Hubbell, Tonya S.

R 400.1923(2)(d) · 1 LANDMARK BUILDING • 105 W. ALLEGAN STREET • LANSING, MICHIGAN 48933 Michigan.gov/MiLEAP R 400.1923(2)(d) Diapering and toilet learning. Have a nonabsorbent, easily sanitized surface with a changing pad between the child and the surface." At the time of the onsite inspection, I advised the licensee that the diaper changing pad would be in need of replacement or repair. Bureau

R 400.1911 · R 400.1911 Care; supervision; children. (1) A licensee shall ensure appropriate care and supervision of children at all times.

On July 28, 2023, I made an unannounced onsite inspection to the child care home. Ms. Hubbell told me that she was planning on calling me during nap today regarding the incident. On July 26, 2023, all of the children were playing outside prior to lunch, along with Ms. Hubbell and Child Care Staff Member 1 (CCSM1). Around 12:00pm, she told the children to line up at the door to go in but some of the children just started going inside, so CCSM1 followed them in. Ms. Hubbell remained outside to gather the remaining children. She was rolling up the outdoor umbrella when she heard Child A cry out. When she turned around, she saw Child A on the ground next to a Little Tike plastic outdoor playhouse. She did not see what had happened. When she tried to help him stand up, he curled both of his legs under, so she proceeded to carry him into the house. He was still crying a little bit at this time. She checked Child A over and did not see any injuries. She asked Child A what had happened, but Child A is not very verbal, and he did not say anything. At this time, lunch was made and served. 2 Child A ate his lunch but continued to cry a little bit. After lunch, he wanted to cuddle in the chair with Ms. Hubbell. Ms. Hubbell and CCSM1 decided that they should probably call Child A's mother and did so at approximately 1:30pm. Child A's mother arrived around 2pm and told them that Child A had been taught to climb trees the previous weekend by his older brother and had been "trying to climb everything" after this. Ms. Hubbell noted that Child A had tried to climb on the outdoor playhouse a few times earlier that week. Ms. Hubbell was informed by Child A's mother that she had an appointment for Child A with his pediatrician at 2:50pm. Child A's mother called her from the pediatrician's office to inform her that Child A had a broken leg. Ms. Hubbell said that she was shocked and in all the time she has done child care, she never had a child have to receive medical treatment for an injury suffered in her care. Ms. Hubbell also stated that in all the years that she has done child care, she has never had a child as active as Child A. This consultant had actually commented on Child A's high activity level during a previous onsite inspection. While at the home, I was able to confirm through attendance records that Ms. Hubbell had 12 children present at noon on July 26, 2023. Ms. Hubbell was in compliance with caregiver to child ratio. I interviewed CCSM1 while at the home. She confirmed that she was present on July 26, 2023. She followed the children inside just prior to lunch while Ms. Hubbell remained outside for a about a minute to wrap things up. She then saw Ms. Hubbell carried Child A in to the home. Child A was crying but she thought he seemed angrier than hurt. She touched different parts of his body to see if he was hurt but nothing stood out. Child A stopped crying after a few minutes and appeared to be clingier than hurt. She continued to ask him "what hurts," but Child A is not very verbal and when he is, he is often difficult to understand. CCSM1 told me that Child A tends to overreact in situations and confirmed that she witnessed him trying to climb on to the outdoor playhouse on the two previous days when they had been outside. Child A's mother did not mention that he had learned to climb recently until she picked him up early on July 26, 2023. On August 1, 2023, I interviewed Child A's mother. She confirmed that Child A had suffered a broken femur and had been treated at Hurley Hospital in Flint after initially going to his pediatrician on July 26, 2023. Child A had to get his leg cast as his leg was also "pushed up" in addition to being broken, which is consistent with a jump. She was informed by Ms. Hubbell that no one witnessed Child A getting injured but that he either jumped off of the playhouse or was fighting with another child that day. She said that Child A has been climbing for some time now. She had no additional concerns

R 400.1911 · R 400.1911 Care; supervision; children. (1) A licensee shall ensure appropriate care and supervision of children at all times.

There is insufficient evidence that Child B received an injury while in the care of Tonya Hubbell.

