922 KAR 2:120. Section 2. Child Care Services.

General: Based on review of documentation, per video surveillance, at approximately 11:52am a five-year-old child left the preschool playground through the playground door and went down a long hallway and out onto the toddler playground. The child was seen by a staff person running down the hallway and out the toddler playground door. The staff person told one of the child's preschool teachers where he went. A toddler teacher found him on the toddler playground and he was returned to one of his preschool teachers. The preschool teacher placed the child back onto the preschool playground without letting anyone know about the incident. The other preschool teachers who were on the playground with this child only found out about the incident once they came back into the classroom for lunch. There were a total of seventeen (17) preschool children on the playground with 2 teachers. Per interview, the child was gone from the preschool playground for approximately 2-3 minutes. All of the playground doors lock from the outside and a code has to be put in for the door to open. It could not be determined how the child was able to get through the playground door and inside the building. The distance from the preschool playground door to the toddler playground door is approximately one hundred eighty (180) feet. Per interview, the child was not found in distress or hurt when the toddler teacher found him on the playground. Per the staff person in charge, the video surveillance was unable to be uploaded for review. Staffing Requirements In Compliance General Administration Not In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:090. Section 8. General.

General: Based on review of documentation, per video surveillance, at approximately 11:52am a five-year-old child left the preschool playground through the playground door and went down a long hallway and out onto the toddler playground. The child was seen by a staff person running down the hallway and out the toddler playground door. The staff person told one of the child's preschool teachers where he went. A toddler teacher found him on the toddler playground and he was returned to one of his preschool teachers. The preschool teacher placed the child back onto the preschool playground without letting anyone know about the incident. The other preschool teachers who were on the playground with this child only found out about the incident once they came back into the classroom for lunch. There were a total of seventeen (17) preschool children on the playground with 2 teachers. Per interview, the child was gone from the preschool playground for approximately 2-3 minutes. All of the playground doors lock from the outside and a code has to be put in for the door to open. It could not be determined how the child was able to get through the playground door and inside the building. The distance from the preschool playground door to the toddler playground door is approximately one hundred eighty (180) feet. Per interview, the child was not found in distress or hurt when the toddler teacher found him on the playground. Per the staff person in charge, the video surveillance was unable to be uploaded for review. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2

922 KAR 2:090. Section 10. Director Requirements and Responsibilities.

General: Based on record review and interview, a two-year-old child was left outside on the playground alone for approximately one (1) minute. The child's teacher and class had gone inside to get ready for lunch. There had originally been two teachers with eleven children but one staff took seven of the children inside. The second teacher was left with four children. When the staff person took the second group of children in she did not find the fourth child and thought there had been a miscommunication. The child was found unharmed by another staff member who heard the child beating on the hallway door that leads out to the playground. The child told the teachers that she was hiding on the playground when everyone went inside.

922 KAR 2:090 · Correction status not published

922 KAR 2:120. Section 2. Child Care Services.

General: Based on record review and interview, a two-year-old child was left outside on the playground alone for approximately one (1) minute. The child's teacher and class had gone inside to get ready for lunch. There had originally been two teachers with eleven children but one staff took seven of the children inside. The second teacher was left with four children. When the staff person took the second group of children in she did not find the fourth child and thought there had been a miscommunication. The child was found unharmed by another staff member who heard the child beating on the hallway door that leads out to the playground. The child told the teachers that she was hiding on the playground when everyone went inside. Staffing Requirements In Compliance General Administration In Compliance Director Requirements Not In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:090. Section 10. Director Requirements and Responsibilities.

General: Based on observation and interview, this regulatory requirement was not met. It was reported by the facility on 5/31/19 that a child in one (1) of the infant classrooms received a bottle of breastmilk belonging to another child. Interviews with staff found that on the day of the incident, multiple bottles had been placed in the crockpot to warm. A staff removed one (1) of the bottles, tested it to determine that it was not too hot, and proceeded to feed a male child this bottle of breastmilk that belonged to another child. Further interview found the staff person who fed the male child the other child's bottle had not checked the name on the side of the bottle to assure the bottle belonged to the child she was getting ready to feed. Interviews with staff and a review of the facility's written procedure found that staff are supposed to check the name on the side of the bottle to assure they have the correct bottle for the correct child before feeding.

