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

General: Based on review of documentation, a copy of the liability insurance was not provided at the time of the survey. Director Requirements In Compliance Employee Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, staff member (DOH 09/22/23) did not have proof of educational qualifications in their personnel file. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, staff member (DOH 12/30/21) did not have evidence of a negative tuberculin skin result, nor a physician’s statement clearing this individual of active tuberculosis.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on observation and review of documentation, no certified CPR/First Aid staff was in the building at the time of the survey. Programming In Compliance Premises In Compliance 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

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 8. General.

General: Based on observation, there were numerous empty plastic bags found in an unlocked cabinet below the changing table in the two-year-old classroom. The plastic bags were accessible to the children. Director Requirements Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on review of documentation, staff members hired 01/02/18 and 10/08/18 respectively did not have a current staff evaluation on file. Employee Records In Compliance Programming In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Premises Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on observation, there was a staff purse found on a low shelf in an unlocked closet in the two-year-old classroom. The straps to the purse were hanging down, making the purse accessible to the children. 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 Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on review of documentation, staff members hired 01/02/18, 10/08/18, and 06/11/21 respectively did not have a current professional development plan on file. Posted Documentation In Compliance Animals In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 8. General.

General: Based on observation, the following was found: 1) There was a power strip located on the floor in Room 209 which did not have child protective covers over each outlet. 2) There was a wall outlet in Room 209 that did not have a child protective cover over the outlet. Director Requirements In Compliance Employee Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, staff hired on 11/01/2021, 01/24/2022, 03/01/2022, and 01/24/2022, did not have education documentation on file. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 4 Inspection Report

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, staff hired on 08/29/2019 and 01/02/2018, did not have documentation on file from a health care professional stating they were free of active tuberculosis.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, the following was found: 1) Staff hired on 08/26/1997 and 02/28/2012, did not have the required 15 hours of cabinet approved training on file. 2) Staff hired on 08/26/1997, completed Pediatric Abusive Head Trauma training on 01/10/2017; however, did not renew the training due 01/10/2022. The ECE-TRIS system was reviewed and confirmed these findings. Programming In Compliance Premises Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

Based on observation, there were numerous plastic bags found in a bucket located in an unlocked sink cabinet of a bathroom next to Room 209. This bathroom is used daily by children.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation, a ceiling vent in Room 210 was covered in dust. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 4 Inspection Report

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

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

General: Based on observation, an overhead light was flashing on and off in Room 212.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation, the following was found: 1) There were several areas of chipping paint on the walls in Room 209. 2) There was a water stain found on a ceiling tile in Room 211. Hygienic Practices In Compliance First Aid/Medication Not In Compliance

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

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

General: Based on observation, there was a container of Desitin and other tubes of diaper rash ointment found in an unlocked drawer in the bathroom located next to Room 209. This bathroom is used daily by the children. These medications were accessible to the children. Outdoor Play Area In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 4 Inspection Report Equipment Not In Compliance

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 13. Toys and Furnishings.

General: Based on observation, the following was found: 1) A drawer front was missing directly below one of the sinks in the bathroom next to Room 209. There was also a broken plastic latch with sharp edges located on the edge of the opening. This bathroom is used daily by the children. This area was accessible to the children. 2) There were a total of 11 highchairs located in Room 211. Only 3 of the highchairs had safety straps. Transportation Not Applicable Kitchen Requirements Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 8. Kitchen Requirements.

General: Based on observation, one bottle was found in the refrigerator in Room 212 without an individual label. Food Service In Compliance Meal Planning/Center Provides Meals In Compliance Meal Planning/Center Does Not Provide Meals In Compliance Children's Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on review of documentation, child enrolled on 01/06/2021, did not have a current immunization record on file. Written Documentation Not In Compliance

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on interview, a written staff schedule was not available at the time of the inspection.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on review of documentation, the names of the children who participated in each drill was not on file. Posted Documentation In Compliance Animals Not Applicable

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 8. General.

General: Based on review of documentation, the Licensing regulations 2:090 and 2:120 presented for review were last updated in 2013. Additionally, regulation 2:280 was not available for staff review.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

General: Based on review of documentation, seven staff members did not have a current employee evaluation on file. The evaluations stored in their personnel files were last updated in 2019. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 4 Inspection Report Employee Records Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, a staff member hired 3/5/2021, did not have evidence of educational qualifications in their personnel file. Programming Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on observation, one crib sheet in the Infant classroom was loose, and presented a suffocation hazard. Premises Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on observation, the following was found: 1.) There were two bottles of shaving cream in the four-year-old classroom; the description on the bottles read, “Keep out of reach of children.” 2.) Staff members’ purses were observed on low shelves within the three-year-old classroom and the four-year-old classroom. Hygienic Practices In Compliance First Aid/Medication Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation, there were two unlabeled diaper cream tubes in the two-year-old bathroom and two tubes of diaper cream that were not labeled in the one-year-old classroom. Outdoor Play Area In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 4 Inspection Report Equipment Not In Compliance

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

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

General: Based on observation, there was a broken basket used as a sink basin in the dramatic-play kitchenette of the four-year-old classroom. Transportation In Compliance Food Service/Food Program Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on observation, only one child brought milk from home in the four-year-old classroom. Milk was not provided to the students missing this component. Additionally, no students brought milk from home with their lunch or were served milk in the three-year-old classroom. Food Service In Compliance Children's Records In Compliance Written Documentation Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on review of documentation, seven staff members had a professional development plan in their personnel file that was last updated in 2019. Posted Documentation Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 8. General.

