• Violation

  R 400.8330 · R 400.8330 Food services and nutrition generally. (4) A center shall ensure a child who has special dietary needs is provided with snacks and meals in accordance with the child's needs and with the instructions of the child's parent or licensed health care provider.

  On 11/7/2021, I met with program director/licensee designee Ms. Carless and informed her of the allegations. Ms. Careless informed me that Child A was cared for at Gilden Woods on 9/1/2021 and 9/3/2021 only. When Child A was enrolled, Child A's Mother explained that Child A needed to be burped after each 2 oz. of formula followed by sitting upright for 20 minutes. This information was also told to CCSMs Ms. Grooms and Ms. Steel by Child A's Mother. Ms. Carless provided me with copies of: • AppleTree & Gilden Woods Allergy & Special Needs form, • AppleTree & Gilden Woods "Get to Know Me! (infant)" form, • Child A's Child Information Card (BCAL 3731). The Allergy & Special Needs form and Child Information Card noted that Child A has an allergy to "cow's milk" and no other allergies, special needs, or special instructions. The "Get to Know Me!" form indicated that Child A spits up "multiple times after each feeding" and that he needed to be burped after every 2 oz. If he was not burped at that time, Child A "spits up a lot." All forms were signed and dated 8/23/2021 by Child A's Mother. Ms. Carless also provided a copy of Child A's Health Appraisal (MDHHS/BCAL-3305) form. No special feeding or care instructions were noted. This form was signed and dated by the examining physician on 8/16/2021. Ms. Carless added that she was not provided with any documentation indicating that special feeding instructions provided by Child A's Mother were medically necessary or at the direction of a medical or dietary specialist. During my onsite, I spoke with CCSM and lead caregiver in Infant 1 room, Ms. Grooms. She confirmed that she was working in the Infant 1 room on the days in which Child A attended Gilden Woods. She added that CCSM Ms. Steel was Child A's primary caregiver while he was at Gilden Woods, so she would have been the CCSM to feed Child A. She also confirmed the instructions for feeding Child A were provided to her and Ms. Steel when Child A was enrolled at the child care center. She added that she did not directly observe Ms. Steel feeding Child A, so she could not speak to the amount of formula Child A ate or when Child A was burped. Ms. Steel stated that on Child A's first day at Gilden Woods, Child A's Mother explained to her and Ms. Grooms that Child A was to be fed 2 oz of formula, burped, fed 2 more oz of formula, burped, and then sat in an upright position for 20 minutes to avoid Child A spitting up while laying down. She confirmed that she was Child A's primary caregiver and was the CCSM that fed him. She added that she followed the parents feeding instructions for Child A regarding feeding 2 oz at a time and burping 3 him after each 2 oz of formula. When asked about Child A being in an upright position for 20 minutes following each 4 oz feeding, Ms. Steel explained that she believes that she followed those instructions as provided but there is a chance that the 20 minutes was cut short due to another infant in the room needing immediate attention and other CCSMs not being able to immediately assist. Ms. Steel explained that she always tries to honor special requests when made by parents, but priority is placed on the overall care and supervision of all children in the room. Child B's and C's Mother stated that Child B (4-month-old, female) has been going to Gilden Woods for child care for about a month and Child C (3-year-old, female) has been going there for approximately 2.5 years. She has never made special requests of CCSMs regarding her children so she could not provide direct information regarding the allegation. Child A and B's Mother added that she has never had concerns with the level or care and supervision provided by Gilden Woods. I also attempted to contact Child A's Mother and Child D's Mother during the investigation regarding the allegations but was unable to reach them.

Gilden Woods was provided specific feeding instructions regarding Child A (6-month-old male) by Child A's Mother. Gilden Woods child care staff members (CCSMs) failed to follow the instructions. The instructions included that Child A was to be fed 2 oz. of formula, burped, then fed 2 more oz. of formula. Following a 4 oz. feeding, Child A needs to be placed in an upright position for at least 20 minutes. CCSMs in the Infant 1 room at Gilden Woods do not wash their hands after diapering children. Child A had five primary caregivers while attending Gilden Woods during the week of 9/1/2021.

Disposition: Substantiated