922 KAR 2:090 · Correction status not published

922 KAR 2:090. Section 10. Director Requirements and Responsibilities.

General: Based on observation and interview, this regulatory requirement was not met. It was reported by the facility on 5/31/19 that a child in one (1) of the infant classrooms received a bottle of breastmilk belonging to another child. Interviews with staff found that on the day of the incident, multiple bottles had been placed in the crockpot to warm. A staff removed one (1) of the bottles, tested it to determine that it was not too hot, and proceeded to feed a male child this bottle of breastmilk that belonged to another child. Further interview found the staff person who fed the male child the other child's bottle had not checked the name on the side of the bottle to assure the bottle belonged to the child she was getting ready to feed. A staff person came back from break and observed that a female child was very fussy and found that the child needed a bottle. However, there was not a bottle in the refrigerator for this child and there was not a bottle warming in the crockpot for this child. It was then discovered that the male child had been fed breastmilk belonging to the female child. The parents of both children were notified at that time. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2

922 KAR 2:120. Section 2. Child Care Services.

General: Based on interview and record review, a therapist found a four-year-old child alone in the hallway. The therapist opened the door to the classroom he was supposed to be in asking the lead teacher if she knew he was in the hallway. The lead teacher stated that she was aware he was out there and that she took complete responsibility for the situation. The therapist stated to the lead teacher that he could not be left alone and that all children are required to be supervised at all times. The lead teacher then had the child go back into the classroom. It was determined through interview with staff that the child was alone in the hallway for approximately two (2) minutes. Staffing Requirements In Compliance Director Requirements Not In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:090. Section 10. Director Requirements and Responsibilities.

General: Based on interview and record review, a four-year-old child was left alone in the hallway outside of his classroom for approximately two (2) minutes. Interviews found that a lead teacher stated after she brought her preschool children in off the playground one (1) four-year-old child did not want to cooperate and go inside the classroom. She stated that the child pulled at her arm and tried to run down the hallway as if he was playing a game. The teacher stated that she told the child she was not going to chase after him and after several attempts to get him to go inside with the other children the teacher decided to go in the room and shut the door leaving the child alone in the hallway. The child was found by a therapist and was then put back in his classroom. The child was in the hallway alone for approximately two (2) minutes according to interview with staff that were present. Programming In Compliance

922 KAR 2:090 · Correction status not published

922 KAR 2:090. Section 10. Director Requirements and Responsibilities.

General: Based on Review of Documentation and interview, on August 21, 2018 a staff person gave an infant approximately three (3) ounces of breastmilk that belonged to another child. Staff stated in interview that although the bottle looked like the child's bottle, there was not a label on the bottle to verify to whom it belonged.

922 KAR 2:090 · Correction status not published

922 KAR 2:120. Section 2. Child Care Services.

General: Based on Review of Documentation and interview, this regulatory requirement was not met. On 3/31/18 a five (5) year old child was made to write sentences as punishment for being untruthful. A staff person working in the classroom wrote the word "I will not lie" on a piece of paper, drew three (3) lines under the sentence and then had the child re-write the sentence three (3) times. The child was singled out in the classroom while at the table. This experience was not developmentally appropriate and did not promote the child's social growth and well-being. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2

922 KAR 2:120 · Correction status not published

922 KAR 2:120. Section 2. Child Care Services.

General: Based on Interview, a four-year-old child was left unsupervised inside the facility when his class went outside to the playground on 9/28/17. The four-year-old child was taken to the bathroom by a staff person at approximately 5:30pm. That staff person then left the area to find a plastic bag for the child's clothing. This staff person returned at approximately 5:32pm, told the remaining staff person that she could not find a bag and then clocked out. Several parents arrived to pick up children at this time so the remaining staff became busy with children leaving. According to this staff person she checked her attendance records and saw four (4) children were still signed in to her class. She called the name of the child on the toilet and when he did not answer, she assumed he had been picked up. This staff then took the remaining three (3) children outside. It was not until the four-year-old's mother arrived that the staff realized he had been left on the toilet in the classroom's bathroom. The child was alone in the bathroom in the classroom for approximately ten (10) minutes before being found by staff and the child's parent. Staffing Requirements In Compliance Director Requirements Not In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:110. Section 4. Director Requirements and Responsibilities.

