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: Age Child Care Staff member to Child Ratio Maximum Group Size a)lnfants and toddlers, 1 to 4 12 birth until 30 months of age b)Preschoolers, 30 months 1 to 8 16 of age until 3 years of age c)Preschoolers, 3 years of 1 to 10 30 age until 4 years of age d)Preschoolers, 4 years of 1 to 12 36 age until school-age e)School-agers 1 to 18 36 WV LI ! . ! . :• . i a • . •- -- 1' it i •- 11111 Isi.][s11I11[s] . . IEYT 1 1 • • • • - -. `i •, i• .•' • i'ii i. a •- • i' i li • I••• •, - -- •' i WI LI W&1 Fi 1 1i -

On 10/06/2022, I received a written complaint stating that all the children, besides infants, gather in one classroom in the morning which causes the center to be "out of ratio every single morning." The complaint also states that two child care staff members where present with approximately 19 children of all ages on 10/06/2022. Additionally, on another occasion, there were approximately 25 children present in one classroom in the morning with one child care staff member. The complaint states that there is video evidence. On 10/11/2022, I completed an on-site inspection. I was greeted by assistant director Samantha Goolsby. Ms. Goolsby advised that program director Karen Farr was off due to medical reasons. I provided Ms. Goolsby with my card to give to Ms. Farr upon her return. I informed Ms. Goolsby of the allegation. Ms. Goolsby agreed to take me on a tour of the center. We observed the classrooms from the hallway through a window. As we observed eight children with two child care staff members in the infant classroom, another child entered the classroom with her mother. Ms. Goolsby advised the child's mother that the child would be transitioning to the toddler classroom. Ms. Goolsby instructed the child's mother to take the child's tote from her cubby to the toddler classroom. She left her child in the infant classroom momentarily to take the tote to the toddler classroom, which required an additional staff member. I suggested to Ms. Goolsby that having a conversation with the parent would be beneficial to the child and the parent prior to a child transitioning to another 3 classroom. Ms. Goolsby stated that the child was only going to the toddler classroom for the day in order to maintain appropriate child to child care staff member ratios. I asked Ms. Goolsby how often children are shuffled from their classroom to another to maintain appropriate ratios. She stated that it has happened since she began working at the center six months ago. Ms. Goolsby acknowledged that moving infants and toddlers from their assigned classroom is not ideal. We observed four children with one child care staff member in the Preschool 1 classroom, eight children (youngest child 3-years-old) with one child care staff member in the Preschool 2 classroom, six children with two child care staff members in the Toddler A classroom, twelve children (youngest child 31-months-old) with two child care staff members in the Preppers classroom, and eight children with three child care staff members in the Twaddler classroom. Ms. Goolsby stated that an additional preschool classroom is currently closed due to staffing and enrollment. After we observed the rest of the classrooms, another infant was being dropped off to the infant classroom. Ms. Goolsby and I observed the drop off from the hallway. One of the child care staff members in the infant classroom was feeding a child in a highchair. She pointed to the child as she looked out the window towards Ms. Goolsby. Ms. Goolsby nodded to her. Ms. Goolsby explained that the child in the highchair would be moved to the toddler classroom in order to maintain appropriate ratios in the infant classroom. As I asked Ms. Goolsby if the child would be allowed to finish breakfast, the child care staff member stopped feeding the child and began to remove him from the highchair. Ms. Goolsby's response was, "I guess not." I suggested that she step into the classroom to maintain appropriate ratios while the child is allowed to finish breakfast. She readily agreed and we entered the infant classroom together. As we waited for the child to finish breakfast, the infant classroom received a call from the toddler classroom requesting they bring (Child L (15-month-old, female) back and switch for another child because she had yet to stop crying. A short time later, Child L was returned to the infant classroom. Her eyes were red from crying, but she appeared to be happy to be back in her assigned classroom. Ms. Goolsby and I fur

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8185 · R 400.8185 Primary care. (2) The center shall implement a primary care system so that each infant and toddler has a primary caregiver.

The center failed to ensure that each infant and toddler had a primary caregiver on multiple occasions between 09/27/2022 to 10/12/2022.

Open Not marked corrected in the state record

Open / not marked corrected.

R 400.8380 · R 400.8380 Maintenance of premises. (1) The premises must be maintained in a clean and safe condition and must not pose a threat to health or safety.

