Loading
Pulling inspections, violations, and complaints.
Home › KY › Lexington › Campus Kids Early Learning Center
License #L359235 · Center · Licensed
When they operate
Ages served
Complaint outcomes are not published by Kentucky CHFS.
Tap a row to expand inspection details, findings, and the state record.
This change of service inspection recorded no violations or advisories.
General: Based on interview and review of documentation, the childcare center has never conducted shelter-in-place drills. The staff in charge stated she was not aware of this additional required drill requirement.
General: Based on observation, in the Toddler Two (2) Classroom, there was a tube of Aquaphor diaper cream located in the cabinet of the diaper changing station. The door to the cabinet (and the diaper cream) was accessible to the children. The diaper cream label stated, "Keep out of the reach of children." Outdoor Play Area In Compliance
Leave your email if you want a note when this facility's license or enforcement status changes.
Generated from this facility's specific inspection record
Data synced from Kentucky Cabinet for Health and Family Services, Division of Child Care on Jul 11, 2026 · Source records · Report an error
General: Based on review of documentation, the childcare center's written orientation policy did not contain a statement for the staff to implement what they learned in the training.
General: Based on interview and review of documentation, the childcare center did not maintain accurate employment status of their employees in the KARES National Background Check Portal (NBCP). The surveyor reviewed the names of current employees listed in the NBCP portal with the staff in charge and was informed that seven (7) listed current employees were no longer employed at the childcare center. In addition, one (1) current employee (present at inspection) had her background check run by the childcare center, but she was not listed as a current employee for the center in NBCP. Supervision In Compliance
General: Based on observation, the following was found: 1) In the Toddler Two (2) Classroom, there were three (3) ceiling tiles with brown stains on them in the middle of the classroom. 2) In the Overflow Classroom, there was a ceiling tile above the partial wall with brown stains on it. 3) In the School Age Classroom, there were two (2) ceiling tiles with brown stains on them located above the sink area and in the corner of the room. 4) In the Toddler Two (2) Classroom, there were two (2) walls with chipped paint. The first one was located under the glass window. The second one was located next to the pantry door wall. Both walls were part of the children's play area.
General: Based on interview and review of documentation, the childcare center did not have a written procedure for maintaining supervision, ratios, and group size throughout the day. The staff in charge stated she was not aware that they needed a written policy. General Administration In Compliance
General: Based on interview and review of documentation, the following was found: 1) One (1) staff member (DOH: 05/20/24) did not have documentation of completing six (6) hours of cabinet-approved orientation. According to the staff in charge, she took orientation in a Spanish format, but she did not have documentation verifying this. 2) Staff member (DOH: 03/19/18) completed fourteen (14) of the fifteen (15) required hours of annual training for the completed training year. A review of ECE-TRIS confirmed these findings.
General: Based on observation, the following was found: 1) In the Toddler Two (2) Classroom, the ceiling vents near the pantry door and above the glass window had an accumulation of dust on them. The waffle style air vent on the ceiling had an accumulation of dust on it. 2) In the Preschool Classroom, the waffle style ceiling vent had an accumulation of dust on it.
General: Based on interview and review of documentation, the childcare center did not have a written reunification plan to communicate with families in the event of an emergency. The staff in charge indicated that she was not aware of the new regulation. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 32 of 33 Inspection Report Posted Documentation Not In Compliance
General: Based on observation, the childcare center's renewal inspection conducted on 03/25/25 with the corresponding plan of correction was not posted for public inspection.
General: Based on observation and review of documentation, the drills conducted by the center were located in the director's office and not in a prominent place for public access.
This change of space/change in capacity inspection recorded no violations or advisories.
General: Based on observation, the outdoor play area used by the older children contained an area of chipped paint on the side of the building near the door to the facility.
General: Based on review of documentation, the facility did not have a written policy that states the staff will implement the procedures taught in orientation training. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 30 of 31 Inspection Report
General: Based on observation, the Infant Room contained three (3) cribs with loose sheets on the mattresses.
General: Based on review of documentation, a staff member (DOH: 05/20/24) did not have written evidence of CPR and First Aid training. A review of ECE-TRIS verified this information.
General: Based on observation, the refrigerator in the kitchen, that was used to store milk, contained a thermometer that read forty-five (45) degrees Fahrenheit.
General: Based on observation and interview on 03/24/25, a staff member was observed having direct contact with children in the four- to- five-year-old classroom at approximately 11:23 am. There was a second staff member and six (6) children present in the classroom. The staff member stated that she had been in the classroom for a couple of hours. She stated that on 03/21/25 (late afternoon) a DCBS representative spoke to her about the allegation. At that time, she was under the impression that she could remain working in the classroom. The staff member told the surveyor that today (03/24/25) was her last day of employment because she was moving to Atlanta. It should be noted, the staff member left the child-care center when the interview was completed. Programming In Compliance
General: Based on interview and review of documentation, it was found that a staff member (DOH:05/20/24) did not have current TB verification from a health care professional indicating the individual is free from the signs and symptoms of TB on file at the facility. The staff in charge spoke with the staff member and found a TB test had been completed but the staff member did not collect the form from the health care facility verifying the individual is free from the signs and symptoms of TB and bring it back to the facility. Premises Not In Compliance
General: Based on observation and interview, at the time of the inspection a group of eleven (11) children ages three to four years old were observed playing in a large inflatable wading pool filled with water in the outdoor play area. The wading pool did not have a filtration system. Three additional smaller inflatable wading pools were observed on an adjacent playground used by the younger children. Although the pools were not filled with water and were not in use at the time of the inspection an interview with the staff member in charge confirmed that the wading pools are filled with water and the younger children are then allowed to play inside the wading pools for water play. These three (3) wading pools did not have a water filtration system. Due to there not being a water filtration system connected to these wading pools the water cannot be filtered making it unsanitary for the children to play inside the wading pools. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2
General: Based on interview and review of documentation, it was found during the investigation that on 04/05/24 around 11:55 am, a staff member walked out of her classroom and facility without telling anyone. She left an individual, that was not a staff member of the facility, with five (5) children ages two to three (2-3) years old for approximately thirty (30) minutes until another staff member came into the room. Staffing Requirements In Compliance General Administration Not In Compliance
General: Based on interview and review of documentation, it was found during the investigation that on 04/05/24 a staff member was using their cell phone while supervising children. The facility has a policy of no cell phone usage during class time.
General: Based on interview and review of documentation, it was found during the investigation that on 04/05/24 between 11:30 am and 11:55 am, a staff member was picking up children in a rough matter, jerking them by one hand and carrying them across the room by one arm. This staff member was observed pushing children onto their cots and patting their backs in a harsh manner. This staff member was observed pushing a child and was yelling at the children. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Director Requirements Not In Compliance
General: Based on observation, in the Preschool A Classroom, at approximately 9:36 am, a staff member diapered a male child but did not wash her hands afterward.
General: Based on observation, in the Preschool A Classroom, at approximately 9:36 am, a staff member diapered a male child but did not sanitize the diapering pad afterward. First Aid/Medication In Compliance Outdoor Play Area Not In Compliance
General: Based on observation, in Preschool A, the surveyor found numerous dents in the wall.
General: Based on observation, in the Preschool B restroom, the surveyor found feces in the toilet that had not been flushed. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report Hygienic Practices Not In Compliance
General: Based on observation, the surveyor found insufficient rubber mulch around the swing set, which resulted in the geotextile cloth being exposed, causing a potential tripping hazard. Equipment Not In Compliance
This investigation inspection recorded no violations or advisories.
This investigation inspection recorded no violations or advisories.
This change of hours inspection recorded no violations or advisories.
General: Based on interview and review of documentation, there was no written evidence that the facility's emergency preparedness plan had been updated or submitted to the proper authority for review since 3/30/2021. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 4 of 5 Inspection Report Posted Documentation Not In Compliance
General: Based on observation, in the PFE-B room, scissors were stored on top of the shelf next to changing pad making it accessible to the children in care.
General: Based on observation, the following was found: 1.) In the Toddler room there was a container with cleaning wipes on the sink where children wash hands, making it accessible to children in care. 2.) In the PFE-B room the staff's personal bag was on top of low shelf and was accessible to the children in care. 3.) In the PFE-A room the wooden cabinet was not locked, and a staff's personal bag was in it making it accessible to the children in care.
