LIC 613C-2 — Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly
LIC 613C-2 is the statement of personal rights given to residents of privately operated RCFEs. It lists the rights every resident keeps after moving in, from privacy and visitors to complaint access.
Official PDF
The current LIC 613C-2 is published by the California Department of Social Services. We link to the live source rather than hosting a copy, so you always get the latest revision.
Open LIC 613C-2 on cdss.ca.govWho completes it and when
The facility provides it; the resident or representative signs the acknowledgement.
Provided and signed at admission.
How to complete LIC 613C-2
- 1Give the resident the personal rights statement at admission and read through it with them.
- 2Confirm the local Long-Term Care Ombudsman and licensing contact information on the form is current.
- 3Obtain the resident's or representative's signature acknowledging receipt.
- 4Give a signed copy to the resident and post the rights where residents and families can read them.
- 5Re-issue the current revision whenever CDSS updates the form.
Mistakes evaluators flag
- Using an outdated revision with stale ombudsman contact details.
- Signature obtained but no copy given to the resident.
- Rights not posted anywhere in a common area.
Questions about LIC 613C-2
Do personal rights have to be posted?
Residents receive a copy and the facility posts the rights where residents and visitors can see them, in addition to keeping the signed acknowledgement on file.
Fill this form from data you already have
- Resident, staff, and facility details populate the form fields automatically.
- Track which forms are on file, which are missing, and which are about to expire.
- Incident reports draft the LIC 624 narrative and finalize an immutable PDF.
Related admission forms
RCFE OS is not affiliated with the California Department of Social Services. This guide is operational information for licensees, not legal advice. Always follow the current form instructions and guidance from your licensing analyst.