General: Based on Interview, a four-year-old child was left unsupervised inside the facility when his class went outside to the playground on 9/28/17. The four-year-old child was taken to the bathroom by a staff person at approximately 5:30pm. That staff person then left the area to find a plastic bag for the child's clothing. This staff person returned at approximately 5:32pm, told the remaining staff person that she could not find a bag and then clocked out. Several parents arrived to pick up children at this time so the remaining staff became busy with children leaving. According to this staff person she checked her attendance records and saw four (4) children were still signed in to her class. She called the name of the child on the toilet and when he did not answer, she assumed he had been picked up. This staff then took the remaining three (3) children outside. It was not until the four-year-old's mother arrived that the staff realized he had been left on the toilet in the classroom's bathroom. The child was alone in the bathroom in the classroom for approximately ten (10) minutes before being found by staff and the child's parent. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2

922 KAR 2:120. Section 2. Child Care Services.

General: Based on Review of Documentation, interview and observation, this regulatory requirement was not met. On 9/20/17 the director reported to the DRCC office that on 9/20/17 at approximately 4:40PM a two (2) year old child exited the Monkey Classroom and walked down the hall to the Giraffe Room doorway. Staff working in the Giraffe Room looked up and observed the child standing at the gate in their doorway. One of the staff working in the Giraffe Room picked up the child and carried him back to the Monkey Classroom through an adjoining closet. The staff working in the Monkey Classroom were not aware that the child was missing until the staff person in the Giraffe Room knocked on the closet door. The director's written statement sent to the DRCC office as notification of the incident stated, "Teachers estimate that he was out of the classroom no longer than ninety (90) seconds". A staff person working in the Monkey Classroom at the time of the incident stated in written documentation that she submitted to the facility, "He couldn't have been gone more than a minute to a minute in a half". A second staff person working in the Monkey Classroom at the time of the incident stated in written documentation that she submitted to the facility that the child was gone "90 seconds at the most". Staff stated during interview and via written documentation submitted to the facility that the latch on the gate in the doorway of the Monkey Classroom was not secure; therefore, the child was able to open it and exit the classroom. Staffing Requirements In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:110. Section 4. Director Requirements and Responsibilities.

General: Based on Observation, this regulatory requirement was not met. An inspection of the medication box in Room #105 (Fireflys) found a plastic ziplock bag with a bottle of Acetaminophen liquid and a medicine dropper that was unclean. The medicine dropper was sticky and had left-over medicine inside of it. This manner of storage promotes the spread of germs. Employee Records In Compliance Programming In Compliance Premises In Compliance Hygienic Practices In Compliance First Aid/Medication Not In Compliance

922 KAR 2:110 · Correction status not published

922 KAR 2:120. Section 7. First Aid and Medicine.

General: Based on Observation, the following was found: 1. An inspection of the medication box in Room #105 (Fireflys) found a plastic ziplock bag with a bottle of Acetaminophen liquid and a medicine dropper that was unclean. The medicine dropper was sticky and had left-over medicine inside of it. These items were not labeled with a child's name. 2. An inspection of the medication box in Room #107 (Crickets) found a tube of Aquaphor Healing Ointment that was not labeled with a child's name. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Outdoor Play Area In Compliance Equipment In Compliance Transportation Not Applicable Food Service In Compliance Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals In Compliance

