• Violation

  R 400.8125(1) · R 400.8125(1) S taff; volunteer; requirements. All staff and volunteers shall provide appropriate care and s upervision of children at all times.

  The child care provided appropriate care and supervision during the diaper change process. NEW RULE R 4 00.8213(1)

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 4(14.8125 Staff; volunteer; requirements. (1) All staff and volunteers shall provide appropriate care and supervision of children at all times.

  On 4/14/23, CCSM 1 picked up Child A by her while outside. Although CCSM 1 did not intend , , CCSM 1 failed to provide appropriate care when she picked up Child A' , causing her to be become'

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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. 12

  I to coordinate the investigation. She does not have an identifiedc ochnitlda catse iRrea this allegation. She stated that during her initial on-site to the center, that she observed an incident report of a child refusing to walk or listen to Child Care Staff Member (CCSM) 2. During her initial on-site, this ecific child had no marks or injuries, nor was he interviewed due to shyness. interviewed the child's mother, who did not report any current concerns iregarding CCSM. 2. I completed an o01ins0pe0ctioMno the center on 4/27/23. 1 was accompanied by . Collaborative interviews were completed with CCSM 3, CCSM 1, 2, CCSM 6, and CCSM 5. CCSM 2 works in the toddler room which cares for children ages 18 months- 3 years old. 7 CCSM 6 stated that she works alongside CCSM 2 in the toddler room. She described CCSM 2 as "awesome" and patient with the children. She has not observed CCSM 2 be frustrated or use physical discipline with the children. She has not observed CCSM 2 put her foot on the children. She stated that the children "love" CCSM 2. Discipline in the room consists of talking and giving the children a break to another area of the room. The children may sit down for about 30 seconds. CCSM 5 stated that she has worked on occasion in the toddler room. She has not had any concerns regarding CCSM to child interactions. She has never observed CCSM 2 put her foot on the children. She has not observed CCSM 2 appear stressed or upset with the children. CCSM 2 stated that she works in the toddler room. She was asked about the children in the room. She stated that the room has some new children, so learning the nap routine can be difficult. The CCSMs in the room read the children stories and have the children lay on their cots. The CCSMs spread out and sit next to the children to pat their backs or hold their hands to keep them on their cots. If the children do not want to lay down, they pick them up and lay them back down. The CCSMs sometimes rest their hands on their backs while rubbing circles and patting them to help the children stay still so they stop trying to get up. When this is done, most children fall asleep in less than a minute. If a child does not fall asleep quickly, the CCSMs continue to stay with the children rubbing their backs. In addition, some of the children flail around, so the CCSMs are careful to not let the children hit their heads on the walls. Sometimes they also hold and cuddle the children and then try to have them lie down again. CCSM 2 used Child C as an example, saying that she flails and throws herself backwards. CCSM 2 sometimes has Child C lay down and she holds her foot. She also puts one or both hands on her lower back and assist her to stop moving by holding her in place so that she will stay on the cot. CCSM 2 stated if some of the children do not want to lie down or sleep, they may hold and rock them, or they may take them out of the nap room to the main child care room. CCSM 2 denied using discipline at the facility, saying the children in the toddler room are too young for time out. The toddler room uses talking and redirection. CCSM 2 has no concerns regarding the CCSMs treatment of the children. None of the children have been injured during nap time. CCSM 2 was asked directly about putting her foot on a child, and she said "yes", indicating that it was with Child B ). Child B is no longer in the toddler room due to her age. She last attended the toddler room the end of 2022 before moving to the next room. CCSM 2 stated that Child B's parents asked that the CCSMs not sit next to or pat Child B during nap time. As such, CCSM 2 continued to stand next to Child B while she was on her cot. CCSM 2 would take her shoe off and gently rest her foot on Child She would lean against the wall with all her weight on the floor. CCSMB '2s'W foooot at contacted Child B had no additional weight on it. CCSM 2 stated that was not done out of anger, as she was trying to help her fall asleep. CCSM 2 also sat an

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8182 · 1 R 400.8182 Ratio and group size requirements. (3) In each room or well-defined space, the maximum group 1 size and ratio of child care staff members to children, 13 ..... ....... ............................................. ...................................................................................................... including children related to a staff member or the licensee, must be as shown in Table 4: (a) Child Care Staff Member to Child Ratio for infants and Toddlers, birth until 30 months of age is 1 to 4.

  Four CCSMs reported that napping children may be left alone in the nap room while sleeping. The CCSMs leave the nap room door open so they can listen for the children. .......................... ................ ............................................................................................................................................................................................................

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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.

  Four CCSMs reported that napping children may be left alone in the nap room while sleeping. The CCSMs leave the nap room door open so they can listen for the children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8188 · R 400.8188 Sleeping, resting, and supervision. (14) Resting or sleeping areas must have adequate soft lighting to allow the child care staff member to assess children.