General: Based on review of documentation, there was not a daily schedule posted in the four-year-old classroom. Animals In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 3 of 4 Inspection Report Emergency Regulation Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:415 · 922 KAR 2:415E. Emergency Regulation.

General: Based on interview and review of documentation, a staff member hired 9/2/2020, had a completed CAN check in their file; however, there was no evidence that an Office of Administrative Court or State Police background check had been completed for this individual. The staff person submitted the Office of Administrative Court background check on 3/23/2021, the date of the survey. The staff member was not present during the survey, and the staff person in charge stated that this individual has not worked alone.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on interview, a two-year-old child received a radial fracture to her left arm on 10/30/2020. The child was standing behind the classroom door and as the teacher was removing her from behind the door, she tripped over the door stop causing her to fall and pull the child down with her. The child was upset and was seen holding onto her arm but no visible signs of an injury were seen according to the staff. The child's parents were contacted and she was taken to the emergency room. Employee Records In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation, the surveyor found a staff person hired on 7/20/2020 did not have proof of education on file.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on review of documentation and ECE-TRIS, the surveyor found that two staff hired on 8/26/1997 and 10/3/2016 only completed twelve hours of early care and education training during their training year. At this time, training hours are calculated from exact hire date to exact hire date. Therefore, fifteen hours of training should have been completed by August 2019 and October of 2019, respectively. Programming In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Premises Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on observation, the surveyor found a crack in the corner of a light fixture located in the school-age classroom. Additionally, the surveyor observed orange residue on the surface of the light fixture.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation, the surveyor found four water stained ceiling tiles located in the children’s restroom and one water stained ceiling tile located in Classroom #211. Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment In Compliance Transportation Not Applicable Food Service/Food Program In Compliance Food Service In Compliance Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals Not Applicable Emergency Regulation Not In Compliance

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

922 KAR 2:400 · 922 KAR 2:400E. Emergency Regulation.

General: Based on observation, the surveyor observed machine washable clothing on seven dolls located in Classroom #213. It is important to note, that machine washable doll clothes are not allowed during the COVID-19 pandemic.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation and interview, this regulatory requirement was not met. An interview with the staff person in charge confirmed that on 9/9/19 a male one-year-old child injured his lip after falling down the stairs. An interview with the staff person supervising the group of children at the time of the incident found that she was caring for four (4) one- year-old children. She reportedly brought the children in from the playground using the side door. The children then crawled up the stairs and waited at the top before being placed in a wagon to be transported to their classroom. The staff person indicated she had placed three (3) children in the wagon, which was parked at the edge of the top of the steps. The fourth child waited on the landing at the top of the steps, close to the edge. The staff person stated as she reached for the male child he stumbled and rolled on his side down the steps to the bottom. The staff person went to the child immediately and found that his mouth was bleeding. The staff person notified the staff person in charge. The child's mouth was cleaned and examined by staff and then the child's parent was contacted. The child was taken to the hospital for treatment. It was also found there was no bruising and the CT scan did not reveal any issues or concerns. An inspection of the stairs where the child fell found that the toddler fell approximately six (6) feet before landing at the bottom of the steps. It should be noted that the steps are made of concrete with a carpeted tread on the surface. Each step is approximately seven (7) inches tall and eleven (11) inches wide. Employee Records In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 2 Inspection Report Equipment Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 11. Toys and Furnishings.

General: Based on interview, this regulatory requirement was not met. An interview with staff found that when the children from the one-year-old room come in from the playground they are brought in through a side door leading from the playground. The children are required to crawl up a five (5) steps and wait at the top of the steps before being placed in a Radio Flyer brand plastic wagon. Once the children are placed in the wagon, they are then transported to their classroom by staff. An observation of the wagon found there are two (2) safety straps attached to the two (2) seats molded into the floor of the wagon. A gray back is attached to each seat. An interview with staff found that on 9/9/19 four (4) one-year- old children were placed in the wagon and transported to the classroom. It was also found through interview that the safety straps are not engaged when the children are transported to their classroom. It should be noted that the manufacturer's safety specifications for this wagon indicated the wagon is for two (2) riders and it mentions the seat belts for added safety.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation and interview during the investigation it was found that a wooden post in the gross motor space had areas where the wood was split and not smooth. It is important to note that a child received an injury when he leaned against the post and slid down resulting in a splinter in his back. Surgery was required to remove the splinter.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

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

General: Based on inspection of the wooden play equipment, it was found that the climber with the slide and the two wooden swing sets was anchored in the ground. However, the equipment was easily shaken and observed to be unstable. Further, the climbing equipment that included a swing set did not have a protective surface that would be adequate in a fall.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on observation, this regulatory requirement was not met. The surveyor entered the facility at 11:15AM and conducted a tour of the facility. The surveyor opened the door to the one (1) year old classroom and observed two (2) staff present with five (5) children that were asleep on cots. The room was so dark that the surveyor had to use the flashlight on her phone to see the children present in the classroom. When the surveyor opened the classroom door to enter, the only light in the room was a small plug in light by the cubbies and the light coming off the staff persons' cell phones. Classrooms being this dark, even during nap time, create a safety hazard for the children and staff. Employee Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on observation, review of documentation, and the Training Records Information System (TRIS), the following was found: 1. One (1) staff file (hire date: 9/15/17) did not contain evidence of the pediatric abusive head trauma training class being completed within the first year of employment and this same staff person did not complete the required fifteen (15) hours of training. 2. One (1) staff file (hire date: 8/14/17) did not contain the required fifteen (15) hours of training. Programming In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report Premises In Compliance Hygienic Practices In Compliance First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on observation, this regulatory requirement was not met. During a tour of the infant classroom, the surveyor observed infants in cribs that were positioned end to end with approximatley two (2) inches in between them. Transportation Not Applicable Food Service/Food Program Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on observation and interview, this regulatory requirement was not met. It was determined that the facility failed to supplement children's lunches that were brought from home and did not consist of the required components listed in this regulation. Three (3) children in the three (3) year old classroom were observed drinking Capri Suns/Kool Aid juice instead of milk. The surveyor did not observe facility staff supplement milk to ensure the meals met the nutritional requirements. The staff person in charge stated that they always have milk available for the children and she indicated that she did not know why this classroom did not have any. Food Service In Compliance Children's Records In Compliance Written Documentation Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 9. Records.