General: Based on observation, an infant was sleeping in a crib with a bottle. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 5 Inspection Report Premises Not In Compliance
This follow-up inspection recorded no violations or advisories.
General: Based on review of documentation and the Training Records Information System (TRIS), the following was found: 1. One staff person hired on 3/19/18, did not complete the required 15 hours of cabinet-approved training hours between 7/1/2020 and 6/30/21. 2. One staff person hired on 8/27/12, completed PAHT training on 3/21/17; however, did not renew the training due 3/21/22. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Programming In Compliance Premises Not In Compliance
General: Based on review of documentation and observation, this regulatory requirement was not met. Upon review of the building diagram, it was found that one room was over capacity. It is important to note that this room had shelves used as a divider down the middle. One side of the room was being used as the preschool classroom and the other side was being used as the school age classroom. Based on measurements obtained during the initial inspection, this room is only large enough to house 21 children; however, 26 children were being cared for in the room at the time of the visit. This does not provide a minimum of 35 square feet of space per child. Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment In Compliance Transportation Not Applicable Kitchen Requirements In Compliance Food Service In Compliance Meal Planning/Center Provides Meals In Compliance Meal Planning/Center Does Not Provide Meals In Compliance Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals In Compliance
This change of space/change in capacity inspection recorded no violations or advisories.
General: Based on review of documentation, there were no current staff evaluations on file at the time of the inspection. Employee Records In Compliance Programming In Compliance Premises Not In Compliance
General: Based on review of documentation, two staff members did not have a current professional development plan on file. Posted Documentation In Compliance Animals Not Applicable Emergency Regulation In Compliance
General: Based on review of documentation, there was no written information on file stating that an emergency preparedness plan was completed for 2020.
General: Based on observation, there was chipping paint found on several classroom walls throughout Building 1. Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Equipment Not In Compliance
General: Based on observation, there were numerous crayon marks found on the back of a wooden play kitchen in the four- to five-year-old preschool classroom. Transportation Not Applicable Food Service/Food Program In Compliance Food Service Not In Compliance
This investigation inspection recorded no violations or advisories.
This change of space/change in capacity inspection recorded no violations or advisories.
General: Based on observation, a sheet in one of the cribs in the older infant classroom was extremly loose fitting and was bunched up in the middle of the crib mattress. Premises Not In Compliance
General: Based on observation, the diaper changing pad in the older infant classroom was torn, rendering it unable to be properly sanitized. First Aid/Medication In Compliance Outdoor Play Area Not In Compliance
General: Based on review of documentation, staff hired on 02/21/2020 and 02/24/2020 did not have tb skin test documentation on file. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 4 Inspection Report
General: Based on observation, the following was found: 1) The blue rug in the older infant classroom was torn and frayed along the edges. 2) The blue rug in the three-year-old classroom was torn and frayed along the edges. Transportation Not Applicable Food Service/Food Program In Compliance Food Service Not In Compliance
Based on observation, this regulatory requirement was not met. During a tour of one of the toddler classrooms the surveyor observed a rotating box fan positioned on top of a piece of equipment. The fan was plugged into an electrical outlet approximately three feet away and was turn on. The cord was hanging loose/not secure. The cord and the fan were accessible to the children in the room. Premises In Compliance
This change of space/change in capacity inspection recorded no violations or advisories.
This follow-up inspection recorded no violations or advisories.
General: Based on observation, this regulatory requirement was not met. The surveyor arrived at the facility at 1:15PM and conducted a tour of the facility with the staff person in charge. The surveyor and the staff person in charge entered the first classroom (one (1) - two (2) year olds) and observed one (1) staff person caring for eight (8) children alone. The children were observed lying on cots. The second staff person assigned to the room entered the classroom immediately behind the surveyor and staff person in charge. She was observed coming out of the bathroom near the front entrance of the facility as the surveyor and staff person in charge began the tour. The youngest child in the group was identified as a one (1) year old, making the minimum staff to child ratio one (1) staff person for six (6) children. The facility exceeded the staff/child ratio by two (2) children. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report General Administration Not In Compliance
General: Based on observation, the toddler classroom and the older infant classroom share a large room that is divided by shelving units. The area is used as two (2) separate classrooms. Parents and staff must walk through the toddler classroom in order to enter the older infant classroom; therefore, the toddlers do not have a protected space. A review of Division of Regulated Child Care files found that this regulatory violation was previously issued as a result of the renewal inspection conducted on 3/20/19.
Based on interview and record review, this regulatory requirement was not met. The facility was not able to locate zoning documentation during the visit; therefore, the surveyor was not able to determine if the facility would be in compliance with the increase in capacity. Premises Not In Compliance
General: Based on review of documentation, the following was found: 1. Staff persons hired 7/11/18, 10/2/17 and 3/19/18 did not have evidence of completing the required orientation training in the first three (3) months of employment. 2. Staff person hired 10/2/17 did not have evidence of completing the Pediatric Abusive Head Trauma training within the first year of employment. 3. Staff person hired on 10/2/17 did not have documentation of any hours of annual training during the last full year of employment. 4. Staff person hired on 3/19/18 had documentation of only thirteen (13) hours of annual training during the last full year of employment. 5. Staff person hired on 8/1/12 had documentation of only four (4) hours of annual training during the last full year of employment. A review of ECE-TRIS records supports the information found during the survey. Programming In Compliance Premises Not In Compliance
General: Based on observation, the Toddler classroom and the Older Infant classroom share a large room that is divided by shelving units. The area is used as two (2) separate classroom. Parents and staff must walk through the Toddler classroom in order to enter the Older Infant classroom. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 4 Inspection Report Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment Not In Compliance
General: Based on review of documentation, staff persons hired 8/1/12, 1/16/17 and 3/14/19 did not have documentation of negative T.B. results on file in the facility that had been obtained within the past two (2) years.
General: Based on observation and interview, the child-care center failed to maintain staff-to-child ratios as required by the regulations. At approximately 11:42 a.m., the surveyor entered the toddler classroom and observed one (1) staff and nine (9) toddlers. The staff person introduced herself and told the surveyor the youngest child present was fifteen (15) months old. A second staff person entered the classroom and stated she was only out of the classroom for thirty (30) seconds. She stated that she only left the classroom to retrieve a cot. It is important to note the surveyor observed this staff person in the hallway prior to entering the toddler classroom. This regulatory violation was cited during an investigation on 11/7/18 for not meeting staff-to-child ratios in the toddler classroom. Director Requirements Not In Compliance
General: Based on interview and review of documentation, the child-care center failed to provide for the health, safety, and comfort of a child enrolled. The child-care center director reported to the DRCC office on 12/12/18 that a staff person scratched a child on his arm when she tried to remove him from the classroom due to his behavior issues. The surveyor conducted an investigation at the child-care center on 1/4/19. The surveyor reviewed camera footage of the incident and the director presented written statements describing what occurred leading up to the incident. After reviewing the documentation, the surveyor found after several attempts by staff that day to redirect and speak to the child about his behavior; the staff person finally resorted to physically picking up the four-year-old child and removing him from the classroom. The surveyor noted from watching the video the staff person reaching slightly over a shelving unit and picking up the child underneath his arms. She then carries him across the classroom to the doorway. The surveyor could not determine how forceful or how quick the interaction was between the child and staff person from reviewing the video footage. The director stated that the child told her that this staff person scratched him. During an interview with the staff person, she indicated she was unaware that she had scratched the child when she picked him up to remove him from the classroom. She stated that her intention was to remove him from the classroom so that he would not hurt any of the children. In short, the child was injured during the incident. He received a small red scratch to the inside of his arm. It is important to note the staff person was reprimanded for causing the injury to the child’s arm.
General: Based on Observation, as the surveyor started a walk through of the facility at 9:06 a.m. she followed a staff person to the toddler room. There were seven (7) children ages one to two (1-2) years old with one (1) staff person upon entry into the classroom. An interview with the staff person who entered the room with the surveyor found she was running late and comes in at 9:00 a.m. It could not be determined as to how long the classroom was out of ratio. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Director Requirements Not In Compliance
General: Based on Observation, while touring the infant room an infant was observed sleeping in a bouncy seat. The infant had on a jacket with the hood pulled up on their head. Interviews found that the infant is two-months-old. A review of the sign-in sheets found that the child arrived at the facility at 8:00 a.m. An interview with the staff person in the room confirmed that the child was placed in the bouncy seat upon arrival at 8:00 a.m. Let it be noted that the surveyor arrived at the facility at 9:06 a.m. Therefore the child had been sleeping in the bouncy seat for approximately one (1) hour.
