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.

Child A's Mother stated that on 11/28/2022, Child A was in different pants when she picked him up from care. The pants Child A was wearing when he was dropped off at the center were in a plastic bag in his diaper bag and were soaking wet. Child A's Mother asked the child care staff member on duty what happened to Child A's pants and the person replied that they didn't know. Child A's Mother left the center with Child A and ran some errands. A few hours later when they were at home, Child A's Mother changed Child A and noticed a mark on the left side of his lower rib cage. Child A's Mother reached out to the center on Brightwheel, which is the app that the center uses for communication to parents, inquiring about Child A's pants and the mark on his rib cage. Ms. Ellis replied that the pants were probably wet from being outside, but she would talk to the child care staff members. The following morning Child A's Mother showed Ms. Elliott the mark. Ms. Ellis told Child A's Mother that she did not believe the injury happened at the center. Child A's Mother reached out to Child A's pediatrician. She submitted a picture of the mark to the doctor on the practice's portal. The doctor indicated that the mark appeared to be some type of burn. Child A's Mother stated that the mark took weeks to heal. Shortly after this incident Child A's Mother received notice that Child A was being disenrolled from care due to classrooms being condensed. She received a two-week notice. Child A's Mother believed that Child A was disenrolled because Child A's Mother brought up too many concerns. Child A's Mother decided to withdraw Child A from care immediately. Child A's Mother stated that she later read a report on the department's website regarding an investigation at the center recently where a child in care was burned from the water from a bottle warmer. Child A's Mother became concerned that this is how Child A received the mark on his chest and would explain why his pants were wet. 3 Child A's Mother stated that she had the communication with the pediatrician as well as pictures and other messages regarding other injures to Child A that she could provide me. As of the writing of this report, I have not received any of these items from Child A's Mother. I interviewed Ms. Ellis and Ms. Elliott at the center. They stated that they were aware of a mark on Child A's chest but did not know how the mark occurred. On the evening of 11/28/2022, Child A's Mother submitted a question on Brightwheel regarding Child A having wet pants. Ms. Ellis responded to the question and asked if the pants were wet on his body, or in a bag. Child A's Mother replied that the pants were in a bag. She stated that she was just curious what Child A got into. Ms. Ellis replied that her first thought was that he got wet outside because she knew his class was outside earlier that day, but she would check and find out. Child A's Mother also sent Ms. Ellis a picture of the mark on Child A's chest. Ms. Ellis provided me with the text message exchange between her and Child A's Mother. After Child A's Mother sent the photograph, Ms. Ellis replied that it looked like a rash of some sort and that she would check with the child care staff members to see if they noticed anything that day. Child A's Mother replied that it wasn't on Child A that morning when she dropped him off and that the staff probably wouldn't have seen it due to it being located on his rib cage. She added that the part of the mark that was darker in color has little scratches on it like it was a scrape. Child A's Mother noted that Child A hasn't been itching recently. Ms. Ellis replied that Child Care Staff Member 4 changed Child A that day and did not notice any marks on his chest. Ms. Ellis reiterated that the mark looked like a rash to her. Ms. Ellis stated that she would check with Child Care Staff Member 2 to see if he noticed any injury to Child A that day. The following day Child A's Mother texted Ms. Ellis to info

Open Not marked corrected in the state record

Category: supervision. 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.

Child A's Mother stated that on 06/28/2022, Child A was sent home from the center with two bite marks on his back. When Child A's Mother inquired about the bite marks, she was told that the child care staff members had no idea what happened, but that he must have been bitten by another child in care. Child A's Mother stated that she asked for an incident report but did not receive one. Ms. Ellis stated that she recalled Child A having a bite mark on his back. The bite was reported to Child A's Mother. Child Care Staff Member 4 witnessed the bite occur. Ms. Ellis provided me with a copy of the incident report that was created regarding the bite mark on Child A. Child Care Staff Member 1 stated that she remembers Child A having a bite mark on his back, but she was not providing care for him when it occurred. A Child Care Staff Member 2 stated that he was not aware of Child A being bitten while in care. There is a child in care that has been having some biting issues and is involved in speech therapy to help him communicate better, but he is not in the same class with Child A. Child Care Staff Member 3 stated that she did not recall a child being bitten on the back when she worked at the center. Child Care Staff Member 4 stated that she did not recall any biting incidents involving Child A. I reviewed the center's policy regarding biting. There is a plan in place to address children engaging in habitual biting. This plan includes working with the parents to decrease the biting and sending a child home if biting continues. Child B's Mother stated that Child B has been bitten a few times while in care. The child care staff members always let her know. Child B's Mother did not have any concerns regarding the care the center provides. Child C's Mother stated that Child C has been bitten a couple of times while in care. One bite was noticed at home after she picked up Child C. She contacted the center child care staff members and they apologized for not witnessing the bite. Child C's Mother has received notifications on the center's communication app regarding bites or the center will call. She had no concerns regarding the care the center provides.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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

