K.C.'S 24 Hr. Child Care Center

591-1-1-.31(2)(b)3.(ii)(I)-(VIII) · Rule 591-1-1-.31(2)(b)3.(ii)(I)-(VIII) requires the Center develop a written plan for newly hired teacher's who do not possess the educational credential or degree listed in 591-1-1-.31(2) (b)2.(i) through (xii).

During a Monitoring Visit conducted on August 27, 2025 ; It was determined based on a review of staff credentials the center did not develop a written plan for two staff members that did not possess the educational requirements for lead teachers.

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591-1-1-.25(3) · Rule 591-1-1-.25(3) requires the Center and surrounding premises to be kept clean, free of debris and in good repair. Hygienic measures such as, but not limited to, screened windows and proper waste disposal procedures shall be utilized to minimize the presence of rodents, flies, roaches and other vermin at the Center.

During a Complaint Closure conducted on May 20, 2025 ; It was determined based on an investigation that the center¶s preschool playground was not kept clean when there was a trash can without a lid that contained soiled pull-ups, trash, and used disposable cups, and that the bathroom wall next to the toilet had peeling paint on April 23, 2025.

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591-1-1-.25(3) · Rule 591-1-1-.25(3) requires the Center and surrounding premises to be kept clean, free of debris and in good repair. Hygienic measures such as, but not limited to, screened windows and proper waste disposal procedures shall be utilized to minimize the presence of rodents, flies, roaches and other vermin at the Center.

During a Monitoring Visit conducted on August 27, 2025 ; It was determined based on observation that chipping and peeling paint were observed on the bottom of the wall near the toilet on the center¶s preschool playground bathroom. It was further determined that in the 2-year-old classroom the edging of the counter top was cracked with a jagged edge at the handwashing sink of the diaper changing table and the counter top at the children's hand washing sink was broken on the edge.

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591-1-1-.25(3) · Rule 591-1-1-.25(3) requires the Center and surrounding premises to be kept clean, free of debris and in good repair. Hygienic measures such as, but not limited to, screened windows and proper waste disposal procedures shall be utilized to minimize the presence of rodents, flies, roaches and other vermin at the Center.

During a Complaint Investigation & Monitoring Visit conducted on January 20, 2026 ; It was determined based on observation that chipping and peeling paint was observed on the bottom of the wall near the sink on the center¶s preschool playground bathroom.

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591-1-1-.26(6) · Rule 591-1-1-.26(6) requires that playground equipment provide an opportunity for the children to engage in a variety of experiences and shall be age-appropriate. For example, toddlers shall not be permitted to swing in swings designed for School-age Children. The outdoor equipment shall be free of lead-based paint, sharp corners and shall be regularly maintained in such a way as to be free of rust and splinters that could pose significant safety hazard to the children. All equipment shall be arranged so as not to obstruct supervision of children.

During a Complaint Closure conducted on February 14, 2025 ; It was determined based on investigation that on December 7, 2023, there was a broken swing where the seat had become detached from the chain. The chain was accessible to the children.

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591-1-1-.26(6) · Rule 591-1-1-.26(6) requires that playground equipment provide an opportunity for the children to engage in a variety of experiences and shall be age-appropriate. For example, toddlers shall not be permitted to swing in swings designed for School-age Children. The outdoor equipment shall be free of lead-based paint, sharp corners and shall be regularly maintained in such a way as to be free of rust and splinters that could pose significant safety hazard to the children. All equipment shall be arranged so as not to obstruct supervision of children.

During a Monitoring Visit conducted on August 27, 2025 ; It was determined based on observation that the following equipment hazards were observed: Small Playground: - There was chipping paint on the green tunnel, the red air force helicopter, and the yellow metal car. Large Playground: -There was rust on two swing chains. - There was chipping paint on the body of the yellow metal car.