  On 4/27/23, I observed the children in the toddler room napping in the nap room. I observed the nap room to be too dark to easily assess the children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  On February 23, 2023, I spoke with program director and licensee designee Chelsea Speers. Ms. Speers stated Child Care Staff Member 4, who is no longer employed at the center, reported to her that Child Care Staff Member 1 does not feed children who are hungry, does not change soiled diapers timely, and does not clean. She addressed with Child Care Staff Member 1 the role of primary caregivers. Herself, the assistant director, and the secretary are always checking the infant room and making sure they have all the help they need and observing how the classroom is going. No one has ever seen Child Care Staff Member 1 not doing work. Child Care Staff Member 4 was employed for 15 days and only came in for her shift nine days. Of those nine days, there were only two days when Child Care Staff Member 1, Child A, and Child B were also present. The child care management application they use is CORAdvantage and the documentation shows Child A and Child B were changed and fed regularly during the times in question. On February 27, 2023, I completed an on-site inspection. I spoke with program director Chelsea Speers. Ms. Speers provided primary care sheets, a log showing there were only two days when Child Care Staff Member 4 was working at the same time Child Care Staff Member 1, Child A, and Child B were all present at the center. Ms. Speers provided printouts of those same dates from the child care management application CORAdvantage for both Child A and Child B. Ms. Speers provided child information cards for Child A and Child B. Ms. Speers stated she notified both Child A and Child B's families that there was an investigation regarding their children. On February 27, 2023, I completed an on-site inspection. I spoke with Child Care Staff Member 1. Child Care Staff Member 1 stated she is a lead caregiver in the infant classroom. She has been employed with SonShine Early Childhood Center for a year. She treats all the children in her classroom the way she would treat her own children; this is the way all the child care staff members in the classroom care for the children. The children eat on demand and when they are hungry child care staff members give them a bottle, then if the child refuses, they simply wait a few minutes and then offer it again. Child A started the week of January 23, 2023, and Child A's Mother brought 8-ounce bottles for him at that time; he only drank 3 ounces at a time for them. Child A was adjusting to a new environment, getting used to everyone. He was at a point of drinking 3-6 ounces and that is what his mom began sending. He ate every 3-4 hours and sometimes he would eat the morning bottle completely and then the next time it was time for him to eat, he would not take any of the bottle. She would then sit the bottle on the counter with a sticky note with when the bottle was good until. Child Care Staff Member 1 stated Child Care Staff Member 4 saw her offer Child A the bottle and he did not want it all and then she put Child A down on the floor and he went to play with a friend. Child Care Staff Member 1, "Oh no he has to eat the whole bottle," and then Child Care Staff Member 4 tried to feed Child A the bottle insisting he eat. Child Care Staff Member 1 told her if Child A does not want the 5 bottle, do not force him to eat. Child Care Staff Member 4 took Child A and sat down with him, leaving Child Care Staff Member 1 to care for the other seven children in the classroom and proceeded to feed Child A the bottle which took her 30-40 minutes. Afterward, Child A spit up a lot of the bottle. Child A took a little longer to eat then most children but he is also breast fed at home and breast-fed children can take longer to eat from a bottle. Child Care Staff Member 4 would regularly feel like the children needed to eat the entire bottle. Child Care Staff Member 1 stated she feeds all the children in her care and there have never been any concerns reported regarding how she feeds Child B his bottles. Child Care S

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8330 · 1 R 400.8330 Food services and nutrition generally. (7) Infants and toddlers shall be fed on demand. 11

  Child Care Staff Member 1 fed Child A and Child B, as well as all the children she cared for in the infant room; the children are fed on demand.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

• Violation

  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 07/15/2022 I spoke with Child A's Mother. She said a previous child care staff member named Dana, unknown last name, was talking about the previous center she worked at, which was Sonshine Early Childhood Center. Dana told a friend of Child A's Mother that she witnessed Amara Jackson throwing Child A while she was in the infant room and Ms. Speers knew this happened but did nothing about it. Dana said Ms. Jackson threw Child A into a bouncer seat because she was crying, but no other details about this are known and it is not known how Ms. Speers was made aware of this information. Dana relayed this information to Child A's Mother friend who then reported this to Child A's Mother. Child A is no longer in the infant classroom, but she began care in the infant room on 7/7/2021 and transitioned out of the infant room just prior to 04/05/2022. Child A's Mother said there were several child care staff members in the infant classroom during this time, but she mainly communicated with Ms. Jackson. This is her first-time hearing of these allegations, and she had a meeting with Ms. Speers to discuss them on 07/15/2022 and Ms. Speers told her she was not made aware of these allegations. Child A's Mother said at the time Child A was in the infant room, she did not have any concerns and despite Ms. Jackson not being "the most happy go lucky person", she never questioned Ms. Jackson's ability to care for Child A. She never noticed any suspicious marks or bruises or had any concerns for the infant classroom. On 07/19/2022 I left a voicemail for previous child care staff member, Dana Kiptoo. As of the date on this report, I have not received communication back from her. On 07/21/2022 I made an unannounced visit to the center and interviewed program director, Chelsea Speers. She said Ms. Jackson is not currently present at the center but will arrive later this afternoon. Ms. Speers reviewed Child A's records and confirmed Child A began care at the center on approximately 06/01/2022 and she transitioned out of the classroom on 04/05/2022. Ms. Jackson and Anna Holmes were the two primary child care staff members during this time. There were a few others as well, but they only worked a day or so in that classroom. Dana Kiptoo started working at the center in August of 2021 and left the center in September of 2021. Ms. Kiptoo was in the infant classroom for approximately two weeks as she was hired as a floater, then moved into another classroom. Ms. Kiptoo worked with only Ms. Jackson and Ms. Holmes in the infant classroom. Ms. Speers met with Child A's Mother on 07/15/2022. When she learned of the allegations she was surprised as Ms. Jackson "adored" Child A. Child A's Mother first texted her on 07/08/2022 that Child A was mis-handled so they arranged to discuss this in person. Once details were known, Ms. Speers submitted a notice to the bureau of child care licensing. Ms. Speers was told on 07/15/2022 that Ms. Jackson threw Child A while in the infant classroom. This was the first time she 3 heard of this happening, and she asked Ms. Damon and Ms. Harnes if they heard this allegation as well, to which both declined. Ms. Speers has no concerns that Ms. Jackson was too rough or physically aggressive with Child A in any way. Child A's Mother has pulled her other children from the center when she believed they were being bullied by other children, therefore if she had concerns on Child A, she would have spoken to Ms. Speers about it at the time or withdrawn Child A from the center. However, Child A's Mother has not reported any concerns on Child A prior to this. I interviewed Anna Holmes, child care staff member in the infant classroom. She said she began working in the infant classroom on 08/23/2021 and when she started, she worked with Ms. Kiptoo. Ms. Holmes said Ms. Kiptoo did not work well with the children as her tone of voice was scary to the children and they did not connect with her as well. Ms. Kiptoo did not get along well with Ms. Jac

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  There is insufficient evidence to support that Ms. Jackson threw Child A onto a bouncer and did not utilize positive methods of discipline.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  R 400.8140 · R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: MA .................................................................................................... (a) Hitting, spanking, shaking, biting, pinching, or inflicting other forms of corporal punishment. ................ ....

  There is insufficient evidence to show that Ms. Jackson used corporal punishment with Child A.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  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.