922 KAR 2:120 · Correction status not published

922 KAR 2:110. Section 4. Director Requirements and Responsibilities.

General: Based on Review of Documentation and interview, the director failed to supervise staff conduct to ensure implementation of program policies and procedures. A review of the facility's policies and procedures labeled "Supervision Policy" determined that a staff person did not follow procedure on 2/4/16 when she transitioned her group of children from the Jungle Room to the Butterfly Classroom and left a fourteen (14) month old child in the infant/toddler hallway alone/unsupervised. It was revealed during interview that this staff person signed a facility supervision policy agreement form when this policy was presented to staff on 1/11/16. The supervision policy contains the following information, "Adequate supervision requires the following: 1. Counting heads continually throughout the day to ensure the whereabouts of each child at all times. 2. Counting heads when transitioning from one space to another - this includes counting heads before leaving, and again when arriveing and your new destination. 3. Supervising children by sight and sound anytime they leave the room. 4. Noting on the classroom attendance log the times that children arrive and leave each day. The staff person stated during interview that she took the classroom attendance record clipboard with her when she went to the Jungle Room on 2/4/16; however, indicated that it had the names of all eight (8) children present and she only had four (4) children with her because the second staff person remained in the Butterfly Classroom with the other four (4) children. The staff person stated, "I counted the children one-by-one as I got them off the buggy, but I didn't do a final count when I put the buggy in the hallway and closed the classroom door. Therefore, the facility supervision policies were not followed.

922 KAR 2:110 · Correction status not published

922 KAR 2:120. Section 2. Child Care Services.

General: Based on Review of Documentation and interview, this regulatory requirement was not met. On 2/4/16 the director reported to the DRCC office that a fourteen (14) month old child was left alone in the infant/toddler hallway after a staff person unloaded children from a buggy, placed them in the Butterfly classroom and then closed the classroom door. The child was found by a custodian staff person that was doing trash pick-ups in the infant/toddler hallway. This staff person stated in written documentation that she submitted to the facility, "Left kitchen at 1:37PM to pull trash in the infant hallway. Child was outside in the hallway playing with wagon. All doors were closed but one. I picked up child, went to the door that was open and ask which room child belonged in, then took the child to classroom". The staff person working in the Butterfly Classroom stated in written documentation that she submitted to the facility, "When I took the last child out of the buggy, the child walked behind me outside of the classroom. I shut the door and heard the trash can being pushed down the hall, seconds later our day porter knocked on the door holding him saying he was right outside the room playing with a wagon". The staff person received a one (1) day suspension as a result of the incident. An interview with staff found that the child was left alone in the hallway less than thirty (30) seconds. Staffing Requirements

922 KAR 2:110. Section 2. General.

General: Based on Observation, it was found that the statement of deficiencies issued and the plan of correction submitted for the 2014 relicensure survey was posted on a bulletin board that was covered with a locked plastic and wood casing. The document was not accessible to the public for viewing. The director stated that she would move the document to a different bulletin board in the hallway.

922 KAR 2:110 · Correction status not published

922 KAR 2:090. Section 6. License Issuance.

General: Based on Review of Documentation, there were two (2) employees, both with hire dates of 12/7/15 who did not have evidence in their file of their criminal abuse and neglect checks having been submitted. The staff person in charge stated that she has never kept copies of the CAN checks because they usually get the results back quickly. Additionally, there was an employee with a hire date of 4/22/13 who did not have evidence in their file of an out of state background check having been conducted.

922 KAR 2:090 · Correction status not published

922 KAR 2:120. Section 7. First Aid and Medicine.

General: Based on Observation, it was found that 1) a child in the Firefly classroom had a medication administration permission form on file that was dated September 2015 - August 2016. The form was for Infant Tylenol 3.75ml every 4 hours as needed; 2) a child in the Caterpillar classroom had a medication administration permission form on file that was dated August 2015 - June 2016. The form was for Cetirizine 2.5mg every 2 hours as needed for rash; 3) a child in the Monkey classroom had a medication administration permission form on file that was dated 10-23-15. The form was for Children's Motrin as needed every 6 hours. Medication administration permission forms are to be signed daily and must list a specific time and dosage to be given. The director stated that the staff should know better because they had just had a training on it.

