R 400.8112 · R 400.8112 Comprehensive background check; fingerprinting (1) Pursuant to section 5n of the act, MCL 722.115n, before an individual has unsupervised contact with children, the department shall determine the individual's eligibility to be any of the following: (a) A licensee. (b) A licensee designee. K (c) A child care staff member. (d) A child care aide. (e) An unsupervised volunteer.

I interviewed Child A's Mother. There were a few days in June when the center was short staffed. Ms. Karn, program director, told Child A's Mother that the other two Child Care Staff Members (CCSM) quit. Ms. Karn and another person were in the classroom with the children. Child A's Mother did not know the other person and doesn't think she was a CCSM. CCSM 4, CCSM 5, and CCSM 6 confirmed that there is a worker at the YMCA front desk who helps in the classrooms sometimes. CCSM 5 and CCSM 6 said that there are two individuals, Volunteer 1 and Volunteer 2, who occasionally work in the classrooms. CCSM 4, CCSM 5, CCSM 6, CCSM 7, CCSM 8, CCSM 9, CCSM 10 and CCSM 11 were unaware of anyone working in the classrooms who did not complete a background check. I interviewed Ms. Karn who has been in her position for approximately seven months. Ms. Karn explained that all volunteers are supervised volunteers and are never left alone with children. There are two individuals, Volunteer 1 and Volunteer 2, who volunteer at the center and have completed the required public sex offender registry (PSOR). There is also a worker at the YMCA front desk who also volunteers occasionally. Although not required, the center had the front desk worker complete a comprehensive background check even though she is a supervised volunteer. Ms. Karn has never had anyone in the classroom with her who has not completed a PSOR and/or a comprehensive background check. Ms. Karn provided me with copies of the completed PSOR forms for Volunteer 1 and Volunteer 2. I confirmed that the front desk YMCA worker is in the child care background check system (CCBC) listed under the child care license and is listed as a unsupervised volunteer. Ms. Karn explained that she is listed as an unsupervised volunteer because there is not an option in the system to code her as a supervised volunteer. Ms. Karn confirmed that all volunteers are supervised volunteers and are never left alone with children.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8143 · R 400.8143 Children's records. (11) A center shall maintain an accurate record of daily attendance at the center that includes each child's first and last name and each child's arrival and departure time. Electronic records may be used. If electronic attendance records are used, then they must be available to the department at the time of an inspection. If the electronic attendance records are not available during an on-site inspection, then the center is in violation of this rule.

I interviewed Child A's Mother. There is an iPad in each classroom for parents to sign their children in. When Child A's Mother dropped Child A off at the center on 06/05/2023, Child A's name was not on the sign-in for the Older Toddler classroom. She was told by Ms. Karn that they are preparing Child A for preschool and told Child A's Mother to sign Child A into the preschool classroom. Child A was present in the Older Toddler classroom, not the preschool classroom. Child A's Mother feels the center is falsifying the sign-in sheets because they are short staffed. Ms. Karn explained that the center has two sign-in sheets for each classroom. The sign-in sheet on the iPad is used strictly to determine what rate the parent pays for tuition. If a child is in the Older Toddler classroom and potty trained, the child may be changed on the iPad, so the parents get charged a lower tuition rate. The center doesn't want parents to pay a higher rate just because they don't have space for that child to move up to the next classroom. The paper sign-in form is completed by child care staff members and shows which children are physically in the classroom. Attendance is taken every half hour on the paper attendance forms. CCSM 4, CCSM 5, CCSM 6, CCSM 7, CCSM 8, CCSM 9, CCSM 10 and CCSM 11 confirmed that the paper attendance is the attendance that shows who is physically present in the classroom. They also confirmed that there are some children listed on the iPad in a different classroom if they are transitioning to another classroom soon. I received copies of the child attendance records for the month of June 2023 and verified that the daily paper attendance contained the child's first and last name, and each child's arrival and departure time. 4

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (2) A center shall ensure that a child who is too ill to remain in the group is placed in a separate area and is cared for and supervised until the parent arrives.

CCSM 4, CCSM 6, CCSM 7, CCSM 8, CCSM 9, CCSM 10, CCSM 11 and Ms. Karn confirmed that sick children are separated from the rest of the group until a parent can pick them up. CCSM 5 said that on 06/19/2023, Child A had spots on his hands that they assumed to be hand, foot, and mouth disease and was separated in the crib. On 06/20/2023, Child G came down with spots on his hands but was not separated from the other children. CCSM 5 let Ms. Karn know about the spots, and she called the parent to come pick the child up. On 06/20/2023, Ms. Karn said CCSMs in the infant classroom let her know that Child A had spots on his hands, and they suspected it was hand, foot, and mouth disease. Ms. Karn contacted Child A's parents, and he was picked up at 10:00 AM. Later in the day on 06/20/2023 at approximately 4:10 PM, CCSM 5 told Ms. Karn that Child G had spots on his hand and foot and suspected it was hand, foot, and mouth disease. Ms. Karn sent a text message to Child A's parents at 4:13 PM. Child A was picked up at 4:30 PM. Ms. Karn does not know if the CCSMs in the classroom separated Child A from the other children during that time.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (3) Items and facilities used by an ill child or adult must not be used by any other individual until washed, rinsed, and sanitized. 1