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591-1-1-.26(6) · Rule 591-1-1-.26(6) requires that playground equipment provide an opportunity for the children to engage in a variety of experiences and shall be age-appropriate. For example, toddlers shall not be permitted to swing in swings designed for School-age Children. The outdoor equipment shall be free of lead-based paint, sharp corners and shall be regularly maintained in such a way as to be free of rust and splinters that could pose significant safety hazard to the children. All equipment shall be arranged so as not to obstruct supervision of children.

During a Complaint Investigation & Monitoring Visit conducted on January 20, 2026 ; It was determined based on observation that the following equipment hazards were accessible to children on this date: Small Playground -There was chipping paint on the green tunnel, the red air force helicopter, and the yellow metal car. Large Playground -There was a large crack at the base of the yellow slide measuring 1 foot, 8 inches. -There was a broken, leaning basketball rim at the front right of the playground.

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591-1-1-.31(2)(b)3.(ii)(I)-(VIII) · Rule 591-1-1-.31(2)(b)3.(ii)(I)-(VIII) requires the Center develop a written plan for newly hired teacher's who do not possess the educational credential or degree listed in 591-1-1-.31(2) (b)2.(i) through (xii).

During a Complaint Investigation & Monitoring Visit conducted on January 20, 2026 ; It was determined based on a review of staff credentials the Center did not develop a written plan for three Staff members that did not possess the educational requirements for the lead teachers.

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591-1-1-.26(9) · Rule 591-1-1-.26(9) requires the playground to be kept clean, free from litter and free of hazards, such as but not limited to rocks, exposed tree roots and exposed sharp edges of concrete.

During a Monitoring Visit conducted on August 27, 2025 ; It was determined based on observation that the following was observed: Small Playground - There was a thorny vine growing on the left side of the playground. - A black rubber mat, near the left fence, was cracked and raised in the middle, creating a possible tripping hazard. -There were loose fence wires, bent outward at the top of the fence separating the small and large playgrounds. - There was a large ear worm web hanging from a tree limb that was accessible to children, near the red metal structure.

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591-1-1-.26(9) · Rule 591-1-1-.26(9) requires the playground to be kept clean, free from litter and free of hazards, such as but not limited to rocks, exposed tree roots and exposed sharp edges of concrete.

During a Complaint Investigation & Monitoring Visit conducted on January 20, 2026 ; It was determined based on observation that the following playground hazards were accessible to children on this date: Small Playground -There was a cracked, raised area in the middle black rubber mat near the left fence, creating a possible tripping hazard. Small and Large Playground -At the top of the fence that separated playgrounds, there were loose fence wires bent outward. Large Playground -There were thorny vines growing through the chain link fence at the back middle and back right of the playground.

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591-1-1-.32(7) · Rule 591-1-1-.32(7) requires that children be supervised at all times appropriate to the individual age, needs and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. "Supervision" means that the appropriate number of Staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children, volunteers and Students-in-Training. The persons supervising in the child care area must be alert, positioned to maximize their ability to hear and see the children at all times, and able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers and Students-in-Training, and provide timely attention to the children's actions and needs. Staff shall be attentive and participating with all children during mealtimes and shall be seated within an arm¶s length away from children thirty- six (36) months of age and younger.

During a Complaint Investigation & Monitoring Visit conducted on May 9, 2025 ; It was determined based on observation that staff were not seated within arm's reach of children who were 1-year-old and 2 -years-old during mealtime as required.

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591-1-1-.32(7) · Rule 591-1-1-.32(7) requires that children be supervised at all times appropriate to the individual age, needs and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. "Supervision" means that the appropriate number of Staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children, volunteers and Students-in-Training. The persons supervising in the child care area must be alert, positioned to maximize their ability to hear and see the children at all times, and able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers and Students-in-Training, and provide timely attention to the children's actions and needs. Staff shall be attentive and participating with all children during mealtimes and shall be seated within an arm¶s length away from children thirty- six (36) months of age and younger.

