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

On 06/28/2022, I spoke with ~~.~ regarding his contact with Child A's Mother. spoke with i s of er ace to face on 06/27/2022. Child A's Mother reported that Child A started in the infant classroom at the center but is now in the totodd"elerr assroom. Child A typically attends the center from 7am to 4:30pm throughout the week. Child A's Mother also reported that Child A has had several "dirty" diapers at pick up over the past year. Child A's Mother has spoken to staff on occasion about Child A not being changed. Child A's Mother noted that staff tend to hang out in the hallway or outside at pick up. Child A's Mother expressed concern that staff are not attending to the children. On 06/28/2022, and I completed an on-site inspection. We interviewed program director Alyssa Lock. The allegations were reviewed with Ms. Lock. Ms. Lock identified Child Care Staff Member (CCSM) CCSM 4 as the lead caregiver and CCSM 7 as the assistant caregiver in the toddler classroom. Ms. Lock denied knowledge of any concerns from parents or staff from the toddler classroom. Ms. Lock identified CCSM 6 as the lead infant caregiver who provided care for Child A prior to her transition to the toddler classroom. Child A transitioned out of the infant classroom in February 2022. Child A has attended the center since September 2021. Ms. Lock stated that the center's diapering policy is to check and or change diapers every two hours or as needed. Ms. Lock noted that CCSM 7 was on vacation and that CCSM 4's shift was nearly over. _ and I agreed to return on 06/29/2022 to interview staff. On 06/29/2022, and I completed a follow-up inspection. We interviewed CCSM 4, CCSM , CCSM 6, CCSM 1, and CCSM 3. CCSM 4 confirmed that she is the lead caregiver in the toddler classroom as well as Child A's primary caregiver. She has worked for the YMCA since September 2020. CCSM 4 identified CCSM 5 as Child A's secondary primary caregiver. CCSM 4 stated that Child A does at all. Child A will sit at the table and watch the other children, cry, and/or throw things. Child A will cry and want to be held if she has not had a long enough nap. Child A is typically picked up between 4pm and 4:30pm. CCSM 4 was not sure if there were missed opportunities by staff to change Child A's diaper prior to Child A's expected pick up time. CCSM 4 agreed to work with the toddler staff to ensure children are checked prior to leaving. CCSM 5 identified herself as a "floating" assistant staff member. She has worked for the center since March 2022. CCSM 5 helps in all the classrooms and covers staff breaks and training times. CCSM 5 stated that diapers are checked and/or changed every two hours. Staff also checks all diapers after rest time. 3 CCSM 6 identified herself as an assistant infant staff member. She has worked for the center since March 2022. She described Child A and for that reason, staff need to watch her more carefully. CCSM stated that diapers are changed every two hours and as needed. She is not aware of any parental concerns regarding Child A being sent home with a "full diaper." CCSM 1 identified herself as a "floating" assistant staff member. She has worked at the center since May 2022. CCSM 1 noted that she has a friendly relationship with Child A's Mother, yet Child A's Mother has not disclosed any concerns regarding Child A to her. CCSM 1 performs diaper checks and/or changes at approximately 4:00pm before the children go outside to play. CCSM 3 identified herself as the lead caregiver in the infant classroom; however, she worked in the toddler classroom prior to being transferred to the infant classroom around May 2022. CCSM 3 stated that staff change diapers every two hours. She was trained to change a diaper even if it is not soiled. She would check Child A's diaper at the end of the day when Child A's Mother arrived at pick up. If Child A's diaper was soiled, she would ask Child A's Mother if she wanted her to change it before leaving. Child A's Mother would typically decl

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

On 06/27/2022, spoke with Child A's Mother. Child A's Mother stated that hi can be a picFeater, but she eats and drinks once she gets home from the center. Child A loves fruits and breads. Child A's Mother gets notifications from staff regarding Child A throughout the day on an app used by the center. Staff have been noting in the app that Child A has been refusing to eat the food offered to her. Child A's Mother clarified that Child A's lack of eating at the center has been over the past few days. Child A's Mother sent an email to program director Alyssa Lock regarding her concern with Child A's refusal to eat. Ms. Lock discussed with her how the word "refused" may not be the best word to [s1 use in the app. Ms. Lock also elaborated on Child A's time and actions during meal time. On 06/28/2022, and I completed an on-site inspection. We interviewed program director Alyssa Lock. Ms. Lock stated that the center serves breakfast, lunch, and an AM and PM snack. Lunch is served family style with one staff member seated at the table with the children, while the other staff member serves the food. Staff do not remove food from children who are slow eaters. The children are allowed to eat as long as necessary. Ms. Lock noted that Child A was recently referred to Early On due to Ms. Lock also noted that Child A's Mother submitted an email on with concerns regarding Child A's refusal of foods served to her. Ms. Lock provided the email thread between herself, Child A's Mother, and CCSM 4. The email thread starts on 06/24/2022 with Child A's Mother wanting to know what Child A is doing to indicate that she is refusing food. Ms. Lock responded on 06/24/2022 that Child A had not been eating her food very well that week. Staff offered Child A the food, had Child A sit at the table, and followed the regular routine. Child A's Mother responded on 06/24/2022 by asking again for specific behaviors shown by Child A that indicated that she was refusing the food. Child A's Mother noted that Child A comes home from the center and eats like she is starving. Additionally, Child A drinks water at pick up without hesitation. The next response was on 06/27/2022 by CCSM 4. It should be noted that CCSM 4 was not available until 06/27/2022. CCSM 4 provided a description of Child A's behavior at meal times. Child A generally sits at the table and watches the other children. Child A periodically dumps her plate or bowl, or she will drop food on the floor when she is done eating. Child A will eat certain food without hesitation such as pizza, chicken nuggets, and hamburgers. Milk is offered at meal times, but Child A typically does not drink it. Water is offered throughout the day and is always available during outdoor play. Child A does drink some water. Staff have tried cutting Child A's food into smaller, more manageable portions, which has prompted her to eat more on occasion. When there is enough support in the classroom, sometimes a staff member will sit next to Child A during meals; however, this is not always an option. On 06/27/2022, Ms. Lock sent Child A's Mother a response asking if her main concern is that Child A is not eating or the word "refuse." Child A's Mother responded on 06/27/2022 indicating that she is more concerned that Child A is not eating or drinking, as Child A eats well at home. This response is the last response in the email thread. On and I completed a follow-up inspection. We interviewed CCS0M6 4/2, C9C/2SM0 2,2," M 6, CCSM 1, and CCSM 3. CCSM 4 stated that Child A will not eat lunch if she does not like the presentation of the food or it is not separated. Staff try to separate the food or sit with her to encourage her to eat. Although Child A's Mother indicated that Child A eats pasta at home, Child A will not eat pasta at the center. Child A mainly enjoys eating fruit and breads. The classroom is provided on portion per child, but if there is extra fruit, staff try to give Child A more if she will eat it. Child A does not want