Former CCSM 1, Former CCSM 2, and Former CCSM 3 all said the center is not being cleaned properly. There is supposed to be a cleaning crew that comes in daily to clean but often the classrooms look untouched. CCSMs have to scrub and clean things because they are not being cleaned. Ms. Karn said she helped the Young Toddler classroom clean and sanitize the toys after a child was diagnosed with hand, foot, and mouth disease using the 3-step process beginning on 06/19/2023 at naptime. CCSMs put the toys in bleach water and laid them out to dry. Ms. Karn told all CCSMs that there was hand, foot, and mouth disease in the building. The Older Toddler classroom was cleaned on 06/20/2023. All toys in the Younger and Older Toddler classrooms are supposed to be cleaned at nap and then sprayed with bleach water at the end of the day. There is a cleaning crew who comes in every night after the center closes. Ms. Karn said the cleaning crew is "not great" and Ms. Karn's supervisor is looking to hire another company. There is also a cleaning person who works for the YMCA who takes the trash out, sweeps, and mops the classrooms. CCSM 4, CCSM 5, CCSM 6, CCSM 8, CCSM 10, and CCSM 11 confirmed the toys are cleaned and sanitized daily and they were deep cleaned after finding out about a child having hand, foot, and mouth disease. CCSM 7 thought the child care center should have been shut down for a deep cleaning and sanitizing. CCSM 9 thought the cleaning should have been done sooner.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (4) If a center becomes aware that a staff member, volunteer, or child in care has contracted a communicable disease, then the center shall notify parents and provide all of the following information: (a) The name of the communicable disease the children were exposed to. (b) The symptoms of the disease. (c) Prevention measures as recommended by the U.S. Centers for Disease Control and Prevention (CDC) at 7 the following website: https:!/www.cdcqov/DiseasesConditions.

Ms. Karn received a text Monday morning 06/19/2023 from Child F's Mother informing her that over the weekend, Child F's sibling got sick and Urgent Care diagnosed both children with hand, foot, and mouth disease. Per center policy, Ms. Karn posted a note to the door of each classroom letting parents know that they have a confirmed case of hand, foot, and mouth disease in the center. The parents in the Young Toddler classroom where this occurred were verbally told about the exposure. I viewed the notice that was posted on the classroom doors, and it contained all of the information required to meet the rule. Former CCSM 2 went into the center for her work shift on 06/20/2023, and "no one in administration" told her that hand, foot, and mouth disease was going around but there was a note on the classroom door saying that there was a confirmed case of hand, foot, and mouth disease in the classroom. CCSM 4, CCSM 5, CCSM 6, CCSM 7, CCSM 8, CCSM 9, CCSM 10 and CCSM 11 confirmed that parents were notified by a note on the classroom door, verbally and through Facebook. I interviewed Child A's Mother, Child B's Mother, Child C's Mother, and Child D's Mother. They were all notified of hand, foot and mouth disease either by the note on the classroom door, verbally, or a Facebook message.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8155 · R 400.8155 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.