922 KAR 2:110. Section 6. Reports.

General: Based on Review of Documentation and interview, this regulatory requirement was not met. Allegations of a preschool child receiving an injury after playing in the the Jungle Room and the injury not being reported to DRCC office were investigated on 11/18/15. During interview the director stated, "Yes, she broke her leg, but we're not sure if it happened here or not". The director identified the date of the incident as 10/28/15 and presented a copy of the facility incident report that was filled out as a result. The director further stated, "When the child's mother dropped her off that morning she told an office staff person and the child's teacher that the child had been rubbing her leg earlier that morning like it was hurting her, but the mother did not see anything visibly wrong with the child's leg. The staff told me that the child played fine in the classroom that morning; however, suddenly cried out and wouldn't walk after jumping off a wedge shaped block in the Jungle Room". The child's mother was contacted as a result and the mother transported the child to be examined by a physician. The director stated during interview that the child was diagnosed with a high tibia fracture and returned to the facility with a cast. The director stated that the incident was not reported to the DRCC office because they did not know if the incident occurred at the facility. Director Requirements

922 KAR 2:110 · Correction status not published

922 KAR 2:110. Section 4. Director Requirements and Responsibilities.

General: Based on Review of Documentation, observation and interview, the following was found: 1. Interviews with facility staff revealed that on 8/4/15 a five (5) year old child was left alone and unsupervised on the playground when her classroom went back inside. The staff person designated as the child's caregiver at the time was not aware that the child was missing from the group until a staff person brought the child into the classroom and told her what happened. The staff person that found the child described the incident by stating that she was sitting in her car in the facility parking lot while on her lunch break and observed the child alone on the playground as she was walking back into the building. The staff person stated that she could not get to the child from the parking lot due to locked gates; therefore, she entered the facility through the main entrance and walked through the office and staff break room to get outside to the child. The staff person designated as the child's caregiver at the time of the incident received a one (1) day suspension as a result. A review of the employee corrective action form in the staff person file found the following statement, "a child was left on the playground unattended by her teacher today for close to ten (10) minutes without the staff person noticing". The staff person that found the child submitted a written statement during the investigation. 2. Interviews with facility staff revealed that sometime during October 2015 (approximately 10/13/15), a two (2) year old female child exited the Elephant Classroom without the three (3) staff in the classroom noticing and used her "turtle" to walk to Therapy Room B, which is located near the front entrance. A therapist that was standing in the doorway of the therapy room observed the child walk into the therapy room and carried her back to her classroom after she relized the child did not have a therapy appointment scheduled. A staff person working in the Elephant Classroom at the time of the incident stated that two (2) foster grandparents entered the classroom to read books to the children and the classroom gate did not get secured properly after they entered the room. This staff person and the therapist that observed the incident submitted written statements during the investigation. This HSS walked the path that the child took to get from the Elephant Classroom to the therapy room during the investigation and measured the distance along the way. The child walked approximately seventy-five (75) - eighty (80) feet down the classroom hallway, turned left and walked approximatley another sixty (60) feet down the main hallway/ therapy gym area before entering Therapy Room B. An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 2 of 3 Web site: http://chfs.ky.gov/

922 KAR 2:110. Section 3. Records.

General: Based on Review of Documentation, it was found that the child that was left outside unsupervised was not signed out of the facility on the day of the incident, therefore the exact time the child left the facility could not be determined.

922 KAR 2:110 · Correction status not published

922 KAR 2:120. Section 2. Child Care Services.

General: Based on Interview, it was found that a nineteen (19) month old child was left unsupervised on the playground from 5:30 p.m. until 5:42 p.m. The teachers in charge of the children were unaware of the child being outside by herself until her father came to pick her up and they could not find her in the classroom. Staffing Requirements

922 KAR 2:120 · Correction status not published

922 KAR 2:110. Section 5. Staff Requirements.

General: Based on Review of Documentation, staff person hired 5/17/13 did not have evidence of completing the required orientation training in the first three (3) months of employment. There was evidence of only two (2) hours completed out of the required six (6) hour course. General: Based on Review of Documentation, staff person hired 5/17/13 did not have evidence of completing the required orientation training in the first three (3) months of employment. There was evidence of only two (2) hours completed out of the required six (6) hour course.