General: Based on observation and review of documentation, this regulatory requirement was not met. Five (5) employee files (hire dates: 9/1/08, 9/30/15, 5/2/17, 1/2/18, and 2/28/18) did not contain a current annual professional development plan.

Open Not marked corrected in the state record

Open / not marked corrected.

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

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 thinks she has this policy; however, she did not present it during the visit. Posted Documentation Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on review of documentation, this regulatory requirement was not met. The school age classroom did not have a schedule of daily activities posted. Animals Not Applicable An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Observation, at the time of the survey lunch was observed in the one-year-old room. Some of the children were served raisins. An interview with staff found that parents provide lunch for their child. Raisins are a choking hazard for children of this age. Employee Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on Review of Documentation, there were four (4) staff (hire dates: 7/27/17, 8/15/17, 5/29/17 and 8/14/17) who had the results of a T.B. test read after their date of hire. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:090 · 922 KAR 2:090. Section 11. Staff Requirements.

General: Based on Review of Documentation and ECE-TRIS records, there was one (1) staff person hired 7/27/17 who did not complete the required six (6) hours of orientation training until 12/10/17. There was an additional staff person hired 9/15/17 who did not have evidence of having completed the required six (6) hours of orientation training. In addition there were two (2) staff with hire dates of 9/1/09 and 2/28/12 who had not completed fifteen (15) hours of annual training for 2016-2017. Programming Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Observation, during a tour of the one-year-old room it was found that the planned program of activities posted was for the week of 2/24/18.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on Observation, during a tour of the infant room an infant was observed sleeping in a crib with a pacifier that had an animal attached to the end in their mouth. Premises In Compliance Hygienic Practices Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 11. Toys and Furnishings.

General: Based on Interview, with staff it was found that toys that are mouthed by children who are not yet toilet trained are sanitized daily by spraying the toys with bleach water and wiping them off and then they are left to air dry. This process does not meet the requirements of the regulation. First Aid/Medication In Compliance Outdoor Play Area In Compliance Equipment In Compliance Transportation Not Applicable An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report Food Service/Food Program Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, during a tour of the two-year-old room a gallon of 2% milk was observed in the refrigerator. Interviews with staff found that the 2% milk is served to the children for lunch. Food Service Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, during a tour of the infant room there was a container of formula sitting in a basket that was labled for an individual child. An interview with staff found that the facility does not participate in the Federal Food Program. Further interviews with staff found that they pour the formula from the container into the child's bottle. Staff indicated they are required to pour four (4) ounces of formula for each bottle.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, during a tour of the one-year-old room several sippy cups of milk were observed in the refrigerator. An interview with the staff person in charge found that if the child does not drink all of their milk from breakfast they will serve the remaining milk to the child for lunch. Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals Not Applicable

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, observation and interview, this regulatory requirement was not met. On 4/6/17 allegations regarding a two (2) year old child being left alone and unsupervised in a storage closet in the gym were reported to the DRCC office. On 4/7/17 the surveyor and the DCBS Worker made a visit to the facility to investigate. The director acknowledged the allegation, reviewed her personal notes and identified 1/31/17 as the date of the incident. The surveyor, the DCBS Worker and three (3) facility staff members watched video footage from the facility's surveillance system during the visit to determine how the incident occurred. A review of video surveillance footage found that the child's group (two-year-olds) entered the gym at 2:19PM. It is important to note that four (4) different age groups (one (1) year olds, two (2) year olds, three (3) year olds and four (4) year olds) were observed playing in the gym together from 2:19PM - 2:45PM. A review of the facility attendance records found that thirty-nine (39) children were present in this group and six (6) staff. At 2:35PM one (1) of the staff stood in front of the storage closet door and the two (2) year old child is observed sitting on the gym floor in front of the staff person. The staff person then leaves the area, walks over to the bleachers and sits down. At this time (2:35PM) the child gets up, walks over to the storage closet door, opens it, goes inside and then shuts the door behind him. At 3:25PM all the children and staff line up at the door and start exiting the gym area. At this time, the two (2) staff at the end of the line run toward the storage closet, go inside and walk back out carrying the child. It is important to note that there is no sound on the video surveillance system. The child was left alone and unsupervised in the storage closet from 2:35PM - 3:25PM (fifty (50) minutes total). No one was aware that the child was missing until the two (2) staff found him in the storage closet. The staff immediately alerted an administrative staff person to the situation; however, the facility did not reprimand any of the staff and did not report the incident to the child's parents. The surveyor and the DCBS Worker conducted an inspection of the storage closet during the 4/7/17 visit. The wooden ladder that the child used to climb to the top of the storage closet is steep and can be easily moved because it is not attached to anything. The ladder measured ten (10) feet, four (4) inches from the floor. The base of the ladder was sitting on concrete floor. Interviews were conducted with the staff that found the child and written statements were obtained. Staff stated during interview that they heard a child crying as they were exiting the gym and that is when they opened the storage closet door and found the child on the top shelf. Staff described what they observed by stating, "The light was off in the storage closet, so I couldn't see him at first. I flipped on the light, looked up and saw him peeking over at me. He was scared and wouldn't come down. A staff person had to climb the ladder to get him to come down". Staff described the child's appearance by stating, "He was covered in dirt. He had snot hanging down out of his nose and he smelled bad because he had pooped in his pants" and "He had pooped and peed on his self and he had snot all over his face and his shirt". An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report Staffing Requirements Not In Compliance

