R 400.8122 · R 400.8122 Lead caregiver; qualifications; responsibilities. ................................................. .... (5) Lead caregivers shall meet I of the following qualification shown in Table 3: Table 3 Lead Caregiver Qualifications Coursework in Early Childhood Education, Hours of Education Child Development, Experience or a Child-Related Field Bachelor's degree or higher in early (a) childhood education, child development, or a child related field .............. .......................... Montessori credential (b) 480 hours with Associate's degree or (C) higher in early childhood education or child development 4 Valid child development (d) 480 hours associate credential with High school diploma 12 semester hours (e) 960 hours or GED with and 12 semester hours, 18 CEUs, or a High school diploma (f) combination to 1920 hours or GED with equal 180 clock hours with 6 semester hours, 9 CEUs, or a High school diploma (g) combination to 3840 hours or GED with equal 90 clock hours with

I received this compliant on 06/17/2022. I attempted telephone contact with the reporting source on 06/21/2022. I received a second complaint on 06/21/2022 under intake 188019. It was an anonymous reporting source, and no information was provided for follow-up. The intake was dismissed, and allegations included in this report. I received additional allegations on 06/24/2022 which are also included in this report. I conducted unannounced onsite inspections at the center on 06/27/2022 and 07/08/2022. I advised Program Director, Nandrae Reidenbach, of the current allegations. She stated that there is only one new lead caregiver, Child Care Staff Member (CCSM) 18. To her knowledge, all lead caregivers are qualified. I advised that due to staffing shortages throughout the State of Michigan, variance requests are available on our website if there are individuals that are not qualified. I had telephone contact with CCSM 11 on 06/24/2022, 06/28/2022, and 08/03/2022. She said that there were multiple lead caregivers that did not meet the qualifications. I interviewed CCSM 1, CCSM 5, CCSM 8, and CCSM 9 over the telephone on 07/11/2022. They are all qualified as lead caregivers. They were not sure if every lead caregiver is qualified. I attempted telephone contact with CCSM 2, CCSM 7, CCSM 3, and CCSM 4, and CCSM 7 on 07/11/2022. I have not spoken to them as of the writing of this report. 3 I spoke over the telephone with CCSM 19 on 08/03/2022. She is a lead caregiver at the center currently. She was not sure what rule she qualified under. She is completing the educational requirements to be a lead caregiver through the MiRegistry training track. I attempted telephone contact with CCSM 13 and CCSM 18 on 08/03/2022. I have not spoken with them as of the writing of this report. I did not interview CCSM 6, CCSM 10, CCSM 12, CCSM 14, CCSM 15, CCSM 16, or CCSM 17 during this investigation. I conducted an exit conference with licensee designee, Lura Corbett, on 08/08/2022. She has some CCSMs that have left or are leaving employment. Some of the classrooms will have new lead caregivers. CCSM 2 will be coming back to Kiddie U Academy as a lead caregiver from working the summer at Kiddie U Two. Due to staffing shortages, CCSM 19 and CCSM 20 are in place as lead caregivers but are not qualified yet. They are still working on their remaining qualifications. I advised that a variance request for the two lead caregivers that do not currently meet qualifications needs to be submitted. Ms. Corbett said she will submit the variance requests for CCSM 19 and CCSM 20.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

While at the center on 06/27/2022 and 07/08/2022, I talked with program director Ms. Reidenbach. She said CCSM 9 does work in a classroom with her own child. She does not think that CCSM 9 favors her own child over the other children and has not seen anything to indicate that is occurring. CCSM 9 has brought other children to the office for ice packs and has been observed caring for all children. On 06/24/2022, 06/28/2022, and 08/03/2022, I had telephone contact with CCSM 11. She believes that CCSM 9 does show favoritism towards her own child. She does not provide the same care for the other children in the classroom. CCSM 11 does not work directly with CCSM 9 but has observed this occur when their classrooms are in the outdoor play area together and she has heard from other CCSMs. On 07/11/2022, I interviewed CCSM 1 over the telephone. She has worked with directly with CCSM 9. CCSM 9 does not only care for her own child or show favoritism. She has observed CCSM 9 to care for all children. 5 On 07/11/2022, I had contact with CCSM 5 and CCSM 8 over the telephone. They did not have direct knowledge of CCSM 9's interactions with her child within the classroom. On 07/11/2022, I talked with CCSM 9 over the telephone. She denied that she favors her child. She treats all the children equally. There may be an occasion when her child falls or is extra upset and she comforts her more. She would do this for any of the children that needed it. She said that her child mostly ignores her when they are in the room together and she is more interested in everything else going on. On 07/11/2022, I spoke with Child A and Child B's Mother over the telephone. She does not see CCSM 9 often. When she does see CCSM 9 in the classroom, she is always holding her own child. She does not see her interact with the other children much. On 07/11/2022, I interviewed Child C's Mother and Child D's Mother over the telephone. They did not have any direct knowledge or concern. On 08/03/2022, I spoke over the telephone with CCSM 19. She has worked in the classroom with CCSM 9. CCSM 9's child is in the room with her most of the time. CCSM 19 does not think that CCSM 9 favors her own child. She takes care of all the children. She has not seen CCSM 9 ignore any children. On 08/08/2022, I talked with Child E, Child F, and Child G's Mother. She stated a lot of the CCSMs have children that attend the center. The CCSMs move around between the classrooms. To her knowledge, this is not a concern. attempted telephone contact with Child H's Mother on 08/03/2022 and 08/08/2022. have not spoken to her as of the writing of this report. On 08/08/2022, Ms. Corbett said that CCSM 9 does work in a classroom with her own child. CCSM 9 does a nice job with her own child and all the other children. She does not show favoritism towards her own child and takes care of all the children equally.