During a Complaint Investigation & Monitoring Visit conducted on January 20, 2026 ; It was determined based on observation that Staff in classrooms 2L and 3L were not seated within an arm¶s length away from children of age thirty-six (36) months of age and younger during meal time, as required. Exhibit "A"

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591-1-1-.36(7)(d)2. · Rule 591-1-1-.36(7)(d)2. requires that the second designated Staff person conduct a check of the vehicle immediately upon the completion of the first check of the vehicle. The responsible person shall physically walk through the entire vehicle; visually inspect all seat surfaces, under all seats and in all compartments or recesses in the vehicle's interior; and sign the passenger transportation checklist(s), indicating all of the children have exited the vehicle. There shall be continuous watchful oversight of the vehicle between the first check and second check.

During a LS POI Follow Up conducted on November 12, 2024 ; It was determined based on a review of records that there were no load and unload indicated for two children who were transported on October 31, 2024 on the morning route from the center to Oak Hill Elementary school, but staff indicated on the second check signature line that there was no bus run. An adverse action was previously issued for this rule violation. This rule violation is no longer appealable. No fine is being issued at this time.

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591-1-1-.36(7)(d)2. · Rule 591-1-1-.36(7)(d)2. requires that the second designated Staff person conduct a check of the vehicle immediately upon the completion of the first check of the vehicle. The responsible person shall physically walk through the entire vehicle; visually inspect all seat surfaces, under all seats and in all compartments or recesses in the vehicle's interior; and sign the passenger transportation checklist(s), indicating all of the children have exited the vehicle. There shall be continuous watchful oversight of the vehicle between the first check and second check.

During a Complaint Investigation Follow Up conducted on November 26, 2024 ; It was determined based on a review of records that there were no second checks for the following: -Five children transported on the afternoon route from Fairview Elementary School to the center on November 15, 2024. -Three children transported on the afternoon route from South Salem Elementary to the center on November 15, 2024. -One child transported on the afternoon route from Cousins Middle School to the center on November 13, 2024. - Two children transported on the morning route from Oak Hill Elementary to the center on November 15, 2024. - Two children transported on the morning route from the center to Clements Middle School on November 22, 2024. - Three children transported on the afternoon route from West Newton Elementary School to the center on November 15, 2024. An adverse action was previously issued for this rule violation. This rule violation is no longer appealable. No fine is being issued at this time.

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591-1-1-.36(7)(d)2. · Rule 591-1-1-.36(7)(d)2. requires that the second designated Staff person conduct a check of the vehicle immediately upon the completion of the first check of the vehicle. The responsible person shall physically walk through the entire vehicle; visually inspect all seat surfaces, under all seats and in all compartments or recesses in the vehicle's interior; and sign the passenger transportation checklist(s), indicating all of the children have exited the vehicle. There shall be continuous watchful oversight of the vehicle between the first check and second check.

During a POI Follow Up conducted on January 14, 2025 ; It was determined based on a review of records that there were no second checks for one child transported on the afternoon route from Cousins Middle School to the center on December 19, 2024. Exhibit "A"

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591-1-1-.36(7)(c)2. · Rule 591-1-1-.36(7)(c)2. requires that the driver or other designated person shall immediately document in writing, with a check or other mark/symbol to account for each child listed on the passenger transportation checklist each time a child enters and exits the vehicle. The driver or other designated staff person shall document in writing with a different mark/symbol to account for each child listed on the passenger transportation checklist who was not present on the vehicle for any reason. An explanation shall be documented in writing whenever a child is transported to a field trip site but is not present on the return trip to the Center.

During a LS POI Follow Up conducted on November 12, 2024 ; It was determined based on a review of records that there was no unload indicated for two children who were transported on November 1, 2024 on the morning route from the center to Oak Hill Elementary school.

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591-1-1-.36(7)(c)2. · Rule 591-1-1-.36(7)(c)2. requires that the driver or other designated person shall immediately document in writing, with a check or other mark/symbol to account for each child listed on the passenger transportation checklist each time a child enters and exits the vehicle. The driver or other designated staff person shall document in writing with a different mark/symbol to account for each child listed on the passenger transportation checklist who was not present on the vehicle for any reason. An explanation shall be documented in writing whenever a child is transported to a field trip site but is not present on the return trip to the Center.

