R 400.8112(6) · R 400.8112(6) Children's records. (6) Physical evaluations must be updated every 13 months for infants and toddlers, and every 2 years f or preschoolers.

I reviewed six infant files. Out of the 18 toddler files I reviewed, 7 files did not have an updated physical within the last 13 months. Out of the 20 preschool classroom files I reviewed, 6 files did not have an updated physical within 2 years.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8280(1) · R 400.8280(1) Discipline (1) Positive methods of discipline that encourage self-control, self- direction, self-esteem, and c ooperation must be used.

Teacher 1 uses positive methods of discipline that encourage self-control, self- direction, self-esteem, and cooperation. She did not grab a child inappropriately in the hallway.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8280(2)(a) · R 400.8280(2)(a) Discipline (2) All of the following means of punishment are prohibited: (a) Hitting, spanking, shaking, biting, pinching, o r inflicting other forms of corporal punishment.

Teacher 1 did not use prohibited forms of punishment and did not forcibly put Child A into time out or pinch him.

Open Not marked corrected in the state record

Open / not marked corrected.

R 400.8280(1) · R 400.8280(1) Discipline (1) Positive methods of discipline that encourage self-control, self- direction, self-esteem, and c ooperation must be used.

Program Director did not provide appropriate care and supervision when she pulled Child C by his arm and put him in time out for five minutes and picked Child D, Child E, and Child F off the floor and set them down aggressively.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8280(2)(a) · R 400.8280(2)(a) Discipline (2) All of the following means of punishment are prohibited: (a) Hitting, spanking, shaking, biting, pinching, o r inflicting other forms of corporal punishment.

PA used corporal punishment when she pushed Child B after she threw her sandwich in the garbage.

Open Not marked corrected in the state record

Open / not marked corrected.

R 400.8280(2)(e) · R 400.8280(2)(e) Discipline (2) All of the following means of punishment are prohibited: (e) Depriving a child of meals, snacks, rest, or n ecessary toilet use.

Program Administrator deprived Child B of her lunch as form of discipline because she did not eat her sandwich.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

R 400.8213(1)(a) · R 400.8213(1)(a) Staff; volunteer (1) All staff and volunteers present at the center shall: (a) Provide appropriate care and supervision o f children at all times.

Program Administrator did not provide appropriate care of Child A when she yelled at Child A for not being able to put on his shoes without assistance and she refused to assist him.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8213(1)(b) · R 400.8213(1)(b) Staff; volunteer (1) All staff and volunteers present at the center shall: 3 LANDMARK BUILDING • 105 W. ALLEGAN STREET • LANSING, MICHIGAN 48933 Michigan.gov/MiLEAP (b) Act in a manner that is conducive to the welfare o f children.

Program Administrator is not conducive to the welfare of children.