  On 06/23/2022, I made an unannounced visit to the center. I conducted a walkthrough of all of lassrooms. All classrooms were operating within ratio. Ms. Speers was interviewed. She said CCSM9 is not present and CCSM1 was moved out of the infant classroom to the school-age classroom. I addressed the new allegations of the ratio concerns with Ms. Speers. She said both the 3-year-old classroom and 4-year-old classroom have a capacity of 20 children and they always have three child care staff members present. Ms. Speers provided a total classroom count of enrolled children for both preschool classrooms. A classroom labeled the Prekindergarten classroom (4-year old's) has 16 children enrolled, and the preschool classroom has 17 children enrolled. CCSM3, child care staff member in the 4-year-old preschool classroom was interviewed. She said her classroom has never operated out of ratio and she has no concerns with this occurring. She said she is not sure why someone would report concerns of the preschool classrooms operating out of ratio. She has no concerns for the 3-year-old preschool classroom operating out of ratio either. In the 3-year-old classroom, the third child care staff member comes in at 12:00PM and in the 4-year- old classroom, the third child care staff member comes in at 11:45AM. CCSMS was interviewed. She said she works in the 4-year-old classroom with CCSM3 and CCSM8. She said her classroom has never operated out of ratio and she has no concerns with this occurring. CCSM8 was interviewed. She said she works in the 4-year-old preschool classroom and they have never operated out of ratio as the classroom operates a 1:12 ratio as required. A discussion was held of what to do if the classroom ever was out of ratio, such as calling CCSM7 or Ms. Speers so someone can come to the classroom to put them back in ratio immediately. On 06/24/2022 I called and interviewed CCSM4. She said she has never had any concerns with SM3 operating out of ratio or having too many children in her care. The center prioritizes all classrooms operating within ratio requirements and has no concerns of this occurring at the center. On 06/24/2022, I called and interviewed Witnessl. She said she was familiar year-old toddler classroom and the lead during this time, from approximately 2018 until 2019, was Witness3. The 2- 13 year-old classroom was operating out of ratio with 'a bunch of kids", but the lead was not present in the classroom. Witness3 came into the classroom late but was upset as an incident had happened to her personally. She does not recall the 3-year- old or 4-year-old preschool classrooms to be operating out of ratio. On 06124/2022, Child D's MothE She believes she has never seen CCSM6 classroom to have more that to one child care staff member, but she has never actually counted the children. On 06/24/2022, 1 spoke with Child C's Mother and Father. Child ' Is currently in the preschool classroom, but she has attended the center since During the summer of 2020, CCSM1 was Child C's primary child care staff mem r, but two other child care staff members were also present. There were a few days CCSM1 was supposed to open the classroom at 7:00AM, but she was late. On 06/27/2022, l spoke with Child B's Mother. She said she had no concern.s.. r~eg.a.r.d" icnga asnsyrooms operating out of ratio. There were a few occasions she made sure the appropriate number of child care staff members were present. Such as, if the infant classroom had four children and a fifth child was coming, she made sure another child care staff member would be present to accommodate the fifth child. The infant classroom always had ratios covered and she has never seen a child care staff member with more than four infants. She said she is not familiar with the other classrooms. On 07/08/20221 looked at the addendum to the original licensing study report and verified that both preschool classrooms have a capacity of 20 child care children. On 07/12/2022, 1 interviewed

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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.

  On 06/23/2022, I made an unannounced visit to the center. Ms. Speers have been no complaints on CCSM3, but she does have a loud voice and she has had multiple conversations with child care staff members in the 3- and 4-year-old preschool classrooms about loud voices. She has spoken with CCSM3 and CCSM6 about being in close proximity to the children and to get on their level to speak with them, so they are not constantly yelling across the playground. CCSM3 and CCSM6 yelled to get the children's attention during outside time, both were receptive when told to get on the children's level to get their attention instead of yelling. No child care staff members have com lained about CCSM3 and she has been working at the center since CCSM3 was interviewed. She said she was worked in the 4-year-old preschool classroom since she started in . She works with CCSM5 and CCSM8. She said her classroom does no"gra children in a rough manner, but child care staff members hold the hands of the children and sometimes carry them, but not in an aggressive manner. Child care staff members use two hands to pick up a child by their underarms. No one in her classrooms yells or screams at the children and she nor any other child care staff members in her classroom hit the children or grabs them aggressively. No one has ever complained about her classroom. She has no concerns in her classroom, but she does have concerns with how CCSM6 handles the children. CCSM3 said there was an incident with a child and CCSM6 today that she observed. Around 1:00PM, when CCSM3 was returning from break and walking towards the center's restroom, she was walking out of the gym doors to come outside and there was a child running to the playground. CCSM6 "caught him, she yelled after him and he was just standing, and she ran and grabbed him by his arm." CCSM6 used one hand and caught him by the lower forearm, carried him like a football with one arm wrapped around the child's waist. CCSM6 walked the child back to the field and then let go and "dropped him" about 2ft from the ground. CCSM3 said she knows that CCSM6 is going through some things, but she has seen other things happen with her and when CCSM6 denies it, it makes CCSM3 feel uncomfortable because "how do you tell your friend like no, you do, do this." The child was already upset when CCSM6 grabbed and held him, but he wasn't crying, and he whines often. However, this is normal for CCSM6 to handle children like this. She does not believe this child had any marks or bruises as a result, but she did not check him. She said she does not think CCSM6 is getting worse with her interactions with children, but it has been slightly better. Normally, CCSM6 actions are appropriate, but approximately once a week she can be inappropriate. She has seen CCSM6 toss a child into a space away from the other children, she took the 16 child by one arm to toss them. Sometimes she will "yell in their face", it is not known what is being said, but she has observed it. She described this to be a raised voice that is frightening to the children and the children cry afterwards, depending on the child. CCSM5 was interviewed. She said she works with CCSM3 and CCSM8 and she has no concerns that either of them are yelling, hitting, or grabbing children inappropriately. She has never seen either one of these child care staff members interact with children in an aggressive manner. She said she has no concerns for CCSM3 or CCSM8 and no parents or other child care staff members have ever complained to her about this. CCSM5 said there was a concern with CCSM6 today. At approximately 1:00PM, CCSM6 was going outside, and CCSM5's class was outside walking around the fence of the playground. A child was standing at the entrance of the playground and CCSM6 was mad that he was standing over there. CCSM5 observed CCSM6 pick the child up and brining the child to where he needed to be. CCSM6 "threw him down and he landed on his shoulder. She picked him up like

