Records to Be Maintained in Your Home (California)

As a licensed child care provider, you are required to keep a number of documents on file in your home. If your facility is inspected, your analyst will check these files. There are also other documents we recommend having on hand to prove that you are providing appropriate care in the rare case that a parent makes a complaint to licensing.

We recommend organizing your documents into 4 binders plus a private file for each child. These recommendations are in line with best practices among ECE administrators.

Please note that you must also post some of these documents publicly on your bulletin board: https://onepreschool.zendesk.com/hc/en-us/articles/115003035288. 

Children’s Files - Required

Use a folder for each child to contain the documents below. For privacy reasons, these files should be stored in a secure place that is only accessible by you, the Licensee.

• California School Immunization Record (CDPH 286) - https://archive.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph286.pdf
  • The parent will provide you with a photocopy of the child’s immunization record. Use that to fill out this form.
  • Must be printed on BLUE paper.
  • This form should be updated quarterly.
  • Please note that you MUST also have a current immunization card filled out for any of your own children (17 years old or younger) living in your home.
• A copy of the signed Enrollment Documents:
  
  • Signed “Keep me home if” notice
  • Signed Consent for Medical Treatment (LIC 627)
  • Signed Identification and Emergency Information (LIC 700)
  • Signed Notification of Parent’s Rights (LIC 995A)
  • Caregiver Background Check Process (LIC 995E)
  • What are Parent’s Responsibilities (PUB 82 / LIC 9212)
  • Signed Affidavit Regarding Liability Insurance (LIC 282) - Please note that as a Wonderschool program, we provide insurance for your program. You do not need to have this form on file because it only applies for programs that do not have insurance.
• [If applicable] Consent for Nebulizer Care (LIC 9166) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9166.PDF
  • A separate form must be filled out for each person who administers inhaled medication to the child)
• [If applicable] Parent Notification, Additional Children in Care (LIC 9150) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9150.PDFOnly needed if you are caring for more than 6 children with a small license or more than 12 children with a large license.

Binder #1: Licensing - Required

This document contains information about your school and your staff. Keep this binder in a safe place where you can access is periodically.

Section 1: Facility Information

• Your facility license
• Property Owner/Landlord Notification Form (LIC 9151) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9151.pdf
• Copy of your deed, lease, or rental agreement
• If you have more than 6 children in care with a small license or more than 12 children in care with a large license - Property Owner/Landlord Consent Form (LIC 9149) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9149.PDF
• A copy of documents submitted for your license application including:
  • Proof of completion of EMSA-certified Preventive Health and Safety Course
  • Proof of completion of EMSA-certified Infant/Pediatric CPR and First Aid Course
  • Floor plan of your home (LIC 999) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC999A.PDF
  • Proof of immunization against Influenza, Pertussis (Whooping Cough), and Measles, as well as TB (Tuberculosis) clearance for yourself and any other adults in your home who will come into contact with the children.
  • More information about immunization requirements: https://onepreschool.zendesk.com/hc/en-us/articles/235957808
  • Signed Statement of Criminal Background Check Statement for yourself and any other adults living in your home - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC508.PDF
  • Documentation of criminal record clearance if required by Section 102370(d) for yourself and any other adults living in your home
  • Signed copy of Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) only for yourself - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9108.PDF

Section 2: Licensing Information

• Notification of Parents Right's (PUB 394) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/pub394L.pdf
• If you had a licensing analyst visit your home due to a complaint, you must include the following items for 30 days that children are in care:
  • Notice of Site Visit (LIC 9213) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9213.PDF
  • Any licensing report or other document verifying compliance or non-compliance
  • Acknowledgement of receipt of licensing reports (LIC 9224) signed by each parent - http://www.cdss.ca.gov/cdssweb/entres/forms/English/lic9224.pdf

