• Violation

  R 400.8125 · ....................................................... 1 R 400.8125 Staff; volunteer; requirements. a (1) All staff and volunteers shall provide appropriate care and supervision of children at all times. 5 LV . r •- r ••r • r- ! ! • ," liii] i INVESTIGATION: On 04/20/2022, I interviewed the Complainant. They stated that there are multiple toys laying on the floor of the Infant Room at the end of the day. They have witnessed child care staff members trying to walk around the room while there are infants laying on the floor. The Complainant is concerned that this is an unnecessary trip hazard which could cause a child care staff member to trip and fall on top of an infant. The Complainant further reported that the facility is not kept clean. They have observed the facility's community bathroom to be filthy, as well as old carpet pieces left sitting in a pile near a door that is used by the children to enter the playground area. On 04/21/2022, Ms. Dunn reported that the Infant Room can, at times, have several toys laying on the floor, as the toddlers who are on the move tend to empty the buckets of toys from the shelves. Sometimes at the end of the day, child care staff members are busy with attending to bottles, diaper changes, preparing children to go home and interacting with parents, and that the toys may not always be picked up and put away. She believes the child care staff members do a good job of ensuring the toys are picked up in a timely fashion and do not pose a risk to children or adults tripping on them. She further reported that there had been a time when carpet squares, which had been removed from the floors, had been sitting in the entrance area that leads out to the playground. She was unsure of how long they had actually been sitting there. They had been stacked in a corner of the entrance area so they were not a trip hazard, they did not prevent entering or exiting the doors and they were far enough away from the children that they were not within their reach. Ms. Dunn showed me where they had been stacked. I observed they carpet squares were no longer present. She stated the center bathrooms are cleaned on a daily basis and she has not had any concerns or reports regarding the center's cleanliness. While on-site, I did a walk-through of the facilities community bathrooms and the Infant Room. Both areas were clean and very well maintained. On 04/21/2022, Ms. Kingsbury reported that the child care staff members try to keep the toys picked up and take turns cleaning the facility. She has no concerns with the toys being a trip hazard in the Infant Room. She does not use the community bathrooms at the center and so she could not speak to their cleanliness and she could not recall if there ever had been any carpet squares by the playground entrance door. She had no concerns with the cleanliness of the facility. On 04/21/2022, Ms. West reported that she does not have any concerns regarding the cleanliness of the facility. The staff take turns cleaning it on a daily basis. She did recall the carpet squares being present in the entrance way leading to the playground, but they were off to the side and did not interfere with anyone entering or exiting the doors. On 04/21/2022, Ms. Baker reported that the staff members try to keep on top of picking up the toys in the Infant Room. She does not believe the number of toys on the floor are ever a tripping hazard and there are never any toys in the way of the door leading in and out of the room. She is not aware of any accidents happening 7 where someone has tripped on the toys. She could not remember any carpet squares being unattended to in the entryway leading out to the playground and she has no concerns with the cleanliness of the center. On 04/21/2022, Ms. Ennis reported that the child care staff members are usually trying to pick up as much as they can; however, when there are toddlers in the room at the end of the day, they like to dump the toys on the floor. She had

  On 04/20/2022, I interviewed the Complainant. They reported that on one occasion Child A had received a scrape on her head when she had been laying on the floor of the Infant Room and another child pushed an activity table over onto her. Child A's parent was notified via the Brightwheel App at the time the 3 incident occurred but was not discussed with the parent when Child A was picked up from the center at the end of the day. Child A did not receive any medical treatment for the scrape. The Complainant reported that they have witnessed children jumping off a wedge-shaped mat while infants were laying on the floor nearby. On 04/21/2022, I conducted an unannounced on-site inspection at the center. I informed the program director Ms. Barbara Dunn about the allegations. She reported that Child A's Mother was informed via the Brightwheel App by child care staff member Ms. Allison Kingsbury on the day the incident occurred. An entry on the Brightwheel App dated 04/19/2022 at 9:11 a.m. stated: "Incident: A friend was playing at an activity table near Child A when it fell on her. She has a small scratch/red mark on her forehead. We comforted her. -Ms. Allie." There was also a picture that accompanied the entry. The picture was of Child A's head and showed a small mark on her forehead; there did not appear to be any broken skin or bleeding. Ms. Dunn further reported that she had spoken to Child A's Mother on the phone and said that she did not voice any concerns to her about the incident. Ms. Dunn confirmed that there is a wedge-shaped mat in the Infant Room that is used by the children who are in the climbing stage of their development. Typically, there is one child care staff member who sits on the floor with the infants and directs toddlers to move away from the infants who might be laying on the floor. There have been no reported incidents of children falling on top of or injuring infants while they have laid on the floor. On 04/21/2022, I interviewed child care staff member Ms. Allison Kingsbury. She reported that on 04/19/2022, she had been working in the Infant Room when the activity table fell onto Child A. "A toddler was learning how to walk, he leaned on it, it fell over and scratched Child A. The table was removed and Child A was comforted." Ms. Kingsbury showed me the activity table. It was a plastic, small, toddler sized activity table designed for children to stand up at to use. Ms. Kingsbury stated that the wedged mat and other foam blocks are kept away from the infants when they are laying on the floor and a child care staff member generally sits on the floor between the infants and the mat/blocks. On 04/21/2022, I interviewed child care staff member Ms. Tiana West. She reported that she was not present when the incident with the activity table and Child A took place. She stated that she liked having the wedged mat in the room for the children to use. "We try to keep the climbers away from the infants." She did not know of any reported accidents regarding infants when they are laying on the floor. On 04/21/2022, I interviewed child care staff member Ms. Nicole Baker reported that she was not working at the center on 04/19/2022. On 04/21/2022, child care staff member Ms. Julia Ennis reported that she was in the Infant Room when the activity table fell onto Child A. She said she was feeding another infant at the time. The incident happened very quickly. Child A had a mark on her head, but she appeared fine. She further reported that the blocks and the 4 wedged mat are usually put off to the side and the infants and toddlers are separated from each other when they are being used. On 04/22/2022, I interviewed child care staff member Ms. Cierra Eckert. She reported that on the day of the incident, she was feeding a baby in the Infant Room. Ms. Kingsbury was standing nearby when the incident occurred, but she was not close enough to catch the activity table before it fell. It barely fell on Child A; she had a small mark on

