28-02 · Technical assistance was given. Staff stated they prepare bottles in the kitchen. 3.9.6 Breastmilk, Infant Formula, and Food A. Breastmilk and formula must be handled in a sanitary manner at all times and according to manufacturers instructions and instructions by parents/guardians. If instructions are not readily available, childcare personnel must obtain information from the World Health Organizations Safe Preparation, Storage and Handling of Powdered Infant Formula Guidelines, as referenced in Caring for Our Children Basics Health and Safety Foundations for Early Care and Education, which is incorporated by in 65C-22.001(7)(v), F.A.C. B. The provider must make sure all formula and food brought from home are labeled with the childs first and last name. The provider is responsible for the label; therefore, if the label is not completed by the parent, childcare personnel must put the label on when the formula or food is received. C. Breastmilk or infant formula provided for a specific infant by a parent or guardian should not be fed to other children. In the event that the wrong breastmilk or formula is given to an infant in care, the provider must immediately inform the childs parent or legal guardian of the incident, as well as the parent or legal guardian of the infant that the formula or breastmilk was intended for. These incidents must be documented as an accident/incident. D. Prepared bottles must be placed in the refrigerator immediately and used within 24 hours. E. Previously opened baby food jars must not be accepted at the center. If food is fed directly from the jar by the caregiver, the jar can be used for only one feeding and the remainder discarded. F. Providers must develop and follow procedures for the preparation and storage of expressed breastmilk that ensures the health and safety of all infants, as outlined by the Academy of Breastfeeding Medicine Protocol, and prohibits the use of infant formula for a breastfed infant without parental consent, as referenced in Caring for Our Children Basics Health and Safety Foundations for Early Care and Education, which is incorporated by in 65C-22.001(7)(v), F.A.C. G. Due to the extreme risk of choking, solid foods, including cereal, may not be given in bottles or with infant feeders to children with normal feeding habits unless authorized by a physician. Solid foods may not be fed to an infant younger than 4 months of age unless directed by a physician. Solid foods must be of a safe consistency and must be developmentally appropriate for the age and developmental ability of the infant. 3.9.7 Bottle Warming For optimum digestion, breastmilk and infant formula should be served at body temperature. A. Bottle warming devices and crock pots, including cords, must be kept inaccessible to children at all times. B. Devices must be maintained on the lowest possible temperature setting and must be secured in such a way as to prevent them from tipping over, splashing, or spilling. C. Any bottle warming device that has a water reservoir must be emptied, washed, and refilled each day. D. Bottled breast milk, infant bottles, and formula must not be heated in the microwave. E. Heated bottles and foods must be tested before feeding to ensure heat is evenly distributed and to prevent injury to children. F. A bottle can only be warmed once. A warmed bottle cannot be returned to the refrigerator or re-warmed. G. All breastmilk and infant formula left in bottles after feedings must be discarded within one hour after serving an infant. Unused breastmilk may be returned to the parent in the bottle or container provided

Licensing Specialist observed a sealed infant milk pack lying inside the handwashing sink in the infants' room with no name label

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

41-01 · Immunization Records

Licensing Specialist reviewed 17 enrollment files. Per Provider has a total of 17 enrollments. There are (3) children with no updated immunization record. 7.1 Immunization Records The childcare facility is responsible for obtaining for each child in care a current, complete and properly executed Florida Certification of Immunization form Part A-1, B, or C, DH 680, which is incorporated by reference in 65C-22.001, F.A.C., or the Religious Exemption from Immunization form, DH 681, which is incorporated by reference in 65C 22.001, F.A.C., from the custodial parent or legal guardian. DH Form 680 and DH Form 681 may be obtained from the local county health department. Specific immunization requirements are included and detailed in the most current edition of the Immunization Guidelines-Florida Schools, Childcare Facilities and Family Day Care Homes as promulgated by the Florida Department of Health. A. Immunizations received out-of-state are acceptable; however, immunizations must be documented on the Florida Certification of Immunization form and must be signed by a physician practicing in the State of Florida. B. If the custodial parents or legal guardians fail to provide the documentation required above within 30 days of enrollment, the facility shall not allow the child to remain in the program. The parent/guardian of a child who has not received the age-appropriate immunizations prior to enrollment and who does not have documented medical or religious exemptions from routine childhood immunizations must provide documentation of a scheduled appointment or arrangement to receive immunizations. Providers must include a general statement in parent handbook/policies to inform parents/guardians, at time of enrollment, that some children in care may not have current immunizations. C. School-aged children attending public or non-public schools are not required to have student health examination and immunization records on file at the childcare facility as such records are on file at the school where the child is enrolled. D. If the custodial parents or legal guardians need assistance concerning these requirements, the facility shall refer them to the Department of Health or to the childs physician. E. Medical records in this section are the property of the custodial parent or legal guardian and must be returned to them when the child withdraws from the facility. The medical records are transferable if the child attends another facility. F. It is recommended that childcare personnel are current with all immunizations routinely recommended for adults by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), as referenced in Caring for Our Children Basics Health and Safety Foundations for Early Care and Education, which is incorporated by in 65C-22.001

