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The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home.
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Home › IA › West Burlington › Mary Conn
License #19876 · Home-based · House
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The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home.
The written report shall include past health history, status of present health, allergies and restrictive conditions, and recommendations for continued care when necessary.
For a child who is five years of age or older and enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the physical examination report.
The examination report or statement of health status shall be on file before the child’s first day of care e. For children under the age of 6,a statement of health condition signed by a physician 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director or designee submitted annually from the date of the admission physical. For a child who is enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the physician statement. f. For each school-age child, on the first day of attendance, documentation of a physical examination that was completed at the time of school enrollment or since. g. A signed and dated immunization certificate provided by the state department of public health. For the school-age child, a copy of the most recent immunization record shall be acceptable. h. For any child with allergies, a written emergency plan in the case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. i. Documentation that is signed by the parent and names persons authorized to pick up the child. The authorization shall include the name, telephone number, and relationship of the authorized person to the child. j. Written permission from the parent for the child to attend activities away from the child development home.k. Injury report forms documenting injuries requiring first aid or medical care l. If the child meets the definition of homelessness as defined by section 725(2) of the McKinney-Vento Homeless Education Assistance Act, the family shall receive a 60-day grace period to obtain medical documentation. Findings:
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110.9(1) Provider File: -The provider does not have up to date provider physicals for herself, her husband or her co-provider.
110.9(4) Children's files: -The provider is missing current physicals/statements of health for some children. Suggestions/Recommendations: A re-check is not needed at this time, corrections need to be made by 7/25/25 and will be reviewed at the next annual compliance check. I encourage you to work with Tabitha Copeland from Child Care Resource and Referral with any ongoing compliance or training needs. Tabitha can be reached at: 563-362-8228 Corrective Action Required:
The provider needs up to date provider physicals for all household members and co-providers.
The provider needs current physicals/statements of health for all children's files. Non-compliance with any of the mandated requirements listed above may lead to the cancellation or revocation of your Child Development Home Registration. Please take whatever steps are necessary to completely address each of the violations noted above. It is essential you correct all above-mentioned violations. 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director Please do not hesitate to contact me at DHS at 319-800-4702 or [email protected] if you have any questions regarding this letter. Sincerely, Holly Bailey Social Worker II Sheila Aunspach Social Work Supervisor Always Remember: Child Care Resource and Referral is an excellent resource for providers to access training options and support in your area. You can reach Child Care Resource and Referral at 563-362-8228 As you plan your future trainings to meet your 24 hours of training requirement, please remember that you can access the approved training by going to http://www.dhs.state.ia.us/Consumers/Child_Care/Professional_Development.html You may also access training at: https://ccmis.dhs.state.ia.us/trainingregistry/ All providers need to maintain compliance with rules set out in Iowa Administrative Code, Chapter 110, which includes: 441 IAC 110.5(1): Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA). 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114
110.8(6) Discipline -Mary was observed by a community member slapping the had of a child due to the child pinching another child. Suggestions/Recommendations: A re-check is not needed at this time. Provider is expected to meet with CCR&R and CCNC regarding appropriate discipline. I encourage you to work with Tabitha Copeland from Child Care Resource and Referral with any ongoing compliance or training needs. Tabitha can be reached at: 563-362-8228 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director Corrective Action Required:
Mary signed a safety plan agreeing to abide by the discipline expectations for a registered daycare home, 110.8(6). SW Bailey made referrals to CCR&R and CCNC to assist Mary with appropriate discipline options. Mary is expected to meet and cooperate with these providers. Non-compliance with any of the mandated requirements listed above may lead to the cancellation or revocation of your Child Development Home Registration. Please take whatever steps are necessary to completely address each of the violations noted above. It is essential you correct all above-mentioned violations. Please do not hesitate to contact me at DHS at 319-800-4702 or [email protected] if you have any questions regarding this letter. Sincerely, Holly Bailey Social Worker II Sheila Aunspach Social Work Supervisor Always Remember: Child Care Resource and Referral is an excellent resource for providers to access training options and support in your area. You can reach Child Care Resource and Referral at 877-216-8481 As you plan your future trainings to meet your 24 hours of training requirement, please remember that you can access the approved training by going to http://www.dhs.state.ia.us/Consumers/Child_Care/Professional_Development.html You may also access training at: https://ccmis.dhs.state.ia.us/trainingregistry/ All providers need to maintain compliance with rules set out in Iowa Administrative Code, Chapter 110, which includes: 441 IAC 110.5(1): Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA). 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114
The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home.
The written report shall include past health history, status of present health, allergies and restrictive conditions, and recommendations for continued care when necessary.
For a child who is five years of age or older and enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director physical examination report.
