2.206.B.5 · The written policies and procedures must be developed, implemented, and followed, and must include at a minimum the following information: The procedure concerning admission and registration of children including whether non-immunized or under immunized children are enrolled in the program;

The facility policies in the handbook are not specific regarding whether non-immunized children are accepted for enrollment. Correction: Immediately (05/22/2024) revise handbook to include information regarding whether or not non-immunized children are accepted for enrollment. Submit copy of revised handbook to Licensing with written response no later than 06/05/2024. Correct by 05/22/2024

Corrected Corrected by May 22, 2024

Category: ratio. Marked corrected in the state record.

7.702.34.A.7 · The admission record must include: A dated, written authorization for emergency medical care signed and updated annually by the parent(s)/guardian(s). The authorization must be notarized if required by the local hospital, clinic, or emergency health care facility.

One child's file reviewed did not have a current authorization for emergency medical care. Correction: Immediately (12/06/2023) obtain current authorization for emergency medical care and retain in child's file. Submit copy to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: health medication. Marked corrected in the state record.

7.702.42.H · Within ninety (90) calendar days of employment, all staff required to register with the Colorado Shines Professional Development Information System (listed in Section 7.702.33, d) must complete the Department-approved training course: Introduction to the Early Intervention and Preschool Special Education Programs. This course is required once and will be counted towards ongoing professional development. FAX 303-866-4453 Phone 303-866-5948 ________________________________________________

No completed Introduction to the Early Intervention and Preschool Special Education Programs training was present in the file for Jasmine. Correction: Immediately (12/06/2023) complete current training and retain verification in employee file. Submit copy of certificate to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: recordkeeping. Marked corrected in the state record.

7.702.42.B · All staff must complete a Department-approved Standard Precautions training that meets current Occupational Safety and Health Administration (OSHA) requirements prior to working with children. This training must be renewed annually and will be counted towards ongoing professional development.

No current Standard Precautions training was present in the files for Nina or Jasmine. Correction: Immediately (12/06/2023) complete current Standard Precautions training and retain certificates in employee files. Submit copies to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: ratio. Marked corrected in the state record.

7.702.42.F · Within thirty (30) calendar days of employment, all employees caring for children, not required by rule to be certified in First Aid and CPR, must complete the Department-approved Introduction to First Aid and CPR module. The module must be renewed every two (2) years.

No verification of completed First Aid and CPR module was present in the file for Renee. Correction: Immediately (12/06/2023) complete current First Aid and CPR module and retain verification in employee file. Submit copy to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Marked corrected in the state record.

7.702.42.G · Within thirty (30) calendar days of employment, all employees and regular volunteers must be trained using a Department-approved training about child abuse prevention, which includes common symptoms and signs of child abuse, how to report, where to report, and when to report suspected or known child abuse or neglect. This training must be renewed annually.

No current child abuse training was present in the file for Julissa, Nina or Jasmine. Correction: Immediately (12/06/2023) complete current child abuse training and retain verification in employee files. Submit copies to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: recordkeeping. Marked corrected in the state record.

7.702.41.G · All staff members must submit to the center a medical statement, signed and dated by a physician or other health care provider, verifying that they are in good mental, physical, and emotional health appropriate for the position for which they have been hired. This statement must be dated no more than six (6) months prior to employment or within thirty (30) calendar days after the first date of employment. Subsequent self-reported health histories must be submitted annually.

No current physicals were present in the files for Teresa, Renee, Karina, Julissa, Zita, Kelly, Janet or Jasmine. The initial physical must be signed by a health care professional before a self-reported health history form may be used. Correction: Immediately (12/06/2023) obtain current physicals and retain in employee files. Submit copies to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: health medication. Marked corrected in the state record.

7.702.42.I · Within ninety (90) calendar days of employment, all staff required to register with the Colorado Shines Professional Development Information System (listed in Section 7.702.33, d) must complete the Department-approved Recognizing the Impact of Bias on Early Childhood Professionals training or other Department-approved training on implicit bias. This course is required once and will be counted towards ongoing professional development.

No Recognizing the Impact of Bias training was present in the file for Kelly or Jasmine. Correction: Immediately (12/06/2023) complete current training and retain verification in employee files. Submit copies of certificates to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: recordkeeping. Marked corrected in the state record.

