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Home › HI › Honolulu › Hanahauoli School After School Care
License #13129 · Home-based · Group Child Care Home
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Physical exam clearance Please provide a completed DHS 984 Medical Report for the following:<br/> <br/> XXXXX<br/> <br/> Note: Must be dated within 1 year from hire.<br/> <br/> Forms can be found on our website below:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
One caregiver with current pediatric first aid certificate and child CPR during operating hours Please provide all available staff's pediatric first aid and child CPR certificate to the Worker. Please also provide the DHS 957 Staff Sequence form, as well as the DHS 954 Staff and Volunteer Listing, to demonstrate that all hours of child care are covered by at least one (1) staff member with department-approved certification.<br/> <br/> Note: The Worker received the DHS 957 Staff Sequence Form submitted on 3/17/26; however, it lists all staff and all children. <b>Please create new copies with the staff organized by the group of children they are assigned to.</b><br/> <br/> Forms can be found on our website below:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Written health policies for staff for personal health care and control for the spread of communicable diseases Please provide a current staff handbook, which should include:<br/> <br/> 1. Provisions for substitutes when staff are ill;<br/> 2. Personal health care;<br/> 3. Control for the spread of communicable diseases;<br/> 4. Smoking;<br/> 5. Alcohol;<br/> 6. Medication which may impair the staff member's ability to care for children;<br/> 7. Accident prevention; and<br/> 8. Procedures for infection control to prevent transmission of blood-born germs.<br/>
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Data synced from Hawaii Executive Office of Early Learning / PATCH on Jul 14, 2026 · Source records · Report an error
Biennial nutrition review dated: <date> Please provide a nutrition review for the PM snacks served.<br/>
TB clearance Please provide a completed TB clearance for the following:<br/> <br/> XXXXX<br/> <br/> Note: Must be dated within 1 year from hire.<br/>
Background checks according with chapter 17-801 (criminal history, sex offender registry, child abuse/neglect, adult abuse perpetrator, employment history check, and other information) <b>1.</b> The following staff have expired or soon-to-be expiring annual background checks:<br/> <br/> XXXXX<br/> <br/> Please have these individuals complete a <b>DHS 948 Authorization for Background Check and to Release Findings form <u>IMMEDIATELY</u></b> and return the completed copies to the Worker for processing.<br/> <br/> <b>2.</b> You have also listed individuals on the DHS 957 Staff Sequence Form who are not currently associated with the After School Care. <b>Please schedule the following for an initial fingerprint at a Department of Human Services office <u>IMMEDIATELY</u>:</b><br/> <br/> XXXXX.<br/> <br/> <b>3.</b> Additionally, <b>please submit completed employment history for staff members XXXXX</b>, which includes the DHS 959 Employment History and DHS 959A Self-Certification of Employment forms.<br/> <br/> Please note that the DHS 959A submitted for XXXXX on 3/17/26 were not considered complete due to lack of a 2nd mailed attempt date.<br/> <br/> <br/> Employment History Instructions:<br/> <br/> All employees shall complete the form DHS 959A Self Certification of Employment and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 Employment History (EH) form and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on the form DHS 959A: the date EH mailed and the date EH returned.<br/> <br/> Keep copies of all forms mailed out to former employers. If EH forms are not returned after the first try, mail out the again in a few weeks and log the date of the second mailing. If forms are not returned after the second try, we will accept the written self-certification that two mailed attempts were recorded on the DHS 959A.<br/> <br/> Forms can be found on our website below:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Evacuation Please provide the program's written disaster plan to cover emergencies such as fire, flood, tsunami, hurricane/tropical storm, and earthquake. The plan must also include written procedures for:<br/> <br/> 1. Evacuation;<br/> 2. Relocation;<br/> 3. Sheltering-in-place;<br/> 4. Lock-down;<br/> 5. Communication and reunification with families during and after an emergency;<br/> 6. Continuity of operations during and after an emergency;<br/> 7. Providing for the needs of children with disabilities and children with special needs during an emergency; and<br/> 8. Providing for the needs of children with chronic medical conditions during an emergency.<br/>
Inspection of facility, activities, records, staff During the visit, the Workers briefly met with the Director of Auxiliary Programs, XXXXX. However, the Workers were unable to discuss the licensing rules with the Director due to time constraints.<br/> <br/> <b>Worker will need to return to review the licensing rules.</b><br/>