R 400.8182 · R 400.8182 Ratio and group size requirements. ................................................. .......................... (3) In each room or well-defined space, the maximum group size and ratio of child care staff members to children, including children related to a staff member or the licensee, must be as shown in Table 4: Table 4 Child Care Staff Member to Child Ratios Child Care Staff Maximum Age Member to Child Group Size Ratio Infants and toddlers, (a) birth until 30 months of 1 to 4 12 age Preschoolers, 30 (b) months of age until 3 1 to 8 16 years of age Preschoolers, 3 years of (c) 1 to 10 30 age until 4 years of age (d) Preschoolers, 4 years of 1 to 12 30 age until school-age (e) School-agers 1 to 18 36

During the onsite inspection on 06/27/2022, I observed all classrooms to have enough CCSMs for the number of children in care at the time. I spoke to CCSM 11 on 06/24/2022 and 06/28/2022. She advised that the lead caregivers are out of their rooms frequently leaving the classrooms out ratio. She indicated that this occurs mostly in the Snugglebug Room. The lead caregiver hangs out in the front of the center for approximately 10-15 minutes. Her classroom has operated out ratio because it is difficult to find someone to come and cover if she needs to leave. She said there is no way to let anyone know when they need help. There are walkie talkies but no one uses them. On 07/08/2022 during an onsite inspection, I observed all classrooms to have enough CCSMs for the number of children in care. I talked with Ms. Reidenbach regarding ratio concerns. She stated that she does not think ratio is a problem. They have tried to keep two extra people at the center to fill in. Not all of their classrooms are full, so it is easier to maintain ratio. They have a CCSM scheduled at 7:00 AM and 7:30 AM. She is generally at the center as well and can step into a classroom if children arrive earlier than expected. I conducted telephone interviews with CCSM 1, CCSM 5, CCSM 8, and CCSM 9 on 07/11/2022, they denied that ratio is a concern at the center. They can ask for help if they need someone to cover in a classroom. They have walkie-talkies and cell phones they can use to communicate. I interviewed Child A and Child B's Mother on 07/11/2022, she indicated that ratio has been a concern. There are a lot of children in the morning when she is dropping her children off. She waits until their specific CCSM arrives at the center before leaving each one. She has seen CCSM 16 ask for help in the morning because there are too many children and not get the help she is requesting. She said she understands that staffing is difficult right now. I spoke to Child C's Mother on 07/11/2022. She advised that she has observed classrooms out ratio on occasion. I talked with Child D's Mother on the telephone on 07/11/2022. She did not have any concerns regarding ratio. 7 I contacted Ms. Corbett on 07/12/2022. She stated that her staffing costs are very high to ensure they are not out ratio. There is almost always an extra individual in the building to cover CCSMs. If the CCSMs are out of their classrooms, they are supposed to let someone know so they can send someone else into the classroom. She has encouraged CCSMs to let them know if there is an issue with ratio. She has put a sign in and out sheet in each classroom so they can track who is in the classroom and when to ensure ratio and that leads are present for the required amount of time each day. She will continue to encourage CCSMs to let them know if they need coverage. When I spoke with CCSM 11 again on 08/03/2022, she said ratio has gotten better but it is still difficult to find someone to cover if they are over. She was out ratio this morning. CCSM 5 walked by and did not come into the classroom to help. I asked if she let anyone know that she needed help. She told CCSM 19 who was working in the next room to go get help since they had an extra person. She denied that she asked for help when CCSM 5 walked by. I advised that she is responsible for communicating her needs within the classroom. I spoke over the telephone to CCSM 19 on 08/03/2022. She did not have a concern regarding ratio. The center maintains ratio by moving CCSMs around when needed. If they need another CCSM, they can use the walkie-talkies. There is usually someone who can come help. I spoke to Child E, Child F, and Child G's Mother on 08/08/2022. She denied having any concerns with ratio. On 08/08/2022, Ms. Corbett said the classrooms should not be out ratio. She works hard to make sure that there are enough CCSMs in the building and it is expensive. The center was cited for ratio under 2022D0220011 and will be providing a corrective action

R 400.8320 · R 400.8320 Food preparation. (1) Food must be in sound condition, free from spoilage, filth, or other contamination and be safe for human consumption.