This investigation inspection recorded no violations or advisories.
This investigation inspection recorded no violations or advisories.
General: Based on Review of Documentation and interview, this regulatory requirement was not met. An interview with staff during the investigation revealed that the infant classroom and the toddler classroom combine daily and take a walk to the park. Staff stated that they start the walk at approximately 10:00AM - 10:15AM each day and return to the facility at approximately 11:00AM. The staff person in charge presented a general permission slip dated 2016/2017 that is signed by the parents; however, the permission slip does not contain specific information such as the times children will be taking walks and the permission slips are not current. The staff person in charge stated, "I did not realize that the forms were old".
General: Based on Review of Documentation, this regulatory requirement was not met. One (1) child (enrollment date: 4/3/17) had an immunization certificate on file that was no longer current as of 3/5/18.
General: Based on Review of Documentation and interview, this regulatory requirement was not met. An interview with staff during the investigation revealed that the infant classroom and the toddler classroom combine daily and take a walk to the park. Staff stated that they start the walk at approximately 10:00AM - 10:15AM each day and return to the facility at approximately 11:00AM. A review of attendance records during the investigation and an interview with staff found that five (5) infants and seven (7) toddlers were present in the group during the walk to the park on 6/11/18. Twelve (12) children total were present in the group and three (3) staff were present. The youngest child in the group was an infant; therefore, the group exceeded the maximum group size by two (2) children. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Director Requirements Not In Compliance
This follow-up inspection recorded no violations or advisories.
This follow-up inspection recorded no violations or advisories.
This follow-up inspection recorded no violations or advisories.
General: Based on Interview, it was found that a former staff person took her daughter's hand and smacked another child across the face after the child bit her daughter on the face. Interview with the staff in charge found that the former staff was terminated on the same date. Interview with a staff person that witnessed the incident stated that the child that was slapped across the face did not receive any injuries.
General: Based on Interview, it was determined that former staff members would often forget to get a child off the public school bus in the afternoons. The child would be returned to his elementary school and the child's mother would be called to pick him up.
This investigation inspection recorded no violations or advisories.
General: Based on Observation and interview, this regulatory requirement was not met. The following was found: 1. At approximately 10:45 AM surveyors observed several children in the infant room crying and upset. At 10:50 AM three (3) of the children were still observed crying loudly. One child was crawling on the floor on the tile area. Another child was sitting near the teacher in the carpeted area and a third child was sitting in a bouncy seat. Each of these children were observed crying loudly and each had mucus observed on their faces. Although one teacher was sitting on the floor with the children, there was no apparent programming that was developmentally appropriate for the children in that room. This continued on for several minutes. 2. In the toddler room the children were observed wandering around the room with several children crying. The teacher was observed holding one child who was upset. There was no evidence of planned programming. There was music playing very loudly and three of the children were observed lying on the floor in tears. The teacher was observed walking around talking to the child she was holding but there was no direction or engagement with the other children in the room. 3. Staff described activity in the Pre-K Classroom the morning of the investigation by stating, "One staff person walked out and quit a few minutes after 9:00AM". The staff person stated that she did not know why the staff person walked out, but stated, "She had already given notice that 3/23/18 would be her last day, but I guess she quit early because of stress". The staff person stated that several parents were upset the morning of the investigation (3/20/18) because they had received messages from terminated staff that children were not safe at the facility. The staff person stated, "There were a couple of parents using profanity in the hallway. They were yelling and cursing at the administrative staff. The kids were running around in the Pre-K room; they were wild". The staff person further stated, "It has been a free-for-all for awhile now. There's only been one (1) or two (2) times that we've actually sat down and done something with the children". Premises Not In Compliance
General: Based on interviews and review of documentation, the surveyor found a staff person who stated she transports two (2) children from Tates Creek Elementary school three to four (3-4) times a week is not currently certified in CPR and First Aid. She stated she picks up the children at approxiamtely 10:45 a.m. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report
General: Based on interviews, the facility failed to be licensed and approved by the cabinet prior to transporting children. Based on staff interviews, it was confirmed day care staff have been driving their own personal vehicles to pick up a four (4) year old female and a three (3) year old male from Tates Creek Elementary School at approximately 10:45 a.m. each day. The public school is located approximately a half-mile from the day care facility. Staff stated they have been picking up the children and transporting them back to the day care facility since the Early Start program began in August 2017. Staff stated they never “clock out” before leaving the day care facility to pick up the children. The staff person in charge stated she became aware that staff were transporting the children on March 14th and told the staff they could not transport the children because the facility was not licensed. However; on the day of the investigation, a staff person stated she picked up a three (3) year old male from Tates Creek Elementary.
A PLAN OF CORRECTION WAS DUE ON 04/06/2018 AND AS OF 04/24/2018, THE PLAN OF CORRECTION HAS NOT BEEN RECEIVED. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report
General: Based on Observation, upon entering the two-year-old room on 3/15/18 a two (2) year-old child was being diapered on her nap mat. The nap mat was covered with the child's bedding. The diapering surface was not nonabsorbent.
General: Based on Review of Documentation, on 3/15/18 a facility staff member came to the door of the child care center to let the surveyors enter and she had a two (2) year-old child with her. The staff member that opened the door for the surveyors while supervising the two (2) year-old child alone did not have a file. This staff member was working in the two to three (2-3) year-old room with another staff member. The staff member indicated that she was hired a week ago. This staff member did not have the results of the background checks, no proof of educational qualifications, no documentation of compliance with tuberculosis screening, and no recorded date of employment. Hygienic Practices Not In Compliance
General: Based on Observation, on 3/15/18 a facility staff member came to the door of the child care center, at approximately 12:30 PM, to let the surveyors enter and she had a two (2) year-old child with her. This left the front two to three (2-3) year-old classroom with one (1) staff member supervising a group of eleven (11) children. The two to three (2-3) year- old room was out ratio. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report General Administration Not In Compliance
General: Based on Review of Documentation, there were no children's names documented who participated in the monthly fire drills. Posted Documentation In Compliance Animals In Compliance
General: Based on Observation, the menu in the infant room was dated 12/11-12/15. The menu in the preschool classroom was dated 01/22-01/26 and the menu in the hallway was dated 01/29-02/02. The director stated that she had not gotten this weeks menu printed off to post. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 4 Inspection Report Children's Records Not In Compliance
General: Based on Review of Documentation, there were no current staff evaluations on file for any of the staff. Employee Records Not In Compliance
General: Based on Review of Documentation, staff hired on 07/05/16 has not completed the required pediatric abusive head trauma class within the first year of employment. Staff hired on 09/25/16 has not retaken the pediatric abusive head trauma class that is required every five (5) years. Staff hired on 07/05/16, 04/08/16, 03/14/16, 08/18/15 and 08/12 did not have the required fifteen (15) hours of cabinet approved training on file. This information if verified through ECE-TRIS. Programming In Compliance Premises Not In Compliance
This investigation inspection recorded no violations or advisories.
General: Based on Observation and interview, this regulatory requirement was not met. A large playground structure was observed lying in several pieces in the corner of the playground. This created a safety hazard due to the large pieces being unstable and metal pipes were exposed. The staff person in charge stated that the pieces had been placed there several weeks ago and indicated that she did not know a date of when the structure would be installed. Equipment Not In Compliance
General: Based on Observation and interview, this regulatory requirement was not met. An inspection of the facility’s first aid kit found that it did not contain a CPR mouthpiece or a flashlight. The staff person in charge acknowledged this finding during the visit.
General: Based on Review of Documentation and interview, this regulatory requirement was not met. At the time of the survey, there was not a written schedule for the staff. The staff person in charge stated that she did not have a written schedule of staff working hours.
General: Based on Review of Documentation, this regulatory requirement was not met. At the time of the survey it was found that there was no record of fire drills conducted by the facility.
General: Based on Review of Documentation, one child's enrollment paperwork was missing the name of his physician and a phone number to contact the physician. The staff in charge acknowledged the information.