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

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

  On 04/20/2022, the Complainant reported that in the Infant Room on 04/19/2022 between approximately 6:30 a.m. and 6:50 a.m., there were two children between the ages of 2 and 3 years of age and four infants present with only one adult. The Complainant has had concerns before regarding the number of children and adults present. When they have spoken to the program director Ms. Barbara Dunn, Ms. Dunn had responded with a statement saying it was due to the lack of staffing. On 04/21/2022, Ms. Dunn provided the sign in and sign out sheet for the Infant/Toddler Room for 04/19/2022. She stated that child care staff members Ms. Allison Kingsbury, Ms. Taylor Stevens and Ms. Julia Ennis were all present on that day during the hours of approximately 6:30 a.m. and 6:50 a.m. The sign in and sign out sheet shows that Ms. Stevens arrived at 6:00 a.m., Child G (7-month-old male) arrived at 6:02 a.m., Child J (27-month-old female) arrived at 6:22 a.m., Child K (28- month-old male) arrived at 6:18 a.m., Child F (6-month-old female) arrived at 6:22 a.m., Ms. Kingsbury arrived at 6:36 a.m., Ms. Ennis arrived at 6:52 a.m.; at 6:55 a.m. Ms. Stevens left the room; and Child A arrived at 7:00 a.m. The caregiver to children ration was maintained at 1:4 from 6:02 a.m. until 6:36 a.m.; from 6:36 a.m. to 6:52 a.m. a 2:4 ratio was maintained; from 6:52 a.m. to 6:55 a.m. a 3:4 ratio was maintained and from 6:55 a.m. to 7:00 a.m. a 2:5 ratio was maintained. On 04/21/2022, Ms. Kingsbury stated that she thought she had arrived at the center on 04/19/2022 sometime around 6:45 a.m. There were less than four children in attendance and she was alone or with another staff member until approximately 7:00 a.m. when more children and Ms. Ennis arrived. She does not have a concern with maintaining ratio in the Infant Room because there is always someone available at the center to help. On 04/21/2022, Ms. West reported that she worked in the Toddler Room on 04/19/2022 and was not present in the Infant Room. She could not recall ever having been out of the required ratio when she has worked. On 04/22/2022, Ms. Eckert reported that she had arrived at the center around 8:00 a.m. on 04/19/2022 and Ms. Kingsbury and Ms. Baker were both present in the room. On 06/15/2022, Child C's Mother could not think of a time when there appeared to be too many children and not enough child care staff members. On 06/15/2022, Child D's Mother reported that she has never noticed an issue with the number of children and caregiver in attendance. On 06/15/2022, Child H stated that she does not have any concerns with the number of children and caregiver present. "I don't' count, but there are never too many babies. There's usually 3 or 4 adults there at a time." 10 On 06/15/2022, Child E's Mother stated that she has always paid attention to the number of children in care and the number of child care staff members present. She has not had a concern. On 06/17/2022, Child F, L and M's Mother reported that she believes the number of caregivers to children always seems appropriate.

• 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 caregivers to children, including children related to a staff member or the licensee, shall be the following: (a) For infants and toddlers, there shall be 1 caregiver for 4 children and a maximum group size of 12.