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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

General: Based on Review of Documentation and interview, the following was found: 1. During a review of video surveillance footage from 1/31/17 and an interview with staff during the investigation it was revealed that three (3) different groups of children (two (2) year olds, three (3) year olds and four (4) year olds) were served snack in a classroom connected to the gym daily around 3:00PM. Staff stated that there are no bathrooms or sinks in the gym area; therefore, children's hands were not washed before or after snack. Staff also stated that snack food was placed directly into the children's hands when snack was served. No cups, napkins or plates were provided. There were no tables or chairs in the area where the children were served. Staff stated that the children either stood up while eating or they sat on the floor. Serving snack in this manner is not sanitary. 2. A review of video surveillance footage from 1/31/17 found that four (4) different age groups of children (one (1) year olds, two (2) year olds, three (3) year olds and four (4) year olds) were observed playing together in the gym from 2:19PM - 2:45PM. A review of the facility attendance records found that thirty-nine (39) children were present in this group and six (6) staff. Therefore, the facility failed to maintain compliance with staff-to-child ratios and group sizes during this time frame and it created an unsafe environment for the younger children in the group. The video footage revealed children pushing, shoving and fighting with each other. Children were observed climbing on top of toys, throwing and kicking balls around the gym and climbing/playing on the metal bleachers. At 2:35PM a two (2) year old child in the group walked over to the storage closet door in the gym, opens it, goes inside and then shuts the door behind him. No one was aware that the child was missing until 3:25PM. Children and staff started lining up at the door to take the group upstairs when two (2) staff heard a child crying and found the child on the top shelf of the storage closet. The child had climbed up a steep wooden ladder to the top shelf and then could not get back down on his own because he was scared. It is important to note that the lights were off in the storage closet when the child was found. The child was dirty and had mucus on his face and shirt from where he had been crying. The child's clothes had to be changed because he had used the bathroom in his pants while in the storage closet. Hygienic Practices Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Interview, this regulatory requirement was not met. An interview with staff during the investigation revealed that a sixteen (16) year old high school student that works at the facility in the afternoons is alone with the children when she takes children to the bathroom. The staff person stated that the two (2) year olds, three (3) year olds and four (4) year olds combine in the two (2) year old classroom late in the day and she takes children, two (2) at a time, to the bathroom area in the hallway.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Review of Documentation, observation and interview, this regulatory requirement was not met. A review of video surveillance footage from 1/31/17 found that four (4) different age groups of children (one (1) year olds, two (2) year olds, three (3) year olds and four (4) year olds) were observed playing together in the gym from 2:19PM - 2:45PM. A review of the facility attendance records found that thirty-nine (39) children were present in this group and six (6) staff. The youngest child in the group was a one (1) year old, making the minimum staff to child ratio one staff person for six (6) children and the maximum group size twelve (12). The facility exceeded the staff/child ratio by three (3) children and the group size by twenty-seven (27). Director Requirements Not In Compliance

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

General: Based on Review of Documentation and interview, this regulatory requirement was not met. During an allegation investigation, an interview with staff determined that the facility does not have policies and procedures in place to ensure adequate supervision of the children. On 1/31/17 a two (2) year old child entered a storage closet in the gym, climbed a wooden ladder to the top shelf of the storage closet and was alone/unsupervised in this area for fifty (50) minutes while three (3) - four (4) different groups of children and staff played in the gym. No one was aware that the child was missing until children and staff started lining up at the door to take the group upstairs. The two (2) staff at the back of the line heard the child crying and found him on the top shelf of the storage closet. An interview with staff and a review of staff time cards during the investigation revealed that one (1) staff person assigned to the two (2) year old group the majority of the day clocked out and went home at 3:12PM. The other staff person assigned to the two (2) year old group the majority of the day clocked out and went home at 3:52PM. The child entered the storage closet at 2:35PM and was found by two (2) staff that arrived late in the afternoon at 3:25PM. The two (2) staff that found the child did not arrive to work until 3:01PM and approximatley 3:20PM. There was no communication between the staff to ensure all children were present in the group and no list to identify the names of the children that were present. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on Review of Documentation and interview, this regulatory requirement was not met. A review of video surveillance footage from 1/31/17 and an interview with staff during the investigation found that the children's hands were not wash before or after eating snack on 1/31/17. At 3:04PM three (3) different groups of children (two (2) year olds, three (3) year olds and four (4) year olds) were served snack in a classroom connected to the gym. Staff stated that there are no bathrooms or sinks in the gym area; therefore, children's hands were not washed before or after snack.

