction - the date that funds were received by the facility or purchases were made on behalf of the resident. This date must be written on the invoice or cash receipt.
2. Describe the transaction. Enter the source of the money received and the goods purchased or service provided. You must adequately represent the transaction - this description has to match the description on the cash receipt or invoice.
3. Record the amount of money received - earnings, cash gifts, tax credits, refunds, etc. Resident cash resources also include funds transferred from facilities where the individual previously resided and funds provided by relatives. Keep these funds at the facility or in a financial institution - either way, you must find a locked and secured location.
4. Write down the amount of money spent or withdrawn on behalf of the resident. This includes money given directly to residents as a spending allowance.
5. Calculate the balance of remaining funds after each transaction.
6. Sign the form. This document requires signatures of the licensee and the resident or resident's representative. These signatures verify a cash transaction and confirm its accuracy.

All the purchases must be supported by receipts filed for each resident in chronological order. Resident records, including ledgers and bank records, have to be retained for a minimum of three years following the termination of community care services. Keep the receipts that support purchases for a resident with the resident's personal file.

Not the form you were looking for? Check out these related documents:

• Form LIC603, Preplacement Appraisal Information;
• Form LIC625, Appraisal/Needs and Services Plan;
• Form LIC601, Identification and Emergency Information;
• Form LIC604, Admission Agreement Guide for Residential Facilities.