I spoke with CCSM 11 on 06/24/2022, 06/28/2022, and 08/03/2022. She said there did appear to be mold on some of the blueberry muffins, so she threw them away. She denied serving any of the muffins to children. She believes that CCSM 19 served the muffins to children without knowing there was mold on them. I spoke to Ms. Reidenbach on 07/11/2022 at the center. She stated that a CCSM brought a concern regarding potential mold on a blueberry muffin. They were not sure if it was mold or not, so they threw the muffins away out of precaution. They have replaced the muffins and are now storing them in the refrigerator. They would not serve compromised or spoiled food to children. I interviewed CCSM 17 while onsite on 07/08/2022. She advised that blueberry muffins were thrown away because of a concern of possible mold. When she started working in the kitchen, she cleared everything out and threw away a lot of food. Some of it was expired and some did not have dates or labels. The muffins are stored in the refrigerator or freezer now, so they stay fresh. We discussed the child care licensing environmental health rules and regulations and proper labeling and storage of food. I interviewed CCSM 1, CCSM 5, CCSM 8, and CCSM 9 over the telephone on 07/11/2022. They did not have any concerns regarding the quality of food served at rj the center. If something was concerning, they would throw it away and not serve to children. I spoke with Child A and Child B's Mother on 07/11/2022. She has not seen or had any concern of mold on food. Her children do not eat everything served at the center. Sometimes she prefers to send healthier options. I interviewed Child C's Mother and Child D's Mother on 07/11/2022. They did not have any concerns regarding moldy food. I talked to Ms. Corbett on the telephone on 07/12/2022. There was a possible concern brought to their attention about some blueberry muffins. The muffins in question were thrown away. To her knowledge no children consumed the muffins. They bought new muffins and are now storing them in the refrigerator. She would never serve spoiled or rotten food to children. I spoke with CCSM 19 on 08/03/2022. She said she does not have a concern with quality of food served at the center. There was one time some of the blueberry muffins may have been moldy. She did not serve them to children and threw them away. I spoke over the telephone to Child E, Child F, and Child G's Mother on 08/08/2022. Her children have always eaten the food served at the center. She has never had a concern. Her children are picky eaters and they have never complained.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8330 · R 400.8330 Food services and nutrition generally. (4) A center shall ensure a child who has special dietary needs is provided with snacks and meals in accordance with the child's needs and with the instructions of the child's parent or licensed health care provider.

While onsite on 06/27/2022, Ms. Reidenbach said she was not sure if a child had been given milk when they should not have had any dairy. She advised that there are several families that are trying to work dairy into their children's diets. Some of the families have requested their children not get dairy but 10 it is not due to an allergy. I advised that children should be served food and beverages according to their family preferences and it does not need to be due to an allergy, intolerance, or other medical reason. I spoke to CCSM 11 on 06/24/2022 and 06/28/2022 over the telephone. She advised there have been numerous occasions that children were given a food or beverage they should have not had for various reasons. Some of them were due to allergies. I talked with Ms. Reidenbach during the onsite on 07/08/2022. She said there was an incident this week when a child grabbed the wrong cup. CCSM 9 caught it and the parent was contacted. The family was already working dairy back into the child's diet. She also recalled a time when CCSM 9 gave a child macaroni and cheese because the parents said the child could only have eggs if they were baked. CCSM 9 talked with the parent about the situation, and they were not upset. I reminded her of the importance of knowing preferences as well as allergies. I had telephone contact with CCSM 1 on 07/11/2022. She was not aware of any concerns with children being served food or beverages they should not have had. I spoke to CCSM 5 on 07/11/2022, she was aware of a few circumstances when children were given food or beverages they should not have had. The parents were advised of those situations. I talked with CCSM 8 on 07/11/2022. She has some dairy free children in her classroom. She knows of one child that took a bite off another child's plate. They told Ms. Reidenbach who contacted the parents. She heard from another CCSM that CCSM 9 gave a child dairy when they should not have had dairy. I contacted CCSM 9 over the telephone on 07/11/2022. She indicated that there have been a several instances where children were given something they should not have had. A child grabbed the wrong cup which contained milk and drank from it. The parents were contacted. There was another instance where the mother had said it was ok to give dairy but then the father said it was not. Parents are always changing back and forth, and it gets confusing. Another child's parents told her the child could have baked eggs, so she served macaroni and cheese. The parents were upset at first, but the child was "perfectly fine." A child was given goldfish crackers because the CCSM working in the room at the time did not know. It was just a parent preference, and nothing happened to that child. They did apologize to the mother because she was upset. I reminded CCSM 9 the importance of knowing allergies as well as family preferences and serving according to those instructions. I interviewed Child A and Child B's Mother over the telephone on 07/11/2022. She said this has been a concern and there have been numerous times when her child was given something they should not have been given. The most recent concern is that Child A got ahold of another child's milk cup. They contacted her right away. 11 Child A was also served cheese on a something when he cannot have dairy. When she talked with CCSM 9, it was a miscommunication and they thought it was just a preference, not related to an allergy. They are unsure if Child A is allergic and have been cautious about what they serve him. She advised there was another occasion that her child was served a peanut butter sandwich for lunch. No one knows how the mix up occurred. Luckily her child does not have a peanut allergy, but one of the CCSMs in the room does. She thinks it was an issue with labeling. I had telephone contact with Child C's Mother on 07/11/2022. Her child has been given food and beverages he should not have been given. He drank some milk that they think was given to him

R 400.8380 · R 400.8380 Maintenance of premises. ........................................... ... ........................................................................................................................................................... (2) The premises must be maintained so as to eliminate and prevent rodent and insect harborage.