Section 3: Health and Safety

• Emergency Disaster Plan (LIC 610A) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC610A.PDF
  • If you have a landline, also post a copy next to your phone. If you only have a cell phone, make sure to have a copy on your bulletin board.
• Earthquake Preparedness Checklist (LIC 9148) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9148.PDF
  • If you have a landline, also post a copy next to your phone. If you only have a cell phone, make sure to have a copy on your bulletin board.
• Fire Drill & Disaster Drill Log
  • Print the drill log sheet at the end of this document.
  • You must perform a fire drill and a disaster drill at least once every six months, including provisions for fire, earthquake, shelter in place, relocation and evacuation.
  • For more information about how to conduct your drills, read this document: https://onepreschool.zendesk.com/hc/en-us/articles/115003046528
  • For full information about disaster planning for family child care homes, read this document: http://ccld.ca.gov/Res%5Cpdf%5CDisasterGuideforHomesCenters.pdf
  • We also recommend that you prepare an emergency backpack: https://onepreschool.zendesk.com/hc/en-us/articles/115002916227
• Exposure Notices (you only need to include these in the case of an exposure at your school)
  • Here are common notices - https://www.sccgov.org/sites/sccphd/en-us/HealthProviders/DiseaseReporting/Pages/exposenotices.aspx
  • You must also post the notice on your bulletin board
  • We recommend also emailing parents exposure notices

Section 4: Student Information

• Student Roster - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9040.pdf
  • Update this document every time a student enrolls in or leaves your program.
• List of student emergency contacts

Section 5: Staff Information

You must have a copy of each of these documents for all employees and volunteers:

• Signed Personnel Record (LIC 501) -  http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC501.pdf
• Signed employee contract (between Licensee and employee)
• Signed copy of Notice of Employee Rights (LIC 9052) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9052.pdf
• Proof of EMSA-approved CPR & First Aid Certification
• Proof of immunization against Influenza, Pertussis (Whooping Cough), and Measles, as well as TB (Tuberculosis) clearance.
  • More information about immunization requirements: https://onepreschool.zendesk.com/hc/en-us/articles/235957808
• Signed Statement of Criminal Background Check Statement (LIC 508) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC508.PDF and documentation of criminal record clearance if required. All employees and volunteers must have criminal record clearance except for some exceptions: https://onepreschool.zendesk.com/hc/en-us/articles/115002967127
• Signed copy of Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) - http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC9108.PDF

Binder #2: Occurrence Reporting

This document contains reports about accidents and incidents that occur at your school and behavior logs of the children you have in care. Sort the children alphabetically in each section Keep this binder in a safe place where you can access is periodically.

Section 1: Accident Reports - Strongly recommended

• If a child sustains a minor injury, fill out a report similar to this and keep a copy: 
  
  • Accident Report Template (Word doc) 
  • Paper documentation is not technically needed, but you are required to notify the child’s parent or authorized representative.

Section 2: Incident Reports - Required

• If a child sustains an injury that requires medical attention, fill out this form and keep a copy:  http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC624B.PDF
  • You are also required to submit a copy of this document to your licensing office.
  • Print 10 copies to use as needed.

Section 3: Behavior Logs - Recommended

• If a child is displaying behavior such as biting or hitting, it’s a good idea to keep a behavior log to recognize patterns if an issue comes up. Here’s an example: https://s-media-cache-ak0.pinimg.com/736x/39/62/11/3962117f8b6f1b74228abf16e39dfe67.jpg

Binder #3: Daily Sheets - Recommended

This binder contains daily sign in sheets and daily reports about food intake and diapering/bathroom use for children. The reports prove that you are providing responsive care. Give a sheet to the parent each day and put a copy in this binder. Keep the binder in a safe place where you can access it daily.

• Download the sign in sheet template at the end of this document.
• For the daily reports, divide binder into sections for each child, organized alphabetically.
• We’ve provided templates for different age groups that you can download at the end of this document.

Binder #4: Needs & Services - Recommended

This binder contains plans agreed upon by the parents to provide care to infants and toddlers. It can be useful as a reference for each child’s care needs. Keep this binder in your classroom where you can access it easily.

• Parents will fill out this form as part of their Admission Contract and Parent Handbook.
• Sort the forms alphabetically.
• Work with the parent to update forms every 3 months if the child is 2 years of age or younger.