General: Based on Review of Documentation, three (3) staff and one (1) substitute staff were missing proof of education on file. These staff were hired on 9/28/15, 9/1/15, 9/24/15, and 2/18/16. The staff in charge acknowledged the information.
General: Based on Review of Documentation, seven (7) college students were missing criminal records checks that were present in the classrooms with the children during the relicensure survey. Four (4) of the same seven (7) college students were missing CAN checks. One (1) substitute staff member that was hired on 2/18/16 did not have a criminal records check or a CAN check conducted by the facility. The criminal records check on site was dated 6/9/15 and it was conducted by The College For Technical Education. The CAN check on file for the sub was dated 7/21/15 and it was conducted by The College For Technical Education. This staff member was not working alone. One (1) staff member hired on 10/10/15 had lived in South Carolina in 2014 and she did not have an out-of-state background on file. This staff was not working alone with the children. The staff in charge acknowledge the information.
This investigation inspection recorded no violations or advisories.
General: Based on Observation, a child size wooden refrigerator/freezer in the 3 year-old room contained a yellow handle that was loose. The wooden child size oven in the 3 year- old room contained a handle that was not secured to the apparatus.
General: Based on Observation, the boys' and girls' bathrooms in the hallway contained an accumulation of dust on the vents in the ceiling.
General: Based on Observation, the drywall was scuffed and the paint was chipped in the one (1) year-old room next to the hand washing sink. The infant room also contained an area of chipped paint on the wall behind the trash can next to the sink. A ceiling tile in the girls' hallway bathroom contained a stain.
General: Based on Observation, the facility did not have posted information on the Kentucky Consumer Product Safety Program and the program's Web site as specified in KRS 199.897.
This investigation inspection recorded no violations or advisories.
General: Based on Review of Documentation, staff persons hired 2/2013 and 2/14/14 did not have evidence of current negative T.B. results on file in the facility.
General: Based on Observation, there was a tube of diaper ointment lying on the changing table in the boy's bathroom. Outdoor Play Area
General: Based on Observation, there was a spray bottle of disinfectant solution and a bottle of correction fluid being stored in an unlocked blue cabinet in the Preschool classroom. These items were accessible to the children in care.
General: Based on Observation, there were two (2) uncovered electrical outlets in the Preschool classroom. The outlets were accessible to the children in care.
General: Based on Review of Documentation, ten (10) of the ten (10) children's files presented for review did not contain contact information for a preferred hospital. 1080 - Documentation for Off Premise Trip Not Applicable 922 KAR 2:110. Section 3. Records. (1) A child-care center shall maintain: (b) A written record for each child: 3. To contain: g. A permission form for each trip off the premises signed by the child’s parent in accordance with 922 KAR 2:120, Section 12; Written Documentation
This change of space/change in capacity inspection recorded no violations or advisories.
This investigation inspection recorded no violations or advisories.
This follow-up inspection recorded no violations or advisories.
General: Based on Observation, there were two (2) cribs that did not meet federal crib standards.
General: Based on Observation, there were two (2) doll houses on the playground that were broken and had been duct taped back together.
General: Based on Review of Documentation, staff with hire date 1/10/06 did not have the required number of annual training hours. 345 - Driver Requirements Not Applicable 922 KAR 2:120. Section 12. Transportation. (18) A driver of a vehicle transporting a child for a center shall: (a) Be at least twenty one (21) years old; (b) Complete the background checks as described in 922 KAR 2:110; (c) Hold a current driver’s license which has not been suspended or revoked during the last five (5) years; and (d) Not caused an accident which resulted in the death of a person. Programming
This investigation inspection recorded no violations or advisories.
This investigation inspection recorded no violations or advisories.
General: Based on Interview, it was found that on 6/15/12 the one (1) year-old room was out of ratio for approximately fifteen (15) minutes around 3:30 PM. The staff in charge indicated that there were seven (7) one (1) year-old children in a classroom with one (1) staff member. The staff in charge indicated that she corrected the ratio problem shortly after it was brought to her attention. General Premises
General: Based on Review of Documentation, the facility did not have documentation of a negative TB test for two staff members. Another staff member had a TB test on file that was not current. 128 - CPR/First Aid Coverage 922 KAR 2:110 - Section 5 (3) At least one (1) person on duty and present with the children shall be currently certified by a cabinet-approved training agency in the following skills: (a)Infant and child cardiopulmonary resuscitation; and (b) Infant and child first aid. 1) CPR In Compliance 2) First Aid In Compliance 131 - Adequate Substitute(s) 922 KAR 2:110 - Section 5 (6) Child-care centers shall have available in case of need: (a) One (1) qualified substitute staff person for a Type II child-care center; or (b) Two (2) qualified substitute staff persons for a Type I child-care center 1) Type I In Compliance 2) Type II In Compliance 139 - Training 922 KAR 2:110 - Section 5 (14) A staff person with supervisory authority over a child shall complete the following: (a) Six (6) hours of cabinet-approved orientation within the first three (3) months of employment; (b) Nine (9) hours cabinet-approved child development training within the first year of employment; and (c) Fifteen (15) hours of cabinet-approved training during each subsequent year of employment. 1) Orientation Not In Compliance Findings: General: Based on Review of Documentation, there was no documentation on file of orientation training for three (3) staff members. 3) 15 hours annually Not In Compliance Findings: General: Based on Review of Documentation, there was no documentation of 15 hours of annual training for both of the staff listed as substitutes. 139 - Training 922 KAR 2:110 - Section 5 (14) A staff person with supervisory authority over a child shall complete the following: (a) Six (6) hours of cabinet-approved orientation within the first three (3) months of employment; (b) Nine (9) hours cabinet-approved child development training within the first year of employment; and (c) Fifteen (15) hours of cabinet-approved training during each subsequent year of employment. 2) 9 hours-first year In Compliance 317 - Driver requirements 922 KAR 2:120 - Section 12 (18) A driver of a vehicle transporting a child for a center shall: (a) Be at least twenty one (21) years old; (b) Complete the background checks as described in 922 KAR 2:110; (c) Hold a current driver’s license which has not been suspended or revoked during the last five (5) years; (d) Not have had any convictions concerning vehicle operation in the past twelve (12) months; and (e) Not caused an accident which resulted in the death of a person. 1) Be 21 years old or over In Compliance 2) Background checks In Compliance An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 8 of 38 Web site: http://chfs.ky.gov/ Inspection Report 3) Drivers license In Compliance 4) No convictions for vehicle operation In Compliance 5) No accident causing death In Compliance Programming 169 - Program of Activities Followed 922 KAR 2:120 - Section 2 (4) The child-care center shall provide a daily planned program of activities: (a) Posted in writing in a conspicuous location with each age group and followed; 1) Posted In Compliance 2) Followed In Compliance
General: Based on observation, the Older Preschool Room contained a wooden stove in the dramatic play area with an excessive amount of red marker on the surface.
General: Based on observation, the outdoor play area used by the older children contained several wrappers and other pieces of litter.
General: Based on review of documentation, the following was found: 1) A staff member (DOH: 05/20/24) has not completed orientation training, which is required within ninety (90) days of employment. 2) A staff member (DOH: 09/12/19) completed pediatric abusive head trauma training on 09/05/19; however, did not renew the training due on 09/05/24. A review of ECE-TRIS verified this information.
General: Based on observation, the following was found: EHS 2 Room 1) This room contained black scuff marks on the wall behind and next to the trash can. Preschool Room 1) This room contained areas of chipped paint by the sink in the classroom. School-Age Room 1) Two small holes were observed in the drywall by the cozy corner. Younger Preschool Restroom 1) An accumulation of dust was on the ceiling vent in the restroom.