While at the center on 06/27/2022, Ms. Reidenbach advised that there are some ants in the center, and they have been working with Mite-E Pest Service. They put out traps over the weekend and called again today because there were ants in the traps. She advised that the ants were in the Doodlebug Room, Whirligig Room, and Caterpillar Room. CCSM 16 told her that the ants were in the bricks of the building, and they have to be treated in a special way. They were making sure the pest company was treating the correct way. They are aware and doing their best to address this concern. While onsite on 07/08/2022, I observed every classroom and asked each child care staff member if they had seen ants. I did not see any ants. There were CCSMs that had observed ants in the center. The CCSMs present in the Snugglebug Room denied seeing ants. The CCSMs in the Doodlebug Room stated that they have observed ants a couple weeks ago. There have been plastic traps set out. The children were interested in the traps, so the CCSMs picked them up. There are no traps out currently. The CCSMs in the Whirligig Room have seen ants. There were a few ants in the room today. There were traps set out over the weekend. The children know not to play with the traps. The center has also been spraying and are going to treat agair this evening. The CCSMs in the Jitterbug Room have seen ants in the classrooms. There were ants in the diapering area and near the exit door. The center has not done anything about it. The CCSM in the Butterfly Room stated that she has not seen any ants. She has heard talk about ants being in some of the classrooms. She is not sure what is being done to treat. The CCSMs in the Ladybug Room said they have seen ants in their classroom a couple weeks ago. They have also seen ants in the Doodlebug Room in early May. There have not been any ants observed in the front office area of the center. The center has intentions on addressing the issue, but CCSMs are unsure of what has been done to treat the ants. The CCSMs in the Caterpillar Room have seen ants starting a few months ago. The center said they treated and sprayed outside the building. They have been putting out ant traps at night. There were traps out over the weekend but were gone this morning. 13 CCSM 16 advised that this has been an issue before, and the ants are in the bricks. The pest management company must spray in a specific way. They put out ant traps over the weekend and threw them away this morning before children arrived. They treat for the ants and the ants go away temporarily and then come back. They will keep treating and addressing any issues. I spoke with Child A and Child B's Mother and Child C's Mother on 07/11/2022. They have seen ants in the center on occasion. I talked with Ms. Corbett over the telephone on 07/12/2022. She indicated that ants do come inside sometimes. They are working with Mite-E Exterminating in Paw Paw, MI. They spray bi-weekly and can come in a day or two if contacted with a problem. They are using a natural spray. She also thinks that the spraying is cutting down on the ticks in the outdoor play area. Mite-E stated it was normal and they needed to keep cleaning and sweeping thoroughly. I spoke with CCSM 19 on 08/03/2022. She has seen some ants. The center sprays and puts out traps. On 08/08/2022, Ms. Corbett advised that they do treat the center regularly for ants. The center works with Mite-E Exterminators in Paw Paw to address any concerns. They have been using a natural spray and treating both inside and outside. The treatment occurs either weekly or bi-weekly depending on the need. They can also call and have treatment that same day if needed. They have been notifying parents of the treatment by hanging a notice on the entrance and in the Remind Application they use to communicate with parents.

R 400.8122 · R 400.8122 Lead caregiver; qualifications; responsibilities. (2) At least 1 lead caregiver shall be assigned to each group of children in a self-contained or well-defined space and shall be present and providing care in the assigned group in the following manner: (a) Full time for programs operating less than 6 continuous hours. (b) At least 6 hours per day for programs operating 6 or more continuous hours.