During a Complaint Investigation Follow Up conducted on November 26, 2024 ; It was determined based on a review of records that there was no load and unload indicated for one child who was transported on November 22, 2024 from Cousins Middle School to the center on the afternoon route.

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591-1-1-.36(7)(d)2. · Rule 591-1-1-.36(7)(d)2. requires that the second designated Staff person conduct a check of the vehicle immediately upon the completion of the first check of the vehicle. The responsible person shall physically walk through the entire vehicle; visually inspect all seat surfaces, under all seats and in all compartments or recesses in the vehicle's interior; and sign the passenger transportation checklist(s), indicating all of the children have exited the vehicle. There shall be continuous watchful oversight of the vehicle between the first check and second check.

During a LS POI Follow Up conducted on November 12, 2024 ; It was determined based on a review of records that there were no load and unload indicated for two children who were transported on October 31, 2024 on the morning route from the center to Oak Hill Elementary school, but staff indicated on the second check signature line that there was no bus run.

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591-1-1-.36(7)(d)2. · Rule 591-1-1-.36(7)(d)2. requires that the second designated Staff person conduct a check of the vehicle immediately upon the completion of the first check of the vehicle. The responsible person shall physically walk through the entire vehicle; visually inspect all seat surfaces, under all seats and in all compartments or recesses in the vehicle's interior; and sign the passenger transportation checklist(s), indicating all of the children have exited the vehicle. There shall be continuous watchful oversight of the vehicle between the first check and second check.

During a Complaint Investigation Follow Up conducted on November 26, 2024 ; It was determined based on a review of records that there were no second checks for the following: -Five children transported on the afternoon route from Fairview Elementary School to the center on November 15, 2024. -Three children transported on the afternoon route from South Salem Elementary to the center on November 15, 2024. -One child transported on the afternoon route from Cousins Middle School to the center on November 13, 2024. - Two children transported on the morning route from Oak Hill Elementary to the center on November 15, 2024. - Two children transported on the morning route from the center to Clements Middle School on November 22, 2024. - Three children transported on the afternoon route from West Newton Elementary School to the center on November 15, 2024.

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591-1-1-.36(7)(c)3. · Rule 591-1-1-.36(7)(c)3. requires that the driver or other designated person document in writing the date and time of arrival and departure each time the vehicle departs from the Center, is loaded or unloaded at each school and when the vehicle returns to the Center; each time the vehicle departs from the Center, arrives at the location where any child is picked up or dropped off and when the vehicle returns to the Center; each time the vehicle leaves the Center, arrives at a field trip destination, leaves a field trip destination, and returns to the Center.

During a LS POI Follow Up conducted on November 12, 2024 ; It was determined based on a review of records that there was no departure, load/unload time, or return time indicated for two children who were transported on October 31, 2024 on the morning route from the center to Oak Hill Elementary school.

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591-1-1-.36(7)(c)3. · Rule 591-1-1-.36(7)(c)3. requires that the driver or other designated person document in writing the date and time of arrival and departure each time the vehicle departs from the Center, is loaded or unloaded at each school and when the vehicle returns to the Center; each time the vehicle departs from the Center, arrives at the location where any child is picked up or dropped off and when the vehicle returns to the Center; each time the vehicle leaves the Center, arrives at a field trip destination, leaves a field trip destination, and returns to the Center.

During a Complaint Investigation Follow Up conducted on November 26, 2024 ; It was determined based on a review of records that there were no return times indicated for the following: -Four children who were transported on the afternoon route from Flint Hill Elementary to the center on November 15, 2024. -Three children who were transported on the morning route from the center to Clements Middle School on November 15, 2024. -Three children who were transported on the afternoon route from West Newton Elementary School to the center on November 15, 2024. Exhibit "A"

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591-1-1-.03(9) · Rule 591-1-1-.03(9) requires that staff shall not engage in, or allow children or other adults to engage in, activities that could be detrimental to a child’s health or well-being, such as but not limited to, horse play, rough play, wrestling, and picking up a child in a manner that could cause injury.