R 400.1923 · 1 R 400.1923 Diapering and toilet learning. (3) Diapers or training pants must be changed when wet or soiled. I

On October 6, 2022, I interviewed Child A's Mother. Child A's last day in care was October 3, 2022. When she picked up Child A (male, 10 months of age), his diaper was soaking wet and had stool seeping out of the diaper and all the way up his back. Child A had been in Ms. Hubbell's child care for approximately 8 hours per day since August. Prior to this, Child A attended for 12 hours per day. She noticed that the diapers she provided were starting to pile up in his diaper bag and he only averaged 1-2 diapers changed per day. On October 7, 2022, I made an unannounced onsite inspection to the child care home. Tonya Hubbell stated that no parents have complained about their child's diaper not being changed enough and that she and her child care staff member check diapers regularly and diapering is done on demand. She denied any children's diapers had piled up in their diaper bag. While in the home, I also interviewed child care staff member Susan Markum. She stated diapers are changed after snack, before going outside, and after nap, in addition to other times. Both she and Ms. Hubbell check diapers regularly and she could not recall any parents complaining about their child's diaper not being changed frequently. I attempted to contact six parents of children that attend Ms. Hubbell's child care and are currently or just recently were wearing diapers. Child B's Mother had no concerns about Child B (female, age 1) not being changed enough. Child C's Mother did not have an issue regarding the frequently of diaper changes for Child C (female, age 2). Child C 3 is usually dry and in a fresh diaper when she picks her up from Ms. Hubbell's. Child E's Mother had no concerns about diapering. Child H's Mother had some issues with diapering when her older child attended the child care. She brought this up to Ms. Hubbell often, but nothing seemed to change. Her child had a diaper rash that would disappear when the child wouldn't go to Ms. Hubbell's child care for an extended length of time, such as a vacation. She has not had this occur with Child H (male, age 2), but his diaper would sometimes be "poopy" when she picks him up. Child G's Father had no concern about frequency of diaper changes and said that Child G's Mother did not have any concerns either.

R 400.1931 · R 400.1931 Food preparation and service. ................................................. ..... (1) A licensee shall ensure that all of the following requirements are met: (b) Children shall be offered food at intervals as individually appropriate, but not to exceed more than 4 hours unless the child is asleep. ........................... ............. .................... ........................................... .................................

Child A's Mother stated that Child A would be excessively hunger and thirsty on a regular basis when picked up. She would drop off Child A with a premade bottle and would also provide an additional three bottles of water to mix formula with for feedings throughout the day. The last few times Child A was picked up, only the premade bottle given at drop off would be empty. The three additional bottles would still have water in them as provided at drop off. Tonya Hubbell denied that any child in care had only been fed one bottle for the day. She asked the parents how often their child eats and keeps track of feedings in a notebook when she has multiple babies present. She did not have any of this documentation as she throws it out at the end of the day. It is used to make sure everyone is fed. Children are fed every three to four hours. Child care staff member Susan Markum could not recall a time when a child wasn't fed regularly, which she characterized as every few hours. The only issue with infant feeding is with a 4-month-old who just recently started at the child care home. The child is breast fed and is having a hard time latching on to a bottle, but they have been working with his mother regarding this. 4 Child B's Mother said that Child B is always hungry, so she is not sure if she is getting enough to eat while in care with Ms. Hubbell. Child B has only attended Ms. Hubbell's child care for two weeks. Child C's Mother stated that has often come home from child care extremely hungry and thirsty. Child E's Mother had no concerns regarding Child E being fed enough or offered water while in Ms. Hubbell's child care home. Child G's Father had no concerns about Child G being fed enough while in Ms. Hubbell's care. Child G has attended this child care since she was three months old. He said that when he picks up Child G around 4pm daily, all of the children are usually being fed snacks. Child G's Father said that Child G's mother also had no concerns about Child G being fed enough. Ms. Hubbell has gone over meals and snacks served with him and Child G's Mother. Child H's Mother said that Child H is always hungry when picked up from Ms. Hubbell's home. She believes Ms. Hubbell might not be providing large enough portions to children in care.

R 400.1916 · 1 R 400.1916 Bedding and sleeping equipment. (13) None of the following are approved sleeping equipment for children 24 months of age or younger: (a) Infant car seats. (b) Infant seats. (c) Infant swings. (d) Bassinets. (e) High chairs. (f) Water beds. (g) Adult beds. (h) Soft mattresses. (i) Sofas. (j) Bean bags. (k) Other soft surfaces.

