R 400.8137 · R 400.8137 Diapering; toileting. (6) Diapers and training pants must be checked frequently and changed when wet or soiled.

On 08/26/2022 I spoke with Child A's Mother. She said she spoke with Ms. Smith regarding diaper changes and asked her if child care staff members were changing Child A frequently. She replied everything is documented within the Bright Wheel app. However, according to the app, on Tuesday, 08/23/2022 Child A went six hours without a diaper change but did not have a diaper rash this week. There was another day, unknown date, that Child A went four hours without a diaper change, and he had to receive ointment because a rash developed. The rash turned into a staph infection; Child A's Mother believes this occurred sometime around the middle of July 2022. When Child A first began care he was part time and it seemed he was only being changed once or twice throughout his half days. It appears Child A is not being changed frequently enough. Child A was taken to urgent care for his staph infection where they confirmed that this infection was caused from not being changed frequently enough. Child A was then put on medications for 14 days that included Amoxicillin and Nystatin. Child A's Mother spoke to child care staff members present in the morning about diaper changes, unknown names, but they do not say much back about Child A's diaper changes. On 08/30/2022 Licensing Consultant Karen Woodman and I made an unannounced visit to the center. caregiver was interviewed. She said when Child A left the child care, he had a very sore, testicle area, and other child care staff members applied cream on the area. Child A's Mother said this was because Child A's Father left Child A in his diaper for too long without a change and he has a sore bottom because of Child A's Father. She is unsure what ointment was being used, but it came in a black tub, 10 that Child A's Mother provided. She said she was not present at the center for the month of July and did not know Child A had a staph infection. said child care staff members change diapers every two hours unless a child is very wet or had a bowel movement. The children that are being potty trained tend to be changed more since they are using the potty and if they are wet, they are changed right away. Child A's Mother wanted Child A to start using the potty, but Child A would not go. The child care staff members did not want to force him to do so to avoid creating a negative connection to using the potty. Child A's Mother was told Child A isn't ready to use the potty. Child care staff members will encourage Child A to use the potty if he shows interest, but no one was going to force him. All child care staff members take turns changing diapers. Diapers are changed in the morning right after snack time and after nap time. When she changed Child A's diaper, she noticed red marks around his area, but the cause of this is unknown. Whenever he has a red area during a diaper change, child care staff members will put ointment on him. Sometimes this is documented on the Bright Wheel app. There have been times that a child was changed, and it was not updated on the Bright Wheel app. She said if the app showed that a child was not changed for six hours, then it would have been because the entry wasn't made. said, "I assure you, there is no way he would have gone six hours without a diaper change. If a change was made and the diaper was dry, the app would or should have reflected a dry diaper." retrieved records from the Bright Wheel app. The records showed the following: • On 7/20/2022, Child A checked into the center at 7:49AM, his first diaper change was recorded at 8:43AM, next diaper change was recorded at 2:36PM, then he departed the center at 3:00PM. • On 7/21/2022, Child A arrived at the center at 7:48AM, was changed at 8:14AM, the next change and again at 11:30AM. He was changed at 2:05PM and departed the center less than two hours later. said Child A could have tried to use the potty and maybe he was dry or wet at this time and a child care staff member forgot to record it. • On 07/22/2022, Child A ar

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8125 · R 400.8125 Staff; volunteer; requirements. (1) All staff and volunteers shall provide appropriate care and supervision of children at all times.

On 08/26/2022 I spoke with Child A's Mother. She said she has not spoken to Ms. Smith or any other child care staff members about the spanking marks on Child A's bottom. She said she noticed the mark on his bottom on Tuesday 08/23/2022. She went to mother-in-law's house after picking Child A up from the center and saw a perfect, red circle at the base of his bottom. She then asked her mother-in-law what she thought the mark could be from? The mark looked like a spank mark in the shape of a palm. She had just picked up Child A from the center and believed it could have only happened while he was in care that day. After the day progressed, the red mark disappeared. Child A pointed to his bottom and said "owie, I have an owie." Child A's Mother poked his red mark and Child A slapped her hand away; it was sensitive to the touch. The mark appeared small and could have been from another child or someone with small hands, but it looked like a spank mark. When 15 she picked up that day, there were two child care staff members present, Ms. Smith and Child A was not seen by a doctor for his red mark. On 08/30/2022 Licensing Consultant Karen Woodman and I made an unannounced visit to the center. was interviewed. She said no one at the center would ever hit a child and does not believe this would even be a possibility. Child A could have fallen, but if he does get hurt it is followed with an immediate "Owie owie". He reacts this way no matter how big or how small an incident is. was present at the center on Tuesday 08/23/2022 but does not recall any moments from Child A that resulted in an injury. He didn't seem to have any injury and she cannot recall a time that day that he pointed to his bottom and said "owie". Most of his injuries come from his hands and knees. She said there aren't any activities that make her, or other child care staff members frustrated enough to want to hit a child. The most yelling from child care staff members occurs to help the children find their voice and their words to model that they didn't like something. Child care staff members have been working on certain word usages, such as steering away from saying no, good job and be careful. They want to tell the children what they can do, not only what they cannot do and instead of saying good job, they can make observations like "I see you working really hard to fill that bucket with sand". She has no concerns that child care staff members are spanking children. - was interviewed. She said for discipline, if a child is hitting another child, child care staff members will say "That isn't nice" and "That hurts our friend, can you say sorry"? If they continue to hit, that child will sit with an adult to help calm themselves and they can get up and play when they are ready. This helps give the child space by themselves for a few minutes to deescalate. She said she has never seen anyone become physical with a child in any manner and no parents have come to her complaining about any of the child care staff members. She has never hit or grabbed a child, nor has she left any marks or bruises on a child, and she has never witnessed anyone doing this. A discussion around mandated reporting was held, ■ = said if she witnessed this happening, she would inform Ms. Smith and if needed, would report to _ and Child Care Licensing. was interviewed. She said she has no concerns for how child care staff members discipline children. If she suspected abuse or neglect or observed something inappropriate, she would stop it right away and speak with Ms. Smith about it. A discussion surrounding mandated reporting was held. She has never noticed any red marks on Child A's bottom, and he has never complained of his bottom hurting that she has observed. If Child A was hurting, he would let a child care staff member know. No parents have complained to her about discipline at the center or marks on a child's body and she has never seen a child care staff member hit or grab a child inappropria

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8140 · 1 R 400.8140 Discipline. (1) Positive methods of discipline that encourage self-control, self-direction, self-esteem, and cooperation must be used.

Child care staff members use positive and conscious discipline with the child care children.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8140 · ................................ R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: (a) Hitting, spanking, shaking, biting, pinching, or inflicting other forms of corporal punishment.

Child care staff members do not use corporal punishment as a form of discipline.

Open Not marked corrected in the state record

Open / not marked corrected.

R 400.8146 · R 400.8146 Information provided to parents. (3) For infants and toddlers, a center shall provide parents with a written daily record that includes at least the following information: (c) Elimination patterns, including bowel movements, consistency, and frequency.

Child care staff members did not provide Child A's Mother with an accurate, daily record of diaper changes as required. There were several diaper changes not recorded on 7/21/2022, 7/22/2022 and on 07/27/2022.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.