During a complaint investigation and follow-up visit conducted on July 18, 2024, it was determined based on staff statements, interviews and video footage that a three-year-old child was injured, in the classroom by a staff member. Video footage shows a staff member picking the child up by the upper right arm, and the child’s arm immediately going limp. A staff member then puts the child on their cot for nap time. The child required professional medical attention.

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591-1-1-.07(2) · Rule 591-1-1-.07(2) requires that parents must be notified of a child's incidents, illnesses or injuriesy as follows: Immediately notify Parent(s) and obtain specific instructions until child can be picked up or returned to group. • When professional medical attention is required, or • When child experiences symptoms of moderate discomfort such as elevated temperature, vomiting or diarrhea., or When child is involved in an incident that puts their health and/or safety at risk (e.g., missing from program, left on vehicle, escaped from building/playground, etc.) Notify Parent(s) by the end of the day. • When professional medical attention is not required, or • When child experiences symptoms of less than moderate discomfort, or • When child experiences an adverse reaction to prescribed medication which does not constitute moderate discomfort.

During a complaint investigation and follow-up visit conducted on July 18, 2024, it was determined based on staff statements, interviews and video footage that a three-year-old child was injured in the classroom by a staff member, and the child’s parents were not notified. The child was in discomfort and pain for approximately an hour and a half before the parents were notified. Professional medical attention was received.

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591-1-1-.03(9) · Rule 591-1-1-.03(9) requires that staff shall not engage in, or allow children or other adults to engage in, activities that could be detrimental to a child’s health or well-being, such as but not limited to, horse play, rough play, wrestling, and picking up a child in a manner that could cause injury.

During an incident investigation and follow-up visit conducted on September 19, 2023, it was determined based on staff statements, interviews and video footage, that a two-year-old child was rough handled by a staff member after having a febrile seizure. Video footage shows a staff member pick up the unconscious child, by the arm, and try to get them to stand up. Professional medical attention was required.

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591-1-1-.30(1)(a)3 · Rule 591-1-1-.30(1)(a)3 requires that each crib shall have only an individual, tight-fitting sheet which is changed daily or more often as needed and prior to a change of occupant.

During a Licensing Study conducted on February 1, 2024 ; It was determined based on observation that two of seven crib sheets were loose and not tight fitting and one of seven crib sheets was too tight fitting. Exhibit "A"

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591-1-1-.25(13) · Rule 591-1-1-.25(13) requires that potentially hazardous equipment, materials and supplies be stored in a locked area inaccessible to children.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that the following hazards existed: 2L Classroom: -There was a staff bag near the cubby area accessible to the children. 3L Classroom: -There were two staff bags on a shelf near the back of the classroom accessible to the children. -There was an unlocked closet with a broom and dust pan accessible to the children. -There was a toilet brush in the boys bathroom accessible to the children. 2R Classroom: -There was an unlocked closet with two staff bags on the floor accessible to the children. An adverse action was previously issued for this rule violation. This rule violation is no longer appealable. No fine is being issued at this time.

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591-1-1-.25(13) · Rule 591-1-1-.25(13) requires that potentially hazardous equipment, materials and supplies be stored in a locked area inaccessible to children.

During a Licensing Study conducted on February 1, 2024 ; It was determined based on observation that the following potential hazards were observed: 2L: -There was a bottle of Purell disinfectant spray on the sink next to the diaper changing table. -There was a broom and dust pan next to the trash can. -There was a toilet bowl brush in the left bathroom. 2R: -There was a can of disinfectant spray on the right bathroom floor. -There were several plastic storage bags in the children's cubbies. 3L: -There was a can of Scrubbing Bubbles on the sink next to the diaper changing table. -There were plastic bags stored under the sink next to the diaper changing table.

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591-1-1-.30(1)(a)3 · Rule 591-1-1-.30(1)(a)3 requires that each crib shall have only an individual, tight-fitting sheet which is changed daily or more often as needed and prior to a change of occupant.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that two of nine crib sheets were loose and not tight-fitting as required. It was further determined based on observation that three of nine cribs had sheets that were too tight fitting. An adverse action was previously issued for this rule violation. This rule violation is no longer appealable. No fine is being issued at this time.