On 06/21/2023, I interviewed Former CCSM 1. Former CCSM 1 recalls a time on approximately 05/25/2023, when Child E came down with a 104- degree fever in the Young Toddler classroom. CCSMs were told by Ms. Karn to feed Child E and put him down for a nap with the rest of the children. Child E's Mother picked him up after naptime. The exclusion policy for fevers is the child cannot return until after 24 hours and they are fever free. Child E returned the next day at approximately 1:00 P.M. because the doctor said the fever was from an already diagnosed ear infection. When Former CCSM 1 worked at the YMCA, Autumn Karn, program director, let children stay in the Young Toddler classroom during the week of 06/12/2023 even though Ms. Karn knew they had hand, foot, and mouth disease. Former CCSM 1 was working in the Young Toddler classroom at this time. Former CCSM 1 is not sure exactly what the exclusion policy at the center is for hand, foot, and mouth disease but she knows they should not be in the classroom. On 6/20/2023, Former CCSM 1 heard from a CCSM who currently works at the center that a child came into the classroom with hand, foot, and mouth disease, had blisters in her mouth and Ms. Karn allowed this child to stay in the classroom. Former CCSM 2 said that on 06/14/2023, Child F came down with symptoms of hand, foot, and mouth disease. Child F was sent home and returned on 06/19/2023 with blisters on her arms, legs, and rear-end. Child F did not stay home for 10 days which is what former CCSM 2 thinks the policy is. Ms. Karn told former CCSM 2 that Child F was no longer contagious. Former CCSM 2 was working with the children on 06/20/2023 and noticed the Young Toddlers and Older Toddlers were combined. She was told by Ms. Karn that the exposure to the illness had already happened, so she wasn't worried about cross-contamination. Ms. Karn was the CCSM in the Young Toddlers classroom that day due to child care staff members quitting. Ms. Karn said the policy for fevers is if a child gets a fever of 100.4 degrees or above, they get sent home. Ms. Karn does not ever remember a time when any child had a 104-degree fever at the center. The child must be fever free without medication for 24 hours to return. Ms. Karn said that Child E had a fever from an ear infection on 05/11/2023, so she called Child E's Mother to pick him up. It took a little time because Child E's Father had to come from Charlotte to pick Child E up. On 05/12/2023, Child E went back to the doctor because his ears were still infected, and they gave him a different antibiotic. Child E was sent home on 05/11/2023 at 12:56 PM and returned on 05/12/2023 at 1:32 PM. I verified the times on the sign in/sign out sheets for those dates. Child E was out for the required 24 hours. The head lice policy at the center is that the child must be lice free before they can return. If a child is found to have head lice, they are sent home. There was recently had a case of head lice in the preschool classroom on 05/18/2023, but the parent found it at home and returned after lice treatment was done on the child. Ms. Karn recalled on 06/14/2023, she was working in the Young Toddler classroom. She thought Child F felt warm when they were outside and was going to take her temperature when they got back into the classroom. When they returned to the classroom Child F's Mother arrived to pick her up. Ms. Karn told Child F's Mother that she felt warm, and Child F's Mother said she would take her temperature when she got home. Child F did not come to child care on 06/15/2023 or 06/16/2023. Ms. Karn received a text Friday morning 06/16/2023 from Child F's Mother saying that she took Child F to Urgent Care, and they diagnosed her with an allergic reaction. Ms. Karn received a text Monday morning 06/19/2023 from Child F's Mother that over the weekend, Child F's sibling got sick and Urgent Care diagnosed both children with hand, foot, and mouth disease. Ms. Karn shared the texts with me, and t

R 400.8182(3) · R 400.8182(3) 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: 11 TABLE 4 Child Care Staff Mer[ther to Ch th Ratios 3'~ ge Ch11rf Care Staff Maldmum G.ssap Member tc C} $d Rs io Size 8D Enia; and ttdlars, k4th urd1E 30 1 s„ 4 12 rr•r~ a4a~e Vie) P oe , 3I MtWIM 4'ff a e I iq `• i [G~ Pfegthmlefss, :]'y`~rs of a I to 10 3£,} 4 wars G'f £d 'fe~dFfwi m 4 s ota a ssr.".€3 3 to 12 SCI'tCWE^ar:~@ ti_ Sc jera 1 to #d 36

Ms. Karn said that the center is usually overstaffed. The center had a "bunch of people quit" in the Young Toddler classroom but they have never been out of ratio. Ms. Karn often works in the classrooms if needed. CCSM 4, CCSM 5, CCSM 6, CCSM 7, CCSM 8, CCSM 10, and CCSM 11 confirmed that they have not been out of ratio in their classrooms. CCSM 9 said that "they have been out of ratio a few times but not recently". She did not have any dates that this happened. All CCSMs knew the required ratios for the classroom they work in. I reviewed the sign in sheets for child care staff members and children for the week of June 12, 2023 to June 16, 2023. The center keeps an attendance count every half hour on their sign in sheets. I confirmed the number of children present each half hour and compared it to the number of child care staff members present during that time for the Infant, Young Toddlers, Older Toddlers, and the Preschool classrooms. During the week of June 12, 2023, to June 15, 2023, the Infant classroom maintained the required child care staff member to child ratio of 1 to 4 each half hour starting at 7:30 AM and ending at 5:30 PM. The Young Toddler classroom maintained the required child care staff member to child ratio of 1 to 4 each half hour starting at 7:30 AM and ending at 5:30 PM. The Older Toddler classroom maintained the required child care staff member to child ratio of 1 to 4 each half hour starting at 7:30 AM and ending at 5:30 PM. The Preschool classroom maintained the required child care staff member to child ratio of 1 to 10 each half hour starting at 7:30 AM and ending at 5:30 PM. I viewed the classrooms during my onsite inspection. The infant classroom had three children and one child care staff member. This meets the ratio requirement of one child care staff member for every four children. The young toddler and older toddler classrooms were combined for a total of five children and three child care staff members. This meets the ratio requirement of one child care staff member to every four children. The preschool classroom had 12 children with three child care staff members. This meets the ratio requirement of one child care staff member for every 10 children. All classrooms maintained an appropriate child care staff member to child ratio.

