2.120.I · Every five (5) years, all child abuse and neglect inquiry background checks must be renewed by resubmitting an inquiry form and current fee to the Department for processing. An updated clearance letter or verification of the submission of the inquiry form must be obtained before five (5) years from the date reflected on the current clearance letter.

Reviewed 6 staff files and found Elizabeth T. with an expired FBI(Exp: 6/6/24) and CBI check(Exp: 5/29/24) Correction: All individuals requiring a background check must review Navigating the Background Check Investigation Unit's (BIU) Webpage powerpoint. Submit verification that staff member Elizabeth has reviewed the powerpoint within 24 hours. Submit documentation of CBI and FBI Clearance Letters for staff members Elizabeth T. with written response to the Specialist. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Category: background checks. Marked corrected in the state record.

2.121.D.4.a · Criminal background check requests must be successfully completed prior to an individual caring for children or allowing the individual unsupervised access to children in child care centers (less than 24-hour care), school-age child care facilities, family child care homes, and qualified exempt provider homes.

Reviewed 6 staff files and found Johanna B. without documentation of a completed CBI check and Megan M. FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ without documentation of a completed FBI check. Correction: All individuals requiring a background check must review Navigating the Background Check Investigation Unit's (BIU) Webpage powerpoint. Submit verification that staff members Johanna B. and Megan M. have reviewed the powerpoint within 24 hours. Submit documentation of CBI(Johanna) and FBI(Megan M.) Clearance Letters for staff members Johanna B. and Megan M. with written response to the Specialist. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Category: supervision. Marked corrected in the state record.

2.213.B · All staff must complete a Department-approved standard precautions training prior to working with children. This training must be renewed annually and will be counted towards ongoing professional development.

Reviewed 6 staff files and found all 6 to have completed the standard precautions course, but none of the certificates were signed showing the exposure control plan was reviewed with the staff. Correction: Obtain and Maintain current training documentation for all staff at the site. Correct immediately and submit compliance by 4/15/25. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Category: recordkeeping. Marked corrected in the state record.

2.229.C · Items labeled “keep out of reach of children” must be inaccessible to children.

In room # 101 there was Dawn dish soap and hand sanitizer at the adult sink accessible to children. Both were labeled "Keep out of reach". Correction: Ensure that all items labeled "keep out of reach" of children are inaccessible to children at all times. Correct Immediately. ** Corrected at time of visit but making the items inaccessible. No response required. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Marked corrected in the state record.

2.237.H · In rooms used by children, all electrical outlets that are accessible to children must have protective covers, or safety outlets must be installed. FAX 303-866-4453 Phone 303-866-5948 ________________________________________________

In room # 103 there was decor lights that were missing a safety plug cover at the end of the string. Correction: Ensure that all outlets have safety plug covers installed. Correct immediately. ** Corrected at time of visit by putting a safety plug cover in the outlet. No response required. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Marked corrected in the state record.

2.127.D · All facilities, except family child care homes must post in every room of the child care facility, excluding bedrooms and living areas, the license capacity of the room and the staff-to-child ratio required by regulation to be maintained for the age of children cared for in the room.

In room # 101, there was no ratio sign posted. Correction: Ensure that a staff to child ratio sign is posted in every room licensed at the facility. Correct immediately. ** Corrected at the time of visit by posting the required sign. No response required. Correct by 04/08/2025

Corrected Corrected by Apr 8, 2025

Category: ratio. Marked corrected in the state record.

2.213.B · All staff must complete a Department-approved standard precautions training prior to working with children. This training must be renewed annually and will be counted towards ongoing professional development.

In reviewing 6 staff files: Staff member Ashley O. (DOH 10/2023) missing current Standard Precautions Training. Correction: All staff must complete Standard Precautions Training. This training must be renewed annually. Correct immediately, Document compliance to Specialist by 6/14/24. Correct by 05/14/2024

Corrected Corrected by May 14, 2024

Category: recordkeeping. Marked corrected in the state record.

2.213.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.

In reviewing 6 staff files: Staff member Ashley O. (DOH 10/2023) missing current CPR & First Aid Training. Correction: Within 30 days, all employees caring for children muust complete the First Aid & CPR module. This must be renewed every two years. Correct immediately, Document compliance to Specialist by 6/14/24. Correct by 05/14/2024

Corrected Corrected by May 14, 2024

Category: recordkeeping. Marked corrected in the state record.

2.213.L · All staff must have at least one (1) hour of child development training within ninety (90) days of employment. This training must include the major domains (cognitive, social, emotional, physical development and approaches to learning). This training is required once and will count toward ongoing training requirements if taken after the date of hire.

In reviewing 6 staff files: Staff members Ashley O. (DOH 10/2023) & Taylor Stones missing a child development training. Correction: All staff must have at least 1 hour of child Development training within 90 days of employment. This training must include the major domains (cognitive, social, emotional, & physical developments and approaches to learning). This training is required once. Document compliance to Specialist by 6/14/24. Correct by 06/14/2024

Corrected Corrected by Jun 14, 2024

Category: recordkeeping. Marked corrected in the state record.

