The Personal Rights Form and the Property Record, Explained

Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). Title 22, section 87468, says that when the admission agreement is signed, the resident and the resident's representative must be personally advised of the resident's personal rights and given a copy. The home must have each of them sign a copy and keep the signed copy in the resident's record.

The California Department of Social Services posts two versions. LIC 613C-2 (3/25), Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly, runs seven pages. LIC 613C (1/19) is a five-page version for publicly operated homes, which the regulation defines as homes licensed to a city, county or other government entity. Both carried those dates on October 13, 2026.

The form says it is provided as a courtesy to licensees, so a home may print the rights in its own layout. The content comes from state law, not from the home.

1. 1

   Page 1: explanation and who to call

   The form explains its purpose, then gives the Community Care Licensing complaint line and the statewide Long-Term Care Ombudsman crisis line for reporting known or suspected elder abuse. It has a blank for the local Ombudsman office's phone number. Check that the home has filled it in.

2. 2

   Pages 2 to 5: the rights

   A long list that starts with dignity, safe and comfortable accommodations and privacy, and runs through visits, mail, money, medical choices, care planning, grievances and records.

3. 3

   Pages 5 and 6: protections for all residents

   Actions a home and its staff may not take, including on the basis of a resident's actual or perceived sexual orientation, gender identity, gender expression or HIV status. Examples are denying admission and refusing a request to share a room.

4. 4

   Page 6: the nondiscrimination notice

   A notice with the home's name written in, and the Ombudsman's number for complaints about this kind of discrimination.

5. 5

   Page 7: the signatures

   The resident, and the representative if there is one, sign and date under one sentence: that they have been personally advised of, and have received a copy of, the personal rights and nondiscrimination notice.

Our guide to RCFE resident rights goes through the rights themselves. These are the lines on the form that families most often come back to:

• Written notice of any room change at least 30 days in advance, unless the resident agrees to the change, it is required to fill a vacant bed, or it is necessary due to an emergency.
• Visits from relatives and others of the resident's choosing during reasonable hours, privately and without prior notice.
• The right to receive or reject medical care or other services, and to choose their own physicians, pharmacies and hospice agency.
• The right to manage their own financial affairs. A home may not require residents to deposit their personal funds with it.
• Prompt access to review all of their records, and photocopies within two business days.

The form also states that a home must post the rights, the nondiscrimination notice and complaint information in a prominent place.

The signature line is an acknowledgment. It records that the resident was told about the rights and handed a copy. The form adds that, as a best practice, staff should explain the rights in a manner appropriate to the resident's needs, so it is fair to ask for a slower walk-through.

Signing does not trade any right away. California's bill of rights for RCFE residents says that no document a resident or representative must sign as a condition of admission may require the resident to waive benefits or rights the law gives them.

If a page in a home's packet seems to limit one of these rights, ask about it before signing. The Long-Term Care Ombudsman or an elder law attorney can tell you how the law applies. Our guide to the admission agreement covers the contract itself.

The state's form is LIC 621 (4/99), Client/Resident Personal Property and Valuables. Its instructions say a home must safeguard personal property and valuables entrusted to it, and that the licensee or administrator is responsible for keeping a record of what is entrusted and what is removed.

The front is two tables: Part A for property entrusted to the home and Part B for property removed. Each line has the number of items, a description, the date, where the item is stored, and the signatures of the resident and the licensee or administrator. The instructions tell the home to give the resident a copy and keep one in the resident's file. The state's template for a home's property policy, LIC 9059 (5/99), names this same form as the inventory of personal property identified by residents.

The back applies to RCFEs only. It prints the three state statutes on theft and loss, then a signature line stating that the resident or responsible person has received a copy of them and is acquainted with the home's property safeguard procedures.

Health and Safety Code section 1569.153 requires every RCFE to run a theft and loss program. As the section read in October 2026, the program includes:

• A written personal property inventory established upon admission, written in ink, witnessed by the home and the resident or representative, and dated. A copy goes to the resident or the person acting for them.
• Items brought in or taken out later are added to or deleted from the inventory at the written request of the resident, family or responsible party. The statute says the home is not liable for items nobody asked to have included.
• A method of marking personal property, including engraving dentures and tagging other prosthetic devices.
• A secured area for safekeeping on request, and a lock for the bedside drawer or cabinet on request, at the resident's expense.
• Written documentation of lost or stolen property worth $25 or more, made no later than 72 hours after it is discovered, and a report to local law enforcement no later than 36 hours after the administrator has reason to believe property worth $100 or more was stolen.
• Return of the resident's belongings, in exchange for a signed receipt, on discharge or after a death.

Section 1569.152 says a home that fails to make reasonable efforts to safeguard resident property must reimburse the resident for, or replace, stolen or lost property at its then current value. Section 1569.154 says no admission document may require or imply a lesser standard of responsibility for residents' property than the law requires. How those sections apply to a particular loss is a legal question for an elder law attorney or the Ombudsman.

In practice, ask for the inventory on move-in day, list glasses, hearing aids, dentures and jewelry by name, and send a written request whenever something valuable is added.

If you believe a resident is being neglected or exploited, call 911 in an emergency. Complaints about a licensed home go to California's Community Care Licensing Division at 1-844-538-8766, the number printed on the rights form. See what to do when something is wrong at a home.

Hamssa Benrekia is a senior living placement specialist in Torrance who holds an RCFE Administrator Certificate. She refers families only to licensed homes she has toured herself, including small board and care homes in the South Bay and Harbor area of Los Angeles County, and she checks each home's public licensing record. Reading that record yourself is worth the time: see how to read an inspection report. She is not an attorney and does not give legal advice.

To talk through a move, contact Hamssa. The other move-in papers are covered in the state forms families see and in the California Assisted Living Placement Guide.