• Violation

  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 06/06/2022, 1 spoke with Child A's Mother. She said Child A started in the infant classroom when he was 2 months old. Child A had been getting "these weird marks" on his cheeks and it looked like he was pinched as they were little red marks. When she asked the child care staff members in the infant room about this, they thought it could have been a grass allergy. However, Child A has been in the grass before without having these reactions. After she spoke to the child care staff members about this, she did not notice any red marks or raised red bumps. She described these bumps as "like when you get pinched, the skin raises" and she believed there could be a connection of someone doing this to him like a child care staff member or another child, but the marks stopped appearing after she communicated about them. She believed she mentioned the red cheeks to Ms. Speers and said it looked like "little pinches" to her. She also spoke with CCSM1, but it was difficult to connect with her and she often felt the infants were uncomfortable around her. She said she would not be surprised if CCSM1 was pinching Child A, as "her gut" tells her CCSM1 3 was pinching Child A or doing something, like flicking his cheeks. The raised skin marks appeared to have two marks on his cheeks, which is not what a grass allergy looks like. This would have occurred in the summer of 2020. She did not tell Ms. Speers that she was worried CCSM1 was pinching him. She has not seen any other marks or bruises on Child A from the infant classroom. On 06/07/2022. I sooke with A case update was provKded, and a plan was e an unannounced visit on 0610912022. On 0610912022, 1 made an unannounced visit to the center and interviewed Cha sea Speers, program director. Ms. Speers said CCSM1 has a ways worked in the infant classroom, but the concerns regarding Child A's cheeks being pinched or hurt were never brought up to her. However, she believes Child A's parents are upset with her because they are behind in their tuition and are not allowed to return back to the center until this is paid. Child A's last day at the center was and was put into the center's Core system (which is the online system used by the center to document attendance, children's feedings, etc.) on 01/06/2022 but started care on Ms. Speers looked through the Core system to see if any _. pictures of Child A could be located when he was an infant, but this was unsuccessful. Child A transitioned into the toddler classroom named the Walker room on 1011512020. Ms. Speers said she receives copies of any physical notes that are written to the parents, but she does not receive copies of messages sent to parents through the Core system. Ms. Speers stated payments have been an issue with Child A's parents since he began care. Ms. Speers gave Child A's parents until the end of the month to pay the balance, but Child A tested positive for COVID-19 so she informed them Child A could not return to the center until payment was made. Child A's parents said they could not make the payment; therefore, Child A was dismissed. Ms. Speers said there have been multiple parents that did not like CCSM1's personality as she isn't "warm and friendly" and she has spoken to CCSM1 about this. She relayed that it is important to have a positive "customer service presence" when working. The assistant director, CCSM7 said she was worried CCSM1 was picking up the infants in a rough manner, but CCSM7 checked on the infants after CCSM1 picked them up and observed her picking the infants up and realized it appears to be rough looking because CCSM1 is tall, and she bends at her waist to lift the infants up. There were never any red marks or bruises on any infants after CCSM1 picked the infants up. Ms. Speers said she never had a parent complain of child care staff members being too rough with any children. CCSM1 has had child care staff member improvement plans for room cleanliness and attitudes, but nothing further. An improvement plan w

• Violation

  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: Age; Child Care Staff Member to Child Ratio; Maximum Group Size c)Preschoolers, 3 years of age until 4 years of age: 1 to 10 Ratio.

  The 3-year-old preschool classroom has operated within the 1:10 ratio requirement. This classroom always has at least two child care staff members in with a third that comes in during the afternoon to help with coverages. ......................................... ........................................................................................................................................

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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: Age; Child Care Staff Member to Child Ratio; Maximum Group Size d)Preschoolers, 4 years of age until school-age: 1 to 12 Ratio

  The 4-year-old preschool classroom has operated within the 1:12 ratio requirement. This classroom always has at least two child care staff members in with a third that comes in during the afternoon to help with coverages. —... .........................................................

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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.

  CCSM6 provided inappropriate care and supervision when she picked up a child "like a football" and dropped him on the grass, causing him to land on his shoulder. ......................................... ......................................................................................................................

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  On 04/29/2022, I spoke with Witness1. It was explained that on 12/23/2021 around 10:00AM, CCSM2 hit Child D in the face. This happened in the walker classroom where children are between the ages of 1-2. On this day, the children sat down on the classroom rug to do an activity such as shapes and colors. CCSM2 was observed to be visibly frustrated that the children were not listening, and the classroom already had incidents of biting earlier this day. Child D grabbed another child and tried to bite them, but CCSM2 took the base of her palm and "smacked" Child D's forehead away from her. The impact of this knocked him back. Child D was sitting down at the time this happened and he rocked backwards as a result of this, but he did return to the sitting position. Witnessl confronted CCSM2, but she tried to convince Witnessl that she did not hit him. CCSM1, was advised of the incident and came down into the classroom and spoke with CCSM2 and Witnessl. The incident report that CCSM2 completed stated "I tried to hit a child to keep him from biting another child", but Witnessl feels this was incorrect as CCSM2 did hit Child D. Child D did not have any marks or bruises as a result of this happening and Witnessl 3 believes this is the first time something like this has happened. No other child care staff members have been observed to hit a child care child. On 05/06/2022, I made an unannounced visit to the center. I interviewed program director, Chelsea Speers. She stated she has been with the center for 8 years. She said CCSM2 works in the walker classroom which has children between the ages of 1 and 2 years. A complaint was never brought to Ms. Speers, but it was brought to CCSM1's attention, and she took care of the complaint. CCSM1 told her she addressed the concerns of CCSM2 possibly hitting Child D and this was unfounded. Ms. Speers did not speak with CCSM2 regarding this; however, CCSM2 has "delays" and is never left alone with children. She said CCSM2 works well with the children in her classroom, and she is no threat to them, but she is always supervised. I interviewed, CCSM1. She stated she has been at the center for almost 5 years. She said she received a complaint a while ago, but unknown exact date, that CCSM2 had hit Child D. She asked CCSM2 if she hit Child D and she said yes, but CCSM2 explained there were ongoing issues with Child D biting that day and CCSM1 has spoken with all the child care staff members in the classroom previously to shadow Child D. CCSM2 was shadowing Child D when the incident happened. CCSM2 was sitting down and on one side of her she had Child D and another child on the opposite side of her. Child D reached a crossed CCSM2 in attempt to bite the other child when CCSM2 reached for him with an open hand, told him no and as she was reaching for him, Child D was also coming forward towards her hand and CCSM2 bumped Child D's forehead with the palm of her hand. CCSM1 had a conversation with CCSM2 about how to appropriately stop a child from biting. Child D did not cry as a result of this happening, nor did he have any marks or bruises. Child D fell on his bottom and stayed in the sitting position. CCSM1 said she explained this incident to the other child care staff members in the classroom and ask that they continue supervising CCSM2 "a little more closely." She believes she spoke with CCSM10, child care staff member about this and she relayed this to the rest of the child care staff members. CCSM1 also spoke with Child D's Father and told him Child D had some biting concerns that day and CCSM2 went to stop Child D from biting by using an open hand that bumped Child D's forehead. Child D's Father seemed okay with everything but asked how CCSM1 was going to handle and respond to this. She advised him additional training and support would be provided. CCSM1 stated this is the first time a parent has ever complained of CCSM2 I interviewed CCSM2. She stated she has been working at the center full time since

