Adh 0006-2025

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4.8 out of 5

145 votes

The document outlines the staffing and service arrangement for Community-Based Adult Services under the California Department of Aging. It includes sections for licensee information, service hours, licensed capacity, and details about various staff positions such as nurses, social workers, therapists, and administrative roles. Additionally, it addresses whether adult day program services are provided.

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Click ‘Get Form’ to open the adh 0006 in the editor.
Begin by entering the LICENSEE NAME and CENTER NAME in the designated fields at the top of the form.
Fill in the HOURS OF SERVICE and LICENSED CAPACITY, ensuring accuracy for compliance purposes.
Indicate whether your center provides Adult Day Program Services by selecting 'Yes' or 'No'.
In the STAFFING section, list all relevant staff positions along with their scheduled hours per month. Be thorough to reflect your staffing accurately.
Complete the SIGNATURE OF ADMINISTRATOR OR PROGRAM DIRECTOR field, followed by the DATE of signing.
Finally, review all entries for completeness and accuracy before submitting your form.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (145 Votes)
2010	4 Satisfied (26 Votes)

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