On December 7, 2021, I interviewed Child A's Mother. Child A was enrolled at the group child care home for approximately one month, but only attended child care two out of the four weeks. During that period Child A's Mother observed Child A sleeping in an infant swing on November 9, 2021, November 12, 2021, and was told verbally by Ms. Hubbell that Child A slept in the swing on November 30, 2021. Child A's Mother observed Child A asleep in the swing on November 12, 2021, while Ms. Hubbell was interviewing a prospective new child care parent. Child A's Mother did not discuss her concerns with Ms. Hubbell during that time because she did not want to discuss personal matters in front of another parent. Child A was out of the child care facility due to illness and returned the week of November 29, 2021. On November 30, 2021, Child A was awake when Child A's Mother arrived for pick up. Child A's Mother asked Ms. Hubbell how Child A's day was. Child A had a great day, she took a nap in the swing from 11:00 am until 12:30 pm. At this point Child A's Mother indicated to Ms. Hubbell that sleeping in a swing is against safe sleep and she was not ok with the practice. Ms. Hubbell responded with "oh I didn't know you weren't comfortable with her sleeping in the swing." On December 1, 2021, during drop off Child A's Mother reminded Ms. Hubbell that Child A is in no way allowed to sleep in a swing. Ms. Hubbell's defense continued to be "I didn't know you weren't comfortable with that." During pick up that day Ms. Hubbell asked if Child A's Mother was ok with Child A rolling onto her belly in her sleep in the crib. Child A is able to roll both ways while asleep, so Child A's Mother indicated this follows safe sleep and is allowed. Ms. Hubbell Is not taking safe sleep seriously and Child A's Mother could not in good faith continue to take Child A to the group child care home and felt Child A is not safe in Ms. Hubbell's care. Child A's Mother expressed concern that Child A 3 may be in the swing all day, and that the tummy time space for infants in not large in size. Child A was disenrolled on December 3, 2021. On December 9, 2021, I completed an unannounced onsite inspection at the facility. I observed one infant aged child asleep in a play yard with an appropriate mattress cover. The play yard adhered to safe sleep guidelines. I did not observe any children asleep in the swing. I interviewed Ms. Hubbell. Ms. Hubbell denied that she allowed Child A to sleep in a swing. Child A had fallen asleep in the swing and was moved to an appropriate sleep surface, which was reported to Child A's Mother. Child A's Mother was adamant about having Child A sleep with a blanket and Ms. Hubbell refused to allow this practice as Child A is less than one year of age. A sleep sack was suggested if Child A's Mother was concerned about Child A being cold while asleep. Child A's Mother supplied a sleep sack for Child A to utilize. Ms. Hubbell returned Child A to her back while sleeping when she was observed on her stomach. This upset Child A's Mother who indicated to that Ms. Hubbell should leave Child A alone while sleeping. Ms. Hubbell will move a child who falls asleep in a non- approved sleep surface. It may take Ms. Hubbell a minute or two to move the child if she is involved in caring for another child care child. Ms. Hubbell originally completed safe sleep training on December 14, 2006 and provided documentation of this course during the onsite inspection. Ms. Hubbell has completed additional training in safe sleep through provider required health and safety training. Ms. Hubbell denied telling Child A's Mother that "oh I didn't know you weren't comfortable with her sleeping in the swing." Ms. Hubbell holds Child A as much as she can, with other children enrolled she cannot hold one child all day. There are several areas for non-mobile infants to play including a swing, bouncer seat, stationary infant play seat and an area for tummy time. The area for tummy

R 400.1918 · ......................................................................... R 400.1918 Medication; administration; procedures. .................................................. ...................................................................................................................................................................................................... (2) Medication, prescription or nonprescription, must be given or applied only with prior written permission from a parent.

On December 7, 2021, I interviewed Child A's Mother. Child A's Mother supplied Ms. Hubbell with a prescription diaper cream to be used for Child A. Child A's Mother was not asked my Ms. Hubbell to fill out a medication permission form. On December 9, 2021, I interviewed Ms. Hubbell. Child A's Mother supplied a prescription diapering cream for Child A and Destin. Ms. Hubbell preferred to use only the Destin for Child A while in attendance, however Child A's Mother insisted that the prescription diapering cream was required. Ms. Hubbell was not aware that 5 a medication permission form was required for anything applied to the skin that was provided in prescription form, she thought it was only for oral prescriptions. I provided technical assistance to Ms. Hubbell regarding the requirement of medication permission forms for any prescription medications given to a child care child, orally or applied to the skin. Ms. Hubbell stated she will ensure all prescription medications have a medication permission form.

R 400.1923 · R 400.1923 Diapering and toilet learning. (3) Diapers or training pants must be changed when wet or soiled.

On December 7, 2021, I interviewed Child A's Mother. Child A was in attendance at the child care for her first week the week of November 8, 2021. Following that week, Child A had severe diarrhea, and was taken to the emergency department for treatment. Child A was diagnosed with Gastroenteritis, which Child A's Mother stated is common among children in child care. According to Child A's Mother this can occur when handwashing does not occur between diapering of children. On December 9, 2021, I interviewed Ms. Hubbell. Handwashing occurs after diapering each child. During the onsite inspection, I observed Ms. Miller wash her hands following diapering a child care child. Ms. Hubbell has not received any parent concerns regarding diapering. On December 9, 2021, I interviewed Ms. Miller. Ms. Miller washes her hands following diapering. Ms. Miller has not received any parent concerns regarding diapering. On December 9, 2021, I interviewed Child B's Mother and Child G's Mother, no concerns were noted regarding handwashing or diapering of child care children. On December 9, 2021, I interviewed Child C and D's Mother. Child D has come home with diaper rash and does not have diaper rash while not in attendance at the child care facility. Child D may be sitting in a wet diaper at the facility. On December 9, 2021, I interviewed Child E's Mother. Child E's Mother is unsure if Child E is receiving a sufficient amount of water a day due to less frequently wet diapers. Child E's Mother sends a cup of water to the facility, and it has come home with the same amount of water in the cup. Ms. Hubbell may use her own cups during the day. Child E's Mother trusts Ms. Hubbell and does not have any concerns. On December 9, 2021, I attempted to interview Child F's Mother. The telephone number was disconnected.

