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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623592
Report Date: 03/22/2022
Date Signed: 03/22/2022 12:16:22 PM

Substantiated


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
03/18/2022 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220318121838
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: 17DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Krystal BarlattTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Child's records are incomplete.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 10:00am and met with Director Krystal Barlott to open and close a complaint investigation, regarding the above allegation. Upon arrival, LPAs observed 17 children with two teachers. LPA conducted interviews and reviewed documents pertaining to the allegation. It was alleged that the facility has incomplete children documents. LPA observed missing and incomplete documents in the children’s files. Krystal stated that the facility is currently auditing their files and are requesting documents from parents. This is considered as a potential risk to the children in care. Based on LPA's investigation the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated.

Title 22 deficiencies are cited on the subsequent page of this report. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 03-CC-20220318121838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FOREVER FRIENDS EARLY LEARNING CENTER
FACILITY NUMBER: 343623592
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2022
Section Cited
CCR
101221(a)
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A separate, complete and current record for each child is maintained in the child care center. This requirement has not been met by evidence: LPA observed missing documents and incomplete documents. This is considered as a potential risk to the children in care.
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Director will submit a complete packet of completed children's documents for child#1, child#2, child#3, child#5 and child#6 by POC date 4/22/2022.
Type B
04/22/2022
Section Cited
CCR
101218.1(e)(1)
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The licensee shall request the child’s parent or authorized representative to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 995 (8/02)... This requirement has not been met by evidence: LPA observed that one file was missing a signture and another
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Director will submit a complete packet of completed children's documents for child#1, child#2, child#3, child#5 and child#6 by POC date 4/22/2022.
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was missing the document entirely. This is considered as a potential risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2