  On 04/20/2022, I interviewed the complainant. The complainant reported that on 04/18/2022, prior to picking Child A up at the center, they had been notified in the Brightwheel App that Child A's nap had ended. When Child A was picked up from the center, she was awake and still sitting in her crib. The complainant estimated that Child A had been left awake in her crib for approximately 10 minutes. They have concerns that Child A is being left unattended. On 04/21/2022, Ms. Dunn stated that the center's policy is to remove children from the crib as soon as they are awake. Sometimes a child care staff member may be delayed in removing a child from their crib, due to attending to other children. She also stated that Child A has a tendency to wake up and then fall back to sleep. A review of the Brightwheel App and the attendance sheet for 04/18/2022, shows that Child A ended her nap at 3:18 p.m. and was sign out for the day at 3:37 p.m. On 04/21/2022, Ms. Kingsbury reported that Child A will wake up from her nap, open her eyes and sometimes go back to sleep. She believes that on 04/18/2022, Child A had just woken up when her mom had arrived to pick her up and that is when she was taken out of her crib. On 04/21/2022, Ms. West stated that infants are not left awake in cribs for very long. "Sometimes we wait to see if they fall back asleep. If a child is upset or crying, we would attend to them immediately." On 04/21/2022, Ms. Baker reported that if infants are awake in their cribs, a staff member will go over and get them. Sometimes infants will wake up and then fall back to sleep again. On 04/21/2022, she said that Child A was sleeping in a crib, she started to wake up, and when she went to go and get her, she rubbed her eyes and went back to sleep. On 04/22/2022, Ms. Eckert reported that she has never witnessed an infant being left alone, unattended in a crib. Sometimes the infants will wake up and fall back to sleep and sometimes we do not take them out immediately if we are attending to other children. On 06/15/2022, Child C's Mother reported that she is not aware of any time when Child C had been left for an extended amount of time awake in her crib. On 06/15/2022, Child D's Mother stated she is not aware of any time when Child D had been left unattended in their crib for an extended amount of time. On 06/15/2022, Child H's Mother reported she was not aware of Child H ever having been left unattended in their crib for an extended amount of time. On 06/15/2022, Child E's Mother reported she is not aware of Child E ever having been left unattended in their crib for an extended amount of time. 12 On 06/17/2022, Child F, L and M's Mother reported she is not aware of any of her children having been left in a crib unattended for an extended amount of time.

• Violation

  R 400.8179 · R 400.8179 Program. (7) When awake, use of confining equipment for infants must be minimized, not to exceed 30 minutes at a time.

  On 04/21/2022, the Complainant reported that when Child A was picked up from the facility at approximately 4:15 p.m., she was in a soiled diaper. They said there were two child care staff members present in the room who were not doing anything at this time. The Complainant also stated that Child A had been dropped off at approximately 6:30 a.m. and did not receive a bottle until 11:30 a.m., when normally she gets a bottle at 9:30 a.m. On 04/22/2022, Ms. Baker reported that she could not really remember when Child A was fed on 04/21/2022, but she did not remember her fussing for a bottle. She did not know if Child A had been sitting in a soiled diaper at the end of the day because she was not in the room at the time she was picked up from the center. She further reported that she has not neglected to provide care for Child A, nor did she believe any other child care staff member had. The Brightwheel App showed that Child A's diaper changes on 04/21/2022 were as follows: wet at 8:30 a.m., wet at 9:35 a.m., wet at 12:26 p.m. and wet with a bowel movement at 2:35 p.m. On 04/22/2022, Ms. Eckert reported that she was present when Child A was picked up for the day on 04/21/2022. She stated that notes are kept on the white board as to when children are to be picked up, so they can have the child ready when their parent arrives. She did not smell or notice that Child A had soiled her diaper. She said that she had not neglected to provide care of Child A, nor had any other child care staff member. On 04/22/2022, Ms. Dunn reported that she was not aware of any child care staff member not providing care for Child A. On 04/22/2022, Ms. Kingsbury reported that she was working in the Infant Room on 04/21/2022, when Child A was present. She said that she had been signed in at 6:55 a.m., she took a nap from 9:00 a.m. to 10:00 a.m. and had a bottle at 11:30 a.m. It did not appear to her that Child A had wanted a bottle after she woke up from her nap. She said that she did not believe Child A had a soiled diaper when she was picked up at the end of the day. She remembered checking her diaper around 2:35 p.m. and that she was picked up around 4:00 p.m. If a child has a soiled diaper when the parents arrive for pick up, a child care staff member will ask the parents if they want them to change the diaper for them. She also said that there are notes written on the white board in the room that help staff to remember to change diapers every two hours. She further stated that she had not neglected providing care for Child A, nor had any other child care staff member. On 04/22/2022, Ms. West reported that she recalled Child A had taken a nap on 04/21/2022 and that they usually do not let children go past their normal feeding time if they are fussy. She left the Infant Room around noon and was not present at the end of the day when Child A was picked up. She further reported that diapers are changed every two hours and if she knows that a parent is coming to pick up their child, she will change the diaper or ask them when they arrive if they would like their 14

• Violation

  R400.8330 · R400.8330 Food services and nutrition generally. (7) Infants and toddlers shall be fed on demand.

  There was no evidence to support that Child A had not been fed on demand.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

• Violation

  R400.8137 · R400.8137 Diapering; toileting. (6) Diapers and training pants shall be checked frequently and changed when wet or soiled.

  There was no evidence to support that Child A had not been changed when soiled.

  Open Not marked corrected in the state record

  Category: recordkeeping. Open / not marked corrected.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.