Open Not marked corrected in the state record

Category: recordkeeping. 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 09/16/2022, and I made an unannounced visit to the center. trim eriy t-ittton, program director was interviewed. She is not present at the center as did called in. Shortly after speaskiangiW , licensee designee, Shawn Towsley joined the meeting and was interviewed with Ms. Flitton. On 10/13/2022, Ms. Flitton received a text message while she was outside on the playground with the child care children from stating Child A hurt his arm and asked if Ms. Flitton wanted to come and check out his injury. When Ms. Flitton arrived in the classroom, Child A was sitting on the floor, next to . Child A was not crying, but he was holding his arm close to him. Ms. FlItton spoke with Child A, and he first said "crash." Ms. Flitton asked him "what does that mean?" and he responded, "Crash n Ms. Flitton asked Child A if he could move his arm and he just looked at her an could not squeeze her finger when asked. Child A's Mother was already at the 3 center, so Ms. Flitton took Child A to his mother as she knew he was in "serious pain." Child A has had issues with nursemaid elbow in the past and the same arm that had nursemaid elbow was the same arm that was inured. Child A's Mother left with Child A and then Ms. Flitton spoke with about what happened. said she believes Child A tripped over another child and landed on a toy dinosaur. At this time, Ms. Flitton needed to be back into another classroom, so she left until ratios in the other room were met. She s oke with again once the children in her classroom left. explained she had her back turned to the child care children because she was on er phone and didn't see what happened to Child A. Ms. Flitton told her you are never supposed to turn your back on the children and advised her this was a serious situation. Ms. Flitton called Child A's Mother at approximately 6:30PM the same day and left a voicemail message asking for updates on Child A. Child A's Mother returned her call later that night and said she took Child A to a local urgent care. He was diagnosed with dislocation of his elbow and the doctor put his elbow back into socket. She also said Child A told her grabbed my arm." Ms. Flitton reported this to child care licensing the next morning. The next day, did not work with children unsupervised, and Ms. Towsley spoke with her. Ms. Towsley said she spoke with alone in the classroom.* told her the children were playing, she believed she had eight or nine "C i en, but Ms. Flitton advised she had seven, said her phone rang three times and on the third time, at 4:23PM she answered Perphone with her back turned towards the children. Child A was running around the classroom, when she turned around, she saw Child A on the floor screaming. She said there was another child that had Legos and blocks on the floor and the other children said Child A tripped over another child and fell. Child A had a scratch on his arm from an unrelated incident earlier in the day. Ms. Towsley said she sent home for the day on paid leave and advised her this incident would e investigated. Ms. Towsley said she spoke with child care staff member who also works in the same classroom as was IMpresent during the time of the incident. Ms. Towsley asked her about Child A. said Child A is a normal 3-year-old child that runs around the classroom arid has to be redirected. Ms. Towsley asked what does when he runs around the classroom, she replied to tells him to stop running, puts toys on the tables and puts him to play by himself. She said does not grab him but asks him sit. She was asked how often takes phone calls and she replied not very many and when she does, they are usually from her Ms. Towsley spoke wit[ later this day as she forgot to ask further questions and asked her again to walk her through what happened that day. She said she walked over to Child A, asked him what happened as he was crying, and the other children said he tripped over another child. Child A was sitting playing with the cars and tapping on the bl

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8140 · R 400.8140 Discipline. (1) Positive methods of discipline that encourage self- control, self-direction, self-esteem, and cooperation must be used. 9

There is insufficient evidence to support that did not use positive methods of discipline with Child .

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.

There is insufficient evidence to support that grabbed or used corporal punishment with Child .

Open Not marked corrected in the state record

Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (5) A center shall have a written policy detailing when children, staff, and volunteers will be excluded from the center due to illness.

Program director Kim Flitton stated that children who are ill are not allowed to remain in care at the center. She stated that children who vomit one time or have diarrhea twice, must be picked up by their parents. Children with fevers are also required to leave the center and they cannot return until they are fever free for 24 hours without medication. When children begin to show symptoms a child care staff member takes the child's temperature. If there is no fever a message is sent to the child's parents to let them know that they child is not feeling well. The child does not have to go home immediately if there is no fever, vomiting or diarrhea. When children are ill and waiting to be picked up, they are separated from the other children as much as possible in the classroom while lying on their cot. Ms. Flitton stated that there have been incidences of COVID-19, hand foot and mouth, croup, and RSV at the center. She stated that she closes classrooms when someone tests positive for COVID-19 and informs parents and the child care staff members if they are a close contact for someone who tests positive for COVID-19. No children have tested positive for COVID-19, but they have been close contacts. The rooms are cleaned and sanitized "really well" whenever any child or child care staff member tests positive for a communicable disease. Ms. Flitton stated that she is really on top of who is sick and who is not. She makes a report of every communicable disease to the health department. Ms. Flitton stated that Child A (male, age 2 years) tested positive for hand foot and mouth disease in September 2021. Child A was not allowed to return to center until he was fever-free for at least 24 hours without medication. Child A remained out of care for five days. When Child A returned to the center his hands and arms were covered in bandages because Child A's Mother reported that Child A was picking at the scabs on his hands and arms while he was at home. Ms. Flitton reported that there were no weeping sores on Child A's body when he returned to care. Ms. Flitton stated that when she received a call from a concerned parent who saw Child A's sores being covered, she explained to her that Child A had been seen by the doctor and was cleared to return to the center. Ms. Flitton denies allowing child care staff members who are ill to work at the center. She stated that because there have been so many cases of COVID-19 among child care staff members at the center she allows the child care staff members to call in sick any time that they are feeling sick. Ms. Flitton does not want anyone to get sick, so she has been making sure that sick children and child care staff members stay at home. She stated that there have been child care staff members present with a cough or runny nose and they have been allowed to work if they did not have a fever and they felt ok to work. If child care staff members have a fever they are not allowed to return to work until they are fever free for 24 hours without medication. Ms. Flitton stated that she also requires children to remain at home for 10 days if 3 their parent test positive for COVID-19 and again for another 10 days after the parent has tested negative just to be sure that the child has not contracted it. During the onsite inspection I reviewed the center's exclusion policy. The policy states that children will be excluded from care if they exhibit any of the following: temperature of 99 degrees Fahrenheit or higher, one instance of vomiting cannot return for 24 hours after vomiting ends, two loose stools, eye discharge, open sores on any exposed area of the body that has fluid discharge that cannot be covered, unidentified rash, and head lice. Child care staff member Stephanie Wright has been employed by the center since February 2021. Ms. Wright works in the infant room. Ms. Wright stated that she does not believe that children who are sick are allowed to remain at the center. She stated that program direc

