R 400.8152 · R 400.8152 Medication; administrative procedures. (9) A center shall maintain a record as to the time and the amount of medication given or applied, with the exception of medications described in subrule (8) of this rule, on a form provided by the department or a comparable substitute approved by the department. One form per medication is required. The signature of the child care staff member administerina the medication must be included.

On 11/23/2022, I completed a telephone interview with Child A's Mother. Child A's Mother stated that Child A was on medication for an ear infection. The medication needed to be administered while at the center. Child A's Mother provided the medication and filled out a permission form for the medication. Child A's Mother knows that the staff administered the medication because they called and asked her questions about the medication. However, the time, the amount, and who gave Child A the medication was not indicated on the daily record sheet. On 11/28/2022, I completed an unannounced on-site inspection at Meadowbank Nursey and Kinderg. I interviewed program directors Denise Urbanowski and Anne Boardman, CCSM's Elizabeth Thomas, Allyssa Dusman, and Hailey Smith. Program director Denise Urbanowski stated that medication administration is recorded on the infant toddler daily record form. The form goes home to parents daily. The center does not keep any other documentation of medication being administered. CCSM's Elizabeth Thomas and Hailey Smith do not remember having any infants that needed to have medication administered. CCSM Allyssa Dusman remembers Child A needing to be given medication however, she did not administer any medication. Allyssa did specifically mention that the staff may have missed recording, "medication being given or diaper change or two." All CCSM's stated that anyone can administer medication to a child. On 11/28/2022 I completed a telephone interview with CCSM Amber Robinson. Amber was not sure of any kids who have had to have medication administered. Amber is very careful when administering medication. Amber always has another staff member verify the dosage and she ensures that she records the medication being administered on the daily record. Medication administration is something that she would never forget to record. On 11/28/2022, I completed telephone interviews with Child B and C's Mother and Child D's Mother. Both parents have never had to have medication administered at the center. During the unannounced inspection on 11/28/2022 I observed four daily records that were provided by the parent for Child A. Child A's parent listed medication that needed to be given to Child A, including the time, amount, and type of medication. Child A's parents also indicated that the medication needed to given with food. Two of the four days, Child A did not have any assigned primary caregiver, and other two Child A had two different primary caregivers. I provided technical assistance to the program directors on mediation administration procedures. I informed program directors that they must keep a record of all medication administered. They were told that they can continue to use the daily record to inform parents of the medication administered however, the center must retain on file the medication that was administered as required by the rule. I also stressed the importance of ensuring that A medication administration is properly recorded, and parents are informed of times and amounts given to prevent from over medicating a child. Lastly, I provided consultation on children who are on medication should have the same primary caregiver for the duration of the medication and only the primary caregiver should administer the medication to ensure that there is continuity of care.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (1)A center shall have a written plan for how and when a parent is notified when personnel observe any of the following: (a) Changes in a child's health.

On 11/23/2022, I completed a telephone interview with Child A's Mother. On 10/11/2022, Child A had a cough that Child A's Mother thought needed to be addressed by a doctor. The doctor's office did not have any early same day appointments and informed Child A's Mother that if Child A did not have a fever Child A would be fine going to the center. Child A's Mother dropped Child A off at the center around 9:30 a.m. Child A's Mother returned to pick Child A up for his doctor's appointment around 2:00 p.m. As soon as she saw Child A, she knew that Child A had a fever. Child A felt warm to the touch. Child A arrived at the doctor's appointment with a 104-degree fever. Child A's Mother felt that the staff should have noticed that Child A was sick and called and informed her. Child A was diagnosed with RSV and was hospitalized for five days. Child A did not return to the center after this incident. Child A has been sick a lot while enrolled at the center which, Child A's Mother expected. However, after unrecorded medication and a hospitalization she felt that Child A should not remain at the center. On 11/28/2022, I completed an unannounced on-site inspection at Meadowbank Nursey and Kinderg. I interviewed program directors Denise Urbanowski and Anne Boardman, CCSM's Elizabeth Thomas, Allyssa Dusman, and Hailey Smith. Program director Denise Urbanowski stated that if staff notice that a child is ill then she goes down to the room and takes the child's temperature. If the child has a 7 temperature of 100.4-degrees or higher the parents are called to come pick the child up. If the temperature is near that, staff are told to monitor the child and let her know if she should come back and retake temperature. Denise does not remember any children being dropped off sick or appearing sick. Generally, children come in ok and then get sick throughout the day. Denise also has not received any complaints from parents about a child being sick or it not being reported by staff properly. Due to the volume of RSV cases the center has begun informing all families of any diagnosis of RSV and in which room. The parent daily record that the parent provides for the center for drop off was not able to be found for 10/11/2022 for Child A. CCSM's Elizabeth Thomas, Allyssa Dusman, and Hailey Smith all stated that there have been several infants who have become ill throughout the day. All three CCSM's stated that once they notice a change in the child, they follow the procedure that Denise stated above. All three CCSM's have had at least one infant that they have called down for because they noticed the child appeared ill or a change in their behavior. All three CCSM's were unable to remember the exact day that Child A was ill. On 11/28/2022, I completed telephone interviews with Child B and C's Mother and Child D's Mother. Child B and C's Mother has never had to come pick Child B or Child C up due to an illness. Child B and C's Mother does have friends whose children attend the center. Child B and C's Mother do know that her friend has had to pick her children up from the center because they were ill. Child D's Mother has had to pick Child D up from the center due to an illness. The center called Child D's Mother and told her that Child D had been really fussy and when they took Child D's temperature it was high.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8173 · R 400.8173 Equipment. (11) Trampolines and bounce houses must not be used by children in care at the child care center.

The center had a large bounce house inflated inside the center. While onsite the bounce was being deflated.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

R 400.8185 · 1 R 400.8185 Primary care. (3) Each infant and toddler shall have not more than 4 primary caregivers in a week. For centers operating less than 24 hours a day, an exception may occur during the first hour after the center opens and the hour before closing. z

Child A had no primary caregiver listed or more than four primary caregivers during a week in which medication was being administered.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.