On 7/18/2022, I completed an onsite inspection at the facility. During my onsite inspection, I spoke to assistant program director, Samantha Schwartz. I discussed the allegations and she reported on 7/6/2022 there was a flood in the kitchen that leaked into the Infant A and Infant B classroom. Ms. Schwartz stated she was doing dishes when she noticed her feet getting wet and the draining system was not draining properly. A plumber was called immediately and came out right away to fix the problem. Infant A classroom was moved to the empty toddler classroom and staff members cleaned up the flood with mops and towels. The next morning staff noticed that Infant B Room also flooded, however that classroom is not being used, which is why it was not noticed. She stated that fans were set up to dry out the carpet and the carpet squares that were wet were removed. Ms. Schwarz stated that she has not seen any visible signs of mold. Ms. Schwartz showed me the kitchen, Infant A and Infant B classrooms. The kitchen is in the middle of the two classrooms. When the drained backed up, the water pooled on the kitchen floor and went into the Infant A and Infant B classroom. In the 2 Infant A classroom there was a small area that flooded near the wall towards the kitchen. The carpet was no longer wet. I did not observe any mold or any lingering effects of the flood. In the Infant B classroom there were six carpet squares that were pulled up. There was not any other carpet in the classroom that was wet or flooded. Under the carpet squares there was a sticky material that kept the squares in place. There was no mold observed. There were no children present in the Infant B classroom. The kitchen was clean and no mold was present. During my onsite inspection, I spoke to program director, Karen Farr. Ms. Farr stated that something got lodged in the draining system, water backed up and flooded the kitchen and the Infant A and Infant B classrooms. Ms. Schwartz was doing dishes when she noticed water on the ground. Ms. Farr reported that she contacted a plumbing service immediately who came out and fixed the draining issue. Staff members moved the children in Infant A classroom to the toddler classroom while they cleaned up the water with towels and mops. There were about five carpet squares in Infant A classroom that were wet and but not saturated. They used bleach spray water to clean up the water and by morning the carpet was dry. She reported the next morning they noticed Infant B had water on the floor. The furniture was removed from the classroom, water was cleaned up, and fans were set in place. Six carpet squares were removed and will be replaced. Ms. Farr stated that she has not seen any mold present and she did not feel that the flood was bad enough to call a restoration service. She also reported that Licensing Consultant Kathleen Hop was present at the facility when the flood occurred. Ms. Farr stated that they ordered the children in care pizza and did not use the kitchen. During my onsite inspection, I spoke to staff member, Makayla Thrush. Ms. Thrush stated she was working in the Infant A classroom when the flood from the kitchen leaked into the room. The water got on the tile and part of the carpet. They transferred the children in Infant A classroom into the toddler classroom that was empty. Staff members cleaned up the water in the Infant A classroom and by the morning the carpet was dry. Ms. Thrush stated that she heard that Infant B classroom had water in it was well, but no one goes in there and she has not seen it. No mold has been observed in the Infant A classroom. On 7/18/2022, I spoke to Licensing Consultant Kathleen Hop. Ms. Hop verified that she was present at the facility the day the flooding incident occurred. Ms. Hop stated that Ms. Farr took the proper actions by contacting a plumber as soon as the flooding started. Ms. Hop stated that the flood was not bad enough to require restoration services and staff members cleaned