I received this complaint on 05/27/2022. I received additional allegations on 05/31/2022. I conducted an unannounced onsite inspection at the center on 05/31/2022. I advised licensee designee, Lura Corbett, of the allegations. She expressed concern that there had been some Child Care Staff Members (CCSM) who left employment or were recently terminated. Former CCSM 3 and Former CCSM 4 have been late and calling off work, starting drama, bullying other CCSMs, and trying to recruit CCSMs to leave for employment at another center. There are a group of CCSMs that have been causing problems. They have been spreading misinformation and now she is worried that they are making complaints against the center because she is the owner. Ms. Corbett said the lead caregivers are in their classrooms. CCSMs are allowed to go to the bathroom but anything longer than that and they are supposed to get someone from the front office to cover. There is typically two or three extra people at the front of the center that can fill in for any of the CCSMs. Ms. Corbett is 3 available as well as program director, Nandrae Reidenbach, and CCSM 5 who serves as an "assistant program director" and lead caregiver. Ms. Reidenbach advised that lead caregiver, CCSM 2, is working at Kiddie U Two for the summer. It might appear to someone that she is out of the classroom, but she is working on other things for Kiddie U Two. There is a new lead in that classroom. She advised that lead caregiver, CCSM 1, does come to the office occasionally to tell them something or if there is a concern with a child, she may bring the child to the office to discuss a concern or have them look at something. CCSM 1 is not "hanging out" and comes to the office if it is work related. I requested child information cards and CCSMs contact information. I conducted a scheduled onsite inspection at Kiddie U Two for a modification on 06/02/2022. While onsite, I interviewed CCSM 6. To her knowledge, the leads are in their classrooms for the required amount of time per day. If they are out of the classroom, someone covers for them. I received another complaint and opened special investigation 2022DO220012 on 06/17/2022. We received additional allegations on that complaint on 06/21/2022. I had telephone contact and exchanged text messages with CCSM 11 on 06/24/2022 and 06/28/2022. She indicated that CCSM 1 does leave the Snugglebug Room a lot and goes to the front office. She is usually out of the classroom for approximately 10-25 minutes. This occurs most days. She knows there have been other complaints about the lead caregivers not being in the rooms and she does not feel the center has taken the allegations seriously. The center has put lead caregivers in place that are "fake." CCSM 11 said that CCSM 5 does not know the children in her classroom or their needs, including allergies. The lead caregiver in the Ladybug Room did not want to be present in her classroom, so she took one of the children to the office for approximately 30 minutes until they moved another child to a different classroom. I conducted an unannounced onsite inspection at the center on 06/27/2022. The Whirligig and Caterpillar Rooms were the only ones with a lead caregiver present at the time of inspection. The Snugglebug, Doodlebug, Jitterbug, Butterfly, and Ladybug Rooms did not have lead caregivers present. I conducted an unannounced onsite inspection at the center on 07/08/2022. I interviewed Ms. Reidenbach. CCSM 2 works at Kiddie U Two now but used to be the lead caregiver in the Snugglebug Room. CCSM 1 is the new lead caregiver in that classroom. The lead caregivers are in the office occasionally. They come to the office to work on things when their classrooms are within ratio. It is difficult for them to do the curriculum piece in the classrooms. She denied that anyone is in the office for 30 minutes and thinks it is an overestimation. 4 On 07/11/2022, I attempted telephone contact with lead caregiver, CCSM 2. I left a

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.

While onsite on 05/31/2022, Ms. Corbett denied that infants are left to cry for long periods of time. The longest the center policy allows a baby to cry is approximately 10 minutes. Some parents have requested longer as they are using the "cry it out" method but they tell them the center policy is 10 minutes. If a baby is very upset or needs immediate attention, they attend to the baby right away. She denied that she has ever seen or heard of a CCSM holding down a baby or force feeding any children. While interviewing CCSM 6 on 06/02/2022, she denied regularly working with children that take bottles. She has worked in the Snugglebug Room briefly. She has never observed anyone holding children down or force-feeding bottles to infants. During my interview with Ms. Reidenbach on 07/08/2022, she indicated that former CCSM 3, brought this concern to her attention when she worked there. Ms. Reidenbach discussed the concern with former CCSM 3 and CCSM 1. CCSM 1 explained that she was holding a baby and was instructing former CCSM 3 to tuck the infant's arm under her arm and hold the infants' hand against the bottle to teach them how to hold it. She believes former CCSM 3 misinterpreted. She did ensure that no children were being held down or force-fed bottles. Ms. Reidenbach is in the Snugglebug Room frequently as she is nursing her own child every 2-3 hours. Ms. Reidenbach said that there are parents that request that their children "cry it out." The center has a policy and would not let a child cry for longer than 10-15 minutes. If the child has a distressed cry, they will rock or pat them until they calm down. She has not seen or heard anyone hold down, force feed, or allow children to cry for extended periods of time. I spoke with CCSM 1, CCSM 5, CCSM 8, CCSM 9, Child A and Child B's Mother, Child C's Mother, and Child D's Mother over the telephone on 07/11/2022. CCSM 1 indicated that former CCSM 3 no longer works at the center. They had a child in the Snugglebug Room that was used to nursing and would not take a bottle unless being held a specific way in the rocking chair. She would tuck the infants' arm under hers and rock and sing to him. She has never and would never hold a baby down to force feed or tell anyone else to do that either. CCSM 1 denied that babies 7 are left to cry too long. They do let some babies cry it out, but it is not very long, and never longer than 10 minutes. CCSM 5 advised that no one has told her to hold down or force feed bottles. She has never heard anyone say or do that. She has not seen any children held down or heard them cry too long. CCSM 8 did not have any direct knowledge of children crying too long, babies being held down, or force-fed. I asked if she had any other concerns. She stated that if she had a concern she talks with the lead caregiver in her classroom, CCSM 13. CCSM 13 then will address any concerns with the program directors. She has not expressed any concerns directly to the program directors. CCSM 9 stated that she has not known the any CCSMs in the Snugglebug Room or any other room to hold babies down, force feed them, or allow them to cry for long periods of time. Child A and Child B's Mother, Child C's Mother, and Child D's Mother denied any knowledge or concern regarding children getting held down, force fed bottles, or left to cry.