Child A's Mother stated that in March 2022 when she arrived at the center, she observed Child A alone in the classroom. He was sitting in a basket. She knocked on the window from outside the center to get his attention. When he saw her, he got up and ran toward the window. Child A tripped and hit his lip on a 7 high chair that was nearby. This caused his lip to split. Child A's Mother pounded on the center's door to be let in. She was upset that Child A was unsupervised. She followed up with Ms. Ellis regarding her concerns. Child A's Mother stated that there was a second incident when Child A split his lip. When she inquired about the injury, the child care staff members were unaware of what happened but stated that he must have fell on something. Ms. Ellis stated that she was made aware of the incident where Child A hit a highchair. She was informed that Child A was playing in the classroom, and he saw Child A's Mother in the window. He started to run and tripped and fell on a high chair leg. Ms. Ellis stated that Child Care Staff Member 1 was in the room with Child A when the incident occurred, and it was her understanding that Child A's Mother saw Child Care Staff Member 1 pick up Child A after he fell. She was aware that Child A's Mother spoke to the child care staff members about the incident after it occurred, but Ms. Ellis did not hear anything from Child A's Mother regarding the incident until several months later. At that time, Child A's Mother told Ms. Ellis that Child A was unsupervised when he split his lip. Ms. Ellis stated that she was also aware of a time when Child A arrived to care with a split lip. She spoke to Child A's Mother about the injury, and she explained that Child A fell while at the park. Ms. Ellis was not aware of Child A experiencing any other injuries to his lips while at the center. Child Care Staff Member 1 stated that she recalled the incident where Child A fell and split his lip. She was caring for him when this happened Child A was seated in a bucket or something similar. Child Care Staff Member 1 heard Child A's Mother knock on the window, so she looked at Child A. Child A got up to run to the window, but as he started moving, he fell and hit his lip. Child Care Staff Member 1 stated that she believes he tripped on a high chair that was nearby. Child Care Staff Member 1 went over to Child A to comfort him and pick him up. Child Care Staff Member 3, who has standing in the hallway right outside the classroom, went and got her an ice pack for Child A. Child Care Staff Member 1 stated that she believes that Child Care Staff Member 3 also let Child A's Mother into the center. Child A's Mother was upset because she thought that Child A was unsupervised, but Child Care Staff Member 1 stated that she was with Child A and was watching him, she was just not visible from the window. Child Care Staff Member 1 stated that she did not recall Child A receiving a second split lip while in care. She recalled Child A coming into the center one time with a bruise that Child A's Mother explained. Child Care Staff Member 1 stated that Child A was an active child. Child Care Staff Member 2 stated that he was aware of Child A receiving a split lip while in care because Child A's Mother told him about the injury. Child A's Mother asked why Child A was unsupervised in the classroom. Child Care Staff Member 2 knew that Child Care Staff Member 3 was outside of the classroom doing dishes when the injury occurred, so he told her that she needed to be in the classroom. Child Care Staff Member 2 was not aware if Child Care Staff Member 1 was in the room with Child A. Child Care Staff Member 3 stated that she did not recall a child receiving a split lip while she worked at the center. Child Care Staff Member 4 stated that she did not recall Child A splitting his lip or receiving any notable injuries. As stated above, Child B's Mother stated that Child B has not received any unexplained injuries while in care. She had n

R 400.8137 · 1 R 400.8137 Diapering; toileting. (6) Diapers and training pants shall be checked frequently and changed when wet or soiled.