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

On 4/15/2022, I spoke with the complainant who reported that the classroom they were referring to is the Prepper's classroom, there are 12 children enrolled in the class and they were told that the classroom follows at 1 adult to 6 children ratio. The complainant thinks that all of the children in the class are 2.5 years and older. The complainant reported that last Wednesday, child care staff member (CCSM) Delaney Washburn was working by herself with 12 children because the lead caregiver had the day off. On 04/15/2022, I completed an unannounced on-site inspection. I spoke with center director Karen Farr about the allegations. Ms. Farr denied the allegations and explained that the classroom follows a 1 adult to 8 children ratio and the children are 2 years and older. She said that last Thursday, lead caregiver Desray Hall had the 1/2 day off and Ms. Washburn was in the classroom in her place. Ms. Farr reported that CCSM Keisha Pickelesimer worked in the classroom from 7:30 AM to 12:00 PM and CCSM Shelbye Snell worked in the classroom from when Ms. Pickelesimer left until 3:30 PM. Ms. Farr was not certain on the times and reported that she would need to look at the records to confirm that the information was accurate, but she was confident that the classroom was not operating out of ratio. I interviewed CCSM Ms. Snell who confirmed that she worked in the Prepper's classroom with Ms. Pickelesimer when Ms. Hall was off. She reported that she worked with Ms. Washburn, and they had 9 children in their care. She said that the day went "good" and she had no concerns. She left after 3:30 PM when the first child left and there were 8 children in the classroom. I spoke with Mr. Fowler, the lead caregiver in the preschool room, who reported that he has no concerns about required ratios not being followed at the center. He stated that Ms. Farr is "very good about it." On 04/15/2022, I received and reviewed attendance records for children and staff. The classroom attendance records show that there were 9 children in the classroom from 9:07 AM until 4:17 PM. The staff attendance records show that Ms. Pickelesimer worked from 7:20 AM to 3:15 PM, Ms. Washburn worked from 9:00 AM to 6:07 PM, and Ms. Snell worked 6:28 AM until 3:40 PM. On 05/05/2022, I spoke with former CCSM Ella Bonner who reported that they were not aware of any classrooms operating out of ratio. On 07/05/2022, I completed an unannounced on-site inspection and spoke with Ms. Farr about the discrepancy between the records and interviews. Ms. Farr explained that CCSMs enter the information about children's attendance on an application that 3 is on a tablet. She reported that parents are supposed to check their children in on a computer in the front office, but they have a lot of parents that forget to complete the check in/out. Ms. Farr said that she has noticed that CCSMs that are completing tasks like changing diapers will change the attendance when they have a chance, but the application will log the time the attendance is taken and does not allow them to change the time to the accurate time. Ms. Farr was able to provide parent sign in/out records for April 7 that showed that the first parent to arrive for pick up came at 3:35 PM. This record shows information that is consistent with what Ms. Snell reported. I provided technical assistance on keeping accurate attendance records for children and CCSMs. Ms. Farr reported that she has implemented a paper attendance for each classroom now to accommodate for the inaccuracy of the other records. I interviewed CCSM Delaney Washburn who reported that the classroom does not operate out of ratio. She explained that they follow a 1 caregiver to 8 children ratio, and they call the office to request another CCSM when the 9th child arrives. She wondered if maybe a parent thought the classroom was out of ratio because a CCSM was in the bathroom changing a child and could not see them. Ms. Washburn confirmed that Ms. Snell did not leave o

Open Not marked corrected in the state record

Category: supervision. 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, including children related to a staff member or the licensee, must be as shown in Table 4: 4 TABLE 4 Child Care Staff Member to Child Ratios. Ice Child Care Staff Maaxinntatt Member to Child Ratio Group Size Infants and toddlers. 'birth until $0 1 to 4 12 as ~ months ofage Preschoolers. 30 mouths of ace Ito 8 16 6) until 3 years of e Preschooleas. 3 years of age until 4 i to 10 Not applicable ct ears ofast_ ----------- ------------- ~ Preschoolers. 4 years of age until I to 2 Not hCable 4) school-age ! School-veers 1 to , f Not applicable

The required ratio of child care staff members to children was followed.