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  On 04/29/2022, I spoke with Witness1 who said there are broken toys on both of the outdoor playgrounds. One playground is for the younger children and the other, for the older children. Some of the broken toys have since been moved, but there is a wooden kitchen set that has rusted out and CCSM1 has admitted that this piece of play equipment should not have been left outside. Witness1 said they removed nails from this wooden playset. Witness1 said every time they went outside onto the playgrounds, a broken toy or object was located and there were white, sharp ceramic pieces that were picked up roughly a dozen times. There were plastic bats on the playground and Child E was playing with a bat that was broken in half and he A sliced his hand on it which caused his hand to bleed. Child E and another child were pulling the broken bat. Child E did not seek medical attention as a result of this injury. CCSM1 was notified of Child E's injury, she met him outside on the playground and he was taken inside to get his cut cleaned. Child E's Mother was notified at pick up of his cut and she seemed concerned. Child care staff members told Child E's Mother the broken toys were cleaned up. It is believed this incident happened in either March or April of 2022. Witness1 has not seen or heard of any other children getting hurt on the outdoor playground as a result of unsafe play equipment or hazardous items. On 04/29/2022, I spoke with Witness 2, who said there are unsafe objects on the outdoor playground. A child got injured and was bleeding because toys were not removed after they were broken. This was not witnessed, but the incident report was read. There is an outside kitchenette that is rusted, and screws can be seen sticking out. Children have been observed picking up several pieces of broken ceramic that was located next to a bush on the courtyard playground. There was also a motorized car, the power to the car did not work but there were exposed wires. Witness 1 believes this car has since been removed, but the children sat in the car and played in it. On 05/06/2022, I made an unannounced visit to the center. I completed a walk through of both of the outdoor playgrounds. I did not observe any broken toys, any motorized toy cars, wooden play sets or anything that would be considered to be hazardous. There were older toys on the playgrounds that appeared worn, but not broken. I interviewed Ms. Speers. She explained Child E was playing in the sandbox and she contacted Child E's Mother about his injury from outside and sent her pictures of the injury. Child E's Mother did not voice any concerns regarding this incident to her. The toy that Child E was injured on was not a toy that the center put in the sandbox, but one that was thrown in by the neighbors. There is a residential neighborhood located within walking distance of the center's fully fenced in outdoor playground. Ms. Speers said the object was a "pump thing" that Child E's finger got stuck in. CCSM1 helped Child E outside when this happened. Ms. Speers observed the object that hurt Child E and said it looked like a pump toy which has since been discarded. This incident happened on March 21, 2022. Ms. Speers provided a copy of the incident report which read: Child E "Was pulling on a toy and it cut his hand, making him bleed", he was provided with tender, loving care, band aids and child care staff members cleaned his cut. The incident report had a date of March 21, 2022. I interviewed CCSM1. She said she has never seen a wooden play structure that was rusted anywhere on the child care premises. She explained sometimes broken toys are found on the outdoor play ground, but these are removed right away. Child care staff members do a good job on pulling and throwing away any broken items. CCSM1 has never seen any plastic, ceramic pieces laying around either of the 7 playgrounds. When asked about Child E, she said she doesn't remember exactly what the toy was but believed Child E pinch

• Violation

  R 400.8170 · 1 R 400.8170 Outdoor play area. (10) An outdoor play area and any equipment located on the center's premises must be maintained in a safe condition and rj inspected daily before use to ensure that no hazards are present.

  On 04/29/2022, I interviewed Witness1. The incident occurred on 04/22/2022 in the toddler classroom. There were water beads located in the sensory table that the children could access. Roughly around 4:45PM-5:OOPM, Child A was observed putting water beads in his mouth and throwing them across the floor. It is unknown if Child A ingested any of the water beads, but the packaging was not readily available in the classroom and it unknown if the water beads were non-toxic. Poison control was contacted, and they advised Child A to be seen by a medical professional for medical treatment. CCSM4 advised that contacting poison control was not necessary because there is nothing in the classroom that is considered toxic to children. Ms. Spears and CCSM1 believed it was an "overreaction" to go to the hospital and this was not considered an emergency. However, after poison control said to go to the hospital, Ms. Speers contacted 911. A second child also put the water beads in their mouths, but there were other families that were contacted regarding this incident. The water beads are also used in other rooms, such as the infant classroom. Currently, the water beads have been removed and the center has pulled any items that are not considered age appropriate in preparation for a licensing visit. Such items include paint, magnet puzzles, that are used for children ages 3 years and older. CCSM1 has also commented that water beads were safe in the infant classroom because child care staff members hold the infants while they play with the water beads. The water beads in the toddler classroom were out a few times, but not out every day. On 05/06/2022, I made an unannounced visit to the center and interviewed Ms. Speers. She said the water beads were purchased and put into the sensory bin for monitored sensory time. On 04/22/2022, in the afternoon, the children in the toddler classroom lifted the lid of the sensory bin and pulled out the water beards. Witness 1 10 and CCSM9 were in the classroom at the time. CCSM1 got a call from Witness 1 that Child A was choking so Ms. Speers called 911 and told them there was a child choking in the classroom. When CCSM1 returned to the office, she clarified that Child A was not choking, but he put water beads in his mouth. Ms. Speers met the paramedics at the center door and CCSM1 went into the classroom to get Child A. Witness1 stated she called poison control and they said to take Child A to the hospital. Child A was asked if he swallowed any and he replied "yes." Ms. Speers explained what happened to the paramedics and they confirmed that it was not an emergency and Child A did not need to go to the emergency room. The paramedics explained they could not take Child A to the hospital because it was not an emergency, and they did not have parental permission. Child A's Mother was contacted, and she gave permission to the paramedics to transport Child A to the hospital. CCSM1 then went with Child A in the ambulance to the hospital where Child A's Mother met them. The water beads were immediately removed from the classroom after the incident. Witness 1 was concerned that Child A needed to go to the hospital, but she relayed to Child A's Mother what the paramedics said. The infant classroom water beads in a sensory jar, but all water beads were removed from the center and banned. She said there could have been water beads in 2019 in the infant classroom in a pool of water, but they would have been closely supervised. Ms. Speers spoke with CCSM4 about the incident, and she made sure to pull everything out of the classroom that could not be used by children under 3 years of age. I received a copy of the incident report that read, "Orbeez spilled on the floor and Child A put some in his mouth. I made him spit them out." Child A was monitored, and poison control was contacted. The date on the report read 04/22/2022 and was signed by Witness 1. I also received a copy of the incident report that was provided to child c

