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. (b) A child experiences an accident, injury, or incident. c A child is too ill to remain in the group.

On 1/18/2023, during the onsite inspection, MDHHS worker Kenyetta Thomas and I interviewed Anna Boardman and CCSM 1 and CCSM 2 about an incident that happened on 1/16/2023. Anna Boardman stated that on 1/16/2023, Child A had what looked like a seizure. Staff had taken her temperature at 4:00 p.m. and it was 100.3 in one ear and 100.7 in the other. Staff retook her temperature at 4:15 p.m. and it was 101.4 and 101.9. Child A was sent back down to the classroom where she was then in the bathroom. CCSM 1 reported that Child A fell, and her eyes were opening and shutting, and she was convulsing. Program director, Denise Urbanowski, contacted the family at 4:26 p.m. Both Child A's Mother and Father were together at the time of the phone call and both parents said not to call EMS, and they arrived at 4:40 p.m. to pick Child A up. CCSM 1 and Denise sat with Child A until her parents arrived. Child A was awake and responsive when they left. Both Child A's Mother and Father stated that they were going to take her to Detroit Medical Center (DMC). Ms. Boardman contacted Child A's Mother on 1/17/2023 and they shared that Child A had an inner ear infection. She stated that she sent her licensing consultant Brandon Robinson and email on 1/17/2023 at 3:31 p.m. letting him know of the situation and that they were working on the full report to send to licensing. We interviewed CCSM 1, who is a floater in the building but was a lead caregiver substitute in Child A's classroom. She stated that on Monday 1/16/2023 at 4:00 p.m. Child A wasn't acting herself. She felt child's head and it felt warm, so she called office. CCSM 16 came to take the child down to get her temperature taken. Ms. Denise took her temperature and then CCSM 16 brought her back to the classroom and said to send her back down in 15 minutes to check again. Child A sat down in her chair, she didn't want to play or eat snack. Child A was sent back down at 4:15 p.m. to retake temperature. She was notified that Child A was going to be sent home. Child A was sent back down to the classroom to go to the bathroom and gather up her items while Denise was calling Child A's Mother. CCSM 1 stated that she helped gathered up Child A's items and had Child A use the bathroom. She watched Child A in the bathroom and had Child A wash her hands. Child A fell to the floor, and her arms were straight out and were jerky and shaking. She rolled Child A to her side and then yelled out the door for CCSM 2 to go get Denise. Denise came in and immediately took control and started timing the incident. The seizure lasted 52 seconds and they added 10 seconds for the time it took Denise to come down to the classroom. They documented that it lasted 63 second's total. Anne Boardman then came in and stayed with Child A. Denise contacted Child A's Mother and she took the rest of the children away. CCSM 1 stated that Child A's Mother and Father arrived at 4:40 p.m. to pick up Child A. She gave them details of what happened so they could communicate everything to doctors. A We interviewed CCSM 2. She stated that on Monday 1/16/2023, she was in the pink room. She was bringing a child down to the front to go home. On way back to the classroom she heard CCSM 1 yell out to her, "Get Denise" and that Child A is having a seizure. She got Denise and then got Anne Boardman from her office. She then checked to see if they needed her for any more assistance, she was not needed so she went back to her classroom. On 1/20/2023, I called Program Director, Denise Urbanowski. She said at 4:00 p.m. Child A was brought down to the office. She took Child A's temperature in both ears; one side was 100.3 and the other was 100.7. She sent Child A back down to the classroom and 10-15 minutes later she retook Child A's temperature, and it was 101.4 in one ear and 101.9 in the other. She sent Child A back down to the classroom to gather up her stuff while she was going to call Child A's parents. Before she could call Child A's parents, s

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8182 · 1 R 400.8182 Ratio and group size requirements. (3) In each room or well-defined space, the maximum group size and ratio of child care staff members to children, including children related to a staff member or the licensee, must be as shown in Table 4: TABLE 4 Child Care Staff Metut>er to ('hild Ratios Age Child Carr Staff' ! 14atiinitun 6. t` f. a .. n... t. s.. .. a.. n... d.. . t.. o.. d... d.. l. e... r. s.. ... . b... i. i.. l. h... . u... n... t. i. l. .. f. i. t. }.. ......... .`.'.l.e...u 1d t oe r 4 t o Child Ratio VS'[)t. 1:d 2.: . SiZr...................... et) FIto37thS of age