General: Based on review of documentation, the facility did not have written evidence of quarterly conducted shelter-in-place/lockdown drills. Posted Documentation In Compliance
General: Based on observation, the following was found: Preschool A Classroom 1. Excessive stains embedded in a soft blue chair. EHS-2 Classroom 1. Excessive tape residue on top of a shelving unit located in the manipulative center. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report
General: Based on observation, in the Preschool A Classroom, the surveyor found the hand-washing sink basin was not completely attached to the cabinet. The surveyor could move the basin back and forth. Transportation Not Applicable Kitchen Requirements Not In Compliance
General: Based on observation, in the Preschool A Classroom, the refrigerator did not contain an indicating thermometer or temperature measuring device. The refrigerator contained five (5) milk cartons designated for the children in care. Food Service In Compliance Meal Planning/Center Provides Meals In Compliance Meal Planning/Center Does Not Provide Meals In Compliance Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals Not Applicable
General: Based on interview and review of documentation, a staff member hired on 2/27/2023, did not have a completed background check, sex offender registry check, and child abuse and neglect check from the state of Illinois. Supervision In Compliance Staffing Requirements In Compliance General Administration Not In Compliance
General: Based on observation, uncovered outlets were found in the Toddler room (back, long wall) and in the EHS-2 room (by the bookshelf). Director Requirements In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 5 Inspection Report Employee Records Not In Compliance
General: Based on review of documentation, a staff member hired on 9/23/2022, did not have evidence of a high school diploma, GED, or Commonwealth Child Care Credential on file at the facility.
General: Based on review of documentation, the following was found: 1.) Two staff members both hired on 3/19/2018, did not have a current TB test or statement from a health professional on file. 2.) A staff member hired on 9/23/2022, did not obtain a TB test or statement from a health professional until 9/24/2022.
General: Based on review of documentation, the following was found: 1.) A staff member hired 5/13/2022, did not complete the required orientation training. This staff member has been employed for more than three months. 2.) A staff member hired on 8/12/2019, completed pediatric abusive head trauma training on 2/1/2018; however, did not renew the training due 2/1/2023. 3.) A staff member hired on 3/9/2018, completed pediatric abusive head trauma training on 10/30/2017; however, did not renew the training due 10/30/2022. 4.) Four staff members hired on 3/9/2018, 3/19/2018, and two hired on 8/24/2020, did not have evidence of completing 15 hours of annual early care and education training on file. A review of ECE-TRIS records supports the information found during the survey. Programming Not In Compliance
General: Based on observation, the following was found: 1.) In the Toddler room, the walls had chipped paint and several holes. 2.) In Preschool Three/Four's room, the walls had chipped paint and the floors were dirty with stains. 3) In Preschool Four/Five's, the floors were dirty with stains. Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment Not In Compliance
General: Based on observation, several cribs had loose-fitting sheets in the Infant room. The cribs were being used for the children in care.
General: Based on observation, the wooden stairs used for children to wash hands were dirty with stains in the Preschool Three/Four's and Preschool Four/Five's rooms. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 5 Inspection Report
General: Based on observation, the trash can was dirty with stains in the Preschool Three/Four's room. Transportation Not Applicable Kitchen Requirements Not In Compliance
General: Based on observation, the refrigerator being used to store milk for the children in the Toddler classroom did not contain an indicating thermometer. It could not be determined that the interior temperature of the refrigerator was 40 degrees or below. Food Service Not In Compliance
General: Based on observation and interview, a four-year-old child enrolled at the center is served chocolate milk instead of 1% or skim milk.
General: Based on observation and interview, a four-year-old child enrolled at the center was drinking Fanta and Capri-Sun drinks provided from home.
General: Based on interview and review of documentation, this regulatory requirement was not met. A four-year-old child is eating and drinking items brought from home that do not meet required food components. This child had a written statement from a Speech-Language Pathologist dated 1/3/2022, that center should allow parents to bring his preferred food. However, it does not list what food the child shall not have and what substitution should be provided to meet all Food Component as regulation, 922 KAR 2:120. Section 9. Food and Drink Requirements for All Child Care Centers, requires. Meal Planning/Center Provides Meals In Compliance Meal Planning/Center Does Not Provide Meals In Compliance Children's Records In Compliance Written Documentation Not In Compliance
General: Based on review of documentation, the daily planned program of activities (lesson plan) posted in Preschool Four/Five's room was dated for previous week. In addition, the daily planned program of activities (lesson plan) posted Preschool Three/Four's was not dated; therefore, it could not be determined if the plan was current. Animals Not Applicable
General: Based on observation, this regulatory requirement was not met. During a tour of the facility, the surveyor observed a toilet plunger and toilet cleaning brush positioned next to the toilet in building #2 that were accessible to the children. This manner of storage is not sanitary and promotes the spread of germs. Director Requirements In Compliance Employee Records Not In Compliance
General: Based on observation, upon entry to the classroom a one-year-old child was found sitting on the floor drinking from a bottle. Children's Records In Compliance Written Documentation Not In Compliance
General: Based on review of documentation, the following was found: 1) Two staff members did not have Orientation I and II completed within the first three months of employment. 2) One staff member had only twelve (12) hours of cabinet-approved training on file. This information was verified through ECE-TRIS Programming Not In Compliance
General: Based on observation, there was no thermometer in the refrigerator located in the younger infant classroom. Children's Records In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 4 Inspection Report Written Documentation Not In Compliance
General: Based on observation, the following was found: 1) The surveyor noted that upon arrival at 8:30 am, the front door was slightly propped open with a door stop. At 8:40 am, the surveyor noted that two children (appeared to be a preschool child and a toddler) came into the facility without an adult and the preschool child went into the preschool classroom while the toddler walked into a toddler classroom that was not being currently used by the facility. At 8:41 am an adult walked into the building carrying an infant, stopped at the preschool classroom and talked to the teacher, then proceeded to go down the hall, and turned down another small hall where he found the toddler in the empty toddler classroom. The parent then took the toddler to the toddler classroom where a staff person was present. The surveyor found an empty white plastic garbage bag in the empty toddler classroom. This plastic bag was accessible to the toddler who was in the room alone. 2) An outlet in the dramatic play area of the older preschool classroom did not have a safety cover. 3) An outlet in the eating area of the younger preschool classroom did not have a safety cover. Employee Records Not In Compliance
General: Based on observation, the following was found: 1) There where two spray bottles filled with an unknown substance found in an unlocked cabinet in a toddler classroom. The bottles were accessible to the children. 2) There was a spray bottle filled with an unknown substance found in an unlocked sink cabinet in the older infant classroom. The bottle was accessible to the children.
General: Based on observation, the following was found: 1) There was an orange substance found on the floor next to some cubbies in the hallway. 2) There was a broken outlet plate cover in the reading area in the younger preschool classroom.
General: Based on observation, there was a flashing overhead light found in the older infant classroom. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 4 Inspection Report
General: Based on observation, there were water stains on the ceiling tiles in the hallway of the facility. Hygienic Practices Not In Compliance
General: Based on observation, there were several pieces of torn paper found on the playground Equipment Not In Compliance
General: Based on review of documentation, one staff member did not have a current professional development plan on file. Posted Documentation Not In Compliance
General: Based on observation, the plan of correction issued from the Cabinet for the change of service visit from 07/01/2019, was not posted for public inspection. Animals Not Applicable
General: Based on review of documentation and observation, this regulatory requirement was not met. Upon review of the building diagram, it was found that the preschool classroom was over capacity. Based on measurements obtained during a previous inspection, the preschool classroom is only large enough to house eight (8) children; however, ten (10) children were being cared for in the room during the visit. This does not provide a minimum of thirty-five (35) square feet of space per child.
General: Based on observation and review of documentation, seven (7) of ten (10) children's files did not have emergency medical authorization signed by the parent. There was no request for the authorization on the enrollment form for those children. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 4 Inspection Report Written Documentation Not In Compliance
General: Based on observation, a current schedule of daily activities, including lists and dates of activities to be conducted with the children, was not posted in the Younger Infant classroom, the Toddler classroom or the Older Infant classroom.
General: Based on observation, the following was found: 1. There werer four (4) uncovered bottles in the refrigerator in the Younger Infant classroom. 2. There were seven (7) unlabeled bottles in the Younger Infant classroom. 3. There were two (2) uncovered bottles in the refrigerator in the Older Infant classroom. 4. There were two (2) bottles of formula located in a cubbie in the Older Infant classroom. The bottles had not been refrigerated. Children's Records Not In Compliance
General: Based on observation, there were two (2) ucovered electrical outlets in the Toddler classroom. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 4 Inspection Report Employee Records Not In Compliance
General: Based on observation, the proper methods of diapering and hand washing were not posted in the changing area in the Infant classroom and the Ones & Twos classroom. Animals Not Applicable
General: Based on review of documentation, a staff person hired 3/19/19 had listed an address in California as a previous residence in the past five (5) years. The staff person did not have the results of or evidence of the application for a criminal background check for California on file in the facility. Supervision In Compliance Staffing Requirements In Compliance General Administration In Compliance Director Requirements Not In Compliance
General: Based on review of documentation, staff hired 10/3/18, 3/14/19 and 3/19/19 did not have evidence of a high school diploma, GED or Commonwealth Child Care Credential on file in the facility.