Open Not marked corrected in the state record

Category: ratio. 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 03122/2022, I spoke with Child A's Mother about the allegations. She reported that on 03115/2022 when she arrived at the center to pick up her child, Child Care Staff Member (CCSM) Delaney Washburn told her that Child B had told her parents that Child A touched her Ms. Washburn did not tell her any other details. Child A's Mother was also told thatChild A was observed touching another child while on the playground but the CCSMs saw the incident starting and separated the children. She said that Ms. Washburn also told her that there was an incident the previous week that Child A was playing doctor with a girl and her shirt was pulled up, Ms. Washburn redirected their play and Child A told her not to watch. Child A's Mother said that she asked Child A about the incident, and he told her that he touched Child B's' and gestured to his private area. Child A's Mother talked to center director Karen Farr about the incident and was told that the room set up was through the corporation but they did rearrange the pretend play area to the middle of the classroom so it would easier to supervise. Child A's Mother that he was a E a On 03/23/2022, l completed an unannounced on-site inspection and spoke with center director Karen Farr. Ms. Farr provided the following information about the incident and the circumstance leading up to it. She reported that Ms. Washburn told her that she saw Child A and Child B playing doctor in the classroom and observed that Child A moved the stools to make a line/wall by the pretend play area. Ms. Washburn told her that Child A then told her to go away but she observed that Child B's stomach was exposed, so she redirected them to play elsewhere. Ms. Farr said that Ms. Washburn told her that she spoke with both parents about the incident and that Child A's Mother told her that , and she would be talking to him about it. Ms. Washburn told Ms. Farr about the incident the following day, she said that she did not think it was a big deal and told her to keep an eye on them and to document any concerns she observed. Ms. Farr said that the next day, she received a text message from CCSM Ella Bonner asking her to come outside to speak with her. She went out to speak with Ms. Bonner who told her that Child A was lifting the shirts up of Child B and another child while they were laying on the ground and she redirected them to play elsewhere. Ms. Farr said that she then spoke with Child A about appropriate play, keeping his hands to himself and that it was not okay for him to lift anyone's shirt up. Ms. Farr spoke with the CCSMs and told them to monitor closely and document any concerns. She does not think they had any concerns to document after that incident. Ms. Farr reported that she spoke with Child A's Mother the followina day. Child A's Mother told her tha been attending the center since and Child A's Mother did not report that information to her at enrollment. s Mother told her that Child A admitted IR that he had touched Child B's over her clothes two times. Child A's Mother also reported to her that Child her that when he asked Child B if he could see her privates, she told him that her mom said that is not ok, and he told her that his mom said it was ok. Child A's Mother told Ms. Farr that she questioned why he lied about her saying that, but his response was that he did not know. Child A also told his mother that he asked another child if he could see her privates and she told him no and will no 011oner011awith him. Ms. Farr reporte tats e a so spo a wit i d B's of er a out Mother told her happened between the two children. Ms. Farr said that Child B's Mother told her that she already knew about it and wanted Ms. Farr to speak with Child B's Father about it. Ms. Farr said that she called him, but he was speaking with her on Bluetooth, and she had a hard time understanding what he was saying. Ms. Farr reported that Child B's Mother told her on 3/16/2022, that Child B said that she had been touched under her c

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8167(3) · R 400.8167(3) Indoor space. (3) A center shall provide a floor plan of all child use areas to the department at initial licensure and before making structural changes or adding any child use space. Only space that has received prior approval for child use by the department may be used for child care.

Ms. Gani allowed children to play in the front office, which is not approved for child use, because there was no room in the classroom for these children.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

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

On 09/27/2021 I spoke with the complainant. She stated Child A had a diaper rash while at the center because staff members were not changing her frequently. She explained when she picked up Child A one day, exact date unknown, Child A's diaper was heavy and soiled. She stated she took her home, changed her and gave her ointment due to the diaper rash. She stated she spoke with Ms. Gani about this, and Ms. Gani replied she would take care of this. She does not recall the names of 3 the staff members present during this incident but reports a Mariam (unknown last name) working in the infant room at times. On 10/05/2021 I made an unannounced visit to the center and spoke with Ms. Gani. She stated infants are not left in soiled diapers as they are changed every two hours unless they are soiled. She explained the center does not buy diapers, instead parents are responsible for bringing diapers to the center. She stated there have been no prior complaints regarding diaper changes and staff members have never mentioned concerns for infants left in soiled diapers. Ms. Gani stated there is no Mariam that works at the center and there has never been a Mariam here. I spoke with Child Care Staff Member 1 (CCSM1). She stated she has worked in the infant classroom. She has no concerns regarding infant diaper changes. Infants do not sit in soiled diapers and are changed frequently. She stated she has never heard of anyone complaining infants were not being changed or were sitting in soiled diapers. I spoke with Child Care Staff Member 2 (CCSM2), who stated infants never sit in soiled diapers as they are changed when they are soiled. She has observed staff members changing infant diapers. She has also changed diapers in the infant classroom. Infants are changed right away since it could harm them to sit in a soiled diaper and could cause diaper rashes. She stated she has not heard of any parents complaining of an infant having a diaper rash because they were not getting changed while at the center. She stated she has no concerns regarding infant diaper changes. I spoke with Child Care Staff Member 3 (CCSM3). She stated diaper changes happen frequently in the infant room. She stated there are few infants in the classroom that are prone to diaper rashes, and she will put cream on them when needed, but they are always changed. She has never had a parent complain that their child is being picked up with a soiled diaper or receiving rashes because they are sitting in soiled diapers. She stated no infant has received a rash as a result of not being changed enough. She completes daily sheets every day and makes sure they are all completed before she leaves for the day. She stated it may not be updated immediately after a feeding or diaper change, but they are updated whenever staff members get a chance to do so. She stated no parents have ever complained about not receiving the daily sheets or the daily sheets not being completed. She stated when she leaves for the day, she communicates with the other staff members that she has completed the daily sheets on the tablet and will place the paper ones on the clipboard for parents to take a physical copy home. I spoke with Ms. Good, she stated infants are changed regularly when soiled or every two hours. She stated she reminds staff to change infants before parents arrive to take them home. She stated no parents have complained about soiled diapers and Child A's Mother has not mentioned concerns with this either. 4