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 06/27/2022, spoke with Child A's Mother. Child A's Mother reported that Child A felland lip at the center approximately four weeks ago. Approximately two weeks ago, Child A was scratched by another child at the center. Child A's Mother expressed concerns over the staff not properly supervising Child A due to staff hanging out in the hallway and parking lot during pick up. On 06/28/2022, and I completed an on-site inspection. We interviewed program director Alyssa Lock. Ms. Lock denied any knowledge of parent concerns related to the allegation. Ms. Lock stated that the center has staff who are "floaters" who fill in for breaks, vacations, and a variety of other reasons. Staff lunch breaks are typically one hour. Staff are allowed to leave for their lunch break. Ms. Lock is not aware of staff hanging in the hallway or parking lot, causing classrooms to not maintain appropriate child to child care staff member ratios. On 06/29/2022, and I completed a follow-up inspection. We interviewed CCSM 4, CCSM 6, CCSM 1, and CCSM 3. CCSM 4 stated that she was present on 05/11/2022 when Child A was bitten by another child. Child A leaned back with her hands out which resulted in her hand being near another child's mouth who in turn bit Child A's hand. Child A was startled but did not cry. The bite did not break skin. Child A continued to play after her hand was washed and she was given a hug by staff. CCSM 4 stated that appropriate child to staff ratios were in place when Child A was bitten. CCSM 4 was present with CCSM 7 when Child A fell and injured her lip, but CCSM 4 could not remember all the details. CCSM 7 completed the incident report because CCSM 4 was preparing to leave for the day. rj CCSM 5 denied knowledge of any classroom operating below child to child care staff member ratio requirements. She stated that staff do linger around while on breaks, but the classrooms always maintain required ratios. CCSM 5 was present with CCSM 7 on 06/16/2022 when Child A was scratched by another child. CCSM 5 was reading to a group of children while CCSM 7 was playing with the other children on the other side of the classroom. CCSM 5 did not see Child A get scratched, but she heard CCSM 7 say, "No thank you, we do not hurt our friends." Staff washed Child A's scratch and placed a bandage on her. Child A continued to play after the incident. CCSM 5 was not present for any other injury incidents regarding Child A. CCSM 6 stated that she was present on 05/11/2022 when Child A was bit by another child, but she does not recall the details. She stated that staff try to catch children before they bite, but they are not always successful in their efforts. Staff wash the area that was bitten and provide "TLC" to the injured child. If the bite draws blood, staff contact an administrator for further guidance, including, but not limited to completing an incident report. Staff complete an incident report even if no blood was drawn. CCSM 6 stated that Child A is unable to tell staff if she gets hurt due to her which is why staff need to watch her carefully. CCSM 6 had no concerns with the center maintaining appropriate ratio requirements. CCSM 1 and CCSM 3 stated that they have no knowledge of Child A being injured at the center. They have no concerns with the center maintaining appropriate ratio requirements. On 07/05/2022, and I completed a second follow-up inspection. We interviewed CC CC SM 2, and CCSM 8. CCSM 7 stated that on one occasion Child A fell and bit her lip when a larger child who was excited was moving too fast in the hallway and accidentally knocked her down. Staff cleaned up Child A's lip and gave her a frozen teether. On another occasion, Child A was bitten by another child when that child became frustrated with Child A. On another occasion, a child scratched Child A out of frustration. The other child wanted to play with Child A, but child A was not interested. On each occasion, Child A continued to play once staff cared for her injuries

R 400.8182 · 1 R 400.8182 Ratio and orouo 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: 11 TABLE 4 Child Care Staff Member to Child Ratios Age Child Care Staff Maximum li4eaubea to Child Ratio Group Size ( Infants and toddlers, birth until 30 1 to 4 12 ai months of age Preaachooleis. 30 mouths of age I to 8 16 b until :3 years of ae ( Pt eschoolers, 3 years of age until 4 1 to 10 Not applicable ..______________________ of age until 1to 12 Not applicable 1to iS Not applicable

Based on staff interviews, parent interviews, and attendance records for staff and children, the center maintains appropriate child to child care staff member ratio requirements.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.