Child A's Mother stated that Child A had a diaper rash issue while attending the center. Child Care Staff Member 3 was the child care staff member providing care to him at that time. Child A's Mother provided diaper rash cream to Child Care Staff Member 3 to apply to Child A. At first Child A's Mother thought that Child A was having reactions to the diapers he was wearing, so she tried different types. Child A kept having diaper rashes. The rashes would go away on the weekend when Child A was home with Child A's Mother, but then would reoccur when Child A was back at the center. This occurred for several months. Child A's Mother spoke to Ms. Ellis about this issue. Ms. Ellis stated that she was not aware of Child A having an issue with recurrent diaper rash. Child Care Staff Member 1 stated that she recalled Child A having an issue with diaper rash, but she was not the child care staff member providing care for him at that time. Child Care Staff Member 3 would have handled that. rj Child Care Staff Member 2 stated that he is not aware of Child A having issues with diaper rashes, but he does not diaper the children in care. Child Care Staff Member 3 stated that she did not recall a child having a persistent issue with diaper rash. Children occasionally would have diaper rash, but not frequently. Child Care Staff Member 4 stated that she did not recall Child A having recurrent diaper rash. Child B's Mother stated that there have been a few times that Child B's diaper has seemed full when she picked him up. She did not inquire with the child care staff members when Child B was last changed, nor did she consult his daily sheet. On a few occasions, Child B has been red in his diaper area when Child B's Mother has picked him up from care. She was not concerned about it enough to address it with the child care staff members. This has not been a frequent occurrence. She had no concerns regarding the diaper procedures used at the center. Child C's Mother stated that Child C has had diaper rashes while in care, but she does not attribute it to poor diapering. Child C has sensitive skin, so it is not unusual for her to have a rash. The center has diaper rash cream that they can use on Child C if needed. She had no concerns regarding the diaper procedures used at the center.

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 3/25/2022 I completed an unannounced on-site inspection at the child care center. I interviewed child care staff member Shaniqua Silver. Ms. Silver said on 3/22/2022 she was working in the infant room. She was preparing to take the children for a walk. She put two bottles in bottle warmers so she could feed two children prior to taking a walk. The bottle warmers were placed on a table that was located in the classroom. Ms. Silver believes the bottle warmer was placed towards the back of the table and the cords were tucked behind the table. Child A (male, age 14 months) and Child B (female, age 2 years) were in the classroom playing together while the bottles were warming. Child A and B were in the middle of the room away from the table where the bottle warmers were located. Ms. Silver stepped out into the hallway to grab the children's coats for the walk. Ms. Silver heard Child A yell. She headed back to the classroom and found that child care staff member Angela Grignani got to Child A first. Ms. Grignani was located at the opposite end of the classroom. The area where Child A and Child B were playing is separated from the rest of the room by a child gate. Initially, Ms. Silver thought Child B bit Child A as Child B has bit other children in the past. At first Ms. Silver believed Child A's injury looked like a scratch on his neck and upper chest. Then Ms. Gragnani noticed the skin was starting to peel away from Child A's neck. Ms. Silver 2 realized the injury was a burn. Ms. Silver grabbed a towel that she soaked in cold water to apply to the injury. Ms. Silver said one of the child care staff members called licensee designee Debra Ellis. Ms. Silver later learned Ms. Ellis contacted Child A's Mother to inform her Child A was injured. Ms. Silver observed Child A was closer to the table than he was when Ms. Silver went into the hallway to get jackets. She also noticed the bottle warmer was tipped over on its side on the table. This is when Ms. Silver realized Child A was most likely burned by the water in the bottle warmer. Ms. Silver and Ms. Gragnani both attempted to apply a cold cloth and gauze to Child A's injury the best they could. However, Child A was hysterical and kept pushing their hands away. Eventually someone took Child A to Ms. Ellis's office in an attempt to comfort Child A while they waited for Child A's Mother to arrive at the child care center. I interviewed child care staff member Angela Grignani. Ms. Grignani said she was at the opposite end of the large classroom when she heard Child A cry. Ms. Silver stepped into the hallway to grab the children's jackets so they could take a walk. Ms. Grignani walked over to Child A to see what happened. She noticed Child A was rubbing himself around his neck area. When Ms. Grignani pulled Child A's shirt away from his skin, she realized Child A had a burn on his chest. Ms. Grignani removed Child A's onesie and pants. Child Care staff member Danielle Elliott came to the classroom to see why Child A was crying. Ms. Grignani believes Ms. Elliott called Ms. Ellis. Ms. Ellis brought burn cream to the classroom. The child care staff members attempted to put burn cream and a cold compress on Child A's injury, but Child A continually pushed their hands away. Ms. Grignani placed a gauze with burn cream on her own chest, then attempted to have Child A lay on her chest so his chest would lay on the gauze, but she was unsuccessful. Ms. Grignani is not sure how much time passed while she attempted to comfort Child A. Ms. Grignani said child care staff member Tracy Andrews arrived at the classroom and attempted to take Child A to give Ms. Grignani a break. Child A would not go to Ms. Andrews until he started to get a little sleepy. Once Child A agreed to go to Ms. Andrews, Ms. Andrews took Child A to Ms. Ellis's office. Ms. Grignani went to check on Child A in Ms. Ellis's office and found Child A to be sleeping as they waited for his mother to arrive. Ms. Grignani said the bottle w