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591-1-1-.32(7) · Rule 591-1-1-.32(7) requires that children be supervised at all times appropriate to the individual age, needs and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. Supervision" means that the appropriate number of Staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children, volunteers and Students-in-Training. The persons supervising in the child care area must be alert, positioned to maximize their ability to hear and see the children at all times, and able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers and Students-in-Training, and provide timely attention to the children's actions and needs. Staff shall be attentive and participating with all children during mealtimes and shall be seated within an arm’s length away from children thirty-six (36) months of age and younger.

It was determined that on September 5, 2023, at approximately 6:30 p.m., a one-year-old child fell off an overturned chair and sustained a fractured right elbow. Staff failed to provide watchful oversight when center staff were observed at one end of the classroom sitting on a foam couch together while the one-year-old child was on the other side of the classroom. The one-year-old child received professional medical attention. 2. A. Rule 591-1-.03(8)

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591-1-1-.03(8) · Rule 591-1-1-.03(8) requires a center to provide individual attention to each child by responding promptly to the child's distress signals and need for comfort.

It was determined based on investigation that on September 5, 2023, a one-year-old child sustained a dislocated right elbow while in care at the center. Staff members failed to respond promptly to the needs of the one-year-old child when the child displayed multiple signs of discomfort as the child clutched and touched their injured arm.

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591-1-1-.03(8) · Rule 591-1-1-.03(8) requires a center to provide individual attention to each child by responding promptly to the hild's distress signals and need for comfort.

It was determined based on an investigation that on July 25, 2023, center staff did not provide individual attention to a two-year-old child who was observed to have their head down on a table for approximately forty-five minutes before the child had a febrile seizure. It was further determined that center staff facilitated transitions, an art activity, sat at the same table as the child, and walked by the child several times before the child had a febrile seizure that caused the child to lose consciousness.

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591-1-1-.20(4) · Rule 591-1-1-.20(4) requires the Center to keep medication in a cabinet or container that is locked or otherwise not accessible to the children and to be stored separate from cleaning chemicals, supplies or poisons. Medications requiring refrigeration shall be placed in a leak-proof container in a refrigerator that is not accessible to the children.

During a LS POI Follow Up conducted on November 29, 2022 ; It was determined based on observation there was an asthma pump located in a child's bookbag in classroom 2R accessible to the children.

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591-1-1-.20(4) · Rule 591-1-1-.20(4) requires the Center to keep medication in a cabinet or container that is locked or otherwise not accessible to the children and to be stored separate from cleaning chemicals, supplies or poisons. Medications requiring refrigeration shall be placed in a leak-proof container in a refrigerator that is not accessible to the children.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation there was an asthma pump located in a pink bag near the cubby area in classroom 2L accessible to the children.

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591-1-1-.25(13) · Rule 591-1-1-.25(13) requires that potentially hazardous equipment, materials and supplies be stored in a locked area inaccessible to children.

During a LS POI Follow Up conducted on November 29, 2022 ; It was determined based on observation that there was a bucket of various hair gel/sprays and hair bows in classroom 2R accessible to the children. It was further determined that there was a cord of christmas lights on the floor in classroom 2R accessible to the children.

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591-1-1-.25(13) · Rule 591-1-1-.25(13) requires that potentially hazardous equipment, materials and supplies be stored in a locked area inaccessible to children.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that the following hazards existed: 2L Classroom: -There was a staff bag near the cubby area accessible to the children. 3L Classroom: -There were two staff bags on a shelf near the back of the classroom accessible to the children. -There was an unlocked closet with a broom and dust pan accessible to the children. -There was a toilet brush in the boys bathroom accessible to the children. 2R Classroom: -There was an unlocked closet with two staff bags on the floor accessible to the children.