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8155 · R 400.8155 1 Child accidents and incidents; child and staff illness. (2) A center shall ensure that a child who is too ill to remain in the group is placed in a separate area and is cared for and supervised until the parent arrives.

On 09/27/2021 I spoke with the complainant. She stated a child from the toddler classroom was placed in the infant classroom as they were not feeling well. This was an attempt to keep the child separated from the other toddlers. Ms. McCracken had taken the child's temperature; the child did not look well from what she has observed and from what Ms. McCracken had told her directly. She stated Ms. McCracken made a comment that this is what happens when a child receives Ibuprofen when feeling ill; their eyes appear glossy, and they become fussy. She stated she asked Ms. McCracken, "shouldn't she go home"? and Ms. McCracken replied that the father is refusing to take her home and they needed to move her into the infant classroom away from the other toddlers because she is sick. She stated she does not recall what day this happened, the name of the child or if this was a communicable disease the child contracted. On 10/05/2021 I made an unannounced visit to the center and spoke with Ms. Gani. She stated there was never a child taken from the toddler classroom and placed into the infant classroom because they were sick. She explained the center rules are if there is an ill child at the center, they need to be sent home. She stated there was never a time when an ill child's parents refused to pick them up. She explained there is a room located in the center that is used to keep children separated from others when a child has an illness or fever. I spoke with CCSM1. She stated there was never a time when a toddler's parent refused to pick up from the center due to an illness. She stated she has never heard of any parent not picking up their sick child nor has she heard of any toddler being placed in the infant room because they were ill. I spoke with CCSM2. She stated there was never a toddler that was sick, and parents refused to pick them up from the center. She stated there was never an ill 5 toddler moved into the infant room either. She stated she has no concerns for the center. I spoke with CCSM3. She stated there was never a time an ill toddler was placed in the infant classroom, and she does not ever recall hearing about a parent refusing to pick up their ill child from the center. She stated there was never an ill child placed in her classroom to wait for their parents either. She stated she has no concerns for the center. I spoke with Ms. Good. She stated toddlers are placed in the infant classroom for maintaining staff to child ratio reasons, but never because they were ill and has never seen this occur. Ms. Good also explained she has never heard or seen of a toddler's parents refusing to pick up their sick child. On 12/21/2021 Ms. Hop and I completed the exit conference with Ms. Farr, program director.

Not marked corrected in the state record

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (4) If a center becomes aware that a staff member, volunteer, or child in care has contracted a communicable disease, then the center shall notify parents and provide all of the following information: (a) The name of the communicable disease the children were exposed to. (b) The symptoms of the disease. (c) Prevention measures as recommended by the U.S. Centers for Disease Control and Prevention (CDC) at the following website: https://www.cdc.gov/DiseasesConditions.

On 09/27/2021 I spoke with the complainant. She stated Ms. Gani sent out an email regarding a communicable disease, however it was not written obviously in the email and was included as an attachment. She stated she had concerns regarding how this was handled as the email was not obvious in explaining the center had a close contact with a communicable disease. On 10/05/2021 I made an unannounced visit to the center and spoke with Ms. Gani. She stated there was an email sent to all the parents in the classroom in contact with a communicable disease advising them of the symptoms and name of the communicable disease. She stated she thought only the parents within the classroom needed to be notified and not all parents within the center. Ms. Gani stated she would forward the email for my review.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8176 · R 400.8176 Sleeping equipment. (6) Car seats, infant seats, swings, bassinets, and play yards are not approved sleeping equipment.