R 400.8134 · R 400.8134 Hand washing. (3) Staff and volunteers shall ensure that children wash their hands at all of the following times: (a) Before meals, snacks, or food preparation experiences. (b) After toileting or diapering. (c) After handling animals and pets. (d) When soiled. z

While onsite on 05/31/2022, Ms. Corbett, advised that children in all classrooms are required to wash hands. She has worked in all the classrooms and sees children and CCSMs washing their hands regularly. She advised that infants approximately 5 or 6-months old start washing hands with running water as long as they are developmentally ready and can hold their head up. Before they are developmentally ready, they are using a wipe when needed. She indicated that they send reminders to CCSMs about washing hands for all age groups as part of their "housekeeping." During the onsite on 07/08/2022, Ms. Reidenbach advised the children are washing hands as long as they are developmentally able. If they cannot hold their heads up they are using a wipe. There may be the occasional time when children or CCSM forget to wash, but the CCSM and children are washing hands constantly. I spoke with CCSM 1, CCSM 5, CCSM 8, CCSM 9, Child A and Child B's Mother, Child C's Mother, and Child D's Mother over the telephone on 07/11/2022. CCSM 1 indicated that children are washing hands before eating and after diapering. They wash everyone's hands, even the "little bitty ones." She puts soap on her hands and then washes theirs. CCSM 5 advised she has witnessed CCSMs and children washing hands in all of the classrooms. She was not sure about the Snugglebug Classroom because they have infants. CCSM 8 stated that handwashing is not a problem in the Jitterbug Room and Whirligig Room. She advised that there have been a few times where children did not wash their hands. CCSM 9 said children are washing hands. Children in her classroom wash hands before food, after diapering, and after going outside. She has seen handwashing in the Snugglebug Room as well. Former CCSM 4 was telling children to not wash their hands in the Doodlebug Room. Child A and Child B's Mother said that her children are washing hands at the center. They know how to do it and they did not learn at home. Child C's Mother and Child D's Mother stated they think children wash hands as required.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

R 400.8152 · R 400.8152 Medication; administrative procedures. (3) All medication must be in its original container, stored according to instructions, and clearly labeled for a named child, including all nonprescription topical medications described in subrule (8) of this rule.

While onsite on 05/31/2022, Ms. Corbett, indicated that sunscreen just started to come in for the season. They are having parents sign a new topical permission form. They require a new bottle of sunscreen and have parents sign the annual permission. The center sent out a reminder to parents on 05/09/2022 or 05/11/2022 to bring sunscreen and sign the permission. The CCSMs have been instructed to label with first and last name if the parent does not. To her knowledge, the sunscreen is labeled. I checked the sunscreen stored in the classrooms while onsite on 05/31/2022. Numerous sunscreen containers were not labeled with the first name and last name of the child in the Doodlebug, Whirligig, Jitterbug, and Ladybug classrooms. I asked CCSMs in the Snugglebug room about sunscreen and they advised they do not have sunscreen because the children do not go outside. CCSM 6 advised during her interview on 06/02/2022 that she has not received sunscreen from any parents or used sunscreen on children this year. While at the center on 06/27/2022, I checked sunscreen in numerous classrooms. Many did not have the first and last name of the child. It appeared that the names on some of the sunscreens had worn off. Some of the sunscreen had tape with the child's name which appeared to work better. I requested that the names be added to the sunscreen using tape or written again if it is not legible. I checked some of the sunscreens while onsite on 07/08/2022. Some of the sunscreen only had first name, some had first name and last initial, some had a name that had been worn off. I requested that the center use tape with the first name and last name. I spoke with CCSM 1, CCSM 5, CCSM 8, CCSM 9, Child A and Child B's Mother, Child C's Mother, and Child D's Mother over the telephone on 07/11/2022. CCSM 1 stated that they do not have sunscreen in the Snugglebug Room because they do not go outside. 10 CCSM 5 advised that all of the classrooms she has worked in have had sunscreen labeled. She denied that there has ever been any confusion or mix up. CCSM 8 indicated that sunscreen is labeled in her classroom. CCSM 9 said the sunscreen is labeled in the Doodlebug and Whirligig Rooms. Sometimes it rubs off, but they ask the parents to label it before bringing it. Child A and Child B's Mother, Child C's Mother, and Child D's Mother all stated that sunscreen is labeled with their children's name.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