Open Not marked corrected in the state record

R 400.8385 · R 400.8385 Poisonous or toxic materials. Containers of poisonous or toxic materials must be clearly labeled for easy identification of contents and stored out of reach of children.

On 12/02/2021, Ms. Megan Christensen, program director, contacted me to inform me that a child had ingested a small amount of diaper rash cream during a diaper change. She stated that she called poison control and they indicated that the child would be fine but may experience some diarrhea. She immediately submitted the written report following the notification. On 12/07/2021, I conducted an unannounced on-site inspection at the center. Ms. Danielle Heinritz, who was changing Child A's diaper during the incident, was not present. Ms. Christensen showed me the diapering table where the incident occurred and showed me the placement of the tube of diaper rash cream during the incident. The diaper table in the toddler classroom is located up against a wall. The diaper cream was placed on the side of the table that is up against the wall on the changing pad against the lip of the table. Ms. Christensen stated that she has instructed all child care staff members to place diaper cream on the hanging shelf near the diaper table to prevent children from being able to access the cream. Ms. Christensen also showed me the diaper rash cream that Child A ingested. It was Boudreaux's Butt Paste and was labeled for Child A. The product does indicate to keep away from children and instructs to contact poison control if ingested. Ms. Christensen stated that she instructed all of the infant and toddler child care staff members to place diaper rash cream on the hanging shelf near the diaper table to make it inaccessible to children. She provided me with a written statement that all of the infant and toddler child care staff members signed regarding this. Ms. Heinritz stated that on 12/02/2021 she was changing Child A's diaper. She sat the diaper cream on the side of the diaper table after she squeezed some on her hand to apply to Child A. While Ms. Heinritz was changing Child A's diaper, Child A grabbed the tube of diaper cream and put it up toward her mouth. A small amount of the cream got in Child A's mouth. Ms. Heinritz rinsed out Child A's mouth and called Ms. Christensen for assistance. Ms. Christensen called poison control and they informed her that Child A would be fine but might have some diarrhea. Ms. Heinritz stated that Child A did not have any signs of diarrhea for the remainder of the day. 3 She was also not aware of Child A having diarrhea after she left care for the day. Ms. Heinritz stated that she was instructed to place the diaper rash cream on the shelf near the diaper table so that it is inaccessible to children. Ms. Martaysia Brown, child care staff member. Stated that she was present in the classroom when the incident occurred but did not witness it happen. Child Care Staff Member 1, who was listed as a witness on the incident report but no longer works at the center, stated that she was working in the toddler classroom on 12/02/2022, but was not in the classroom when the incident occurred. I interviewed Child A's Mother regarding the incident. She stated that she received a text message and phone call regarding the incident right after it happened. Ms. Christensen explained to her what occurred and indicated that she had called poison control. She reported that poison control stated that Child A would be alright but may experience some diarrhea. Child A's Mother stated that Child A did not experience diarrhea or any other symptom due to the incident. She reported that she has been very happy with the care the center provides and has no concerns regarding the care and supervision.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8113 · R 400.8113 Program director qualifications; responsibilities. ................................................ (3) All program directors are responsible for the general management of the center, including the following minimum responsibilities: (a) Developing, implementing, and evaluating program and center policies. (b) Administering day-to-day operations, including being available to address parent, child, and staff issues. (c) Monitoring staff, including an annual evaluations.