• Violation

  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 care staff members did not provide appropriate care and supervision as Child A and possibly other children put water beads in their mouths. Child A was seen at the hospital and no concerns were reported. The packaging on the water beads indicated this product is for children 3 years of age and older.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8173 · R 400.8173 Equipment. (4) Play equipment, materials, and furniture, must be all of the following: (a) Appropriate to the developmental needs and interests of children as required by R 400.8179(2).

  The toddler classroom consists of children between the ages of 2 and 3 years. Water beads are designed for children over the age of 3 and therefore, are not appropriate for their age and developmental needs.

  Open Not marked corrected in the state record

  Category: physical safety. Open / not marked corrected.

• Violation

  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 care staff members did not provide appropriate care when multiple infants received bleach stains on their clothing from the changing pad not being dry prior to a diaper change. ................... .......... ............................................................................................................................

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  Appropriate care and supervision was not provided as multiple child care staff members reported concerns on how CCSM6 physically addresses children and how she speaks to the children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8158 · R 400.8158 Incident, accident, injury, illness, death, fire reporting. (2) A licensee, licensee designee, or program director shall report to the child's parent and the department, directly or via phone, fax, or email, within 24 hours of the occurrence of any of the following: (b) An incident involving an allegation of inappropriate contact.

  Ms. Speers did not notify licensing of the allegations regarding CCSM2 hitting Child D in the face.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  R 400.8158 · R 400.8158 Incident, accident, injury, illness, death, fire reporting. (4) A licensee, licensee designee, or program director shall submit a written report to the department of the occurrences outlined in subrules (1), (2), and (3) of this rule, in a format provided by the department, within 72 hours of the verbal report to the department.

  Ms. Speers did not submit a written report to the department regarding CCSM2 hitting Child Din the face as required. ................

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  R 400.8176 · R 400.8176 Sleeping equipment. (13) Soft objects, bumper pads, stuffed toys, blankets, quilts, comforters, and other objects that could smother a child must not be placed in, or within reach of, a crib or porta-crib with a resting or sleeping infant.

  During my onsite inspection I observed an 11 -month-old to be sleeping in a crib with a pacifier that had a small, stuffed animal as an attachment. Multiple child care staff members also reported that infants less than a year-old transition to cots are allowed to sleep with blankets.

  Open Not marked corrected in the state record

  Category: recordkeeping. Open / not marked corrected.

• Violation

  R 400.8176 · R 400.8176 Sleeping equipment. (3) A crib or porta-crib must be provided for all infants in care.

  Multiple child care staff members in the infant classroom stated infants sleep on a cot prior to turning a year old to help transition them into the walker classroom. All infants 12 months of age or younger, must sleep in a crib or porta-crib.

  Open Not marked corrected in the state record

  Category: physical safety. Open / not marked corrected.

• Violation

  R 400.8179 · R 400.8179 Program. (8) Tummy time is required daily for all infants under 12 months of age, and must meet all of the following requirements: (a) Infants shall be directly supervised at all times while engaged in tummy time.

  I completed an unscheduled on-site inspection to the center. I interviewed program director and licensee designee, Ms. Speers. She stated that the infant room practices tummy time with the children. Tummy time takes place on hard foam tiles or carpet on the floor. At times, the child care staff may spread out a thin blanket on top of the carpet for the infant to lay on. Ms. Speers was aware of Child A (age 7 months) having "irritation to his nose" while practicing tummy time on the foam tiles. Ms. Spears observed Child A to have a small amount of blood inside his nose. Child A was not otherwise injured, and his mother was contacted. This type of injury has never happened before, and that it has not happened since. Ms. Speers stated that she has no concerns regarding the care or supervision the children receive in the infant room. She stated that the child care staff members (CCSMs) work hard to provide a "good and safe" environment for the children. I interviewed Ms. Jackson, CCSM. She has worked at the center for two years. She enjoys working in the infant room. Ms. Jackson stated that the infant room practices tummy time with the infants on the carpeted floor, the hard foam floor tiles, or by using an infant "boppy pillow", which was described as a soft "U" shaped pillow. The children are always directly supervised. For younger infants that have not yet mastered the skill of tummy time, Ms. Jackson always sits directly next to the infant. Ms. Jackson stated that on 11/11/2021, she was working directly with Child A as he was practicing tummy time. Ms. Jackson was sitting on the floor with her legs in a "V" shape. The boppy pillow was positioned inside her legs. Child A was lying face down on a boppy pillow with his head facing away from her so that he could look out at the room as he picked up his head. Child A was actively moving his head. Child A "got a little bit fussy", which she assumed was because he did not want to continue with tummy time. Child A was not overly upset, and he was not crying. Ms. Jackson picked up Child A and saw a small amount of blood inside his left nostril. There was also a small amount of blood on the boppy pillow. Child A's nose was not actively bleeding and seemed to be "more irritated." Ms. Jackson believes that the irritation occurred from Child A rubbing his nose on the boppy pillow. Ms. Jackson took Child A to the office to show Ms. Speers. Ms. Jackson put a tissue on Child A's nose, and it "immediately" removed the blood in his nose. Child A's Mother was notified quickly. Child A's Mother did not express that Child A had any previous nose bleeds. Ms. Jackson stated that this was an isolated incident, saying that no other child has ever been injured while participating in tummy time. Ms. Jackson believes that the children in the infant room receive good care and supervision. Ms. Jackson stated that she provides the infants with the "best care" that she can as she wants the parents to be happy with the center and to trust her with their children. I interviewed Ms. Holmes, CCSM. Ms. Holmes stated that she enjoys working in the infant room. She has worked in the infant room a couple of months but has previous child care experience elsewhere. Ms. Holmes stated that the infant room practices 3 tummy time daily. Tummy time is practiced on the hard foam floor tiles or on a boppy pillow. The infants are "always directly supervised", and she has never had any concerns. Ms. Holmes stated that on one occasion, Ms. Jackson was sitting directly with Child A. Child A was using the boppy pillow for tummy time and his nose was slightly bleeding from rubbing on the pillow. The bleeding stopped quickly, and he was not otherwise injured. Child A's Mother was contacted about the incident. Ms. Holmes stated that she this was an isolated incident and that this has not happened again. She stressed that the CCSMs are "very cautious" about supervising the children during tummy time to be sure that they are safe. She