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. r

On November 6, 2020 1 spoke with Child A's Mother. She stated Kim Flitton, program director, called and said Child A fell and she did an assessment of her fall. Ms. Flitton told her there was no swelling, no warmth to the injury site, no visible injury, and Child A was able to pick up toys and move the arm around. Child A's Mother stated Ms. Flitton told her if it was still bothering her then she would want to take her to the doctor. Child A's Mother stated she decided to pick her up at her normal time and when she picked up, Ms. Flitton told her that when Child A tried to stand up out of the little chair she would not put pressure on the arm and she was favoring the arm. Child A's Mother stated Ms. Flitton told her she did not have a written report to give her because her staff did not know they needed it due to the fact Ms. Flitton had called her. Child A's Mother stated she took Child A to Sparrow main campus and it was determined that her arm was broken. Child A's Mother stated they put it in a plaster splint, and she has to take her in in a week to see if it is healing or if it will need to go into an actual cast. Child A's Mother reported Child A has been attending Greyhound Early Learning Center since she was 3 months old and she has been very happy with the care her daughter receives there. Child A's Mother stated Child A is quite incident prone and they do fill out incident reports regularly on her. Child A's Mother reported she does not have any concerns regarding the incident, it is more difficult with COVID-19 because she does not get to go in and see how interactions are. Child A's Mother stated Child A seems to be doing well. Child A's Mother reported as to her over all time at Greyhound Early Learning Center, she has no concerns regarding supervision, or the care Child A receives there. Child A's Mother reported the climber Child A fell off of is a foot off the ground, if it was a higher fall or a different piece of equipment this might be a bigger concern, but she feels it was an accident. On November 7, 2020 I completed an on-site inspection from 9:00 a.m. to 10:00 a.m. I interviewed Kimberly Flitton and she indicated on November 5, 2020 Child A was playing on the climber and fell, landing on her arm/wrist. Ms. Flitton reported she checked Child A and she was able to pick up a toy. Ms. Flitton reported she called Child A's Mother and let her know what happened. The incident report submitted by Ms. Flitton notes the incident occurred at 4:00 p.m. and she was picked up at 5:19 p.m. Ms. Flitton stated she checked on Child A consistently until Child A's Mother arrived and Child A was picking up things and waiving at people. The climber was observed, photographed, and measured. It was noted from the platform where children stand to the floor is 16 inches and from the top edge of the climber to the floor is 29 inches and the padding under the climber is just under an inch thick. Ms. Flitton provided the sign-in sheet for November 5, 2020. The sheet indicates there were four toddlers and one staff present at the time Child A fell from the climber. 3 On November 7, 2020 I interviewed Michelle Lokken, child care staff member. Ms. Lokken reported she has been working for Greyhound Early Learning Center for two years and she was working the day Child A fell from the climber and injured herself. Ms.Lokeen reported she was helping other children, and was facing the climber so she was able to see Child A as well. Ms. Lokken stated Child A was on the climber and she flipped over the top edge of the climber and landed on her arm. Ms. Lokken reported she ran to Child A and got her up, Child A was crying and upset. Ms. Lokken stated she got ice for Child A's arm and Child A's Mother was contacted. Ms. Lokken reported Child A was at the table for much of the time until she was picked up, and Ms. Lokken tried to keep her as comfortable as she could. Ms. Lokken stated Child A would burst out crying and then hold her arm. Ms. Lokke

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8173 · .................... R 400.8173 Equipment. ............................................. ...................................................................... ............................. .................................................................................. (4) Play equipment, materials, and furniture, must be all of the following: (b) Safe, clean, and in good repair.

Kimberly Flitton used the climber Child A fell from without reading and/or following the instructions manual to ensure the climber was being used safely.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.