It was alleged that Ms. Megan Christensen is the center's program director, and she is not present at the center every day. She works on Mondays, Wednesday, and Fridays, but does not work on Tuesdays and Thursdays as she teaches preschool at another YMCA those days. On 05/27/2021, I completed an unannounced on-site inspection at the center. Ms. Christensen was not present at the onset of the inspection but did arrive during the time I was at the center. The main entrance of the center is in the middle of the child care area. The infant and toddler program is on one side of the entrance area and the preschool classrooms are on the other side. Child Care Staff Member 1 stated that Ms. Christensen is the program director at the center. She is present at the center on Mondays, Wednesdays, and Fridays from about 8:00am to 5:30pm. Ms. Christensen is not normally at the center on Tuesdays and Thursdays. Child Care Staff Member 2 stated that Ms. Christensen is the program director for the center. Ms. Christensen is present at the center on Mondays, Wednesdays, and Fridays. She is usually at the center for about five hours. Sometimes she comes to the centers on Tuesdays and Thursdays, but not usually. Child Care Staff Member 3 stated that Ms. Christensen is the program director at the center. She is present Mondays, Wednesdays, and Fridays for about 3-4 hours a day. Ms. Christensen is not normally at the center on Tuesdays and Thursdays. 3 Child Care Staff Member 4 stated that Ms. Christensen is the center program director. She works on Mondays, Wednesdays, and Fridays. She is present at the center at least six hours on those days. Ms. Christensen does not work at the center on Tuesdays and Thursdays. Child Care Staff Member 5 stated that Ms. Christensen is the center's program director. Ms. Christensen is present at the center on Mondays, Wednesdays, and Fridays for most of the day. Ms. Christensen does not work on Tuesdays and Thursdays. Child Care Staff Member 6 stated that Ms. Christensen is the center's program director. She works at the center on Mondays, Wednesdays, and Fridays. When Ms. Christensen is gone, Ms. Christine LeBrun is in charge. Ms. Lebrun does not have much of a presence on the infant and toddler side of the building when Ms. Christensen is absent. Ms. Lebrun stated that she primarily works in the preschool classroom. She indicated that Ms. Christensen is the center's program director and that she is present at the center on Mondays. Wednesdays, and Fridays for the whole day. Ms. Christensen is not normally present at the center on Tuesdays and Thursdays. At no point during the interview did Ms. Lebrun indicate that she is the center's program director. Ms. Christensen stated that she works at the center on Mondays, Wednesdays, and Fridays. She is at the center on those days from about 8:00am until 5:00 or 5:30pm. On Tuesdays and Thursdays, she is at another YMCA location where she teaches preschool. Ms. Christensen stated that Ms. Kimberly Vaughn, licensee designee, had discussed the situation with Ms. Darlese McConnell, who was their licensing consultant, and that they decided to have Ms. Christine LeBrun, preschool lead caregiver, be assigned as the center's program director. Usually, Ms. Christensen will handle the administrative duties while she is at the center, but Ms. LeBrun is supposed to be in charge of the center on Tuesdays and Thursdays when Ms. Christensen is present. Ms. LeBrun works Monday through Friday from 8:45am to 5:15pm. Ms. Vaughn also occasionally stops by the center on Tuesdays and Thursdays when Ms. Christensen is not able to be present. Ms. Christensen provided me with a copy of a letter dated 02/22/2021 explaining this arrangement to the parents after the previous program director left employment. I informed Ms. Christensen that all of the staff I interviewed, including Ms. LeBrun, referred to Ms. Christensen as the program director. That indicates that the staff are not aware that Ms.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

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

Ms. Christensen stated that there were several biting incidents on 05/20/2021 involving Child A biting other children in care. Child A had been in A attendance for three weeks. He only attended 10:00am to 2:00pm Monday through Friday, so it was hard for him to adjust to the center. Child A had a speech delay and did not speak. It was his first time in a child care setting. Child A was working with Early On. They started doing an evaluation of him on 05/20/2021. Child A did not participate in the classroom activities. He did not listen to the staff and would often push them or block them from accessing him. Child A did not like people in his space. He sometimes threw toys. Prior to 05/20/2021, Child A had made a few attempts at biting, but he was not able to make contact. Ms. Christensen stated that on 05/20/2021, Child A bit Child B while in the classroom. Child B started crying so the staff put him to sleep because they thought he was tired. When Child B woke up from his nap, the staff noticed a bite mark on his leg. The bite was believed to occur around 10:00am and it was later discovered around 12:30 to 1:00pm. Child Care Staff Member 6 called Ms. Christensen when the bite was discovered. Ms. Christensen told her to put ice on it and write an incident report. Ms. Christensen came to the center. Child A ended up biting four children on 05/20/2021. The bites were not malicious in intent and were not surrounding a disagreement with another child. They were all very random. When Child A's Mother arrived, Ms. Christensen spoke with her regarding that day's events. She informed Child A's Mother that she was disenrolling Child A from the center. Ms. Christensen stated that Child A's Mother did not fully disclose Child A's special needs when she enrolled him, and it was not a good fit for him at the center. She was trying to work with Child A's family by having Early On evaluate him and she recognized that it was harder for him to transition because he was only at the center for a few hours a day and most of that time consisted of lunch and naptime. After Child A bit several children on 05/20/2021 she could not continue to allow Child A to remain in care. Child Care Staff Member 6 stated that Child A had a hard time handling his emotions. He would bite, kick, and hit the other children in care. His action against the other children in care was always unprovoked. Child A began trying to bite the staff and children in care when he first started at the center. His bites started as putting his mouth on a staff or other child, but not biting down with his teeth. Towards the end of Child A's time at the center, he started using his teeth and his bites got harder. Child A bit Child Care Staff Member 6 without teeth as well as bit Child D, Child E, and Child F prior to 05/20/2021. These bites did not leave marks. Child Care Staff Member 6 was also aware of Child A attempting to bite other staff as well. Child Care Staff Member 6 stated that Child A hit another child in care every day. The staff tried to split the younger and the older kids up so that Child A was with children his age and not able to hurt any infants in care. Child Care Staff Member 6 stated that on 05/20/2021, she was informed that Child B started crying suddenly in the infant classroom. The staff were unsure what happened and assumed that Child B had just fallen down as he was learning to walk. Child A was near Child B when he started crying. Later that day she was 7 shown Child B's leg, which had a large bite mark bruise on it. Ms. LeBrun told the staff to call Child B's parents. Ms. Christensen was called, and she later arrived at the center. Child A ended up biting multiple children that day. A few of the bites did not leave a mark, so they were not documented. Child Care Staff Member 6 felt that Child A should have been disenrolled prior to 05/20/2021. She did not feel that Child A's behavior was being taken seriously until the multiple incidents that occurred on 05/2