Open Not marked corrected in the state record

Open / not marked corrected.

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

Based on review of documentation and interview, this regulatory requirement was not met. An interview with staff during the investigation revealed that in July 2016 an infant was dropped two (2) times within a week by the same staff person. The staff person informed the child's parent of the first incident verbally when the parent arrived to pick up the child because the child had a bump on her forehead. The child's parent stated during interview that she was told that the child slipped out of the staff person's lap when the staff person went to stand up from a sitting position. The child's head hit the floor as a result. A written statement that was obtained during the investigation revealed that the second incident occurred two (2) days later (7/15/16). The written statement contained the following information, "The staff person working the infant classroom told me that one of the older children in the infant room had hit a child in the face with a toy, she said it left a red mark. When the staff person left to go on her lunch break, another staff person informed me that she heard a thump in the infant room and said she thought that the infant staff person dropped a baby. The director asked me to come to her office and showed me on the security camera that the infant staff person dropped the same child that was dropped on 7/13/17". The written statement explained the incident with the following statement, "The infant staff person was trying to separate two babies that were on the floor playing while she was holding the child. She dropped the child to the floor from her knee height". The child's parent was not informed of the second incident and the staff person working the infant classroom was switched to the toddler classroom as a result of the incident.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, the surveyor found that a staff person hired on 10/31/16 lives in Ohio. File review found that an out of state background check was not completed for this individual. The surveyor observed this staff person working alone with children in the four (4) year old classroom at approximately 10:25 a.m. It is important to note that a qualified staff person was placed in the classroom with the staff person. The director stated that she recalled requesting the out of state background check but she could not locate the documentation during the inspection. Employee Records Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, the surveyor found that a staff person hired on 10/31/16 lives in Ohio. File review found that an out of state background check was not completed for this individual. The surveyor observed this staff person working alone with children in the four (4) year old classroom at approximately 10:25 a.m. It is important to note that a qualified staff person was placed in the classroom with the staff person. The director stated that she recalled requesting the out of state background check but she could not locate the documentation during the inspection. An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 1 of 3 Inspection Report

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, one (1) staff hired on 10/31/16 did not have proof of education on file such as a High School Diploma, GED, or Commonwealth Child Care Credential.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation and ECE-TRIS, one (1) staff (hire date: 10/15/15) only had six (6) hours of early care and education training during the first year of employment. Programming Not In Compliance

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on Observation, an infant was lying on her back sleeping in a crib in the nursery. The surveyor noted that the child had a striped pink blanket covering her body and slighly covering her face. The staff stated that the child was eleven (11) months old. In short, the blanket was not tucked around the child. Premises Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Observation, the surveyor noted in the middle stall that urine was on top of the toilet seat and inside of the toilet bowl in the restroom that is used by the children. Hygienic Practices Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

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

Based on observation, the surveyor found that there was a small tear in the diaper pad located in the nursery. First Aid/Medication In Compliance Outdoor Play Area In Compliance An Equal Opportunity Employer M/F/D @chfsky | CHFS.KY.GOV Page 2 of 3 Inspection Report Equipment Not In Compliance

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 11. Toys and Furnishings.

General: Based on Observation, the surveyor observed a medium sized flat screen television on top of a wooden folding table in the four (4) year old classroom. The surveyor noted that the table was not sturdy. The surveyor could move the table side to side. The television and table were located in the children's play space. The staff person stated that the television was only used during circle time activities. She stated that she would find another table for the television. Transportation Not Applicable Food Service Not In Compliance

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 8. Kitchen Requirements.

Based on interview and observation, the surveyor found that the children bring their own lunches. The surveyor inquired about the types of food that are supplemented when a child does not bring a required food component. The director showed the surveyor some cans of food such as corn and green beans. The surveyor noted that the food is heated in a microwave. Furthermore, some of the children's lunches require heating in a microwave. The director stated that they also offer milk with lunch. The surveyor found that the facility does not serve individual milk cartons. The staff pour the milk from milk containers. In short, the facility is alternating food temperatures and not using single service food items. The facility does not have a food service permit.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 8. Kitchen Requirements.

General: Based on Observation, the surveyor observed a bottle that was not covered and another bottle that was not labeled. The bottles were observed in the refrigertor located in the toddler classroom.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, the surveyor observed a half gallon of 2% milk in the refrigerator located in the toddler classroom. The director stated that the milk was for the toddlers. Children's Records In Compliance Written Documentation In Compliance Posted Documentation In Compliance Animals Not Applicable

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Observation, at the time of the survey during a tour of the one (1) year old room there were seven (7) children ages one (1) to two (2) years old on one (1) side of the half wall with one (1) staff person. On the other side of the half wall where there are high chairs and a small refrigerator there was an additional staff person getting the children's lunches ready. This staff person was then observed opening the closed gate located in the middle of the half wall and come over to the side with the other staff person and the seven (7) children. Let it be noted that upon entry into the area where the children were the surveyor asked the staff person in the area the age of the children and it was indicated that all of the children were one (1) year old. However, a review of children's files found that one (1) of the children was two (2) years old.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