The examination report or statement of health status shall be on file before the child’s first day of care e. For children under the age of 6,a statement of health condition signed by a physician or designee submitted annually from the date of the admission physical. For a child who is enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the physician statement. f. For each school-age child, on the first day of attendance, documentation of a physical examination that was completed at the time of school enrollment or since. g. A signed and dated immunization certificate provided by the state department of public health. For the school-age child, a copy of the most recent immunization record shall be acceptable. h. For any child with allergies, a written emergency plan in the case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. i. Documentation that is signed by the parent and names persons authorized to pick up the child. The authorization shall include the name, telephone number, and relationship of the authorized person to the child. j. Written permission from the parent for the child to attend activities away from the child development home.k. Injury report forms documenting injuries requiring first aid or medical care l. If the child meets the definition of homelessness as defined by section 725(2) of the McKinney-Vento Homeless Education Assistance Act, the family shall receive a 60-day grace period to obtain medical documentation. Findings:
Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice).
Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that it is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds.
Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank.
All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste.
No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times 441 IAC 110.8(2) Use of Outdoor Space 441 IAC 110.8(2) “c” If children are allowed to use an aboveground or in-ground swimming pool:
110.1(1)a Provider needs to keep a list of the children's names with their emergency contact information in the vehicle during any transportation activity.
110.9(4) Children's Files: -Provider needs to have updated physicals/statements of health for all children. Suggestions/Recommendations: Corrective Action Required: Non-compliance with any of the mandated requirements listed above may lead to the cancellation or revocation of your Child Development Home Registration. Please take whatever steps are necessary to completely address each of the violations noted above. It is essential you correct all above-mentioned violations. Please do not hesitate to contact me at DHS at 319-800-4702 or [email protected] if you have any questions regarding this letter. Sincerely, 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director Holly Bailey Social Worker II Sheila Aunspach Social Work Supervisor Always Remember: Child Care Resource and Referral is an excellent resource for providers to access training options and support in your area. You can reach Child Care Resource and Referral at 877-216-8481 As you plan your future trainings to meet your 24 hours of training requirement, please remember that you can access the approved training by going to http://www.dhs.state.ia.us/Consumers/Child_Care/Professional_Development.html You may also access training at: https://ccmis.dhs.state.ia.us/trainingregistry/ All providers need to maintain compliance with rules set out in Iowa Administrative Code, Chapter 110, which includes: 441 IAC 110.5(1): Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA). 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114
Written permission from parents shall be available for review.
Equipment needed to rescue a child or adult shall be readily accessible. 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director
The child care provider shall accompany the children and provide constant supervision while the children use the pool.
The child care provider shall complete training in cardiopulmonary resuscitation for infants, toddlers, and children, according to the criteria of the American Red Cross or the American Heart Association. 441 IAC 110.9 Files 441 IAC 110.9(1) A provider file is maintained and shall contain the following: 441 IAC 110.9(1)“a” A physician’s examination report for the provider and all members of the provider’s household aged 18 years or older. Acceptable physical examinations shall be documented on Form 470- 5152, Child Care Provider Physical Examination Report. All children residing in the household must have medical documentation outlined in 110.9(4) “d”, 110.9(4) “f”, and 110.9(4) “g” 441 IAC 110.9(1)“b”(2) Documentation from the department confirming the record checks required under 441 IAC 110.11(3) have been completed and authorizing or conditionally limiting the person’s involvement with child care. 441 IAC 110.9(2) An individual file is maintained for each staff assistant and contains:
Documentation from the department confirming the record checks required under subrule 110.11(3) have been completed and authorizing or conditionally limiting the person’s involvement with child care
A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated at least every three years.
Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code section 232.69 within 3 months of employment. 441 IAC 110.9(3) An individual file is maintained for each substitute and contains:
Documentation from the department confirming the record checks required under 441 IAC 110.9(1) “a” have been completed and authorizing or conditionally limiting the person’s involvement with child care.
A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated at least every three years.
Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code section 232.69 within 3 months of employment.
Certification in infant and child first aid
Certification or other documentation that minimum health and safety training has been completed within 3 months or prior to providing substitute care, whichever occurs first. 441 IAC 110.9(4) Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: a. Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. b. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name, telephone number, and relationship to the child of another adult 470-5431 (Rev. 8/17) 1305 E. Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Adam Gregg Kelly K. Garcia Governor Lt. Governor Director available in case of emergency. c. A signed medical consent from the parent authorizing emergency treatment. d. An admission physical examination report signed by a licensed physician or designee in a clinic supervised by a licensed physician
The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home.
The written report shall include past health history, status of present health, allergies and restrictive conditions, and recommendations for continued care when necessary.
For a child who is five years of age or older and enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the physical examination report.