On 09/27/2021 I spoke with the complainant. She stated staff member Mariam, unknown last name, told her Child A is often in a bouncer when she is in the infant classroom as Mariam will work in the infant and toddler classrooms interchangeably. She explained "The classroom setup is weak, there are not enough areas for the children to play." She explained beforehand, she had concerned that Child A was left in a crib all day and afterwards, two bouncers arrived in the classroom, but they leave Child A in this bouncer for the majority of the day. She stated every time she arrives to pick up Child A from the center, she is in a bouncer. After our phone call I texted the complainant and asked if she had seen or heard about Child A sleeping in a bouncer, she did not reply. On 10/05/2021 I made an unannounced visit to the center. I spoke with licensee designee and owner, Sandy Gani. She stated infants are not left in bouncers for the majority of the day. She explained the center has a rule that infants can only be in the bouncer for ten minutes at a time. She stated Child A's Mother wanted Child A to be in the bouncer and even brought a bouncer to the center for her to use, but she did not accept the bouncer as play equipment needs to be tracked by the corporate office. Ms. Gani stated she advised Child A's Mother that Child A could not be in the bouncer longer than ten minutes at time. Child care staff members are trained to not 7 allow infants to sleep in bouncers and not to allow infants to be in the bouncers longer than ten minutes. Ms. Gani stated infants only sleep in a crib and nowhere else. I spoke with CCSM1, she stated infants are not sleeping in bouncers and they are only in the bouncers when staff are bouncing an infant or trying to get them to fall asleep. Once an infant falls asleep, they are immediately transferred to their crib because all staff members know that infants can only sleep in cribs. I spoke with CCSM2. She stated she has observed infants playing with sensory toys or staff members playing with them, but she has never observed infants to be in a bouncer all day. She stated infants to not sleep in bouncers, if they are in a bouncer and they fall asleep, they are immediately transferred to the crib. She stated she has no concerns regarding infants being placed in a bouncer all day. I spoke with CCSM3, she stated infants are not placed in bouncers all day as she always moves them around and tries to give them something to do. Such as ensuring all infants receive "tummy time". She stated she would worry that infants' heads would become misshaped if they were sitting in a bouncer for the majority of the day. She stated infants do not sleep in the bouncers, if they fall asleep in one, they are immediately transferred to a crib. Infants are not placed in a crib all day either when they are fully awake, they are taken out of the crib. I spoke with Ms. Good, she stated infants are not left in bouncers for the majority of the day. Child A was often placed in a bouncer after feedings to help sit her upright due to her acid reflux, but she was not in the bouncer all day. She explained the center has a policy that infants are only allowed to be in a bouncer for ten minutes at a time. Infants are also not allowed to sleep in bouncers, and she has never observed this happening. All infants sleep in their cribs. She stated infants are not left in their cribs either as most of the infants are crawlers and like to explore the classroom. .................... .........................................

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, including children related to a staff member or the licensee, must be as shown in Table 4: a) For infants and toddlers, birth until 30 months of age, there shall be 1 staff member to 4 children and a maximum group size of 12.

