• Violation

  R 400.8380(5) · R 400.8380(5) Maintenance of premises. There must be no flaking or deteriorating paint on interior and exterior surfaces or on equipment accessible to children.

  There was flaking paint on the walls in three classrooms that was accessible to children.

  Open Not marked corrected in the state record

  Category: physical safety. Open / not marked corrected.

• Violation

  R 400.8380(4) · R 400.8380(4) Maintenance of premises. Floors, interior walls, and ceilings must be kept in sound condition, good repair, and maintained in a clean condition.

  The wall in the Preschool classroom is not maintained in a clean condition. There was dried food all over the wall.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

• Violation

  R 400.8134(2)(e) · R 400.8134(2)(e) Hand washing. After each diapering.

  The child care staff member in the Preschool classroom did not wash her hands after each diapering.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  R 400.8134(2)(g) · R 400.8134(2)(g) Hand washing. After handling bodily fluids.

  The child care staff member in the 2's classroom did not wash her hands after each time she handled bodily fluids (wiping children's noses).

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

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

  Staff in the 2's classroom and Early Preschool classroom did not ensure that children washed their hands before meals.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  R 400.8131(12) · R 400.8131(12) Professional development requirements. When the department of licensing and regulatory affairs or the department of education publishes a notice that a new health and safety update document or a new health and safety update training activity has been published on MiRegistry, the licensee shall ensure that all personnel read and acknowledge the document or complete the activity within 6 months of the notice.

  There were five child care staff members who did not complete the MiRegistry Health and Safety Refresher 2023. There were six child care staff members who did not complete the MiRegistry Health and Safety Refresher 2024.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

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

  The premises were not maintained in a clean and safe condition. There were scissors and trash bags within the reach of children. The trash cans and child sinks in two classrooms were dirty and had dried food on them.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  R 400.8131(3) · R 400.8131(3) Professional development requirements. Before caring for children, all child care staff members and unsupervised volunteers who work directly with children shall be trained on prevention of shaken baby syndrome, abusive head trauma and child maltreatment, and recognition and reporting of child abuse and neglect.

  There were seven child care staff members who did not complete training on prevention of shaken baby syndrome, abusive head trauma and child maltreatment, and recognition and reporting of child abuse and neglect prior to caring for children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8330 · R 400.8330 1 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.

  The center did not ensure that Child A who has special dietary needs due to an allergy to sun butter was not in contact with sun butter on May 9, 2023, which led to an allergic reaction that required the administration of an Epi-pen and medical attention. The center also did not maintain instructions provided by the licensed health care provider at the center.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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: (b) After toileting or diapering. ................

  Child Care Staff Member 1 did not wash Child H's hands after changing his diaper.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  R 400.8134 · R 400.8134 1 Hand washing. (2) All staff and volunteers shall wash their hands at all of the following times: (c) Before preparing and serving food and feeding children. I

  Child Care Staff Members 1 and 2 did not wash their hands before serving the children lunch.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

• Violation

  R 400.8134 · R 400.8134 Hand washing. (2) All staff and volunteers shall wash their hands at all of the following times: (e) After each diapering.

  Child Care Staff Member 1 did not wash her hands after changing Child H.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  R 400.8134 · R 400.8134 Hand washing. (2) All staff and volunteers shall wash their hands at all of the following times: (g) After handling bodily fluids.

  Child Care Staff Member 1 did not wash her hands after wiping Child L's nose.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  R 400.8325 · R 400.8325 Sanitization. (1) All tableware, utensils, food contact surfaces, and food service equipment must be thoroughly washed, rinsed, and sanitized after each use. Multi-purpose tables must be thoroughly washed, rinsed, and sanitized before and after they are used for meals or snacks.

  I The tables were not washed before lunch.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

• Violation

  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. 13

  On May 3, 2023, and I completed an on-site inspection. and I reviewed the video footage of the Two's classroom from April 20, 2023. It should be noted the video starts at 00:00 (9:15am) to 3:00:00 (12:15pm) hour mark and the following incidents were observed: 1. At 04:22 Child Care Staff Member 1 - Child B backward, —him by the Child B pulls away from Child Care Staff Member 1 and she walks _. faster than Child B would naturally walk. Child Care Staff Member 1 places Child B in a corner alone, which is called the quiet corner. 2. At 06:26 Child Care Staff Member 1 picks Child B up by hi and his ■ are off the ground for a second. She does this to make him stand from a laying position and then she sits him down. 3. At 27:00 located directly below the camera, Child C is playing with Child H. Child Care Staff Member 1 uses her left arm to against Child H. 4. At 29:00 Child Care Staff Member 1 conducts a diaper check with Child H, and she his to the diaper table making him walk 14 until they are halfway across the room. There is a distraction and Child Care Staff Member 1 leaves Child H standing with his around his = Child H's diaper was not changed until 30:32. 5. At 1:20:00 the children are sifting down at the tables having a drink of water. At 1:45:00 the children were allowed to get up from the table from having water. 6. At 1:40:00 Child B was at the little sink and Child Care Staff Member 1=him by him to sit back to the ground. 7. At 1:43:00 Child Care Staff Member I1_ Child B as he is on the ground next to his chair. Child Care Staff Member Child B's him up to a standing osition. She puts him in the chair while holding both of his - and his hands down while he is in the chair. On April 26, 2023= „' and interview Child Care Staff Member 1. Child Care Staff Member 1 stated ok Child D into the and over Child D's with an open hand. She stated there were no mars or bruises left from this She Child D because she was not listening. She felt she could Child D because she knows she gets a 'pow pow" at home which she assumed was a ~ ..............................................................................................................................................................................................................................................................................................................................