During the onsite inspection, I interviewed staff regarding ratio of each classroom. Assistant director Kristy Krohm and Anna Boradman stated that they are always in ratio. When children arrive, they are dropped off in one classroom. As staff come in, they separate the children into their classrooms. I observed all classrooms while onsite. Upon inspection, the blue room, which is a toddler classroom, to not be within the required ratio. There were 13 children present and 1 CCSM. It was rest time but not all children were asleep. There should have been two additional CCSMs present. I interviewed CCSM 1, CCSM 6, CCSM 7, CCSM 8, CCSM 10, CCSM 11, and CCSM 12. All staff members said that they have no concerns about ratio. I interviewed CCSM 9. She stated that sometimes they are out of ratio in the morning. On Monday of this week there were two CCSMs and 11 to 12 children in a toddler classroom all day when the ratio is supposed to be 1 to 4. I interviewed CCSM 3 and CCSM 4. Both CCSMs said they are often left out of ratio in a toddler classroom. It is usually just in the morning time as staff and children are arriving. I interviewed CCSM 5. She stated that she is sometimes out of ratio for up to 30 minutes in the morning time and that office staff told her it was okay to be one child over. This morning she had seven children present in a toddler classroom for 10-15 minutes while she was by herself when the classroom is at a 1 to 4 ratio. There should have been one additional staff member present. I followed up with Anne Boardman and Co-Director Terri Boardman, they stated that they send office staff down to help cover breaks and that an office staff was just sent down to the blue room. They have a staggered staff schedule, so staff come in every 15 minutes in the morning. Sometimes children come earlier then they usually do, which leads classrooms to be out of ratio but not for very long. I provided technical assistance informing them that when they find that students are arriving quicker then staff, office staff members should step into those classrooms to avoid being out of ratio, even for just 10-15 minutes. They should also document this on attendance sheets. I reviewed all staff and children attendance sheets from 1/9/2023-1/13/2023 and found multiple times classrooms were out of ratio. For the infant and toddler classrooms, which are the Pink, Blue, Orange, and Purple rooms, they have should have one CCSM for every four children present. On 1/9/2023, Pink room had five infants signed in but only one CCSM. They were out of ratio for 15 minutes until another staff member arrived. They were out of ratio three other times in that week all in the morning time for 10-20 minutes. On 1/9/2023, the Blue room had eight children signed in but only one staff member. They were out of ratio for an hour until a CCSM signed in. They were out of ratio one other time in that week in the morning time. All five days of the week, children are signed in 30-60 minutes before a staff member is singed in. It is unclear who is present with those children. rj On 1/9/2023, the Orange room has two children signed in, but no staff signed into that room. This happened all five days of the week. It is unclear who is present with those children. On 1/9/2023, the Purple room was out of ratio from 11:00 a.m. — 4:45 p.m. where there were nine children signed in but only two CCSM. They needed one additional staff member. On 1/10/2023, they had nine children signed in but only two CCSM. They were out of ratio for 20 minutes until an additional CCSM signed in.On 1/11/2023, they had nine children signed in but only two CCSM. They were out of ratio from 9:15 a.m. -10:25 a.m. until an addition CCSM signed in. On 1/12/2023, they had 10 children signed in that day but only two CCSM were signed in. They needed one additional CCSM in that classroom for the whole day. For each day in that week, they also had children signed in 30-60 minutes each morning before staff sign

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8182 · ................................................... R 400.8182 Ratio and group size requirements. .............................................. .............. ................................. ......................................................................................................................................... (3) In each room or well-defined space, the maximum group size and ratio of child care staff members to children, 11 ..... ....... . . including children related to a staff member or the licensee, must be as shown in Table 4: TABLE 4 Child Care Staff Member to Child Ratios Age Child Care Staff J xnuaau Member to Child Ratio Chup Size ( Preschooler.. 30 mouths of age I to 8 16 b until 3 years of age ( Preschoolers. 3 Sears of age until 4 1 to 10 Not applicable c years of age ( Preschoolers. 4 years of age until I to 12 Not applicable d) school-age { School-age►c I to 1S Not applicable e)

On 1/18/2023 I talked to all the CCSMs in the infant and toddler classrooms. No one reported having any concerns with primary caregivers. They have primary caregiver sheets in the classrooms detailing what child each CCSM is responsible for. I reviewed primary caregiver sheets from 1/9/2023-1/13/2023 and found two children, Child K, from Pink room, and Child L, from Purple room, that had six primary caregivers in one day. I also found that multiple children were not assigned second primary caregivers when their first primary caregivers left for the day or when a child was moved to a second room. 12 In the pink room, on 1/10/2023 and 1/13/2023, one child was not assigned a second primary caregiver after their first primary caregiver signed out. The staff's hours work listed on the primary caregiver sheet did not match that on their sign in/out sheet. In the blue room, on 1/9/2023, one child was moved to Purple room but was not assigned a new primary caregiver in Purple room. Another child was not assigned a second primary caregiver when their first primary caregiver signed out. On 1/10/2023, two children were not given second primary caregivers when their first primary caregivers left for the day. On 1/11/2023, one child was not assigned a second primary caregiver when their first primary caregiver left for the day and one child was moved to Pink room and was not assigned a primary caregiver. On 1/12/2023, two children were not assigned a second primary caregiver when their first primary caregiver left for the day. On 1/13/2023, one child was moved to Pink room but was not assigned a second primary caregiver. In the orange room, on 1/12/2023, one child was not assigned a second primary caregiver when her first primary caregiver left. On 1/31/2023 I spoke to Child I's Mother, and she stated that she does not know who her child's primary caregiver is. Staff don't always write who is filling out the daily information sheet that is sent home. They do not get to drop off or pick up in the classroom, so they don't get to talk to their child's primary caregiver. Child F's Mother stated that she feels staff are pretty good with primary caregivers "but since we can't go down to the classrooms it is harder to put a name to the face." We see different CCSMs at pick up and drop off. Child G's Mother and Child H's Mother, said that they always get a daily information sheet on how their child's day was. They had no concerns over primary caregivers. On 2/3/2023, I spoke to Anne Boardman and Terri Boardman and conducted an exit conference. They both stated that each child always has a primary caregiver but that it sounds like it is not being documented effectively. I provided consultation to Anne and Terri Boardman. I recommended that they change the way their primary caregivers are assigned to make sure that every child has a primary caregiver for their entire time at the center. I also provide technical assistance, informing them that if a staff member leaves before one of their assigned children, that child must be given a second primary caregiver. When they are moving children to different classrooms, they must assign that child a new primary caregiver and ensure children do not have more than four primary caregivers in one week. Staff must also write their names on the daily information sheets for their assigned children. If a child has more than one primary caregiver that day, both names must be on the form. This will ensure parents know who provided care for their child. 13

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8185 · 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.

The primary caregiver sheets from 1/9/2023-1/13/2023 show that Child K and Child L had six primary caregivers in one week.

Open Not marked corrected in the state record

Open / not marked corrected.