General: Based on Observation, during a tour of the four (4) year old room (# 210) there was an uncovered outlet beside the writing table.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, there was one (1) staff person with a hire date of 10/30/15 who did not have a copy of a high school diploma, GED or other qualifying documentation on file. During an interview with the staff person in charge it was indicated that this staff person is enrolled in college.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, there was one (1) staff person with a hire date of 10/30/15 who did not have the results of a T.B. test or a statement from a health professional indicating they are free from the symptoms of T.B. on file at the facility. In addition there were three (3) staff with a hire date of 10/15/15. These staff had the results of a T.B. test read on the following dates; 12/11/15, 11/19/15 and 12/8/15. There was one (1) staff person with a hire date of 9/30/15 who had the results of a T.B. test read on 10/13/15 and another staff person with a hire date of 4/27/15 who had the results of a T.B. test read on 5/6/15. Al of these T.B. test were completed after the staff person's date of hire.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, there was one (1) staff person listed as a substitute with a hire date of 8/10/11 who had a T.B. test on file with a read date of 9/10/13 This exceeds the two (2) year timeframe.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, there was one (1) staff person with a hire date of 10/30/15 who did not have evidence of having completed six (6) hours of cabinet approved orientation within the first three (3) months of employment. In addition there were two (2) staff with hire dates of 9/30/15 and 10/15/15 who did not complete the six (6) hours of cabinet approved orientation training until 2/1/6 and 2/9/16. During an interview with the staff person in charge it was indicated that the staff person who had a certificate documenting the completion of the six (6) hours of orientation training dated 2/9/16 had completed it earlier on line but there was a glitch in the system that kept her from printing the certificate. Further review of staff files and the ECE- TRIS system found one (1) staff person with a hire date of 9/1/08 only had evidence of having completed twelve (12) hours of cabinet-approved early care and education training for the 2014-2015 training year. A review of staff files and the ECE-TRIS system also found a staff perosn with a hire date of 8/10/11 who only had evidence of having completed fourteen (14) hours of cabinet-approved early care and education training for the 2014-2015 training year. 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: 1. The background checks as described in 922 KAR 2:110; and 2. An annual check of the: a. Kentucky driver history records in accordance with KRS 186.018; or b. Driver history records through the state transportation agency that issued the driver’s license; (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

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Observation, there was no a daily planned program of activities posted for the school age children for a full day nor was there a daily planned program of activities for after school. The children were present all day at the time of the survey due to the weather. During an interview with the staff person in charge it was indicated that there is a lesson plan somewhere but the documentation could not be produced at the time of the visit nor was it posted.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 5. Infant and Toddler Play Requirements.

General: Based on Observation, at the time of the survey during a tour of the one (1) year old room there were seven (7) children observed with one (1) staff person. Let it be noted that upon entry into the area where the children were the surveyor asked the staff person in the area the age of the children and it was indicated that all of the children were one (1) year old. However, a review of children's files found that one (1) of the children was two (2) years old and has been two (2) since 12/30/15. In interview with the staff person in charge found that this child has remained with the one (1) year old children and not moved to the two (2) year old room in order for him to stay with the same group of children he will be going to school with. The staff person in charge indicated that the facility likes to move children up to the next age group as a group in order for them to stay with children they will go to school with.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on Observation, during a tour of the bathroom located beside the two (2) year old room a can of Lysol disinfectant and a bottle of Windex glass cleaner were found in an unlocked cabinet over the sink. There are step stools at the sink making the cleaning supplies accessible to the children. An interview with the staff person in charge indicated that children ages one (1) to four (4) years old use this particular bathroom.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, it was found that ibuprofen had been administered to a child in the one (1) year old by a staff person. The instructions given by the parent said "as needed". There was no date or time documented when the medication was administered. However, the staff person's signature was listed in the space on the medication administration form indicating the medication had been administered. A review of medication records in the infant room found that a staff person had administered Tylenol to a child based on the parent's written insturctions to administer as needed every four (4) hours. The Tylenol was administered eight (8) times to the child between the dates of 2/2/16-2/16/16. During interviews with staff there was no comment or statement given as to why the medication was administered in this manner.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 8. Kitchen Requirements.

General: Based on Interview, upon arrival at the facility it was stated to the surveyor by a staff person that the staff person in charge was in the kitchen and she would have to call her and let her know the surveyor was present. The surveyor then went and started a walk through of the facility while the staff person contacted the staff person in charge. As the surveyor exited the one (1) year old room the staff person in charge was standing in the hallway. The staff person in charge stated she had been cooking pancakes for lunch for the children in celebration of National Pancake Day. The staff person in charge also indicated that this was something that has been done at the facility for many years and was started by a former director. However, a review of documentation found that the facility does not have a food service permit that would allow them to prepare food. An interview with the staff person in charge also indicated that children normally bring their lunch each day with this one (1) day out of the year being an exception.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, during a tour of the three (3) year old room the children were observed eating lunch. The children were served pancakes and applesauce with milk to drink. There was no additional fruit or vegetable nor was their a protein served. During a tour of the two (2) year old room the children were observed eating pancakes, applesauce, corn and milk to drink for lunch. They were not served a protein. Children's Records

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110. Section 3. Records.

General: Based on Review of Documentation, out of ten (10) children's files reviewed it was found that none of the children's enrollment information included a preferred hospital. Only the name and phone number of the children's physician was listed. The staff person in charge indicated in interview she was not aware this information needed to be part of the information in the children's files. 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; An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 24 of 27 Web site: http://chfs.ky.gov/ Inspection Report Written Documentation

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110. Section 3. Records.