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8330 · R 400.8330 Food services and nutrition generally. (15) Bottle warmers must be placed where children cannot access them or reach the cords for them.

A bottle warmer was placed on a table in the infant classroom that allowed Child A to gain access to the bottle warmer, resulting in Child A sustaining a second-degree burn.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

R 400.8330 · R 400.8330 Food services and nutrition generally. (16) Bottle warmers must be shut off when not in use. A child care staff member shall not hold a child while removing a bottle from the heating device.

The bottle warmer was on and in use when Child A pulled it over. The bottle warmer was shut off and moved out of the classroom after Child A was burned by the water in the bottle warmer.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

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

The complainant alleged that Child A has been observed to have a soiled diaper at least eight times since August 2020. It was obvious to the complainant that Child A had been sitting in the diaper for an extended period and a diaper rash began to form. The director has been informed of the concern several times, but it is still occurring. On 04/29/2021, I called the complainant to conduct a phone interview. The complainant's phone was disconnected at that time and I was unable to leave a message. I again called the complainant later that day, but the phone was still disconnected. On 04/29/2021, I conducted an unannounced inspection at the child care center. Upon arriving at the child care center, I observed the licensee/program director, Debra Ellis, assisting a child in the bathroom. I told Ms. Ellis why I was at the child care center and she asked to conduct the interview after she finished changing diapers and helping the other children use the bathroom. After Ms. Ellis was finished helping the children, she escorted me to her office to conduct the interview. I explained the allegations to Ms. Ellis, and she stated that she was shocked at what was being alleged. Ms. Ellis is also the lead caregiver in Child A's classroom and is primarily responsible for changing Child A's diaper. Ms. Ellis stated she changes Child A's diaper "constantly" because Child A's parents give her Miralax every day. Ms. Ellis explained that Miralax is a laxative, however she was not aware if Child A has a medical condition that required her to take Miralax daily. Ms. Ellis indicated that there was one incident the week prior to this allegation when Child A had several "very loose" bowel movements in one day. Ms. Ellis sent Child A's Mother a text message informing her of this information and Child A's Mother responded stating that she may have "accidently doubled up on her Miralax." Ms. Ellis stated that Child A was beginning to get a rash because of the loose bowel movements so she informed Child A's Mother that she applied diaper rash cream to the affected area. Ms. Ellis added that Child A typically has five or six bowel movements a day because of the Miralax. Ms. Ellis stated that Child A usually tells her when she needs her diaper changed, but she also changes Child A's diaper routinely throughout the day. Ms. Ellis stated that Child A's Mother approached her about Child A having a soiled diaper in the past, but this typically only occurs when Child A's Father picks Child A up from the child care center. Because Child A is over 30 months of age, Ms. Ellis stated that she does not keep a log of how often she is changed. Ms. Ellis indicated that bathroom breaks are included in the classrooms daily routine to ensure the children's diapers are being changed or they use the bathroom regularly. She added that the children's diapers are changed, or they go to the bathroom before they transition to a new activity, such as waking up from a nap, going outside, or 3 having snack. She also stated that the diapers are changed as needed and the children who are potty trained are free to use the bathroom. During the onsite inspection, Child B's Mother arrived to pick up Child B (three-year- old male). I took this opportunity to interview Child B's Mother while she waited for Child B. Child B's Mother stated that she has no concerns with how often Child B's diaper is changed. She added that if she arrives to pick Child B up from the child care center and his diaper is wet or soiled, Ms. Ellis will change him before he leaves the child care center. During the onsite inspection, I interviewed child care staff member, Karen Richardson. Ms. Richardson stated that she works in the classroom with Ms. Ellis. She provides direct supervision to Child C (three-year-old male), so she only changes his diaper. Ms. Richardson stated that she sees Ms. Ellis frequently changing the children's diapers. On 06/01/2021, I called Child A's Mother requesting a phone interview. I ha

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.