2.237.H · In rooms used by children, all electrical outlets that are accessible to children must have protective covers, or safety outlets must be installed.

In room 103, A powerstrip with open electrical outlets without protective covers accessible to children. Correction: All electrical outlets that are accessible to children must have protective covers, or make inaccessible. Correct immediately, 5/14/24. ***Corrected at time of visit by making inaccessible. No response required. Correct by 05/14/2024

Corrected Corrected by May 14, 2024

Marked corrected in the state record.

2.133.A · Prior to caring for children, all staff must complete a Department-approved training in emergency and disaster preparedness: Evacuation, Shelter in Place, Lockdown, and Active Shooter on Premises Plans for Children in Care. For seasonal children’s resident camp programs, operating no more than 90 days per calendar year, at least one on site director must be trained in the Department approved training.

In reviewing 6 staff files: Staff member Taylor S. (DOH 2/2024) missing Emergency Preparedness or FEMA training. Correction: Prior to caring for children, all staff must complete approved training in emergency & disaster preparedness or FEMA,. Correct immediately, Document compliance to Specialist by 6/14/24. Correct by 05/14/2024

Corrected Corrected by May 14, 2024

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.

Reviewed six (6) staff files and observed Tasha G., Elizabeth H., Jennifer M., and Houachu L.'s file to have an expired Department-approved Standard Precautions training certificate. The Certificates on file were dated 08/11/2022. Additionally, Deborah H., and Nadine C. files were missing the Standard Precautions training. Deborah H. and Nadine C. hire date was 8/10/2023. Correction: Obtain a Department-approved Standard Precautions training for Tasha G., Elizabeth H., Jennifer M., and Houachu, Deborah H., and Nadine C. Correct immediately. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

Category: ratio. 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 FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ 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.

Reviewed six (6) staff files and observed Houachu L.'s file to have an expired Department-approved training about child abuse prevention. The certificate on file was dated 8/15/2022 Correction: Obtain a Department-approved training about child abuse prevention for Houachu L. Correct immediately. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

Category: recordkeeping. Marked corrected in the state record.

7.701.33.D · . Each owner or employee, who is eighteen (18) years of age or older, of a facility or agency must submit to CBI a complete set of fingerprints to obtain any criminal record held by the CBI and FBI. Payment of the fee for the criminal record check is the responsibility of the individual being checked or the facility or agency. The results of the criminal record check, the CBI and FBI clear letter, must be maintained at the home, center, facility, or agency and must be available for review upon request by a Licensing Specialist.

Reviewed six (6) staff files and observed Deborah H. and Nadine C.'s files to be missing a FBI clearance letter. Deborah H. and Nadine C. hire date was 8/10/2023. Correction: All individuals requiring a background check must review Navigating the Background Check Investigation Unit's (BIU) Webpage powerpoint. Submit verification that staff members Deborah H. and Nadine C. have reviewed the powerpoint within 24 hours. Submit documentation of FBI clearance Letters for staff member FBI clearance letters for Deborah H. and Nadine C. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

Category: background checks. Marked corrected in the state record.

7.702.35.A · A record must be maintained, either written or electronic, for each staff member that includes the following:

Reviewed six (6) staff files and observed Deborah H. and Nadine C.'s not to have any record, either electronic or written. Correction: A record must be maintained, either written or electronic, for each staff member. Correct immediately. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

Category: recordkeeping. Marked corrected in the state record.

7.702.42.A.1 · This training is developed and facilitated by the program for staff to identify program specific environmental hazards. Staff must be retrained if there are changes to the building and physical premises.

Reviewed six (6) staff files and observed Deborah H. and Nadine C.'s not to have a building and physical FAX 303-866-4453 Phone 303-866-5948 ________________________________________________ premises training. Correction: Obtain a building and physical premises training for Deborah H. and Nadine C. Correct immediately. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

Category: recordkeeping. Marked corrected in the state record.

7.702.72.B · Indoor and outdoor equipment, materials, and furnishings must be sturdy, safe, and free of hazards.

The preschool playground double slide had an opening on top of the equipment, posing a safety hazard. Correction: Indoor and outdoor equipment, materials, and furnishings must be safe, and free of hazards. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

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

7.702.72.C.1.a · All climbing equipment eighteen (18) inches or higher must have resilient surfacing of at least six (6) inches in the use zone surrounding the equipment.

In the preschool playground the resilient surfacing was less than one (1) inch, posing a potential safety hazard. Correction: All climbing equipment eithteen (18) inches or hicher must have esilient surfacing of at least six (6) inches. Correct immediately. Send verification with written response to Specialist. Correct by 08/18/2023

Corrected Corrected by Aug 18, 2023

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