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8179 · ................................................................................................................. ..................................................................... R 400.8179 Program. .................................................. ......................................................................................................... .................................................................................. (8) Tummy time is required daily for all infants under 12 months of age, and must meet all of the following requirements: 5 (c) During tummy time, infants shall not be placed on or near soft surfaces, including but not limited to cushions, pillows, or padded mats.

  I interviewed Ms. Speers. She denied the allegations. She stated that the infant room contains a portable speaker that is used to provide "white noise" in the room. The speaker may be placed in an empty crib or somewhere else in the room. It is not placed next to an infant's ears. She remembered once or twice hearing the music "maybe" on the loud side; however, it was "not irritating or upsetting" to the infants in the room and the infants were sleeping. Ms. Spears stated that the children all sleep comfortably with the background noise in the room, and she has no concerns. I interviewed Ms. Jackson, CCSM. She denied the allegations. She stated that the infant room contains a portable speaker that is used to play background music for the children. The room usually plays rain sounds. The speaker is not placed next to the infant's ears, nor is it too loud. She has only seen the speaker placed on the counter in the room, which is across the room from the cribs. Ms. Jackson stated that the infants enjoy the music, that it is soothing for them, and it helps them to sleep better while in the room. She had no concerns. I interviewed Ms. Holmes, CCSM. She denied the allegations. She stated that the infant room contains a portable blue tooth speaker that is used to play white noise, such as water sounds. The music helps to soothe the infants and helps them to sleep better in the room. Ms. Holmes stated that the music volume level is appropriate, and speaker is kept on the counter or in an empty crib. She had no concerns. I interviewed Ms. Sears, CCSM. She denied the allegations. She stated that the infant room contains a portable speaker that is used to play white noise, such as rain sounds. The music helps to soothe the infants and helps them to sleep better in the room. The music is on frequently as the children sleep at different times. Ms. Holmes stated that although she does not always enjoy the music, the music volume is not at a "dangerous level", nor does it disturb the infants. The speaker is "never" placed up to the infant's ears. She has observed the speaker kept on the counter or whiteboard area. She had no other concerns. I observed the infant room. I observed the portable speaker used for playing music. The speaker was not turned on. It was located on a counter on the opposite side of the room as the infant cribs. I separately interviewed three parents including Child A's Mother, Child B's Mother, and Child C's Mother. The three parents did not express any concerns regarding the use of music in the room. Child A's Mother has not heard any loud music in the room. Child B's Mother has been present during nap time, saying that the infants listen to the music sounds of rain or other white noise. Child B's Mother had no concerns with the volume of the music, and she has observed the portable speaker located on the whiteboard or on the counter on the opposite side of the room as the cribs. Child C's Mother has observed the infants napping in the room. She has heard background music such as ocean sounds. Child C's Mother had no concerns with the volume of the music, and she has observed the portable speaker on the counter on the opposite side of the room as the cribs. I interviewed Ms. Spears a second time. She continues to not have any concerns regarding the use of music in the room.

• Violation

  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.

  The infants receive appropriate care. Loud music is not placed next to infant's ears.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8155 · R 400.8155 1 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.

  I interviewed the complainant. If CCSMs are sick, they are told they still need to report to work unless they are in the hospital. The complainant was not certain if there was a CCSM on site with pneumonia but stated there was one CCSM that was taking antibiotics at one point. I completed an on-site inspection to the center on 8/23/2021. I did not observe any CCSMs appear ill. None of the CCSMs reported to me that they have a contagious illness or pneumonia. I interviewed Ms. Speers, Program Director and Licensee Designee; and Ms. O'Donnel, CCSM. I interviewed Ms. Speers. Ms. Speers stated that CCSMs are allowed to call in sick if they are ill. CCSMs are required to find a replacement substitute from a provided substitute list. If they are unable to find a substitute, they may still call in sick, but the sickness will not be excused without a doctor's note. Ms. Speers indicated that there have been incidents of staff not wanting to work, so they will call in sick. She stated that there is a difference between not wanting to work, not feeling well, and being contagious. With staffing shortages, she counts on the CCSMs to report to work. All the CCSMs wear masks, wash their hands, and use hand sanitizer. As such, being at work while not feeling well, but not contagious, is not harmful to others. Ms. Speers stated that she was aware that that CCSM, Ms. O'Donnel was sick. She was negative for Covid 19. Ms Speers first heard that Ms. O'Donnel had been ill when she told her that she had a sinus infection and that she has been taking antibiotics for over a week. She did not report that she was contagious. Ms. Speers was not aware of, nor did she receive any written doctor's statements from Ms. O'Donnel. Ms. Speers was not aware of any CCSMs being at the center with a contagious illness. She is not aware of any anyone having pneumonia. She acknowledged that she has told CCSMs that she still expects them to report to work unless at the doctor or hospital if they are not contagious. She believes that it is acceptable for CCSMs to not feel well or be tired and still report to work, but she would expect the CCSMs to stay home if they are contagious. Ms. Speers stated that if Ms. O'Donnel had submitted her written doctor's statement, that she could have stayed home, and it would have been excused. However, seeing that she was not contagious, as well as 3 has been taking antibiotics for several days, Ms. Speers believes that it was safe for her to report to work. I reviewed the center's sick leave policy. Sick leave credits are awarded to salaried employees. It is the responsibility of the employee to contact the director as soon as possible when unable to report to work. It is also the employee's responsibility to find a substitute to ensure proper coverage. A physician's certification is required for any illness beyond two working days. I provided Ms. Speers with a rule review and technical assistance regarding the center's written policy detailing when staff and volunteers will be excluded from the center due to illness. The rationale for the rule is to help to prevent the spread of illness or communicable diseases within a center. Technical Assistance for the rule includes that the policy should detail when staff and volunteers cannot be present at the center and when they can return to the center. I interviewed Ms. O'Donnel. She has worked in the Walker Room since May 2001. She "loves" the children and her job. Ms. O'Donnel stated that if she wants to use sick time, she is responsible to find another CCSM to work in her place. In addition, she was not sure if she could take off work if she had a contagious illness, as she has never asked. She is not aware of anyone having pneumonia. She stated that a couple of weeks ago she got a sinus infection and was placed on antibiotics. She was later placed on a steroid which helped her feel better. She continued to work during this time, and she wore a mask. She stated that she attended an on-li

