101419.3(a) · Modifications to Infant Needs and Services Plan (a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in three of six infant files reviewed did not contain documenation that the needs and service plan was updated at least quartrly, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/31/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101220.1(g) · Immunizations (g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two of six infant files reviewed were missing immunization paperwork, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/31/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101229.1(a)(1) · Sign In and Sign Out (a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two of twelve infants in attendance were not signed into the Center, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/28/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101427(b)(3) · Infant Care Food Services (b) There shall be an individual feeding plan for each infant. (3) The plan shall include the following items

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in six of six infant feeding plan records were missing the plan for introducing new food, plan for introducing cups and utensils, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/31/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101161(a) · A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation

Deficient Practice Statement Based on observation, interviews, and record review, the licensee did not comply with the section cited above when the Center was caring for 12 infants which is beyond the conditions and limitation specified on the License. The License allows the Center to care for 11 infants. This poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 08/24/2023

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

101439.1(f)(1)(A) · Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. (1) Pacifiers shall be allowed in the crib if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in when C1 was observed sleeping in a crib with a pacifer in their mouth. The pacifier was attached to C1 clothing, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 08/24/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101439.1(b) · Infant Care Center Sleeping Equipment (b) A crib or portable -crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib.

Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above when LPA observed five cribs in the infant sleeping area. During LPAs inspection the Center had six children who required a crib for sleeping, therefore the Center failed to provide a crib for each infant who is unable to climb out of a crib, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/23/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101439.1(b)(6)(A) · Infant Care Center Sleeping Equipment (b) A crib or portable -crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib. (6) Crib mattresses shall be: (A) Covered with vinyl or similar moisture-resistant material.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in three of five cribs mattress were covered in a polyester material which is not vinyl or a similar moisture-resistent material, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/30/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101439(l)(1) · Infant Care Center Fixtures, Furniture, Equipment and Supplies (1) The combination of toys shall provide and encourage

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in when LPA observed one tummy mat and one mobile for the children birth to 12 months. Based on LPA observation the Center does not appear to have a proper amount of materials to encourage and provide auditory, visual, tactile and manipulative stimulation for the infants under one year of age, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 08/30/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101439.1(b)(6)(A) · Infant Care Center Sleeping Equipment (6) Crib mattresses shall be: (A) Covered with vinyl or similar moisture-resistant material.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in three out of three crib mattress were covered in a cloth material not a vinyl or similar moisture-resistent material, as required which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/12/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101239(n) · Fixtures, Furniture, Equipment and Supplies (n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when vinyl blocks on the shelving units in the infant room, had tears along the edges and corners of the materials. In addition LPA observed the molding at the base of the wall was ripped and had a sharp edges exposed, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/12/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101439(k)(2) · Infant Care Center Fixtures, Furniture, Equipment and Supplies (k) Toy storage containers shall meet the following requirements: 2) All edges and corners shall be rounded and padded.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one of the low shelving units did not have rounded edges which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/13/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101226(d)(1) · Health-Related Services (d) The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children: (1) A current edition of a first-aid manual.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one of one first aid kit located in the infant room did not contain a current edition of a first aid manual which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/12/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101174(d) · Disaster and Mass Casualty Plan (d) Disaster drills shall be conducted at least every six months.

Deficient Practice Statement Based on [(record review)], the licensee did not comply with the section cited above when the last disaster drill was completed in October 2020 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101238.2(d)(1) · Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when the soft mats which were previously secured to the concrete were not secured at the time of this inspection. Mats were observed upside down with the glue exposed and scattered around the outdoor activity area, the mats posed a potential tripping hazard to the infants in care which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101238.2(d)(2) · Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when the outdoor licensed space, was observed to have nails, construction materials, empty beer bottles, water bottles, used facial masks, and additional trash accessible to the children in the licensed space. Furthermore there were 6 inch plants growing in licensed space, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/01/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101238.2(f) · Outdoor Activity Space (f) Sandboxes shall be inspected daily and kept free of hazardous foreign materials.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when the sandbox had five piles of animal feces. Based on LPA observation the area was not inspected daily and kept free of hazardous material which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/29/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101220(a) · Child's Medical Assessments (a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

Deficient Practice Statement Based on record review the licensee did not comply with the section cited above in eight of ten infant files reviewed were missing a medical assessment of the child preformed a licensed physician, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/19/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101229.1(a)(1) · Sign In and Sign Out (a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above when C1 was at the Center five days in June The sign in and out sheets for all five days did not have the time that C1 was signed into the Center. Furthermore, on June 17 and 20 the sign in and out was missing the signature of the person who signed C1 into care which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101419.2(a) · Infant Needs and Services Plan (a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in nine of ten infant Needs and Services Plans were not signed by the Center staff they were completed by the Parent which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/12/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101419.2(b)(2) · Infant Needs and Services Plan (b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in four of the ten infant files reviewed were missing an individual Infant Sleeping Plan as required, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/12/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101419.3(a) · Modifications to Infant Needs and Services Plan (a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in four out of the ten infant files reviewed did not have the Needs and Service Plans updated quarterly as required, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/01/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.