On 09/27/2021 I spoke with the complainant. She explained multiple staff members have quit employment at this center due to Ms. Gani and she has been questioning Ms. Gani about the quality of care the center provides and the amount of children that are in the classrooms at one time. She explained every time she tries to speak with Ms. Gani about her concerns, Ms. Gani will turn the conversation on her. She explained Child A is in the infant room and because there are many revolving staff in that classroom, it is difficult to know who her caregivers are. She explained when she picked up Child A on an unknown date, Ms. Good was the only staff member in this classroom with six infants. She stated she counted the infants and then said to Ms. Good "You have six kids in here" and asked if Ms. Gani knew about this and Ms. Good stated she did. She stated she told Ms. Good "This is ridiculous for the safety of the kids." Ms. Good responded that the classrooms have been operating out of ratio "so much". She stated there was another staff member, she believes by the name of Mariam, unknown last name working in the infant room the next day. Mariam told her, "Remember when you told Ms. Good she had too many kids? Well I had seven toddlers by myself the same day". She stated there was another day, unknown date, when Ms. Lake was in the infant room with four infants and one toddler. After the phone call I texted the complainant my email address so she could send specific dates and numbers via email. I have not received any emails from the complainant. On 10/05/2021 I made an unannounced visit to the center. Ms. Gani came to the door and I explained I received staff to child ratio allegations and needed to evaluate the classrooms. The infant classroom was within the required ratio as well as the toddler and twaddler classrooms. However, there was a child who was under the age of 3 in the preschool classroom, with ten children total and one child care staff member. Ms. Gani moved this child, who was the youngest in the preschool classroom to a toddler classroom. Thus, placing each classroom within the required staff to child ratio. Ms. Gani stated she has not been able to move this child as she had been working in the infant classroom to maintain ratios. During the ratio evaluation of the classrooms, a child care staff member arrived and Ms. Gani advised them to go to the infant classroom in order to maintain ratios. Ms. Gani explained there has never been a time in the last few weeks where there were six infants and one child care staff member in the classroom. She stated the toddler and twaddler classrooms have been within staff to child ratio as well over the last few weeks. She explained children have been moved into different classrooms to make sure all classrooms are operating according to ratio requirements. She explained the center only had five infants enrolled during those time periods, one withdrew, and a new infant started today, therefore the center currently still has five total enrolled infants. CCSM1 stated the infant classroom has been over the required staff to child ratio, although she is unsure of an exact date this occurred. CCSM1 believes this could have occurred either last week or two weeks ago. She stated she recalls the infant 10 room having five infants with only one child care staff member. She stated sometime last week, there was a separate incident where the infant room had five infants and a toddler with one child care staff member. She stated she is sure Ms. Gani knew about this as Ms. Good often communicates these concerns to her as well as when staff members call in absent for the day. She explained the only reason the classrooms operate out of ratio are due to staff members calling in absent and the center does not have extra staff to use to fill those positions. CCSM1 stated last week or two weeks ago, she had seven children by herself "for a little while". She stated she believes this occurred on a Tuesday

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 14 children related to a staff member or the licensee, must be as shown in Table 4: c) For preschoolers, 30 months of age until 3 years of age there shall be 1 staff member for 8 children and a maximum group size of 16.

On 09/27/2021 I spoke with the complainant. She stated Child A has had several missed meals in one day and she believes other parents have had similar concerns. She believes the center does not have enough staff members to safely provide and accommodate for the needs of the children. She stated another mother, unknown name, told her that her son had missed a bottle. Therefore, she told this mother that Child A had missed several meals and the other mother wondered if this was a problem. Child A's Mother stated there was a day when Child A only ate two bottles of formula as the other bottles were full. She sent an email to Ms. Gani regarding this, and Ms. Gani replied she would address the feeding issues with the staff members. However, no follow up was received. She stated the reports she receives for Child A, are not filled out entirely. Ms. Gani told her they were having trouble with the classroom iPad's, but staff members have told her they do not have the time to complete the daily sheets. Therefore, she is receiving incomplete and conflicting information from others. She stated staff members do not get through half a day's worth of information. Because the daily sheets are incomplete, she gauges how much Child A eats by the bottles she comes home with. Ms. Gani. stated Child A's Mother thought Child A was not being fed because there were toddlers in the infant classroom and she thought staff members were too busy to feed infants. Ms. Gani explained she asked Ms. Good if staff were too busy to feed the infants. Ms. Good responded that staff were trying to feed Child A, but Child A was not wanting to feed. She stated there are no concerns regarding infant feeding and no complaints have been made about infant feeding previously. She 15 explained child care staff members complete the daily sheets for parents on the tablets and parents are alerted and made aware of all feedings, sleeping times and diaper changes. She has no concerns that staff members are not completing the daily sheets as she checks these every now and then and she has never noticed anything missing. She stated if she has a new staff member who does not include all information on a daily sheet, she will train them to make sure the daily sheets are filled out entirely. CCSM1 stated the parents of the infants and toddlers receive daily reports that are updated on their classroom's tablet. She frequently observes other staff members logging information into the tablet and she has never heard of any parents complaining about not receiving these reports. She has no concerns that staff members are not feeding or caring for the infants. She has been in the infant room and witnessed infants being fed and being changed. If an infant is not being fed, that is usually because they are fussy eaters. Staff members are "good about taking care of the children and making sure everyone gets their bottles." She stated she has no concerns regarding Child A's care in the infant room as she knows Child A has acid reflux and does not like to take a bottle, which means feedings for her can be tricky. She explained Child A would have to be fed small increments, she would eat an ounce or so then wait a few minutes, then she would feed again and wait. Staff members always tried to feed her regardless and never skipped feedings for her. She stated she believes Child A's daily sheets were always filled out. CCSM2 stated she has no concerns about infant feeding as infants are fed on demand. She stated she has met Child A and she has "spit up issues" which made feedings difficult for her. She has never fed Child A directly, but staff had discussed her feedings, the need to burp her often during feedings, and sit her up to monitor afterwards and to be diligent about how much she is feeding to ensure she is keeping the food down. She stated she had no concerns that staff members were not feeding Child A. She stated reports are completed on the tablets every day. She explained staff members