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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) Infant and Toddlers, birth until 30 months of age. Child Care Staff Member to Child Ratio is 1 to 4. Maximum Group Size is 12 children.

  I interviewed the complainant. The complainant was not aware of the exact numbers of children being cared for by the center. On 8/16/21, one CCSM was supposed to leave at 11:00a.m., but she was not able to leave until 12:30 p.m. to have enough CCSMs in the room. The complainant believes that on 8/17/21, the toddler room may have had ten toddlers with only two CCSMs. Reviewed the center's approved use areas. The center is located inside the Holt Lutheran School building. The approved child care center use areas include: • Room 101 (Young infant room) accommodates 12 children ages newborn to 10 months. This age group requires one CCSM to four children to be in compliance with ratio requirements. • Room 100 (Walker Room) accommodates 12 children ages 10 months to 24 months. This age group requires one CCSM to four children to be in compliance with ratio requirements. • The Toddler Room accommodates 12 children ages 18 months to 36 months. This age group requires one CCSM to four children to be in compliance with ratio requirements. • Room 104 accommodates 20 children ages 3 to 4 years. This age group requires one CCSM to ten children to be in compliance with ratio requirements. • Room 105 accommodates 20 children ages 4 and 5 years. This age group requires 1 CCSM to 12 children to be in compliance with ratio requirements. • Room 109 accommodates 18 school age children. This age group requires 1 CCSM to 18 children to be in compliance with ratio requirements. • Library Annex accommodates 33 school age children. This age group requires 1 CCSM to 18 children to be in compliance with ratio requirements. I completed an on-site inspection to the center on 8/23/2021. I observed the center to be in compliance with CCSMs to child ratio requirements in each room. The Young Infant Room contained one CCSM with four children. The Walker Room contained one CCSM with four children. The Toddler Room contained two CCSMs with seven children. Room 104 contained one CCSM with three children ages 3 years. Room 105 contained 2 CCSMs with 13 children ages 4 years. Room 109 contained one CCSM with seven children school age children. I interviewed the Ms. Speers. Ms. Speers stated that the center works diligently to remain in compliance with CCSM to child ratio requirements in each room. The center has been struggling to find CCSMs. They are currently short two positions. Despite this, they continue to have 11 substitutes to call upon, the assistant to the director, the school secretary, and herself to assist in maintaining the proper CCSM to child ratio requirements for each room. There are times when CCSMs are asked to come in early or stay late if needed. There have been other times that CCSMs are scheduled to work, but they decide they do not want to finish their shift, so others have to cover. In addition, there have been incidents were CCSMs have allowed extra children to sign into care that are not scheduled, thus keeping CCSMs from leaving on time as they were now needed in the room. On 8/16/21 CCSM Ms. Jefferson, was supposed to finish her work shift at 11:00a.m. but stayed until 12:30 p.m. to allow for proper CCSM to child coverage in the Walker Room after an additional child was allowed to join the room despite not being on the schedule. This extra child placed the Walker Room with five children, thus requiring two caregivers, Ms. Jefferson and Ms. O'Donnel. Ms. Jefferson was able to leave once Ms. Speers was able to go into the room to cover for her. Regarding 8/17/2021, Ms. Speers stated that the Toddler Room followed CCSM to child ratio requirements. Specifically, she went into the room with Ms. Rushton and 9th Ms. Crawford when the child arrived in the room prior to their scheduled start time. Ms. Speers had been working in the Walker Room that morning assisting Ms. O'Donnel care for five children. When the 9th child arrived in the Toddler Room, she took Child A (age 20 months) with her to the Toddler Room, which is approved for children a

Child Care Staff Member 1 does not feed Child A or Child B. She is documenting she is feeding them and they go home with empty bottles each day. r

Disposition: Substantiated

Child care staff member, Amara Jackson threw Child A (Male, aged 1) while in the infant room.

Disposition: Substantiated

Child A (male aged 2) had red marks on his cheeks due to child care staff member (CCSM)1 pinching or hurting Child A's cheeks during the summer of 2020. Both preschool classrooms operate out of ratio. CCSM6 and CCSM3 are mean, they yell at the children in care and Kate "snatches" children by their arms.

Disposition: Substantiated

Child care staff member (CCSM) 2 hit Child D (Male aged 2) in the face. There are broken toys on both playgrounds and these toys have been unsafe since the winter. There is a rusty wooden kitchen set with rusted nails. Child E (Male age 2) cut his hand on a broken bat on the playground. Child A (Male age 2) put water beads in his mouth and went to the hospital to receive care. The toddler classroom has toys and objects like the water beads that are not suitable for children under 3 years of age.

Disposition: Substantiated

A baby that cannot hold his head up was placed on his tummy for tummy time. This caused the infant to get a bloody nose. The infant room puts loud music next to the infant's ears so they will sleep.

Disposition: Substantiated

Child care staff members (CCSM) must work while ill. There is a CCSM working that has pneumonia, thus putting children at risk. The only excuse allowed for not coming to work is that the CCSM is in the hospital. Child care staff members (CCSMs) are required to come in early and stay late in order to have enough staff at the center. On 8/17/21, the Toddler Room may have had ten toddlers with only two CCSMs.

Disposition: Substantiated