922 KAR 2:110 · Correction status not published

922 KAR 2:120. Section 4. Premises Requirements.

General: Based on Observation, the surveyor observed several small areas of peeled paint along the wall above a secured mirror in the Fire Fly Classroom.

922 KAR 2:120 · Correction status not published

922 KAR 2:120. Section 10. Toilet, Diapering, and Toiletry Requirements.

General: Based on Observation, the surveyor tested the water temperature with a caliberated thermometer and found the water temperature registered at sixty (60) degrees Fahrenheit in some classrooms and eighty (80) degrees Fahrenheit in other classrooms. The staff person in charge stated the facility currently has only one (1) water heater; however, an additional water heater is in the process of being installed in order to rectify the water temperature issue.

922 KAR 2:120 · Correction status not published

922 KAR 2:110. Section 5. Staff Requirements.

Review of Documentation: it was found that one (1) staff file out of forty-six (46) staff files reviewed did not have evidence of orientation training within the first ninety (90) days of employment.

922 KAR 2:110 · Correction status not published

922 KAR 2:110. Section 4. Director Requirements and Responsibilities.

Review of Documentation: it was found that two (2) staff files out of forty-six (46) staff files reviewed did not have evidence of a current staff evaluation.

922 KAR 2:110 · Correction status not published

922 KAR 2:090. Section 6. License Issuance.

Review of Documentation: it was found that four (4) staff files out of forty-six (46) staff files reviewed did not have evidence of an out of state background check for individuals who lived outside of the state within the past five (5) years. The dates of hire for the staff were 07/29/2013, 04/22/2013, 01/22/2013, and 08/12/2013.

922 KAR 2:090 · Correction status not published

922 KAR 2:110. Section 5. Staff Requirements.

Review of Documentation: it was found that three (3) staff files out of forty-six (46) staff files reviewed did not have proof of education. The hire dates for the staff were 01/22/2013, 08/13/2012 and 08/12/2013.

922 KAR 2:110 · Correction status not published

922 KAR 2:110. Section 5. Staff Requirements.

Review of Documentation: it was found that two (2) staff files out of forty-six (46) staff files reviewed had evidence of a TB skin test that was read past their date of hire. Staff with a hire date of 01/13/2013 had a TB skin test completed on 01/18/2013. A staff person with a hire date of 03/07/2013 had a TB skin test read on 03/21/2013. Two (2) staff files out of forty-six (46) staff files reviewed had no evidence of a current TB skin test. The dates of hire for those staff were 08/20/2012 and 09/04/2012.

922 KAR 2:120 - Section 11

Classroom I: Based on Interview, it was found through interview with staff that the toys are cleaned with a bleach water solutions. This does not meet the rgeulatory requirement for the toy sanitation procedure. First Aid/Medication 244 - First aid supplies 922 KAR 2:120 - Section 7 (3) If a child becomes ill while at the center: (a) The child shall be placed in a supervised area isolated from the rest of the children; (b) The parent shall be contacted immediately; and (c) Arrangements shall be made to remove the child from the child-care center as soon as practicable. 1) Availability In Compliance 2) Storage In Compliance 3) Inventoried In Compliance 4) Sanitized, if reusable In Compliance 5) Maintained in sanitary manner In Compliance 6) Liquid soap In Compliance 7) Adhesive bandages In Compliance 8) Sterile gauze In Compliance 9) Medical tape In Compliance 10) Scissors In Compliance 11) Thermometer In Compliance 12) Flashlight In Compliance 13) Cold pack In Compliance 14) First aid book In Compliance 15) Disposibale gloves In Compliance 16) Cardiopulmonary resuscitation mouthpiece protector In Compliance

922 KAR 2:120 · Correction status not published