Ages of children accepted §17-896.1-11 Statement of operation policies states that the facility shall have written operation policies, which shall be available to the department, caregiver staff, and parents or guardians to the children for whom care is, or may be, available.<br/> <br/> Please provide a current parent handbook to the Worker.<br/>
Evidence of liability coverage Please provide the program's Certificate of Liability Insurance to the Worker.<br/>
Written notification of changes in staff member who provide direct care to children provided to the department within five working days after the change Please provide a DHS 974A Notification of Changes form with the following information:<br/> <br/> 1. When XXXXX was hired for the After School Care.<br/> 2. When XXXXX was hired for the After School Care.<br/> <br/> Forms can be found on our website below:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Name, address and phone numbers of person to assume responsibility when parents/guardians are not available Please provide the Worker additional or amended enrollment forms demonstrating that the facility is collecting the name, address, and phone numbers of persons to assume responsibility when a child's parent/guardian is unavailable.<br/>
Name, address and phone numbers of person authorized to take child from facility Please provide the Worker additional or amended enrollment forms demonstrating that the facility is collecting the name, address, and phone numbers of persons who are authorized by the child's parent/guardian to take their child away from the facilty.<br/>
Roster/attendance records During the visit, the Worker observed staff having a clipboard with their group of assigned children. The clipboard contains the enrolled children's names and time checked in to the program, as well as notes of children who are signed up for in-school extracurricular activities, in which those children may check in late or check in and out of the After School Care. However, the staff members do not actively notate when the child has checked out. Instead, there is a staff member at the front of the school with a roster of the total enrollment who notates the children that are picked up.<br/> <br/> Please amend the attendance record keeping system to ensure that the assigned staff are actively collecting both the sign-in and sign-out times for the children in their group.<br/>
List of staff members and position Please provide a DHS 954 Staff and Volunteer Listing.<br/> <br/> Forms can be found on our website below:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Log of emergency preparedness drills Please provide a log of emergency preparedness drills conducted during the After School Care.<br/>
Caregivers qualified for the age group with which they work Please provide the following staff members resumes so that we can determine if they are program leader qualified:<br/> <br/> XXXXX<br/>
All caregivers, substitutes, and volunteers shall complete initial health and safety training within 45 days of hire <b>1.</b> The following must complete the basic initial health and safety assessment immediately:<br/> <br/> XXXXX<br/> <br/> <b>As a reminder, all new staff members must complete the basic initial health and safety assessment within 45 days of their hire date. Please have new hires complete the assessment with 100% accuracy and submit to People Attentive to Children (PATCH) immediately to avoid delay in processing time.</b><br/> <br/> <b>2.</b> Additionally, the DHS 957 Staff Sequence form you submitted lists individuals who are not associated with the After School Care.<br/>
Caregivers shall complete at least 16 hours of ongoing training in at least 2 of the department approved topic areas The following staff have deficient annual health and safety training. Please have the following complete all 16 hours of on-going health and safety training and submit their certificates to PATCH immediately:<br/> <br/> XXXXX - Has 0 out of 16 hours. Training period expired 12/27/2025.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 12/27/2025.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 12/27/2025.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 2/18/2026.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 2/13/2026.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 2/13/2026.<br/> XXXXX - Has 0 out of 16 hours. Training period expired 3/23/2026.<br/>
Staff-child ratio shall be met and maintained at all times Hanahau'oli School After School Care is licensed for 90 children, ages over 4 years 8 months to under 13 years of age. During the visit, the Workers observed the following groups of children and which did not meet staff-child ratio:<br/> <br/> Pavilion: 15 children with 1 program leader. XXXXX<br/> Outdoor play area: 35 children with 1 program leader and 3 aides. XXXXX<br/> <br/> Staff-child ratio was not met in the outdoor play group as a minimum of 2 program leaders are required. Although in the DHS 957 Staff Sequence Form XXXXX were listed as program leaders, their resumes were not provided to the Worker to verify that those individuals meet qualifications. <b>To correct this deficiency, please provide their resumes to the Worker.</b><br/>
Written evidence that an arrangement has been made with a health care professional to provide consultation All programs shall have on file written evidence that an arrangement has been made with a health care professional to provide consultation. Please provide a health consultation agreement letter to the Worker.<br/>