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

03-01 · Technical assistance was given to provider and licensing specialist emphasized the importance of being in ratio. 2 General Requirements 2.3 Ratios The staff-to-child ratio, as established in Section 402.305(4), F.S., is based on primary responsibility for the direct supervision of children and applies at all times while children are in care. 2.3.1 Mixed Age Groups A. In groups of mixed age ranges, where children under one year of age are included, one childcare personnel must be responsible for no more than four children of any age group, at all times. B. In groups of mixed age ranges, where children one year of age but under two years of age are included, one childcare personnel must be responsible for no more than six children of any age group, at all times

Licensing Specialist observed only (1) staff with (2) infants and (7) 4-year-olds at the center. The director arrived at the center with (2) children while licensing specialist was standing at the door to enter center once the director completed transporting. Per Provider the infant teacher arrives at 8 a.m

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

42-01 · Student Health and Records

Licensing Specialist observed 1 file with no updated health physical. Provider contacted mother during inspection to bring a copy of physical

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

17-03 · Outdoor Play Area/Fencing

Licensing Specialist observed no shade in outside play area. 3.5 Outdoor Play Area C. The outdoor play area must provide shade. Shade may be provided by trees, buildings, or structures

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

03-01 · Ratio Sufficient

Licensing Specialist observed staff out of ratio: Mixed Classroom (1) 8-month-old (1) 1-year-old (1) 2-year-old (4) 3-year-olds 7:1 2.3 Ratios The staff-to-child ratio, as established in Section 402.305(4), F.S., is based on primary responsibility for the direct supervision of children and applies at all times while children are in care. 2.3.1 Mixed Age Groups A. In groups of mixed age ranges, where children under one year of age are included, one childcare personnel must be responsible for no more than four children of any age group, at all times. B. In groups of mixed age ranges, where children one year of age but under two years of age are included, one childcare personnel must be responsible for no more than six children of any age group, at all times. Per Provider called parents to do pick-up due to staff getting sick and leaving for the day

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

33-01 · Technical assistance given. 4.2 Training Requirements 4.2.1 Mandated Introductory Training Childcare personnel must successfully complete 40 hours of childcare training as evidenced by successful completion of competency examinations offered by the Department or its designated representative with a weighted score of 70 or better. Childcare personnel who successfully completed the mandatory 40-hour Introductory Child Care Training prior to January 1, 2004 are not required to fulfill the competency examination requirement. A. Part I Courses (30 Hours) Childcare personnel must complete all of the following: Child Care Facility Rules and Regulations, Health, Safety and Nutrition, Identifying and Reporting Child Abuse and Neglect, Child Growth and Development, Behavioral Observation and Screening B. Part II Courses (10 Hours) Child care personnel must also complete 10 hours of the following Part II courses: Special Needs Appropriate Practices (10 hours), or ? Understanding Developmentally Appropriate Practices (5 hours) and one of the following courses: 1. Infant and Toddler Appropriate Practices (5 hours) 2. Preschool Appropriate Practices (5 hours) 3. School- Age Appropriate Practices (5 hours) 4.2.2 Early Literacy Training Pursuant to Section 402.305(2)(e)5., F.S., all childcare personnel must complete a single course of training in early literacy and language development of children ages birth through five years that is a minimum of five clock hours or .5 CEUs. Early literacy training must be completed within 12 months of date of employment in the childcare industry. Proof of completion may be documented on a certificate of course completion, classroom transcript, or diploma. Childcare personnel must complete one of the following: A. One of the Departments online literacy courses available on the Departments website. Child Care Facility Handbook Page B. One of the Departments approved literacy courses. A list of these courses can be obtained from the Departments website. (No additional courses will be approved by the Department.) C. One college level early literacy course (for credit or non-credit) if taken within the last five years

Licensing Specialist reviewed completed required training for staff K.H. in Cares System in which staff has not completed Introductory training

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

05-02 · Transportation

Licensing Specialist reviewed CARES profile. Provider is not licensed to offer transportation service as the transportation requirements to transport are not currently met. As corrective action EE needs to complete Transportation Safety Training. 2.5 Transportation Childcare providers must comply with minimum health and safety standards to ensure the well-being of children in their care being transported. For the purposes of this section, transportation pertains to travel by foot or in a vehicle that is owned, operated or regularly used by the child care program, and vehicles used to provide transportation through a contract or agreement with an outside entity. Prior to transporting children, the facility must be approved by the Department to offer transportation services. Transportation services will be approved if the conditions set forth in parts 2.5.1, 2.5.4., 2.5.5., and 4.2.6., of this Handbook are met. Pursuant to the Child Safety Alarm bill in 2021, all vehicles used to transport children by childcare facilities and large family childcare homes must be equipped with a reliable alarm system which prompts the driver to inspect the vehicle for children before exiting the vehicle. 2.5.1 Driver Requirements The driver of any vehicle used by a childcare program to provide transportation must have the following: A. A valid Florida drivers license including the proper endorsement. B. An annual physical examination which grants medical approval to drive, and valid certificate(s) of course completion for first aid training and pediatric cardiopulmonary resuscitation (CPR) procedures. 2.5.2 Transportation Log A. A log must be maintained for all children being transported in a vehicle or on foot away from and/or to the premises of the childcare facility. The log must be retained on file at the facility for a minimum of 12 months and available for review by the licensing authority. The log must include: 1. Each childs name, 2. The date and time of departure, 3. Time of arrival at the destination, 4. The signature of the driver (or in the case of travelling on foot, the signature of the childcare personnel), 5. The signature of a second childcare personnel or person(s) authorized by the provider to verify the transportation log and that all children have arrived safely and left the vehicle (if applicable)