R 400.1924 · R 400.1924 j Hand washing. (1) All personnel shall wash their hands appropriately and in the following manner: (b) After all of the following: (i) Diapering.

On December 7, 2021, I interviewed Child A's Mother. During Child A's last week of child care during the week of November 29, 2021, Child A came home with her hair 7 matted on the left side of her head. Her hair was sticky, and she smelled of formula. Child A may have had her bottle propped for feeding. Child A's Mother did not observe this occur. On December 9, 2021, I completed an unannounced onsite inspection. I did not observe any children consuming bottles during the onsite inspection. On December 9, 2021, I interviewed Child B's Mother. Child B's Mother has observed infants being held during feedings. Child B's Mother has not observed infants being fed with propped bottles. On December 9, 2021, I interviewed Child C and D's Mother. Child C and D's Mother has observed infants being held during feedings during pick up and drop off. On December 9, 2021, I interviewed Child E's Mother. Child E's Mother has observed infants being held during feedings by Ms. Hubbell. Child B's Mother has not observed infants being fed with propped bottles. On December 9, 2021, I interviewed Child G's Mother. Child G's Mother has observed infants being held during feedings. Child B's Mother had not observed infants being fed with propped bottles. On December 9, 2021, I attempted to interview Child F's Mother. The telephone number was disconnected. On December 13, 2021, Child A's Mother reported that Child A was diagnosed with a left ear infection on December 13, 2021. During the week of December 6, 2021, Child A was congested, and Child A's Mother took her for medical care on December 13, 2021, after she was having congestion symptoms for a week. This makes Child A's Mother believe that Ms. Hubbell was propping bottles for feeding. On December 13, 2021, I interviewed Ms. Hubbell. Children are held while being fed bottles and are not propped during feeding. Ms. Hubbell denied that she has ever allowed a child to be fed with a propped bottle.

R 400.1931 · R 400.1931 Food preparation and service. ..................................................... ............................................. (14) The propping of bottles is prohibited.

On December 7, 2021, I interviewed Child A's Mother. Ms. Hubbell provides child care in the basement of her home. There have been occasions when the finished basement has smelled of mold. On December 9, 2021, during an unannounced onsite inspection, I toured the child care area and did not observe any evidence of mold. The area did not smell of mold. On December 9, 2021, I interviewed Ms. Hubbell. Ms. Hubbell does not have any issues with water in her basement. Ms. Hubbell had a leak in upstairs sink several years ago, which resulted in a small area of replacement to the basement ceiling. The area was repaired by a licensed plumber and has not had any issues since. Ms. Hubbell denied that the basement has smelled of mold.

R 400.1932 · R 400.1932 Home maintenance and safety. (1) The structure, premises, and furnishings of a child care home must be in good repair and maintained in a clean, safe, and comfortable condition.

On December 7, 2021, I interviewed Child A's Mother. Child A was running a fever during pick up and it was not reported to Child A's Mother. When Child A was picked up on December 3, 2021, Ms. Hubbell was holding her. Child A was taken from Ms. Hubbell and placed in her car seat. When Child A arrived home, she felt warm, and her temperature was taken. Child A had a temperature of 100.7 degrees Fahrenheit. Child A did not seem like her normal active self and Child A's Mother is concerned that she was ill during the day and was not contacted by Ms. Hubbell. On December 9, 2021, I interviewed Ms. Hubbell. Ms. Hubbell informs parents of children who have a suspected illness about concerns regarding the child's health. Parents of enrolled children also call during the day to check in on their children. rj On December 9, 2021, I interviewed Ms. Miller. Ms. Hubbell telephones parents of children who are not feeling well to inform them of concerns. On December 9, 2021, I interviewed Child B's Mother, Child C and D's Mother, Child E's Mother and Child G's Mother. There have been no concerns regarding illness reporting. Ms. Hubbell calls when children are not feeling well to report her concerns. On December 9, 2021, I attempted to interview Child F's Mother. The telephone number was disconnected.

R 400.1961 · R 400.1961 Parent notification required; incidents; accidents; illness; disease; isolation. ................................ .................................. (1) A licensee shall promptly report to a child's parent any of the following: (a) Any incidents, accidents, suspected illness, or other changes observed in the health of a child. ................. .....

There is insufficient evidence to support the allegation that Ms. Hubbell does not report suspected illnesses to parents of enrolled children.