Table 4 Child Care Staff Member to Child Ratios Child Care Staff Maximum Age Member to Child Group Size Ratio Infants and toddlers, (a) birth until 30 months of 1 to 4 12 age Preschoolers, 30 months (b) of age until 3 years of 1 to 8 16 age Preschoolers, 3 years of (c) 1 to 10 30 age until 4 years of age (d) Preschoolers, 4 years of 1 to 12 30 age until school-age (e) School-agers 1 to 18 36 1K ALLEGATION: The individual serving food does not change gloves in between serving food to different classrooms. INVESTIGATION: While onsite on 05/31/2022, Ms. Corbett indicated CCSM 10 serves food. She does not have any direct contact with children. The food is served with utensils, but it is possible a ready to eat food could be handled with used gloves. I reminded her that ready to eat foods could not be handled with bare hands and required a glove to be worn. The individual serving the food puts it on the plates and then the CCSMs serve the plates to the children and pour the milk. Ms. Corbett is not sure how frequently gloves are being changed as she is not directly supervising lunch service. I interviewed CCSM 6 on 06/02/2022. She is not normally there when the main cook is, but she was in the kitchen last Wednesday and observed the cook changing gloves throughout the time she was in there. The cook also served the food and changed gloves at every classroom and opened the door with her elbow or asked someone else to open the door. She has also seen the cook leave the plates on the ledge of the classroom and the CCSMs serve to the children. She indicated that ready to eat foods are served while wearing gloves or using utensils. While onsite on 07/08/2022, I interviewed CCSM 17. She started working at the center at the end of May. She advised that she is responsible for preparing and serving lunch. CCSM 16 is responsible for preparing breakfast and snacks. CCSM 16 leaves the snacks in a snack basket or in the refrigerator labeled. Each room is responsible for getting their own snack from the kitchen. CCSM 17 indicated that she has not been really shown anything or trained. She works at a local school in the cafeteria. She follows the menu, puts together the food, and serves each classroom. She is careful to follow special diet restrictions. I asked CCSM 17 about her use of gloves. She said she changes gloves appropriately every two classrooms. CCSM 17 was not aware of the child care licensing rules. I showed her the environmental health section and encouraged her to familiarize herself with the rule requirements. I advised that ready to eat foods could not be handled with bare hands and required use of a glove or utensil. I encouraged CCSM 17 to change her gloves before serving each classrooms food. We discussed the possibility of leaving the plates on the ledge and not entering the rooms. I spoke with CCSM 1, CCSM 5, CCSM 8, CCSM 9, Child A and Child B's Mother, Child C's Mother, and Child D's Mother over the telephone on 07/11/2022. CCSM 1 is typically the first room served food. She has seen the person serving the food put on and take off gloves within her room. She does not know if gloves are being changed in other classrooms. 14 CCSM 5 said there is a new cook for the summer. The old cook did not change gloves. The new cook changes gloves and washes hands. CCSM 8 did not remember if the individual serving food is wearing or changing their gloves. CCSM 9 said it is hard to tell if the person serving food is changing their gloves. She is one of the first classrooms served and they are always putting on gloves and taking them off. Child A and Child B's Mother has seen trays of food delivered to classrooms. The trays were on a cart that was pushed, and they would hand the plates to the CCSM in the classroom. She was not sure about the frequency of glove changes. Child C's Mother and Child D's Mother did not have any concerns regarding the way food was served at the center.

R 400.8320 · R 400.8320 Food preparation. (5) Ready to eat foods must not be prepared or served using bare hands.

While onsite on 05/31/2022, Ms. Corbett indicated CCSM 10 serves food. She does not have any direct contact with children. The food is served with utensils, but it is possible a ready to eat food could be handled with used gloves. I reminded her that ready to eat foods could not be handled with bare hands and required a glove to be worn. The individual serving the food puts it on the plates and then the CCSMs serve the plates to the children and pour the milk. Ms. Corbett is not sure how frequently gloves are being changed as she is not directly supervising lunch service. I interviewed CCSM 6 on 06/02/2022. She is not normally there when the main cook is, but she was in the kitchen last Wednesday and observed the cook changing gloves throughout the time she was in there. The cook also served the food and changed gloves at every classroom and opened the door with her elbow or asked someone else to open the door. She has also seen the cook leave the plates on the ledge of the classroom and the CCSMs serve to the children. She indicated that ready to eat foods are served while wearing gloves or using utensils. While onsite on 07/08/2022, I interviewed CCSM 17. She started working at the center at the end of May. She advised that she is responsible for preparing and serving lunch. CCSM 16 is responsible for preparing breakfast and snacks. CCSM 16 leaves the snacks in a snack basket or in the refrigerator labeled. Each room is responsible for getting their own snack from the kitchen. CCSM 17 indicated that she has not been really shown anything or trained. She works at a local school in the cafeteria. She follows the menu, puts together the food, and serves each classroom. She is careful to follow special diet restrictions. I asked CCSM 17 about her use of gloves. She said she changes gloves appropriately every two classrooms. CCSM 17 was not aware of the child care licensing rules. I showed her the environmental health section and encouraged her to familiarize herself with the rule requirements. I advised that ready to eat foods could not be handled with bare hands and required use of a glove or utensil. I encouraged CCSM 17 to change her gloves before serving each classrooms food. We discussed the possibility of leaving the plates on the ledge and not entering the rooms. I spoke with CCSM 1, CCSM 5, CCSM 8, CCSM 9, Child A and Child B's Mother, Child C's Mother, and Child D's Mother over the telephone on 07/11/2022. CCSM 1 is typically the first room served food. She has seen the person serving the food put on and take off gloves within her room. She does not know if gloves are being changed in other classrooms. 14 CCSM 5 said there is a new cook for the summer. The old cook did not change gloves. The new cook changes gloves and washes hands. CCSM 8 did not remember if the individual serving food is wearing or changing their gloves. CCSM 9 said it is hard to tell if the person serving food is changing their gloves. She is one of the first classrooms served and they are always putting on gloves and taking them off. Child A and Child B's Mother has seen trays of food delivered to classrooms. The trays were on a cart that was pushed, and they would hand the plates to the CCSM in the classroom. She was not sure about the frequency of glove changes. Child C's Mother and Child D's Mother did not have any concerns regarding the way food was served at the center.