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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. 15

  Child Care Staff Member 1 did not provide appropriate care and supervision of children at all times. There wer different incidents involving Child B and Child H, where hild Care Staff Member 1 used excessive force to address these children's behaviors in the classroom. Child Care Staff Member 1 did not provide appropriate care and supervision of the children when she required the children sit at a table to drink water for 25 minutes, not allowing the children to get up when finished with their water.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  MCL 722.115m Child care center, group child care home, or family child care home; requirements for licensure. (2) A person, partnership, firm, corporation, association, nongovernmental organization, or governmental organization shall not establish or maintain a child care center, group child care home, or family child care home unless licensed by the department. Application for a child care center, group child care home, or family child care home license shall be made on forms provided, and in the manner prescribed, by the department, including the fees required under subsection (10). Before issuing or renewing a child care center, group child care home, or family child care home license, the department shall investigate the applicant's activities and proposed standards of care and shall make an on-site visit of the proposed or established child care center, group child care home, or family child care home. Except as otherwise provided in this 16 subsection and sections 5q and 5r, if the department is satisfied as to the need for a child care center, group child care home, or family child care home, as to its financial stability, and that the service, facility, applicant, licensee, child care staff member, or member of the household is conducive to the welfare of the children, the department shall issue or renew the child care center, group child care home, or family child care home license. If the department determines that a service, facility, applicant, licensee, child care staff member, or member of the household is not conducive to the welfare of the children, the department shall deny that application or revoke that licensee's license according to section 11.

  Child Care Staff Member 1 is not conducive to the welfare of children and is not eligible to be associated with a child care organization. ............................................... ................

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  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.

  The Child Care Staff Members in the Two's classroom did not provide appropriate care and supervision to Child A when he continued to have documented from December 1 through March 9, 2023. Child Member 3 re orted he had incident reports sent home for . However there were on y incident repo s regarding

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  The children did not wash their hands before lunch.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  R 400.8140 · R 400.8140 Discipline. ...... ................... (1) Positive methods of discipline that encourage self- control, self-direction, self-esteem, and cooperation must be used. ...................................... ........

  Child Care Staff Member 1 did not demonstrate positive methods of discipline on April 20, 2023, from 9:15 a.m. to 12:15 p.m. Child Care Staff Member 1 used physical force and intimidation which did not promote self-control, self-direction, self-esteem, or cooperation.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  R 400.8140 · R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: (a) Hitting, spanking, shaking, biting, pinching, or inflicting other forms of corporal punishment. I

  Child Care Staff Member 1 — Child D on April 20, 2023. — .............................

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  R 400.8140 · R 400.8140 Discipline. (4) A written policy must be developed and implemented regarding the age appropriate, non-severe discipline of children. The policy must be provided to staff and parents.

  Child Care Staff Member 1 did not follow the discipline policy of Tutor Time Child Care Learning Center.

  Open Not marked corrected in the state record

  Open / not marked corrected.

• Violation

  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.