General: Based on observation, the following was found: 1. There were two (2) purses belonging to staff being stored on a lower shelving unit in the Preschool classroom. The purses were accessible to the children in care. 2. There was a can of air freshener being stored on a lower shelf of an open cabinet in the Preschool classroom. The freshener was accessible to the children in care.
General: Based on observation, the following was found: 1. There was a white box fan on a shelving unit in the Older Infant classroom. The fan vent and blades had an accumulation of black dust and grime. 2. There was an accumulation of dirty tape residue on a shelving unit in the Older Infant classroom. Transportation Not Applicable Food Service/Food Program In Compliance Food Service Not In Compliance
General: Based on review of documentation, there was no evidence that the facility's Emergency Preparedness Plan had been updated or submitted to the proper authority for review since 2/23/17.
General: Based on observation and review of documentation, there were forty-four (44) children present in the facility at the time of the initial tour of the facility. A review of the facility's attendance records found that there were only thirty-seven (37) children signed in with an arrival time on the facility's attendance record.
General: Based on review of documentation, the recorded drills on file in the facility did not have the full date of the practiced drills. There was no year noted as part of the date for the drills; therefore, it could not be determined in what year the drills were performed. Posted Documentation Not In Compliance
General: Based on observation, the statement of deficiencies, plan of correction and two (2) civil penalties issued from the current licensure year were not posted in the facility.
General: Based on Review of Documentation and interview, one (1) staff (hire date: 3/14/16) eligible for an annual performance review did not have documentation of a review on file in the facility. The staff person in charge acknowledged the finding and stated, "I'm trying to get caught up with these".
General: Based on Observation and interview, this regulatory requirement was not met. The following was found: 1. An interview with staff during the investigation revealed that the infant classroom and the toddler classroom combine daily and take a walk to the park. Staff stated that they start the walk at approximately 10:00AM - 10:15AM each day and return to the facility at approximately 11:00AM. A review of attendance records during the investigation and an interview with staff found that five (5) infants and seven (7) toddlers were present in the group during the walk to the park on 6/11/18. Two (2) staff individually escorted the surveyor and the DCBS Worker along the route that they walk to get to the park and identified the shelter/shade structure that they stopped at on 6/11/18. An inspection of the area at approximately 3:15PM on 6/11/18 found that it was unclean. The concrete platform in the shelter/shade structure contained an excessive amount of geese feces throughout the area. Staff stated during interview that they bring a broom with them to sweep the geese feces off the area and a blanket to lay the babies on. Geese feces residue was visible in the area identified as where the blanket was laid down. Staff stated that two (2) infants are non-mobile and three (3) are "starting to crawl". Staff also stated during interview that the one (1) year olds are allowed out of the strollers two (2) at a time to walk around in the area. The geese feces in the area pose a health hazard to the children. 2. An interview with staff and an observation of the area during the investigation revealed the one (1) year old child was allowed to walk away from the group approximately thirty (30) - forty (40) feet to a gravel area next to the parking lot on 6/11/18. Staff stated that the child was "gathering rocks and bringing them back to staff". Staff stated that two (2) cars were parked in the parking lot at the time. The only barrier separating the gravel area from the parking lot were a row of wooden posts mounted in the ground. Staff stated that the child walked a couple of steps past the wooden posts towards the parking lot, because he saw a lady walking with her two (2) children and the children were carrying buckets. Staff further stated that the child turned around and walked back to the group when they called out to him. Allowing a one (1) year old child to carry gravel is a safety hazard and allowing the child to walk independently so close to a parking lot with potential moving vehicles is also a safety hazard. Programming Not In Compliance
General: Based on Observation and interview, this regulatory requirement was not met. During tour of the facility at 2:48PM on 6/11/18, it was observed that younger children (two (2) - five (5) year olds) were grouped with the school-age children in the preschool classroom. Thirteen (13) children were present in the preschool classroom during the tour. Three (3) of the children were identified as school agers. Staff stated that these age groups had been combined all day. Children's Records Not In Compliance
General: Based on Observation, this regulatory requirement was not met. The following was found: 1. At approximately 11:00 AM it was found that there was one staff person caring for nine (9) children in the toddler room. The youngest child in the room was one-year-old, thus the minimum staff to child ratio was exceeded by three. After about five (5) minutes an additional staff person joined the classroom and stayed in there until the original co-teacher returned to the room. It is unknown how long the room was out of ratio before the second staff person joined the class. 2. At approximately 11:07 AM one of the teachers from the infant room was observed to leave that room and enter the kitchen area to gather supplies then return to the infant room. During that time there was one (1) staff person caring for eight (8) infants. 3. At approximately 11:08 AM there was one (1) staff person caring for a group of seventeen (17) children whose ages ranged from two to four-years-old in the preschool room. The second staff person assigned to this group was observed down the hall in another classroom with another child. This staff person rejoined the preschool group shortly after. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report Programming Not In Compliance
General: Based on Observation, this regulatory requirement was not met. There were several areas where the drywall was damaged. Outside the toddler room there was a section where drywall had been patched but the repair work was not complete. In the hall near the kitchen area there were several patches where the drywall was either in disrepair or the repair work was incomplete.
General: Based on Observation, this regulatory requirement was not met. A tour of the facility found that there were two (2) large bottles of Pine-Sol cleaner sitting on the floor in immediately to the door in the kitchen. The door to the kitchen was open throughout the duration of the survey making the cleaner accessible to the children in care.
General: Based on interviews, staff stated a four (4) year old female and a three (3) year old male are not placed in car seats when they are transported from Tates Creek Elementary to the day care facility. It is important to note the distance from the public school to the day care facility is approximately a half-mile. Children's Records In Compliance
General: Based on interviews, the facility failed to obtain approval from the cabinet before implementation of transportation services. Based on staff interviews and written statements provided by staff, it was confirmed that day care staff have been driving their own personal vehicles to pick up a four (4) year old female and a three (3) year old male from Tates Creek Elementary School at approximately 10:45 a.m. each day. The public school is located approximately a half of a mile from the day care facility. Staff stated they have been picking up the children and transporting them back to the day care facility since the Early Start program began in August 2017. Staff stated they never “clocked out” before leaving the day care facility to pick up the children. It is also important to note staff stated the children were never placed in car seats as they drove them from the public school to the day care facility. File review found there were no written agreements from parents of the children giving staff permission to transport their children from the public school to the day care facility. Further review of personnel files found staff did not have annual driving records. Additionally, a staff person who stated she picks up the children three to four times a week was not certified in CPR and First Aid. The staff person in charge stated she became aware that staff were transporting the children on March 14th and told the staff they could not transport the children because the facility was not licensed. However; on the day of the investigation, a staff person stated she picked up a three (3) year old male from Tates Creek Elementary. Director Requirements Not In Compliance
General: Based on interviews, the facility failed to obtain approval from the cabinet before implementation of transportation services. Based on staff interviews and written statements provided by staff, it was confirmed that day care staff have been driving their own personal vehicles to pick up a four (4) year old female and a three (3) year old male from Tates Creek Elementary School at approximately 10:45 a.m. each day. The public school is located approximately a half-mile from the day care facility. Staff stated they have been picking up the children and transporting them back to the day care facility since the Early Start program began in August 2017. Staff stated they never “clock out” before leaving the day care facility to pick up the children. It is also important to note staff stated the children were never placed in car seats as they drove them from the public school to the day care facility. File review found there were no written agreements from parents of the children giving staff permission to transport their children from the public school to the day care facility. Further review of personnel files found staff did not have annual driving records. Additionally, a staff person who stated she picks up the children three to four times a week was not certified in CPR and First Aid. The staff person in charge stated she became aware that staff were transporting the children on March 14th and told the staff they could not transport the children because the facility was not licensed. However; on the day of the investigation, a staff person stated she picked up a three (3) year old male from Tates Creek Elementary. Employee Records Not In Compliance
General: Based on review of documentation and interviews, the facility failed to ensure a driver of a vehicle transporting children have a driving history record on file. During the investigation, the surveyor noted at least five (5) staff have taken turns transporting two (2) children from Tates Creek Elementary to the day care facility each day at approximately 10:45 a.m. since August 2017 when the Early Start program began. It is important to note the cabinet has never approved the facility for transportation services. The staff person in charge stated she became aware that staff were transporting the children on March 14th and told the staff they could not transport the children because the facility was not licensed. However; on the day of the investigation, a staff person stated she picked up a three (3) year old male from Tates Creek Elementary. Transportation Not In Compliance
General: Based on interviews, the facility failed to notify the cabinet in writing the type of transportation offered and the type of vehicle used prior to transporting children. Based on staff interviews, it was confirmed day care staff have been driving their own personal vehicles to pick up a four (4) year old female and a three (3) year old male from Tates Creek Elementary School at approximately 10:45 a.m. each day. One (1) staff person stated when she picks up the children, she borrows a co-worker’s vehicle. During interviews the surveyor noted at least five (5) staff take turns transporting the children from the school. The public school is located approximately a half-mile from the day care facility. Staff stated they have been picking up the children and transporting them back to the day care facility since the Early Start program began in August 2017. Staff stated they never “clock out” before leaving the day care facility to pick up the children. The staff person in charge stated she became aware that staff were transporting the children on March 14th and told the staff they could not transport the children because the facility was not licensed. However; on the day of the investigation, a staff person stated she picked up a three (3) year old male from Tates Creek Elementary.