Written permission from parent/guardian for child to receive emergency care Every child care facility shall have the following in writing:<br/> <br/> 1. The name, address, and telephone number of a physician or health resource that shall be called in case of emergency; or<br/> 2. The name of the nearest hospital or clinic where such care may be provided; and<br/> 3. Permission of the parent or guardian to call the stated physician or health resource, or the hospital or clinic, if the parent/guardian cannot be reached in the case of a health emergency.<br/> <br/> Please provide the form in which the program is collecting the child's physician/health resource or hospital/clinic information, as well as the authorization form allowing the program to contact that physician/health resource or the hospital/clinic.<br/>
Child care abuse/neglect check The child abuse/neglect clearance for <b>XXXXX</b> is expired.<br/> <br/> In addition, the clearance for <b>XXXXX</b> will be expiring soon.<br/> <br/> <b>Please submit a completed DHS 948 Authorization for Background Check and to Release Findings form for the above mentioned staff members immediately.</b><br/> <br/> <br/> <b>*Note: please use the new DHS 948 Authorization for Background Check and to Release Findings form with the date of 06/2024. See attached</b>*<br/>
Criminal history check The criminal history clearance for XXXXX is expired.<br/> <br/> In addition, the clearance for XXXXX will be expiring soon.<br/> <br/> <b>Please submit a completed DHS 948 Authorization for Background Check and to Release Findings form for the above mentioned staff member immediately.</b><br/> <br/> <br/> <b>*Note: please use the new DHS 948 Authorization for Background Check and to Release Findings form with the date of 06/2024. See attached</b>*<br/>
Please provide the DHS 984 Medical Report and TB clearance for the following new hires:<br/> <br/> XXXXX<br/> <br/> Note: The DHS 984 Medical Report can be found at https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-licensing-forms/.<br/>
Please provide the Worker a copy of the DHS 954 Staff and Volunteer Listing. Please also provide the DHS 957 Staff Sequence form for each group.<br/>
The Worker received a copy of the roster and attendance record for March 13, 2025.<br/> <br/> The attendance record shows the names of all the children who were in attendance but does not show when they checked in or checked out. Please amend your attendance recording system to notate when the children check into the program, especially for those attending after their extracurricular lessons, and when the parents pick up the children. Please provide the Worker a sample of the attendance record which shows when the child is checked into the program and when the child is checked out.<br/>
Please have XXXXX complete a DHS 948 Authorization for Background Check and to Release Findings form and provide a copy to the Worker for processing.<br/>
Child care abuse/neglect check The child abuse/neglect clearances for XXXXX will be expiring soon.<br/> <br/> <b>Please submit a completed DHS 948 Authorization for Background Check and to Release Findings form for the above mentioned staff members immediately.</b><br/> <br/> <br/> <b>*Note: please use the new DHS 948 Authorization for Background Check and to Release Findings form with the date of 06/2024. See attached</b>*<br/>
Criminal history check The criminal history clearances for XXXXX will be expiring soon.<br/> <br/> <b>Please submit a completed DHS 948 Authorization for Background Check and to Release Findings for XXXXX immediately.</b><br/> <br/> <br/> <b>*Note: please use the new DHS 948 form with the date of 06/2024. See attached</b>*<br/>
DHS 984 Medical Report to include physical exam clearance and TB clearance Please provide a DHS 984 Medical Report and/or a TB Clearance Form that shows a physical exam and TB clearance was completed within 1 year from their employment at your facility for the following staff members:<br/> <br/> Pending completion to meet requirement:<br/> <br/> 1. XXXXX - DHS 984 both PE & TB clearances<br/> <br/> <br/> <b>Note: The DHS 984 form and all other DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/</b><br/>
Staff's employment history of previous 3 years prior to start of employoment at Hanahauoli School Please submit the completed DHS 959A Self-Certification of Employment and DHS 959 Employment History Clearance Form(s) for the following staff members:<br/> <br/> - XXXXX- DHS 959A (a second mailing attempt date to past employers; including Pali View preschool, Kailua Methodist preschool, McKeague & Haley Inc and Little Learners preschool is required on the DHS 959A.<br/> <br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on the form DHS 959A: Date EHC mailed and Date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again and log the 2nd date mailed. If forms are not returned after the second try, we will accept the self-certification of two mailed attempts.<br/> <br/> <b>Note: The DHS 959 Employment History Form and DHS 959A Self-Certification of Employment and all other DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/</b><br/>
