$89.00
Every California Adult Residential Facility must have a written emergency and disaster plan under H&S Code §1565. This kit covers every required element, including evacuation and relocation sites, 72-hour self-reliance, utility shut-offs, medications and a quarterly drill record, in three formats so you can finish it your way.
Option 1: Edit in Word
Open the Editable Word file. Every answer is already filled in with a sample in yellow, so you just type over it with your facility’s details. Easy to update each year.
Option 2: Fill in the PDF
Open the Fillable PDF in free Adobe Acrobat Reader and type into each shaded box, or print it and complete it by hand.
Either way, keep the Completed Sample open as your guide to what to write.
| Document | Title on the document | File name |
|---|---|---|
| Editable Word (9 pages) |
Emergency and Disaster Plan for Adult Community Care Facilities and Residential Care Facilities for the Chronically Ill (Public), Editable Word Version | ARF-Emergency-Disaster-Plan-LIC-610D-Editable.docx |
| Fillable PDF (6 pages) |
Emergency and Disaster Plan: Adult Residential Facilities and other adult community care facilities, LIC 610D (12/21) content | ARF-Emergency-Disaster-Plan-LIC-610D-Fillable.pdf |
| Completed Sample (PDF) (9 pages) |
The official CDSS LIC 610D (12/21) form, filled in for the fictional "Sample Residential Care" | ARF-Emergency-Disaster-Plan-LIC-610D-Completed-Sample.pdf |
Title: Emergency and Disaster Plan for Adult Community Care Facilities and Residential Care Facilities for the Chronically Ill (Public), Editable Word Version
File: ARF-Emergency-Disaster-Plan-LIC-610D-Editable.docx
A Microsoft Word document with every answer already filled in with sample content highlighted in yellow. Best if you want to finish fast.
Title: Emergency and Disaster Plan: Adult Residential Facilities and other adult community care facilities, LIC 610D (12/21) content
File: ARF-Emergency-Disaster-Plan-LIC-610D-Fillable.pdf
A blank PDF form with a shaded box for every answer. Best if you prefer a clean form.
Title: The official CDSS LIC 610D (12/21) form, filled in for the fictional "Sample Residential Care"
File: ARF-Emergency-Disaster-Plan-LIC-610D-Completed-Sample.pdf
A fully completed plan for a fictional facility. Use it as your answer key: it shows the level of detail Licensing expects. Keep it open beside your Word or PDF version as a guide. Do not submit it as your own plan.
Sample names, addresses and 555 phone numbers are fictional; verify every public agency number for your area. This template is a planning tool, not legal advice.