A PLAN OF CORRECTION WAS DUE ON 04/17/2018 AND AS OF 05/22/2018, THE PLAN OF CORRECTION HAS NOT BEEN RECEIVED. Director Requirements Not In Compliance
General: Based on Observation, on 3/15/18 a facility staff member came to the door of the child care center, at approximately 12:30 PM, to let the surveyors enter and she had a two (2) year-old child with her. This left the front two to three (2-3) year-old classroom with one (1) staff member supervising a group of eleven (11) children. The two to three (2-3) year- old room was out ratio. The staff member that opened the door for the surveyors while supervising the two (2) year-old child alone did not have a file. This staff member did not have written evidence of completed background checks, or submission of the background checks, as described in 922 KAR 2:280. The staff member indicated that she had worked at the facility for a week. Employee Records Not In Compliance
General: Based on Observation, upon entering the two-year-old room on 3/15/18 a two (2) year-old child was being diapered on her nap mat. After the child was diapered her hands were not washed. The child laid back down on her mat after being diapered. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report
General: Based on Observation, upon entering the two-year-old room on 3/15/18 a two (2) year-old child was being diapered on her nap mat. The nap mat was covered with the child's bedding. The diapering surface was not disinfected after the child was diapered.
General: Based on Observation, at 10:24am and again at 11:00am a student volunteer took a child to the restroom located down the hallway from the classroom. The student volunteer is not considered a qualified staff person. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 4 Inspection Report Staffing Requirements Not In Compliance
General: Based on Observation, there were two (2) qualified staff and one (1) student volunteer in the Head Start classroom with seventeen (17) children. At 10:44am one (1) of the qualified staff left the classroom and took a child to the restroom located down the hall leaving the classroom with sixteen (16) children and only one (1) qualified staff person. General Administration In Compliance Director Requirements Not In Compliance
General: Based on Review of Documentation, staff hired on 08/31/15 and 07/01/10 did not have the results of a criminal record check on file. Neither staff person was working alone at the time of the survey. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 4 Inspection Report
General: Based on Review of Documentation, staff hired on 10/02/17 had a tuberculosis skin test read on 10/13/17. Staff hired on 10/23/17 had a tuberculosis skin test read on 11/10/17. Staff hired on 09/01/17 had a tuberculosis skin test read on 09/20/17. These were the only tuberculosis skin tests on file and were not obtained prior to employment.
General: Based on Observation, there were several black marks and small drywall tears in the toddler classroom. Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment In Compliance Transportation Not Applicable Food Service Not In Compliance
General: Based on Review of Documentation, child enrolled on 08/29/16 did not have physician's contact information listed on file. Child enrolled on 02/27/16 did not have a preferred hospital listed on file. Written Documentation Not In Compliance
General: Based on Review of Documentation, staff hired on 07/05/16, 08/31/15, 04/08/16, 03/14/16, 08/12 and 09/25/16 did not have a current professional development plan on file.
General: Based on Review of Documentation, there were no children's names documented who participated in the quarterly earthquake and tornado drills.
General: Based on Review of Documentation and interview, the following was found: 1. One (1) staff person (hire date: 7/5/16) did not have evidence or results of a child abuse/neglect check (CAN) on file. The staff person in charge stated that this staff person works alone with children in the infant classroom from 3:00PM - 4:00PM each day. 2. One (1) staff person (hire date: 6/20/16) did not have evidence or results of a criminal records check (CRC) on file. The staff person in charge stated that this staff person works alone with children in the two (2) year old classroom from 4:00PM - 5:30PM each day. 3. One (1) staff person (hire date: 11/21/16) had a signed CAN check application in her file; however, the results had not been obtained. This same staff person had a CRC that was submitted for processing on 12/1/16; therefore, it was not submitted within the required timeframe. 4. One (1) staff person (hire date: 9/25/16) had a CAN check dated 10/4/16 and a CRC dated 10/10/16. 5. One (1) staff person (hire date: 8/24/16) had a CAN check dated 11/14/16 and a CRC dated 11/14/16. 6. One (1) staff person (hire date: 1/8/17) had a CAN check dated 1/23/17 and a CRC dated 2/1/17. 7. One (1) staff person (hire date: 2/6/17) had a CAN check dated 2/17/17. 8. One (1) staff person (hire date: 5/16/16) had a CAN check dated 1/10/17 and a CRC dated 11/14/16. 9. One (1) staff person (hire date: 3/14/16) had a CRC dated 4/22/16. 10. One (1) staff person (hire date: 1/17/17) had a CRC dated 2/1/17. This same staff person had Alabama listed as a previous address. The staff person in charge stated that she has not submitted an out of state background check for this employee.
General: Based on Observation and interview, this regulatory requirement was not met. During a tour of the facility the surveyor observed a group of six (6) children (two (2) - three (3) year olds) eating breakfast in their classroom. The surveyor toured this classroom a few minutes later and found that children had finished eating and were observed playing with toys in the room. The surveyor asked the staff working in classroom to describe hand washing procedures. The staff person stated that the portable sink in the classroom was not working because the tube that leads from the water tank to the faucet was broken. Therefore, the children's hands were not washed after eating breakfast. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 7 Inspection Report First Aid/Medication Not In Compliance
General: Based on Review of Documentation, the following was found: 1. Two (2) staff files (hire dates: 7/1/10 and 8/6/14) contained results of negative T.B. tests that are no longer current. The tests were dated 8/24/08 and 9/5/08 which exceeds the two (2) year time frame. 2. Two (2) staff (hire dates: 2/6/17 and 3/14/16) did not have T.B. documentation on file. 3. Five (5) staff did not have evidence of a negative TB skin test or physician's statement documenting he/she was free from tuberculosis prior to employment. The first staff person was hired on 9/25/16; however, did not have a TB skin test until 10/17/16. The second staff person was hired on 11/21/16; however, did not have a TB skin test until 12/5/16. The third staff person was hired on 8/24/16; however, did not have a TB skin test until 8/29/16. The fourth staff person was hired on 1/8/17; however, did not have a TB skin test until 2/6/17. The fifth staff person was hired on 6/20/16; however, did not have a TB skin test until 6/24/16.
General: Based on Observation, this regulatory requirement was not met. The facility had proper methods for hand washing posted next to the diaper changing table in the two - three (2-3) year old classroom; however, did not have diaper changing methods posted. Animals Not Applicable
General: Based on Observation and interview, the following was found: 1. During a tour of the two - three (2-3) year old classroom, an interview with the staff person working in the classroom revealed that the portable sink positioned next to the diaper changing table was not working. The staff person stated that the tube that leads from the water tank to the faucet was broken. The staff person in charge stated that she is in process of getting the sink repaired. 2. A wooden dramatic play cabinet in the two - three (2-3) year old classroom had a broken cabinet door. The hinge was broken; therefore, the cabinet door was hanging loose. 3. A tour of the children's bathroom located across the hall from the office found that the soap dispensor mounted on the wall was broken. It was missing the plastic cover. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 4 of 7 Inspection Report
General: Based on Review of Documentation and interview, this regulatory requirement was not met. At the time of the survey, it was found that there was no documentation of current liability insurance at the facility. The staff person in charge stated that she did not know where this documentation was located.