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591-1-1-.30(1)(a)3 · Rule 591-1-1-.30(1)(a)3 requires that each crib shall have only an individual, tight-fitting sheet which is changed daily or more often as needed and prior to a change of occupant.

During a LS POI Follow Up conducted on November 29, 2022 ; It was determined based on observation that three of nine crib sheets were loose and not tight-fitting as required.

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591-1-1-.30(1)(a)3 · Rule 591-1-1-.30(1)(a)3 requires that each crib shall have only an individual, tight-fitting sheet which is changed daily or more often as needed and prior to a change of occupant.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that two of nine crib sheets were loose and not tight-fitting as required. It was further determined based on observation that three of nine cribs had sheets that were too tight fitting.

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591-1-1-.36(4)(b) · Rule 591-1-1-.36(4)(b) requires that the interior of a transportation vehicle be clean, in safe repair and free of hazardous items, objects and/or other non-essential items which could cause injury.

During a LS POI Follow Up conducted on November 29, 2022 ; It was determined based on observation that there was a broom located at the front of the vehicle with the tag number PB6307. It was further determined based on observation that three of four transportation vehicles had trash and debris across the floors.

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591-1-1-.36(4)(b) · Rule 591-1-1-.36(4)(b) requires that the interior of a transportation vehicle be clean, in safe repair and free of hazardous items, objects and/or other non-essential items which could cause injury.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that there was a torn seat on the first right row of the vehicle with tag number PB6307 and two broken cup holders on the vehicle with tag number CJY1309. It was further determined based on observation that two of four transportation vehicles with tag numbers, CJY1298 and CJY1309, had trash and debris across the floors.

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591-1-1-.17(8) · Rule 591-1-1-.17(8) requires staff to wash their hands with liquid soap and warm running water upon arrival for the day, when moving from one child care group to another, upon re- entering the child care area after outside play, before and after diapering each child, dispensing medication, applying topical medications, handling and preparing food, eating, drinking, preparing bottles, feeding each child, assisting children with eating and drinking, after toileting or assisting children with toileting, using tobacco products, handling garbage and organic waste, touching animals or pets, handling bodily fluids and after contamination by any means.

During an Incident Investigation & Follow Up conducted on September 19, 2022 ; It was determined based on consultant observation in 2L classroom the teacher did not wash their hands after a diaper change.

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591-1-1-.17(8) · Rule 591-1-1-.17(8) requires staff to wash their hands with liquid soap and warm running water upon arrival for the day, when moving from one child care group to another, upon re- entering the child care area after outside play, before and after diapering each child, dispensing medication, applying topical medications, handling and preparing food, eating, drinking, preparing bottles, feeding each child, assisting children with eating and drinking, after toileting or assisting children with toileting, using tobacco products, handling garbage and organic waste, touching animals or pets, handling bodily fluids and after contamination by any means.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on observation that a staff in classroom 2L did not wash hands before a diaper change and after handling bodily fluids.

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591-1-1-.30(2) · Rule 591-1-1-.30(2) requires the Center to provide a safe sleep environment in accordance with American Academy of Pediatrics (AAP), Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) recommendations as listed in these rules for all infants. Center Staff shall place an infant to sleep on the infant¶s back in a crib unless the Center has been provided a physician¶s written statement authorizing another sleep position for that particular infant that includes how the infant shall be placed to sleep and a time frame that the instructions are to be followed. When an infant can easily turn over from back to front and back again, Staff shall continue to put the infant to sleep initially on the infant¶s back but allow the infant to roll over into his or her preferred position and not re-position the infant. Sleepers, sleep sacks and wearable blankets that fit according to the commercial manufacturer¶s guidelines and will not slide up around the infant¶s face may be used when necessary for the comfort of the sleeping infant. Swaddling shall not be used unless the Center has been provided a physician¶s written statement authorizing its use for a particular infant that includes instructions and a time frame for swaddling the infant. Center Staff shall not place objects or allow objects to be placed in or on the crib with an infant such as but not limited to toys, pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys, or other soft items and shall not attach objects or allow objects to be attached to a crib with a sleeping infant, such as, but not limited to, crib gyms, toys, mirrors and mobiles.