R 400.8182 · R 400.8182 1 Ratio and group size requirements. (3) In each room or well-defined space, the maximum group si2 and ratio of child care staff members to children, including child related to a staff member or the licensee, must be as shown in Table 4: TABLE4 Child Care Staff Member to Child Ratios Age Child Care Staff Maximum Member to Child Ratio Group Size ( Infants and toddlers, bitch until 30 1 to 4 11 a months of age Preschooler. 30 mouths of age Ito 8 16 b until 3 years of Preschoolers. 3 years of age until 4 1 to 10 Not applicable c years of age ( Preschoolers. 4 years of age until Ito 12 Not applicable .4)__ School-apt .__________________ _____________ ( School-agers Ito 13 Not applicable

During the on-site inspection on 05/27/2021, there were 15 children present in the preschool classroom with 4 child care staff members. There were five infants present with two staff in the infant classroom. There were four toddlers present with one staff in the toddler classroom. The center was in compliance with the staff to children ratio requirements. Ms. Christensen stated that she was aware of the center not complying with the staff to children ratio in the infant classroom earlier that morning. There were nine children with two staff from 9:04am until 10:00am when Child Care Staff Member 7 arrived at the center. One additional staff member was needed after the ninth child arrived. Ms. Christensen stated that she made an error when scheduling staff and that is why the center was out of ratio. Ms. Christensen stated that she was not aware of staff taking long restroom breaks or leaving the classrooms out of ratio. Although she admitted that she is not sure what the staff do on the days that she is not at the center. She could see staff stopping at the front desk to talk to coworkers when they go to the restroom. I informed Ms. Christensen that staff can leave the classroom out of ratio temporarily to use the restroom as long as there are no supervision issues in the classroom, but that stopping to talk to friends while taking a restroom break would not be permitted. Ms. Christensen added that she recently found out that a staff member was not taking lunch breaks because she did not want to leave the classrooms out of ratio, so Ms. Christensen started to schedule lunch breaks for the staff. Ms. Christensen added that there are usually extra staff in the preschool classroom, so rooms should not be left out or ratio. 10 Ms. LeBrun stated that she is usually in the preschool classroom and that the room always follows the staff to child ratio. She was not aware of any ratio issues in the infant and toddler classrooms. She stated that she used to cover breaks in those classrooms, but she does not any more. Child Care Staff Member 2 stated that the center was out of ratio earlier that day, 05/27/2021. There were nine infant and toddler children present in the infant classroom with two staff. The required ratio was one staff to four children. Child Care Staff Member 6 called and texted Ms. Christensen because they weren't sure what to do. Child Care Staff Member 2 stated that she has not been trained on what to do if a parent is present to drop of a child for care and there aren't enough staff present to care for that child. Child Care Staff Member 2 added that there has also been times that staff have left the classrooms out of ratio to wash dishes or to take extended bathroom breaks. Child Care Staff Member 6 stated that she is aware of the center being out of ratio in the morning on a few occasions. She recalled the ratio issue on the morning of 05/27/2021. She stated that a ninth child showed up and there were only two staff working in that classroom at that time. The next staff arrived at the center about an hour later. The staff have not been given direction on how to handle situations where there are too many children in care and not enough staff. Usually, the ratio issues occur in the morning at drop off. Child Care Staff Member 6 could not think of times that the center was out of ratio during the day. Staff will leave the classroom briefly to use the restroom or to run an errand, but it is usually during nap time. She has not witnessed a class being left out of ratio when there was a supervision issue present. Child Care Staff Member 1 stated that she is not aware of any violations of the staff member to child ratio. Child Care Staff Member 3 stated that she is not aware of any violations of the child to staff member ratio recently. She is aware of issues in the past. She was also not aware of any situation where a parent dropped a child off for care and that child put the center in violation of the staff member to chil

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (1)A center shall have a written plan for how and when a parent is notified when personnel observe any of the following: (b) A child experiences an accident, injury, or incident.

