Klassic Kids Day Care - Jerabek

101218.1(e)(1) · Admission Procedures and Parental and Authorized Representative's Rights (e) At the time of acceptance of each child into care…the licensee shall give each parent or authorized representative a copy of the Notification of Parents' Rights (LIC 995 [8/02])…(1) …The bottom portion of this form must be kept in the child's file as proof that the parent or authorized representative has been notified of his or her rights by the child care center.

Deficient Practice Statement Based on interview and record review, the licensee did not have a copy or other proof of the signed LIC995 form in the children’s files reviewed, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/21/2025

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101223(b)(1)(a) · Personal Rights : (b) The center shall inform each child's authorized representative of the rights specified in (a) (1) through (8) above. (1)m The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). (A) Each authorized representative shall be asked to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 613A (9/96). This documentation shall be kept in the child's file.

Deficient Practice Statement Based on interview, the licensee did not have a copy or other proof of the signed LIC613A form in the children’s files reviewed, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 11/21/2025

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