During an Incident Investigation & Follow Up conducted on September 19, 2022 ; It was determined, based on consultant observations, that a two month old child in the infant room was sleeping in a crib with a blanket wrapped around them.

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591-1-1-.30(2) · Rule 591-1-1-.30(2) requires the Center to provide a safe sleep environment in accordance with American Academy of Pediatrics (AAP), Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) recommendations as listed in these rules for all infants. Center Staff shall place an infant to sleep on the infant¶s back in a crib unless the Center has been provided a physician¶s written statement authorizing another sleep position for that particular infant that includes how the infant shall be placed to sleep and a time frame that the instructions are to be followed. When an infant can easily turn over from back to front and back again, Staff shall continue to put the infant to sleep initially on the infant¶s back but allow the infant to roll over into his or her preferred position and not re-position the infant. Sleepers, sleep sacks and wearable blankets that fit according to the commercial manufacturer¶s guidelines and will not slide up around the infant¶s face may be used when necessary for the comfort of the sleeping infant. Swaddling shall not be used unless the Center has been provided a physician¶s written statement authorizing its use for a particular infant that includes instructions and a time frame for swaddling the infant. Center Staff shall not place objects or allow objects to be placed in or on the crib with an infant such as but not limited to toys, pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys, or other soft items and shall not attach objects or allow objects to be attached to a crib with a sleeping infant, such as, but not limited to, crib gyms, toys, mirrors and mobiles.

During a Monitoring Visit conducted on February 9, 2023 ; It was determined based on statements that staff placed infants who were older than four months on their stomachs to sleep in their cribs. Exhibit "A"

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591-1-1-.12(4) · Rule 591-1-1-.12(4) requires equipment and furniture shall be secured if it is of a weight or mass that could cause injury from tipping, falling, or being pulled or pushed over. Potentially unstable equipment and furniture that might injure a child if not secured include, but are not limited to, televisions, chests of drawers, bookcases, shelving, cabinets and fish tanks. Examples of items not required to be secured include, but are not limited to, child-sized tables and chairs, rocking chairs, and cribs.

During an investigation, it was determined that on September 2, 2022, the center failed to secure a child size wardrobe shelf equipment. A two-year-old child climbed on the unsecured wardrobe shelf and pulled it over on themself. The center’s video footage revealed that center staff sat in a rocker chair on the opposite side of the classroom and observed the incident as it occurred. The staff member indicated that they called out to the child to redirect the child before the incident happened. The two-year-old child was observed to climb up on the unsecured wardrobe shelf. As the two-year-old was standing on the unsecured wardrobe shelf, the shelf rocked and then fell on the two-year-old child. The two-year-old child was taken to the front office, first aid was administered, and the parents were notified. It was determined that the center failed to secure a wardrobe shelf to prevent it from falling over on a two-year-old child who sustained an injury to the fingers.

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591-1-1-.32(7) · Rule 591-1-1-.32(7) requires that children be supervised at all times appropriate to the individual age, needs and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. "Supervision" means that the appropriate number of Staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children, volunteers and Students-in-Training. The persons supervising in the child care area must be alert, positioned to maximize their ability to hear and see the children at all times, and able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers and Students-in-Training, and provide timely attention to the children's actions and needs. Staff shall be attentive and participating with all children during mealtimes and shall be seated within an arm’s length away from children thirty-six (36) months of age and younger.

During an investigation, it was determined that on April 28, 2022, there was a lack of watchful oversight when a one-year-old child sustained multiple bite marks and open wounds on the face, arm, stomach and back. One staff member attended to a toddler who woke up from nap feeling ill while the other staff member left the room for an undetermined amount of time to search for a change of clothes. There were approximately fourteen one-year-old and two-year-olds in the class, including a known biter. Staff members failed to anticipate the behavior and supervise the child to prevent them from biting the one-year-old child or insist on assistance from administrators or other staff. Professional medical treatment was obtained.

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