On 12/23/2020, I spoke with Child A's Father. He said Child A was in a physical altercation with another child, the children were pushing each other and neither he nor Child A's Mother were informed of this incident. Child A's Father said the family is currently working with Person 1, from another state agency, and he initially learned of this incident on 12/17/2020, but the incident occurred on 12/03/2020. Child A's Father said when he got home, he spoke with Child A. The incident was verified, and Child A added after the incident, the child care staff members told Child A if he did not tell him what happened they were going to take his iPad away and tell his father what happened. Child A's Father said he and Child A's Mother have joint custody, so he called Child A's Mother and she said she was never made aware of the incident. Child A's Father provided me with the contact information for Person 1 and we scheduled a time for me to interview Child A. On 12/30/2020, I spoke with Person 1. She stated she been working with the family and was told the by child care staff members that the YMCA did not inform Child A's Mother and Father of the incident because Child A stated, "if you call my dad, he will hit me again." Person 1 said Child A's Father became very upset about this and has a lot of "animosity" towards the YMCA. Person 1 said Child A is very verbal but hesitant to talk most of the times. On 12/30/2020, I made face to face contact with Child A's Father and Child A at their home. I completed a forensic interview with Child A following the forensic interview protocol. I was able to build rapport with Child A, establish ground rules and Child A was able to distinguish between a truth or lie through asking several different questions. Child A said he and Child B (male, age 7) got into a "fight" because they were playing freeze tag and Child B said Child A was "out." The two began "arguing" and Child B punched Child A in the forehead, Child A said he "kicked Child B in the nuts." Ms. Quinn Bezenah intervened and told Child A to go sit on the bench and did not believe his side of the story. Child A said Child B "lied" about what happened but Ms. Bezenah should have known Child A was telling the truth because Child A had marks on his forehead from Child B hitting him. Child A said Child B was able to continue playing but he had to sit on the bench until his mother picked him up. Child A said he told his mom what 3 happened when he got into the car. When I asked Child A if he told his father what happened. Child A became very defensive and told me to "back off." Child A then became very emotional and started crying. He said his father told him if anyone asks about him to tell them to, "fuck off." I told Child A I did not want to make him upset; I was only there to find out what happened between him and Child B while he was at the YMCA. I ended the interview and spoke with Child A's Father. Child A's Father said Child A is very emotional right now due to "everything," that is going on. I informed him of what Child A told me. Child A's Father said Child A never told his mother about the incident, he said in fact it was not his mother's week for custody, so she would not have picked him up from child care. Child A's Father said he would talk to Child A and let him know it was ok to speak with me. When I attempted to finish my interview with Child A, he still was very emotional. He began to cry and stated this is all Ms. Claire Smith's, child care staff member, fault because she called Person 1. I ended the interview and did not ask any further questions. On 12/30/2020, I spoke with Child A's Mother. She said Child A did not tell her about the incident. The week of the incident Child A was in the care of his father. Child A's Mother said she learned about the incident from Child A's Father after he learned about the incident. The child care staff at the YMCA never contacted her. After learning about the incident, she reached out to

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8113 · R 400.8113 Program director qualifications; responsibilities. (5) A substitute program director shall be appointed for a program director who has left employment or has a temporary absence that exceeds 30 consecutive workdays until return or replacement. A substitute program director shall at least meet the qualifications of lead caregiver. The department shall be notified when a substitute program director is appointed.

On 11/17/2020, I spoke with Megan Christensen, child care staff member. Ms. Christensen is also the program director at the YMCA Parkwood location. Ms. Christensen said Ms. Stephanie Scavarda, program director, has been on a medical leave of absence since 10/01/2020. Ms. Scavarda was expected to return on 11/01/2020 but has not yet returned. Ms. Christensen said she and Ms. Kimberly Vaughn, licensee designee, have been assisting at the center. They both stop in the center a couple times a week for about an hour. When they are not present Ms. Christine Senko-Lebrun, lead caregiver, assumes the role as substitute program director. Ms. Christensen said at this time she does not know if Ms. Scavarda is planning to return, as the human resources department has not heard back from Ms. Scavarda. On 11/20/2020, I completed an unscheduled on-site inspection. I spoke with Ms. Jayd Gogarn, child care staff member. Ms. Gogarn said Ms. Stephanie Scavarda has been out since October 2020 and is not coming back until January 2021. She said Ms. Kimberly Vaughn, licensee designee, and Ms. Megan Christensen, child care staff member both come to the center 2 times a week for about 30 minutes to an hour. When they are not present Ms. Christine Senko-Lebrun, lead caregiver, is "in charge." Ms. Senko-Lebrun works from 7:15am to 2:45pm Monday through Friday. Ms. Pinky Jhanwar, child care staff member, said Ms. Scavarda has been out for about 1 months. Ms. Vaughn and Ms. Christensen comes to help at the center "sometimes," 1/2 and when they are not present, Ms. Christine Senko-Lebrun, lead caregiver, is "in charge." Ms. Jhanwar said she does not know when Ms. Scavarda is planning to return to work. I then spoke with Ms. Theresa Norris, child care staff member. Ms. Norris said the program director Ms. Stephanie Scavarda, has been out for over a month. Ms. Norris said "sometimes," Ms. Vaughn and Ms. Christensen come to the center to "help out," but Ms. Christine Senko-Lebrun, lead caregiver, is supervising when Ms. Vaughn and Ms. Christensen are not present. Ms. Christine Senko-Lebrun was not present at the center at the time of my on-site inspection. I spoke to her via telephone. She stated Ms. Scavarda has been out on medical leave and when Ms. Vaughn or Ms. Christensen are not present at the center, she is the designated person in charge. Ms. Senko-Lebrun is typically present at the center every day for at least seven hours. On 11/20/2020, I received an email from Ms. Kimberly Vaughn, licensee designee. She explained that Ms. Stephanie Scavarda, program director, has been out on medical leave and she thought she was going to be back by now. Because her leave is 3 extended past 30 days, Ms. Christine Senko-Lebrun, lead caregiver, will be the substitute program director until Ms. Scavarda returns.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (4) If a center becomes aware that a staff member, volunteer, or child in care has contracted a communicable 5 disease, then the center shall notify parents and provide all of the following information: (a) The name of the communicable disease the children were exposed to. (b) The symptoms of the disease. (c) Prevention measures as recommended by the U.S. Centers for Disease Control and Prevention (CDC) at the following website: https: //www.cdc. ov/DiseasesConditions.