Employment history check Please submit the completed DHS 959A Self-Certification of Employment form and DHS 959Employment History Clearance Form(s) for the following staff members:<br/> <br/> 1.$tXXXXX<br/> 2.$tXXXXX<br/> 3.$tXXXXX<br/> 4.$tXXXXX<br/> 5.$tXXXXX<br/> 6.$tXXXXX<br/> 7.$tXXXXX<br/> 8.$tXXXXX<br/> 9.$tXXXXX$t<br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on the form DHS 959A: Date EHC mailed and Date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again and log the 2nd date mailed. If forms are not returned after the second try, we will accept the self-certification of two mailed attempts.<br/> <br/> Note: DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Physical exam clearance and TB clearance within 1 year from employment at facility Please provide DHS 984 Medical Report and or TB Clearance Form to include the physical exam (PE) clearance date and TB clearance date within 1 year from employment at facility.<br/> <br/> 1. XXXXX - Both<br/> 2. XXXXX - Both<br/> 3. XXXXX - Both<br/> 4. XXXXX - Both<br/> 5. XXXXX- TB only<br/> 6. XXXXX - Both<br/> 7. XXXXX - Both<br/> 8. XXXXX- PE only<br/> 9. XXXXX - TB only<br/> 10. XXXXX - Both<br/> 11. XXXXX - Both<br/> <br/> NOTE: DHS will NOT accept medical documents in place of the DHS 984 form or Department of Health (DOH) Tuberculosis (TB) clearance form to prevent violations of Health Insurance Portability and Accountability Act (HIPAA)<br/>
Employment history of previous 3 years of employment and or unemployment Please submit the completed DHS 959A Self-Certification of Employment form and all completed DHS 959<br/> Employment History Clearance Form(s) for the following staff members;<br/> <br/> 1.$tXXXXX<br/> 2.$tXXXXX<br/> 3.$tXXXXX<br/> 4.$tXXXXX<br/> 5.$tXXXXX<br/> 6.$tXXXXX<br/> 7.$tXXXXX<br/> 8.$tXXXXX<br/> 9.$tXXXXX<br/> 10.$tXXXXX<br/> <br/> Employment history for the three (3) years prior to their employment date with your program is required for each employee. Please document each mail out to each employer. If you don't receive a response from the previous employers after the first mail out, do a second attempt two weeks later. If you don't receive any response from the employee's previous employers, we will accept two documented mail attempts as meeting this requirement.<br/> <br/> Please submit a DHS 974A Notification of Change form for any staff members whose no longer employed with Hanahauoli School.<br/> <br/> Note: DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Initial/Annual Background Checks including child care/neglect checks and criminal history check The initial fingerprinting appointments for staff members, XXXXX have been scheduled.<br/> <br/> This deficiency will be corrected upon satisfactory results of all background checks including child care/neglect checks and criminal history checks for each staff member.<br/> <br/> Please find the DHS 948 Authorization for Background Checks to Release Findings form on our website here:<br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/> <br/> Please have them take a completed DHS 948, a state issued ID and a money order for $13.25 payable to State of Hawaii to their fingerprint appointment.<br/> <br/> Fingerprint appointments were scheduled on February 22, 2024 and awaiting completion of all background checks.<br/>
Health Consultant Agreement Letter Please provide an updated statement from a private physician or non-profit organization showing that they have agreed to serve as the after school program's health consultant to review and approve the after school care program's health policies.<br/>
Please provide the DHS 959A Self-Certification of Employment and DHS 959 Employment History Clearance form for the following staff hired since the previous licensing visit:<br/> <br/> XXXXX<br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on the form DHS 959A: Date EHC mailed and Date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again and log the 2nd date mailed. If forms are not returned after the second try, we will accept the self-certification.<br/> <br/> Please visit the following for the required forms:<br/> http://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Please provide the Worker a copy of all available staff CPR and first aid certificates. As a reminder, there must be at least 1 caregiver with current department-approved pediatric first aid and CPR certification during all hours of licensed child care. Please also provide the Worker a DHS 957 Staff Sequence form to verify that all hours of child care are covered.<br/>
Please have XXXXX complete 16 hours of department approved on-going health and safety training. Please submit the cover sheet and training certificate to PATCH for credit.<br/> <br/> The on-going training certificates can be submitted online to PATCH at https://www.patchhawaii.org/providers/child-care-centers/early-childhood-registry/.<br/>
Please provide the Worker a copy of the most current Food Establishment Permit. We understand that the Department of Health have had delays in issuing the permits, as such, you may also provide a copy of the green placard which was issued in conjunction with the inspection report completed on October 15, 2024.<br/>
Please provide the Worker a copy of the current and unexpired Certificate of Liability Insurance.<br/>