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The licensee/administrator keeps a detailed inventory record, including item quantity, description, date, location, and required signatures. Each entry must be signed by the client/resident (or include an explanation if no signature is provided) and by the licensee/administrator. When property is removed, the removal reason and date must be documented and the form signed. A retained reverse side supports health and safety notice requirements and includes legal provisions for theft-and-loss programs.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/clientresident-personal-property-and-valuables-facility-record-and-signatures/246794/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/clientresident-personal-property-and-valuables-facility-record-and-signatures/246794.png","ImageObject",442,249,{"name":88,"@type":89},"eBook King","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-25","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be recorded for each item entrusted to the facility?","Question",{"text":108,"@type":109},"Record the quantity, description, date, and storage location, and collect the required signatures. If the client/resident does not sign, include an explanation.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What steps must be followed when personal property/valuables are removed from the facility?",{"text":113,"@type":109},"Document the reason for removal, record the removal date, update the relevant entry, and ensure the form is signed by the required persons.",{"name":115,"@type":106,"acceptedAnswer":116},"What is required under the Health and Safety Code for facilities’ theft and loss program?",{"text":117,"@type":109},"Implement a theft and loss program within the required timeframe, establish and post policies and procedures, orient employees, and document lost/stolen resident property with specific details and retention/access rules.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},246794,1790046863,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","CLIENT/RESIDENT PERSONAL PROPERTY AND VALUABLES  \nFacilities must safeguard client's/resident's personal property/valuables entrusted to the facility. Licensee/Administrator is responsible for maintaining a record of personal property/valuables entrusted to and removed from the facility. Under \"Number\", enter the quantity of items entrusted. Under \"Description\", describe the item (marking articles by names or numbers may aid identification. ) . Under \"Location\", enter where items are stored. Licensee/Administrator and client/resident must sign each entry. Explain why, if client/resident does not sign. Provide a copy to the client/resident and maintain a copy in client's/resident's file. As property/valuable is removed, explain the reason for removal, enter the removal date, and ensure form is signed by all required persons specified above.  \nThe reverse side of this form may be completed and retained in Residential Care Facilities for the Elderly to meet the notice requirements of Health and Safety Code Section 1569. 153(k) .  \n\n| Name of Client/Resident | Social Security No. |\n| --- | --- |\n\nA. PERSONAL PROPERTY/VALUABLES ENTRUSTED TO FACILITY  \n\n| Number | Description | Date | Location | Signature of Client/Resident\u003Cbr>(or if \"None\" explain)\u003Cbr>Signature of Licensee/Administrator |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nB. PERSONAL PROPERTY/VALUABLES REMOVED  \n| Number | Description | Date | Location | Signature of Client/Resident\u003Cbr>(or if \"None\" explain)\u003Cbr>Signature of Licensee/Administrator |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nLIC 621 (4/99) (CONFIDENTIAL)  \nRESIDENTIAL CARE FACILITIES FOR THE ELDERLY ONLY.  \nSection 1569.152 of the Health and Safety Code:  \n1569.152. (a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. The facility shall be presumed to have made reasonable efforts to safeguard resident property if the facility has shown clear and convincing evidence of its efforts to meet each of the requirements specified in Section 1569.153. The presumption shall be a rebuttable presumption, and the resident or the resident's representative may pursue this matter in any court of competent jurisdiction.  \n(b) A civil penalty shall be levied if the residential care facility for the elderly has no program in place or if the facility has not shown clear and convincing evidence of its efforts to meet all of the requirements set forth in Section 1569.153. The State Department of Social Services shall issue a deficiency in the event that the manner in which the policies have been implemented is inadequate or the individual facility situation warrants additional theft and loss protections.  \n(c) The department shall not determine that a facility's program is inadequate based solely on the occasional occurrence of theft or loss in a facility.  \nSEC. 3. Section 1569.153 of the Health and Safety Code:  \n1569.153. A theft and loss program shall be implemented by the residential care facilities for the elderly within 90 days after January 1, 1989. The program shall include all of the following:  \n(a) Establishment and posting of the facility's policy regarding theft and investigative procedures.  \n(b) Orientation to the policies and procedures for all employees within 90 days of employment.  \n(c) Documentation of lost and stolen resident property with a value of twenty-five dol","cbCaidldRwtzPkjs","https://ap.wps.com/l/cbCaidldRwtzPkjs","pdf",42354,"English","# Personal Property/Valuables Entrusted to Facility\n# Personal Property/Valuables Removed\n# Legal Requirements (Health and Safety Code Sections 1569.152 and 1569.153)","[{\"question\":\"What information must be recorded for each item entrusted to the facility?\",\"answer\":\"Record the quantity, description, date, and storage location, and collect the required signatures. If the client/resident does not sign, include an explanation.\"},{\"question\":\"What steps must be followed when personal property/valuables are removed from the facility?\",\"answer\":\"Document the reason for removal, record the removal date, update the relevant entry, and ensure the form is signed by the required persons.\"},{\"question\":\"What is required under the Health and Safety Code for facilities’ theft and loss program?\",\"answer\":\"Implement a theft and loss program within the required timeframe, establish and post policies and procedures, orient employees, and document lost/stolen resident property with specific details and retention/access rules.\"}]","CLIENT/RESIDENT PERSONAL PROPERTY AND VALUABLES - Facility Record and Signatures | PDF",1789238175]