R 400.8170 · R 400.8170 Outdoor play area. (3) A center operating with children in attendance for 3 or more continuous hours per day shall provide daily outdoor play, unless prevented by inclement weather or other weather conditions that could result in children becoming overheated or excessively chilled.

Infants are not being provided with daily outdoor time or play.

Open Not marked corrected in the state record

Category: physical safety. 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. K

I made an unscheduled onsite inspection at Kiddie U Academy on 10/1/2021. Licensee designee/program director Lura Corbett and program director Nandrae Reidenbach were not present at the center on this date. Kasey Benavides has been a staff member at the child care center since April 2021 and is currently an assistant to the program directors. Ms. Benavides acknowledged that the center is at the tail end of an RSV and HFMD outbreak. Every classroom has a cleaning checklist that includes wash, rinse and sanitize all toys, cots, and infant room floor mats every evening. Additional cleaning and sanitizing are done during naptime. Toys that are placed in children's mouths are tossed in a "yucky bucket" to be cleaned and sanitized. If a child becomes ill, equipment is washed and sanitized prior to use by another child. In addition to the daily cleaning, the owner hires someone to clean the center twice a week. An additional unscheduled onsite inspection at Kiddie U Academy was made on 10/11/2021. Licensee designee/program director Lura Corbett and program director Nandrae Reidenbach were interviewed. Ms. Corbett and Ms. Reidenbach reiterated that staff members have a cleaning checklist that is implemented during naptime and at closing, mouthed toys are cleaned and sanitized prior to use of another child and they hire someone to clean the center twice a week. The directors acknowledged that over the course of three weeks, approximately 30 children were diagnosed with HFMD. Once a child appears to be unwell, their temperature is taken. If symptoms are minor, the center will notify parents and monitor the child for the remainder of the day. If child has a high temperature or experiencing other concerning symptoms, they are removed from the classroom until a parent comes to pick them up. I spoke on the telephone with Child A's Mother on 10/12/2021. Child A's Mother stated that she does not have any concerns regarding the cleanliness of the child care center. She does not have any knowledge of the cleaning/sanitizing routine. I spoke on the telephone with Child B's Mother and Child C's Mother on 10/13/2021. Neither parent expressed any concern regarding the cleanliness of the child care center. Both parents have witnessed staff cleaning at the end of the day. Child B's Mother stated that the center has stepped up their cleaning since COVID.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

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.

Kasey Benavides informed me that parents are notified of confirmed communicable diseases through the Remind App as well as a posting on the parent board every Friday. I viewed the posting on the parent board on 10/1/2021. The posting listed the name of the communicable disease and the number of infections per classroom for the week. It did not list symptoms or preventative measures as recommended by the U.S. Centers for Disease Control and Prevention (CDC). Lura Corbett and Nandrae Reidenbach informed me that parents are notified of new confirmed cases of communicable diseases in two ways. Parents are notified through the Remind App immediately and the posting on the parent board is updated weekly. The notifications did not initially include symptoms or preventative measures. Policy has changed since 10/1/2021 to include the required information. All parents acknowledged that they receive messages regarding communicable diseases through the Remind App as well as a posting near the entrance. Child A's Mother indicated that the posting is updated weekly. Child B and Child C's Mothers believe that families are promptly notified of the communicable disease though the Remind App. 4 ......................................................................................................

Open Not marked corrected in the state record

Category: health medication. 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 the following website: littps://www.cdc.€govlDiseasesCond itions.

Parents were promptly notified of confirmed instances of communicable disease; however, these notifications did not include symptoms or prevention measures as specified by the CDC.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8182 · R 400.8182 Ratio and group size requirements. (3) In each room orwell-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 Group Age Member to Child Size Ratio (a) Infants and toddlers, birth 1 to 4 12 until 30 months of age (b) Preschoolers, 30 months 1 to 8 16 of age until 3 years of age (c) Preschoolers, 3 years of 1 to 10 Not applicable age until 4 years of age (d) Preschoolers, 4 years of 1 to 12 Not applicable age until school-age (e) School-agers 1 to 18 Not applicable I

The center is operating within ratio in each room.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.