R 400.8134(3)(a) · R 400.8134(3)(a) Hand washing. Before meals, snacks, or food preparation experiences. Bureau

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8152 · ........... R 400.8152 Medication; administrative procedures. (2) A child care staff member shall give or apply medication, prescription or nonprescription, only with prior written permission from a parent. 4

On May 6, 2022, I made telephone contact with Child Care Staff Member, Jessica Frost. She reported that she works in the young preschool room and for months she has been asked to give Child A, Child B, and Child C melatonin at nap time, but she has not seen a medication permission form. She was told by Program Director/Licensee Designee, Tamie Moran, and Lead Caregiver, Karmin Andrews to give the medication. Ms. Frost reported that she never had a form to document when the melatonin was being given. She reported feeling uncomfortable giving the medication because the children would be groggy and had trouble focusing after waking up from nap. She stated that she left the facility yesterday and is no longer working there. On May 6, 2022, I completed an unannounced onsite inspection at the facility and interviewed Program Directors Yvonne Brooks and Mae Collins. Ms. Brooks reported that she does not handle the medication permission forms, Ms. Moran does. She was aware of Child A and Child B being on medication. She was not aware of Child C taking medication. She reported that Ms. Moran was away from the facility for a training. Ms. Brooks reported that if Ms. Frost was giving medication without documenting it, she was not aware it was happening. Ms. Brooks reported that Ms. Andrews, the lead caregiver for the young preschool room, was out of the facility on her break. Ms. Collins reported that she was aware that Child A and B's mother gave verbal permission to give the melatonin, but she was not positive a medication form was completed. She stated that Ms. Moran would have completed the form and she was out of the office for the day. Ms. Collins reported that Child A and B's mother is sisters with Child C's mother, and Child A and B's mother is their main contact for all three children. Following my onsite inspection, I emailed Ms. Moran requesting that she email me a copy of the medication permission forms for Child A, Child B, and Child C. On May 11, 2022, I received an email from Ms. Moran. Attached in the email was a written letter dated 1/6/2022 giving permission for the facility to give Child A, Child B, and Child C 1m g of melatonin as needed. It was signed by Child A and B's mother. On May 24, 2022, I made telephone contact with Ms. Moran and Ms. Andrews. Ms. Moran reported that after receiving the written request from Child A and B's mother, the medication forms were sent home, but she never brought them back and Ms. Moran forgot to follow up. I asked if Child A and B's mother has guardianship for 3 Child C. Ms. Moran stated, she does not officially, but is their main contact for drop off and pick up. I informed Ms. Moran they needed written permission from Child C's mother before medication can be given. Ms. Moran reported that the center practice is for lead caregivers to administer the medication. She was not aware that Ms. Frost was giving medication. She spoke with Ms. Andrews about documenting when medication was given, and Ms. Andrews told Ms. Moran she was not consistent about filling out the form when she gives Child A, Child B, and Child C medication. Ms. Moran stated that following my onsite inspection she has received the medication forms from Child A and B's mother. Ms. Andrews reported that she and Ms. Frost were giving Child A, Child B, and Child C melatonin at nap time. Ms. Andrews said she did not consistently document when the medication was given. On May 24, 2022, Ms. Moran sent me a photo of the melatonin bottle. The suggested use is that children 2 years of age or older chew one gummy daily under adult supervision. On May 31, 2022, I made telephone contact with Child A and B's mother, Child C's mother, Child D's mother and Child E and F's mother. Child A and B's mother reported that she met with staff in January and told them that the children's pediatrician recommended giving them melatonin to help them sleep. She reported completing the written letter requesting the melatonin be given, but she forg

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8152 · R 400.8152 1 Medication; administrative procedures. (9) The center shall maintain a record as to the time and the amount of medication given or applied, with the exception of subrule (8) of this rule, on a form provided by the department or a comparable substitute approved by the department. The signature of the caregiver administering the medication shall be included.

Ms. Brooks, Ms. Collins, and Ms. Moran reported that when they have enough staff to cover nap time, they have two staff for the 15 children in the young preschool room; however, they are not always able to meet this requirement. Ms. Moran reported that she does have a live camera positioned in that room, so she is able to watch the room via video when they are not able to meet ratio. Ms. Frost reported that almost daily she was left alone with 15 children during nap time when Ms. Andrews was on break for an hour. She often asked for additional support because all the children do not fall asleep, but she was told they did not have enough staff. Ms. Andrews reported sometimes there are enough staff to have two in the room during nap time, but ratio is not always maintained. 5

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8182 · 1 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: Table 4 Child Care Staff Member to Child Ratios Child Care Staff Maximum Age Member to Child Group Ratio Size Infants and toddlers, (a) birth until 30 months 1 to 4 12 of age Preschoolers, 30 (b) months of age until 1 to 8 16 3 years of age Preschoolers, 3 years (c) of age until 4 years 1 to 10 30 of age Preschoolers, 4 years (d) of age until school- 1 to 12 36 age (e) School-agers 1 to 18 36

In the young preschool room, the center should always follow a 1 to 8 ratio. During nap time, ratio is often not being followed when there is 1 staff member to 15 children.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.