General: Based on Review of Documentation, it was found that there are two (2) children who receive child care services through the Child Care Assistance Program. It was also found that one (1) of the children's daily attendance records documenting the time of arrival and time of departure had not been documented on the appropriate form since 10/31/15. Further record review found that there was no evidence of documentation of the child's time of arrival and time of departure using the appropriate recording form for the other child who has been enrolled since 9/15. During an interview with the staff person in charge it was indicated that she keeps her own ledger of the required information and that it is too much to keep up with using the other forms. Let it be noted that as of the date of the survey the children were still enrolled.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Observation, during a tour of the facility daily schedules with times listed for activities was posted. However, during a tour of the facility the following dates were listed on planned program of activities posted in various classrooms. The date on the planned program of activities posted in the one (1) year old room was February 29, in the three (3) year old room the date had been written in pencil but was erased but you could see a portion of what was erased and it read Feb. 10-14. Another date had not been put in place of what had been erased. In the four (4) year old room Week 22 was listed at the top of the planned program of activities and no date and in the two (2) year old room Week 25 was listed at the top with no date. The school age children were present at the time of the visit becasue school had been closed due to the weather. However, there was not a daily schedule posted for the school age children nor was there a planned program of activities posted with a date when activities are to be conducted.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Interview, it was found that the three (3) year old child was being placed in a high chair for time out. In an interview with staff, they stated that the child was placed in a high chair to keep her from injuring herself because she liked to throw herself back on the floor.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Observation, upon arrival at 10:30 a.m., the surveyors observed a female child in the hallway putting a piece of paper into her designated basket which was positioned along the wall outside of her classroom. After a few seconds the child was observed to go back into her classroom. The child was not within scope of vision of the classroom teacher during this time.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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

General: Based on Review of Documentation, four (4) staff (hire dates: 8/13/14 and (3) 9/2/14) did not have proof of education on file.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, two (2) staff (hire date: 9/2/14) had TB skin documentation on file that was completed after their hire date. The TB skin documentation on file for both staff was dated 9/18/14.

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Review of Documentation, five (5) staff did not complete the fifteen (15) hours of cabinet- approved training. One (1) staff (hire date: 8/27/14) did not have documentation on file of the required six (6) hour cabinet- approved orientation training. 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: 1. The background checks as described in 922 KAR 2:110; and 2. An annual check of the: a. Kentucky driver history records in accordance with KRS 186.018; or b. Driver history records through the state transportation agency that issued the driver’s license; (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

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Observation, one (1) ceiling tile located in the restroom was discolored with a brown water stain.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on Observation, the surveyor observed a staff person change a child's diaper in the Nursery at approximately 11:00 a.m. The staff person sent the child back to the group without having her hands washed after the diaper change.

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

General: Based on Interview, the surveyor found that staff administer Little Remedies Gas Relief Drops to an infant every day before and after she takes a bottle. The staff person stated the parent verbally told them to do so. She stated there was no written request from the parent. The staff person stated she was under the impression that parents only complete a written medication permission form if it is prescription medication prescribed by a doctor. Little Remedies Gas Relief Drops contain the following drug fact: 20 mg of Simothicone.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

General: Based on Observation, the surveyor found that staff administer Little Remedies Gas Relief Drops to an infant every day before and after she takes a bottle. The staff person stated the parent verbally told them to do so. She stated there was no written request from the parent. The staff person stated she was under the impression that parents only complete a written medication permission form if it is prescription medication prescribed by a doctor. Little Remedies Gas Relief Drops contain the following drug fact: 20 mg of Simothicone. There was no documentation of the times this medication was administered to the child.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 11. Toys and Furnishings.

General: Based on Observation, the surveyor observed the following in the four (4) year old extended day classroom: (1) a tear was observed on the arm of a blue child sized couch and the legs of a child sized table were found to be very wobbly and not secure. (2) The red shelving units located in the toddler classroom #211 had areas of peeling red paint.

Open Not marked corrected in the state record

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922 KAR 2:120 · 922 KAR 2:120. Section 3. General Requirements.

General: Based on Interview, the surveyor found that bottles are heated in the microwave. The staff peson stated sometimes she uses a bottle warmer and sometimes she heats the bottles in the microwave. 915 - Kitchen Exemption Not Applicable 922 KAR 2:120. Section 4. Premises Requirements. (18) A kitchen shall not be required if: (a) The only food served is an afternoon snack to school-age children; and (b) Adequate refrigeration is maintained. 920 - Kitchen Requirements Not Applicable 922 KAR 2:120. Section 8. Kitchen Requirements. (1) The kitchen shall: (a) Be clean; (b) Be equipped for proper food: 1. Preservation; 2. Storage; 3. Preparation; and 4. Service; (c) Be adequately ventilated to the outside air; and (d) Except in a Type II child-care center when a meal is not being prepared, not be used for the activity of a child. 925 - Food Service Permit Not Applicable 922 KAR 2:120. Section 8. Kitchen Requirements. (2) A child-care center required to have a food service permit shall be in compliance with 902 KAR 45:005 and this administrative regulation. 930 - Food Preparation Utensils Not Applicable 922 KAR 2:120. Section 8. Kitchen Requirements. (3) Convenient and suitable sanitized utensils shall be: (a) Provided; and (b) Used to minimize handling of food during preparation.

Open Not marked corrected in the state record

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922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, the surveyor found that 2% milk is being served to children ages two (2) and older.

Open Not marked corrected in the state record

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922 KAR 2:120 · 922 KAR 2:120. Section 9. Food and Meal Requirements.

