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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 11-62
December 30, 2011


TO:
Home Health Agencies

SUBJECT:
Fingerprint Clearance Requirements for Owners, Administrators, and Administrator’s Designee
(This AFL supersedes AFL 11-53)


This All Facilities Letter (AFL) serves as the final notification and reminder of the information communicated in AFLs 11-06 and 11-53, on the same topic. These notices indicated that criminal record clearance requirements for home health agencies licensed by the department are mandatory and must be submitted. Pursuant to Health and Safety Code Section 1728.1(a) (2) (A) a criminal record clearance is required for the following individuals:

  • The owner or owners of a home health agency if the owners are individuals;
  • If the owner of a home health agency is a corporation, partnership or association, any person having a ten (10) percent or greater interest in that corporation, partnership or association and;
  • The administrator and administrator’s designee of a home health agency.

The individuals identified above are required to submit a Request for Live Scan Service: BCIA 8016 form.  Once the form is completed, the Request for a Live Scan Service: BCIA 8016 form should be taken to a live scan vendor.

BC8016 - Request for Live Scan Service

Please note that the live scan vendor will complete the Transaction Section (gray area) of the Live Scan Service, BCIA 8016 form.

The following link to the California Department of Justice website may assist you in locating a live scan vendor.

Attorney General - Live Scan Locations

Once the live scan process is complete, please submit the CDPH 325 Criminal Record Clearance Submission listing the owners, administrators, administrator’s designee and proof of live scan to the Licensing and Certification Centralized Applications Unit. The CDPH 325 form can be found using the following link:

Criminal Record Clearance Submissions, CDPH 325

All individuals identified above who have not already completed the criminal record clearance process should mail the CDPH 325 before February 28, 2012 to:

Department of Public Health
Licensing and Certification Program
Centralized Applications Unit
P. O. Box 997377, MS 3402
Sacramento, CA 95899-7377

Failure to comply with the above will result in a delay or denial of license renewal, please note that renewal extensions are not allowed under law.

If you have any questions please contact the Centralized Applications Unit at (916) 552-8633.

 

Sincerely,

Original signed by Pamela Dickfoss

Pamela Dickfoss
Acting Deputy Director

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