R 400.8330 · R 400.8330 Food services and nutrition generally. ................................................ ........... (7) Infants and toddlers shall be fed on demand.

On 10/05/2021 I made an unannounced visit to the center and spoke with Ms. Gani. She stated she has never seen a bouncer located on the refrigerator before in the infant classroom. During my classroom evaluation, I did not observe any play equipment stored on the refrigerator. CCSM1 stated she has never observed a bouncer stationed on top of the infant refrigerator. CCSM2 stated she has never noticed a bouncer stored on top of the infant refrigerator and believes that because the bouncers are so big, they likely would not fit on this space. CCSM3 stated when the center first opened there was a bouncer placed on the infant refrigerator, but it was not unsafe to store the bouncer in this location as there was only one infant during this time and this infant was not crawling around the classroom. The bouncer was only on the refrigerator for a short time, roughly a week. Ms. Good stated she has never observed a bouncer stored on top of the infant refrigerator.

Open Not marked corrected in the state record

Category: nutrition. 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: (a) Food intake time, type of food, and amount eaten. 17

On 10/05/2021, I explained the allegation to Ms. Gani. She stated Ms. Good is the director and she is licensee designee and owner. She stated she has the trainings to be a child care staff member and has taken the infant safe sleep training and shaken baby. She did not receive a certificate for this training. Ms. Good came into the room and explained all staff members take this training through "Bubbles." I took a picture of the computer screen showing the trainings Ms. Gani has completed. Ms. Gani provided a copy of her CPR/First aid certificate, but this has been expired and she plans to renew this certification quickly. Ms. Gani explained she does not have a file at this center location and therefore, does not have the required paperwork for verification. She stated she has a copy of her TB test at the Novi center location, but has no documentation, such as fingerprinting documentation or signed statements of abuse and neglect or file at this location.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8380 · R 400.8380 Maintenance of premises. (1) The premises must be maintained in a clean and safe condition and must not pose a threat to health or safety.

The bouncer was stored on top of the infant refrigerator for a week, but did not pose a threat to infant safety and a bouncer was not observed to be stored on the refrigerator during my onsite inspection.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8112 · R 400.8112 Comprehensive background check; fingerprinting. (2) An applicant or licensee shall do all of the following: (b) Maintain a copy of the completed and signed form or forms for each individual entered into the child care background check system under the license.

Ms. Gani was not able to provide her completed and signed consent and disclosure form upon request.

Open Not marked corrected in the state record

Category: background checks. Open / not marked corrected.

R 400.8125 · .............. R 400.8125 Staff; volunteer; requirements. (5) A written statement must be signed and dated by staff and volunteers at the time of hiring or before volunteering indicating all of the following information: (a) The individual is aware that abuse and neglect of children is against the law. (b) The individual has been informed of the center's policies on child abuse and neglect. (c) The individual knows that all staff and volunteers are required by law to immediately report suspected abuse and neglect to children's protective services.

Ms. Gani was not able to provide her signed statement attesting to the above information upon request.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8128 · R 400.8128 Staff; volunteer; tuberculosis. A center shall keep on file at the center evidence to verify that each child care staff member and each volunteer who has contact with children at least 4 hours per week for more than 2 consecutive weeks is free from communicable tuberculosis (TB). Verification of TB status is required within 1 year before employment or volunteering.

Ms. Gani did not have verification of a negative TB test on file at the center.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8113 · R 400.8113 Program director qualifications; responsibilities. (1) Before hiring a new program director, a licensee or licensee designee shall submit a completed BCHS-CC 001 form, titled Child Care Licensing Information Request, and the credentials of the proposed program director to the department for review and approval.

Ms. Gani did not submit credentials for approval for Ms. Farr prior to hiring her as a program director.

Open Not marked corrected in the state record

Open / not marked corrected.