General: Based on Observation, during the survey at lunch time, the surveyors observed the children's lunches that their parents provided. Most of the children ages two (2) to four (4) years old were missing some of the required components of their meal such as a protein, fruit, and vegetable. The three (3) and four (4) year olds also did not have milk to drink. A gallon of 2% milk was observed in the two (2) year old classroom; however, the staff stated they do not give the children milk until they have eaten most of their food first. It is important to note the facility had individual portions of peas and carrots stored in a cabinet. The staff person in charge indicated supplemental food such as peas and carrots are offered to the children who are missing food components but if the child refuses the food then it is not physically given to them. An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 23 of 26 Web site: http://chfs.ky.gov/ Inspection Report Children's Records

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

General: Based on Review of Documentation, there was not a current annual evaluation for two (2) staff; hire dates 10/11/10 and 9/8/11. An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 5 of 26 Web site: http://chfs.ky.gov/ Inspection Report

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

General: Based on Observation, there were several uncovered electrical outlets in areas used by the children. These areas included the hall area where the children gathered when coming in from the playground and the fellowship hall where some children ate lunch.

Open Not marked corrected in the state record

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

General: Based on Observation, a toilet in the two (2) year olds' bathroom had been used but had not been flushed properly. Hygienic Practices

Open Not marked corrected in the state record

Open / not marked corrected.

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

General: Based on Observation, the waste receptacle in the two (2) year olds' bathroom used for disposing of diapers was not covered.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

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

General: Based on Observation, the black ground covering sheet was exposed through the mulch in multiple large areas of the playground.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on Observation, an infant was sleeping in a swing, not in a crib. The infant's daily sheet stated she had fallen asleep at 9:05 AM and she was observed still sleeping in the swing at 10:50 AM.

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922 KAR 2:120 · 922 KAR 2:120. Section 6. Sleeping and Napping Requirements.

General: Based on Observation, the children's bedding was stored on the children's cots. The bedding was piled on the cots so that it was touching the cot above or it was hanging over the edge so that it was touching the cot below. This was found in the two (2) year old room and with the cots stored in the hall near the three (3) year old room.

Open Not marked corrected in the state record

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922 KAR 2:110 · 922 KAR 2:110. Section 3. Records.

General: Based on Review of Documentation, there were not current professional development plans for two (2) staff; hire dates 10/11/10 and 9/8/11.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 5 (1)

General: Based on Review of Documentation, it was found that the files for employees hired on 8-26-05, 9-9-10 and 8-21-11 contained the results of TB skin tests that were read on 8 -3-10, 9-5-10 and 8-20-10 respectively. These dates are not within the two (2) year timeframe required by the regulation. 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 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 2) Type II Not Applicable 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 In Compliance 2) 9 hours-first year In Compliance 3) 15 hours annually In Compliance 317 - Driver requirements Not Applicable 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 Not Applicable An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 8 of 40 Web site: http://chfs.ky.gov/ Inspection Report 2) Background checks Not Applicable 3) Drivers license Not Applicable 4) No convictions for vehicle operation Not Applicable 5) No accident causing death Not Applicable 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

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 4 (1)

General: Based on Review of Documentation, it was found that the file for an employee hired on 9-9-10 did not contain evidence of an annual performance evaluation.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 3

General: Based on Review of Documentation, it was found that the file for an employee hired on 9-9-10 did not contain an annual professional development plan. 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 An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 7 of 40 Web site: http://chfs.ky.gov/ Inspection Report 3) Previous State of Residence In Compliance 4) Current State other than KY In Compliance

Open Not marked corrected in the state record

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

General: Based on Review of Documentation, it was found that the files for employees hired on 9-9-10 and 2-11-13 did not contain evidence of a high school diploma, GED or Commonwealth Childcare Credential.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120 - Section 5

Toddlers: Based on Observation, it was found that there were five (5) two (2) year old children present in the one (1) year old classroom. The teacher stated that the age groups are together in the classroom all day every day.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 3

General: Based on Review of Documentation, it was found that the file for a child enrolled on 3-6-12 contained an immunization certificate that expired on 2-16-13.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 5 (1)

General: Based on Review of Documentation, the surveyor found that two (2) staff (hire dates: 6/9/2011 and rehire 9/8/2011) had TB skin tests read after their hire date. 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 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 2) Type II Not Applicable 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 In Compliance 2) 9 hours-first year In Compliance 3) 15 hours annually In Compliance An Equal Opportunity Employer M/F/D Cabinet For Health and Family Services Page 8 of 40 Web site: http://chfs.ky.gov/ Inspection Report 317 - Driver requirements Not Applicable 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 Not Applicable 2) Background checks Not Applicable 3) Drivers license Not Applicable 4) No convictions for vehicle operation Not Applicable 5) No accident causing death Not Applicable 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

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:110 · 922 KAR 2:110 - Section 2

General: Based on Observation, the surveyor found an allergy document posted on the three (3) year old bulletin board. The list included the children's names and what type of allergy/ health condition they each had i.e.- peanut allergy, asthma etc. The staff person in charge removed the document during the inspection.

Open Not marked corrected in the state record

Open / not marked corrected.

922 KAR 2:120 · 922 KAR 2:120 - Section 3

Nursery: Based on Observation, the surveyor noted that there were two (2) sleeping infants propped in a slightly upright position with "boppy pillows" that were inside of their cribs. The staff person in charge stated that the infants did not have a medical note that would require the them to sleep in a slightly upright position.

Open Not marked corrected in the state record

Open / not marked corrected.