On 11/17/2020, I spoke with Megan Christensen, child care staff member. Ms. Christensen said Child A was last in attendance on 11/06/2020. He was tested for COVID-19 on 11/10/2020 and received positive results on 11/13/2020. Ms. Christensen informed the YMCA human resources contact Amy Stearns, who then contacted the Ingham County Health Department. Ms. Christensen said parents were not notified because the contact person at the health department said they did not need to inform parents and Child A could return to the center on 11/20/2020. On 11/20/2020, I completed an unscheduled on-site inspection. I first spoke with Ms. Jay Gogarn, child care staff member. Ms. Gogarn said she was aware Child A tested positive for COVID-19. Child A was last in attendance at the center on 11/6/2020. On 11/09/2020 Child A's Mother called the center to inform them that she and Child A were exposed to COVID-19 over the weekend, so she would not be bringing Child A to child care and was going to have him tested. Ms. Gogarn said she was not aware of Child A's positive result until 11/17/2020, when Ms. Vaughn and Ms. Christensen came to the center and informed the staff Child A tested positive for COVID-19. Ms. Gogarn said 4 she does not know if other parents were informed. She said she does not believe the families are aware because a letter was not sent in home. I also spoke with Ms. Pinky Jhanwar, child care staff member. Ms. Jhanwar said she was made aware of Child A's positive COVID-19 result two days ago. She is not in the same classroom as Child A, so she was not exposed. Ms. Jhanwar said she does not think the parents were told because no "paperwork," was sent out. When I interviewed Ms. Theresa Norris, child care staff member, she said she works in the toddler classroom and was not told Child A tested positive for COVID-19 until 11/ 17/2020. She said the center usually sends out a letter to parents whenever their child may have been exposed to something and a letter has not gone out to parents regarding Child A's positive COVID-19 result. While at the center, Ms. Megan Christensen contacted Ms. Amy Stearns, human resources contact and Ms. Kimberly Vaughn. Ms. Vaughn explained YMCA protocol is for Ms. Stearns to contact the health department and get guidance regarding any positive COVID-19 results. Ms. Vaughn and Ms. Stearns said they were under the impression from the Ingham County Health Department that they did not have to notify parents and no further action was required on their end because the health department determined there was not exposure to child care facility. Ms. Stearns provided me with the contact information for Hilary Pummell, COVID-19 Investigator, with the Ingham County Health Department. On 11/20/2020, I spoke to Hilary Pummell, COVID-19 Investigator, Ingham County Health Department. Ms. Pummell said she completed the investigation of Child A's positive COVID-19 results. She said based on the information provided to her by Child A's Mother, Child A was not at the center during his "contagious" period and therefore, there was no exposure of COVID-19 to the child care facility. Child A was last at the center on Friday 11/06/2020, he was tested on 11/10/2020, Child A's Mother said he began showing symptoms on 11/12/2020 and received a positive result on 11/13/2020. Ms. Pummell said the Ingham County Health Department follows CDC guidelines which state a person is contagious two days prior to showing symptoms. Ms. Pummell said she did not tell the YMCA they did not need to contact parents, she told them Child A was not at the center during his contagious period and therefore, there was no COVID- 19 exposure to the center. Ms. Pummell sent a link to the CDC website that the health department follows to make determinations on exposure.