7.702.51.A.2.a · At the time of admission, the parent(s)/guardian(s) must provide for each child entering the center: Documentation of school-required immunization status or Certificate of Medical or Nonmedical Exemption, is required by the Colorado Board of Health. Up-to-date school-required immunizations must be documented as specified on the Colorado Department of Public Health and Environment Certificate of Immunization or on an "approved alternate" FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ Certificate of Immunization. Colorado law requires proof of immunization status or exemption be provided prior to or on the first day of admission.

Two children's files reviewed did not have any immunization information in the file. Correction: Immediately (12/06/2023) obtain immunization information and retain copies in children's files. Submit verification to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: health medication. Marked corrected in the state record.

7.702.51.A.2.b · At the time of admission, the parent(s)/guardian(s) must provide for each child entering the center: Within thirty (30) calendar days of admission, and within thirty (30) calendar days following the expiration date of a previous health statement, the parent(s)/guardian(s) of each child must submit a statement of the child’s current health status or written verification of a scheduled appointment with a health care provider. The statement of the child’s current health status must be signed and dated by a health care provider who has seen the child within the last twelve (12) months, or within the last six (6) months for children less than two and one-half (2½) years of age. The statement must include when the next visit is required by the health care provider. All health statements must be kept at the center.

Five children's files reviewed did not have current physicals on file. Correction: Immediately (12/06/2023) obtain current physicals and retain copies in children's files. Submit verification to Licensing with written response no later than 12/20/2023. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: ratio. Marked corrected in the state record.

7.702.62.D.5.a.1 · Cots or pads must be spaced at least two (2) feet apart on all sides during rest time. Children must have a safe area in which to rest that is easily supervised, out of the path of traffic, and free of hazards.

Nap cots were not spaced two feet part on all sides in the Sea Turtles classroom. Correction: Immediately (12/06/2023) ensure that cots are spaced at least two feet apart on all sides as required. Corrected during the visit by staff moving the cots to maintain the required distance. No written response is required. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: supervision. Marked corrected in the state record.

7.702.91.B · Buildings must be kept in good repair and maintained in a safe condition.

Observed bolts on the base of two toilets were missing the protective caps and presenting a potential injury hazard. FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ Correction: Immediately (12/06/2023) install protective caps over the bolts at the base of the toilets. Corrected during the visit by staff installing the protective covers. No written response is required. Correct by 12/06/2023

Corrected Corrected by Dec 6, 2023

Category: physical safety. Marked corrected in the state record.

7.702.46.A.14 · Staff to Child Ratios by AGES OF CHILDREN and NUMBER OF STAFF 6 weeks to 18 months (infants): 1 staff member to 5 infants 12 months to 36 months: 1 staff member to 5 toddlers 24 months to 36 months: 1 staff member to 7 toddlers 2-1/2 years to 3 years: 1 staff member to 8 children 3 years to 4 years: 1 staff member to 10 children FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ 4 years to 5 years: 1 staff member to 12 children 5 years and older: 1 staff member to 15 children Mixed-age group 2-1/2 yrs to 6 yrs: 1 staff member to 10 children

When children in classroom awakened from nap the staff to child ratio was exceeded for approximately ten minutes with 1:14 before another staff member was sent in to help with ratio and to cover for a staff member who had earlier left for the day Correction: Immediately (10/04/2023) ensure that required staff to child ratios are met and maintained at all times. Submit verification of correction to Licensing with written response no later than 10/18/2023. Correct by 10/04/2023

Corrected Corrected by Oct 4, 2023

Category: ratio. Marked corrected in the state record.

7.702.31.B.9.a · The written policies and procedures must be developed, implemented, and followed, and must include at a minimum the following information: How decisions are made and what steps are taken prior to the suspension, expulsion, or request to parents or guardians to withdraw a child from care due to concerns about the child’s behavioral issues. These procedures must be consistent with the center’s policy on guidance and positive instruction, and include documentation of the steps taken to understand and respond to challenging behavior including: Identify and consult with an early childhood mental health consultant or other specialist as needed.

Per discussion with Teresa Sadulski, Director and Mackenzie Jones, ECT along with a review of CH1's file and facility handbook, no documentation was observed to demonstrate that facility had documented steps and procedures to resolve any challenging behavior. CH1 was immediately disenrolled even though handbook indicates that facility "works with children who are displaying challenging behavior". Correction: Immediately (10/04/2023) develop steps and procedures to resolve challenging behaviors including consulting with an early childhood mental health consultant prior to disenrolling a child. Submit verification of correction to Licensing with written response no later than 10/18/2023. Correct by 10/04/2023 ________________________________________________

Corrected Corrected by Oct 4, 2023

Category: health medication. Marked corrected in the state record.