102419(d)(1) · Admission Procedures and Parental and Authorized Representative's Rights. The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. 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...

as evident by By POC 10/15/2021, Licensee stated that she will submit LIC 995A for C-1 and C-2 to Licensing. Based on record reviews, LPAs observed that C-1 and C-2 did not have the bottom portion of the LIC 995A. This poses a potential risk to the health and safety to the children in care. SUPERVISOR'S NAME: Sandy Knight