General: Based on Review of Documentation, this regulatory requirement was not met. Six (6) staff (hire dates: 7/5/16, 8/24/16, 1/8/17, 2/6/17, 5/16/16 and 3/14/16) did not have educational documentation on file. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 7 Inspection Report
A PLAN OF CORRECTION WAS DUE ON 07 Mar 17 AND AS OF 23 Mar 17, THE PLAN OF CORRECTION HAS NOT BEEN RECEIVED. Director Requirements Not In Compliance
General: Based on Interview, this regulatory requirement was not met. An interview with staff during the visit revealed that the director is employed by the technical college located next door to the facility and teaches a child development class two (2) days a week from 1:30PM - 3:30PM. Furthermore, a letter in the director's file from the facility owner stated, "Dear Robin: This is to add the duties of the Child Care Center Director to your current position of Early Childhood Education Instructor effective September 23, 2016. Both job descriptions are enclosed". The director stated during interview that it is difficult for her to do both jobs. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 7 Inspection Report
General: Based on Review of Documentation, this regulatory requirement was not met. Six (6) staff eligible for an annual performance review did not have documentation of a review on file in the facility.
General: Based on Observation, the following was found: 1. During a tour of the two - three (2-3) year old classroom, the surveyor observed two (2) uncovered electrical outlets in the dramatic play area. 2. A small television and DVD player was observed sitting on a toy shelf in the two - three (2-3) year old classroom. These two (2) items were plugged into an electrical outlet approximately two - three (2-3) feet away and the cords were observed hanging loose. The cords were accessible to the children. 3. There were no provisions to keep the toilet tissue in the children's bathroom across from the office clean and sanitary. The roll of toilet tissue was observed sitting on the tank of the toilet.
General: Based on Review of Documentation and interview, the following was found: 1. One (1) staff person (hire date: 7/5/16) did not have evidence or results of a child abuse/neglect check (CAN) on file. The staff person in charge stated that this staff person works alone with children in the infant classroom from 3:00PM - 4:00PM each day. 2. One (1) staff person (hire date: 6/20/16) did not have evidence or results of a criminal records check (CRC) on file. The staff person in charge stated that this staff person works alone with children in the two (2) year old classroom from 4:00PM - 5:30PM each day. Employee Records Not In Compliance
General: Based on Review of Documentation and the Training Records Information System (TRIS), the following was found: 1. Three (3) staff files (hire dates: 7/5/16, 11/21/16 and 3/28/16) did not contain evidence of the six (6) hours of cabinet-approved training being completed within the first three (3) months of employment. 2. Four (4) staff files (hire dates: 8/17/15, 8/31/15, 8/15/15 and 2/14/14) did not contain evidence of the pediatric abusive head trauma training class being completed within the required time frame. 3. Three (3) staff files (hire dates: 8/17/15, 2/14/14 and 7/1/10) did not contain the required fifteen (15) hours of training. Programming In Compliance Premises Not In Compliance
General: Based on Observation, this regulatory requirement was not met. An exterior concrete wall on the playground contained a large area of peeling paint that was accessible to the children. Hygienic Practices Not In Compliance
General: Based on Observation, this regulatory requirement was not met. An inspection of the facility first aid kit found small packets of Neosporin antibiotic ointment and small packets of Motrin pain medication. The first aid kit was not stored in a locked area; therefore, the medications were not being stored properly. Outdoor Play Area Not In Compliance
General: Based on Observation and interview during a tour of the outdoor playground, the following was found: 1. A large Little Tykes tree play structure was observed lying on it's side and in dis-repair. It appeared as though the main "tree" structure was broken at the base. The staff person in charge stated that the playground had recently been vandalized. 2. A blue sensory table on the playground was observed in dis-repair. One side was broken and hanging down towards the ground. Transportation Not Applicable Food Service In Compliance Children's Records Not In Compliance
General: Based on Review of Documentation, this regulatory requirement was not met. Two (2) children (enrollment dates: 3/28/16 and 2/11/14) had immunization certificates that were no longer current as of 12/1/16 and 9/25/16.
General: Based on Review of Documentation and interview, this regulatory requirement was not met. One (1) child that was identified as being enrolled at the facility did not have enrollment paperwork on file; therefore, none of the required information had been obtained. The only documentation that the child had on file at the facility was an immunization certificate. The staff person in charge identified the child as her nine (9) month old grandchild and stated that the child has been attending approximatley two (2) days a week since December 2016.
General: Based on Observation and interview, this regulatory requirement was not met. The surveyor observed the preschool children playing on playground equipment at a public park located directly behind the facility during the visit. The staff person in charge acknowledged this during the visit and stated that the facility sometimes takes children on walks around the area. The staff person in charge did not have permission forms signed by the parents for these activities. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 5 of 7 Inspection Report Written Documentation Not In Compliance
General: Based on Review of Documentation and interview, this regulatory requirement was not met. The surveyor found that the facility has yet to establish their emergency preparedness plan according to KRS 199.895. The staff person in charge stated that she was not aware of this regulatory requirement.
General: Based on Review of Documentation, this regulatory requirement was not met. Four (4) staff did not have evidence of a current staff professional development plan on file in the facility.
General: Based on Review of Documentation, this regulatory requirement was not met. At the time of the survey it was found that there was no record of quarterly earthquake and tornado drills conducted by the facility.
General: Based on Review of Documentation and interview, this regulatory requirement was not met. At the time of survey, it was found that the facility did not have a written policy regarding the implementation of procedures taught at orientation training. The staff person in charge stated that she did not have such a policy.
General: Based on Review of Documentation, this regulatory requirement was not met. At the time of the survey it was found that there was no record of fire drills conducted by the facility. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 6 of 7 Inspection Report
General: Based on Review of Documentation, this regulatory requirement was not met. At the time of the survey it was found that there was no record of quarterly earthquake and tornado drills conducted by the facility. Posted Documentation Not In Compliance
General: Based on Review of Documentation and interview, the following was found: 1. The statement of deficiencies and plan of correction from the 2/24/16 relicensure inspection was not posted. The staff person in charge stated that she did not have a copy of this inspection report. 2. Information on the Kentucky Consumer Product Safety Program and the program’s website was not posed.
General: Based on Review of Documentation, one (1) staff that was hired on 2/14/14 did not have a CAN check on file from the facility. The CAN check on file was from the College For Technical Education and page 2, with the findings, was missing from the check. In addition, another staff hired on 2/23/15 did not have page 2 (with the findings) of the CAN check on file. The staff in charge acknowledged the information.
General: Based on Review of Documentation, five (5) college students were missing negative TB skin test documentation. The staff in charge indicated that it was the facility policy that the students working in the classrooms have current TB skin tests on file.
General: Based on Observation, the wooden privacy fence on the playground contained a broken plank. A sharp, jagged edge of wood was exposed and within reach of a child. The staff in charge indicated that a work order would be placed to get the fencing repaired.
General: Based on Observation, a schedule of daily activities, including lists and dates of activities to be conducted with the children was not posted in the Infant classroom. An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 25 of 26 Web site: http://chfs.ky.gov/ Inspection Report
General: Based on Review of Documentation, there was no documentation that professional development plans had been prepared for any staff members. 107 - Maintenance of Background check/Out of State 922 KAR 2:110 - Section 3 (12) For the director, employee, volunteer, or any person with supervisory or disciplinary control over, or having direct contact with a child, results of the: (a) Criminal records check in accordance with KRS 17.165; (b) Child abuse and neglect check in accordance with 922 KAR 1:470; and (c) Background check from: 1. Previous state of residence, if the individual has been a resident outside of Kentucky in the previous five (5) years; or 2. Current state of residence, if other than Kentucky; 1) Criminal Records Check In Compliance 2) Child Abuse/Neglect Check In Compliance 3) Previous State of Residence In Compliance 4) Current State other than KY In Compliance
General: Based on Review of Documentation, there was no documentation of evaluations performed on any staff members. Fifteen (15) records were reviewed.