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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623592
Report Date: 07/15/2021
Date Signed: 07/15/2021 08:37:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2021 and conducted by Evaluator Mai Lor
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210604161743
FACILITY NAME:FOREVER FRIENDS EARLY LEARNING CENTERFACILITY NUMBER:
343623592
ADMINISTRATOR:KRYSTAL BARLATTFACILITY TYPE:
850
ADDRESS:1355 FLORIN ROAD, STE.9TELEPHONE:
(916) 912-0758
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:38CENSUS: 6DATE:
07/15/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Marquise RossTIME COMPLETED:
08:45 AM
ALLEGATION(S):
1
2
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5
6
7
8
9
Child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
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13
Application Specialist (AS) Mai Lor conducted a follow-up complaint investigation at the above facility and met with staff Marquise Ross on 7/15/21. AS Lor telephone owner/licensee Krystal Barlatt and discussed the complaint investigation findings. Krystal granted permission for Marquise to sign this report in her absence. Census included six children supervised by one staff. It was alleged a child sustained unexplained injuries while in care. During the investigation, AS Lor obtained pertinent documents including children roster, unusual incident report, text messages that included photos, and ouch reports; and conducted interviews with Reporting Party, facility staff and daycare children. Evidence obtained revealed the child was observed with two bruises, one on each of the thighs; however, it is unclear as to how and where the child sustained the bruises. Due to conflicting statements in interviews, AS Lor was unable to determine how the injury occurred. Based on the above, the allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur at the facility, therefore the allegation is UNSUBSTANTIATED. No Title 22 Deficiencies cited.
Exit interview conducted and appeal rights provided. Notice of site visit was posted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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