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

06-01 · Driver's License, Physician Certification

Per provider does not have required driver's physical to transport children at the facility. At the time of the investigation the facility was not licensed to provide transportation. Therefore, the facility did not have supporting document on file for review. Driver EE. needs to get a drivers physical granting permission to transport children in care. 2.5.1 Driver Requirements The driver of any vehicle used by a childcare program to provide transportation must have the following: B. An annual physical examination which grants medical approval to drive, and valid certificate(s) of course completion for first aid training and pediatric cardiopulmonary resuscitation (CPR) procedures

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

07-04 · Vehicle Requirements

At the time of the investigation the facility was not licensed to provide transportation. Therefore, the facility did not have supporting document on file for review. Complete a vehicle inspection and provide written proof. 2.5.4 Vehicle Requirements A. All vehicles regularly used to transport children must be inspected annually by a mechanic to ensure that they are in proper working order. Documentation by the mechanic must be maintained in the vehicle

Open Not marked corrected in the state record

Category: transportation. Open / not marked corrected.

07-05 · Vehicle Requirements

At the time of the investigation the facility was not licensed to provide transportation. Therefore, the facility did not have supporting document on file for review. As correction action - Please Install a vehicle alarm. F. By January 1, 2022, all vehicles used by childcare facilities to transport children must be equipped with a reliable alarm system approved by the Department which prompts the driver to inspect the vehicle for children before exiting the vehicle. 1. Approved alarm systems must meet the following criteria: a. The alarm system must be armed or activated automatically when the vehicles ignition is turned on. b. The alarm system must be designed and installed so that the vehicle horn, siren or other type of audio alarm will sound if the driver or staff member does not walk to the rear or, in the case of a passenger van, the side entry point of the vehicle, to manually shut off or deactivate the alarm. c. The time delay from the time the ignition is turned off after activation of the alarm system until the alarm sounds shall be no longer than one minute. d. The alarm must be audible from the distance of 500 feet from the vehicle. e. The alarm system must be installed so that the driver must walk to the back of the vehicle to reach the deactivation mechanism. Deactivation mechanisms installed in locations that do not require the driver to walk to the back of the vehicle and view all seating areas will not be acceptable. 2. List of approved alarm manufacturers may be found on the Departments website at www.myflfamilies.com/childcare 3. Alarms must be installed and maintained according to the manufacturers recommendations. 4. Alarm systems installed according to the manufacturers instructions prior to October 1, 2021, will be deemed to satisfy this requirement if they meet the criteria set forth in 2.5.4.F.1. above. Under this allowance, the existing alarm system must always be properly maintained in working order. Should at any time the alarm system require replacement, the new system must be selected from the Departments approved list referenced in 2.5.4 F.2. above

Open Not marked corrected in the state record

Category: transportation. Open / not marked corrected.

25-12 · Meals and Snacks

During the time of inspection, the licensing specialist observed that the Provider did not have an allergy listing posted in the kitchen or any area of the facility. As corrective action, post all allergies in a conspicuous place visible to all employees. 3.9 Food Preparation-Food Service G. If a special diet is required for a child by a physician, a copy of the physicians order, a copy of the diet, and a sample meal plan for the special diet must be maintained in the childs file and followed. If the custodial parent or legal guardian notifies the program of any known food allergies, written documentation must be maintained in the childs file for as long as the child is in care. Special food restrictions must be shared with childcare personnel posted in an easily seen location that is not readily visible by parents or non-childcare personnel and followed

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

25-13 · Meals and Snacks

The allegation stated that the child was given candy with nuts and that the child was allergic to nuts. The teacher admitted to giving the child a snicker bar that contained nuts. The teacher stated that she was unaware that the child could not have the candy or is allergic to nuts. There was no positing in the classroom of the child's allergies. However, during onsite investigation the licensing specialist reviewed and observed the child's file where it was documented that the child was allergic to nuts. As corrective action, post all allergies in a conspicuous place visible to all employees. 3.9.3 Food Safety G. If a special diet is required for a child by a physician, a copy of the physicians order, a copy of the diet, and a sample meal plan for the special diet must be maintained in the childs file and followed. If the custodial parent or legal guardian notifies the program of any known food allergies, written documentation must be maintained in the childs file for as long as the child is in care. Special food restrictions must be shared with childcare personnel posted in an easily seen location that is not readily visible by parents or non-childcare personnel and followed

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.