  The complainant reported that "caregivers" have been observed sleeping instead of supervising children during nap time. Program director Jamie Lindeman stated that she does not believe that child care staff members sleep during the children's nap times. She stated that she helps during nap time sometimes and she has never seen any child care staff members asleep and she has never had anymore report anything like this to her. She stated that she has seen child care staff members lay on the floor next to a child's cot while they pat the child's back and she has asked them to sit up, but she stated that they were not sleeping. Child care staff member Alissa Hillsburg stated that in the infant room she rocks children to sleep while sitting in a rocking chair and may close her eyes if the baby is looking at her while she's trying to get them to sleep but she never sleeps while children are napping. Ms. Hillsburg stated that she has never seen or heard of anyone sleeping while the children are napping. Child care staff member Pat George stated that she never naps with the children. She stated that at nap time she lays beside or sits beside children on the floor while they are laying on their cot to pat their backs as they fall asleep. Ms. George stated that she has never seen any child care staff members sleeping at the center. Child care staff member Jada Robinson stated that she usually takes her break during the children's nap time. She stated that when she returns from break, she has never seen any child care staff members sleeping and she has never heard anyone mention seeing that happen. Child care staff member Chandler Turner stated that she has never seen any child care staff members sleeping while children are napping. She stated that child care 611 W. OTTAWA. P.O. BOX 30664. LANSING, MICHIGAN 48909 www.michigan.gov/lara . 517-335-1980 staff members in the infant room will sometimes close their eyes to try to get the children to close their eyes and go to sleep. She has also seen some child care staff members lay next to children on their cots to pat their backs, but they never actually go to sleep. Child A's Mother and Child B's Mother both reported that they are happy with the center and the care that their children receive. They have no concerns about the child care staff members supervision of their children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  Program director Jamie Lindeman stated that the only time that children are moved is to maintain ratio. She never sends children to another room if they are misbehaving. She stated that typically she goes into the classroom if a child care staff member calls for assistance to try to resolve the issue. Ms. Lindeman stated, "we don't punish our kids." If a child is misbehaving to the point that a child care staff member must call her, she talks to the child in their classroom or walks with them in the hall, but she never takes the child to a different room. She has never had anyone report anything to her about a child being moved to a different room as a means of punishment. Child care staff member Alissa Hillsburg stated that child care staff members in the older classrooms like preschool or pre-k call Ms. Lindeman for assistance sometimes if a child is misbehaving but she has never heard of a child being taken to a different classroom for "acting out." Ms. Hillsburg stated that children are never brought to the infant room where she works as a means of punishment. Only infants are cared for in the infant room. Child care staff member Pat George stated that she has never sent a child to another classroom for misbehavior. She knows how to redirect toddlers who are "acting out" so she would never need to send them to another room. Ms. George 611 W. OTTAWA. P.O. BOX 30664. LANSING, MICHIGAN 48909 www.michigan.gov/lara . 517-335-1980 stated that she has never witnessed any other child care staff members remove a child from their class due to misbehavior. Child care staff member Jada Robinson stated that she only sends children to a different classroom to maintain ratio. She stated that she never sends children out of the room due to misbehavior and she has never seen it done by any other child care staff member. Child care staff member Chandler Turner stated that the only time children are moved from one room to another is to maintain ratio. Ms. Turner stated that she wouldn't move a child to another room as a means of punishment because the child would only act up in the next room. She has never seen any other child care staff member moving a child to another classroom because they were acting out. Child A's Mother and Child B's Mother both reported that they are happy with the center and the care that their children receive. They have no concerns about the child care staff members supervision of their children.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8140 · ........................................ I R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: (d) Inflicting mental or emotional punishment, such as humiliating, shaming, or threatening a child.

  The complainant reported that the center is not cleaned properly after COVID-19 cases leading to other children and child care staff members contracting COVID-19. Program director Jamie Lindeman stated that whenever there are positive COVID-19 cases in children or child care staff members she contacts the center's district manager to make a report. At that time based on the number of positive cases a determination is made whether to close the classroom or not. Ms. Lindeman stated that the last time that a classroom had to be closed due to COVID-19 cases was in January 2022. At that time a cleaning company was sent in for a deep cleaning and 611 W. OTTAWA. P.O. BOX 30664. LANSING, MICHIGAN 48909 www.michigan.gov/lara . 517-335-1980 sanitation of the entire classroom and all toys and equipment in the room. Ms. Lindeman stated that there have been other positive cases of COVID-19, but they have not required that the entire classroom be closed. At the end of each day all classrooms are cleaned and sanitized whether there has been a positive COVID-19 case or not. The last positive case at the center was in the infant room on August 31, 2022. The child in the infant room stayed home for 10 days and all parents of infants were notified of the positive case in the infant room. After the infant tested positive the room was cleaned and sanitized as normal including all toys and equipment used by the infant. Prior to the positive case in the infant room there was a positive case in the school- age classroom on August 15, 2022, just before children returned to school. The school-age child was excluded from care for 5 days and returned to care for 5 days with a mask based on health department recommendations. Children under 2 years of age who test positive however must remain home for 10 days since they are unable to wear a mask. Child care staff members who test positive for COVID-19 isolate for 5 days and can return to work if they are symptom free but must wear a mask for 5 days. The school-age classroom was cleaned and sanitized thoroughly along with all equipment at the end of the day as always after the school-age child tested positive for COVID-19. Child care staff member Alissa Hillsburg stated that she cleans and sanitizes toys in the infant room regularly because children put toys in their mouths. She stated that she uses the three-step cleaning method of soap and water, clear water, and sanitizer. When a child in the infant room tested positive all the same cleaning protocols were followed in addition to cleaning and sanitizing the entire room at the end of the day when children were no longer present. Child care staff member Pat George stated that she believes that children are being brought to the center with COVID-19 symptoms by parents even though parents know that the child has been exposed to COVID-19. She believes that is how COVID-19 has been contracted by children and staff at the center. Ms. George stated that Ms. Lindeman requires children with COVID-19 symptoms be tested before they can return. Ms. George stated that all child care staff members clean and sanitize the classrooms and equipment throughout the day using soapy water, clear water and bleach and water. Ms. George stated that typically if there were more than three cases of COVID-19 in a classroom the room is shut down for a week and the room gets a deep cleaning from a cleaning company. Child care staff member Jada Robinson stated that she does everything that she can to prevent the spread of COVID-19 in the preschool room. She stated that she uses the three-step cleaning method every day. She has children wash their hands before eating and she cleans and sanitizes toys while children are eating. Ms. Robinson sanitizes cots and toys at the end of each day. She cleans and sanitizes all heavy touch areas such as faucets, door handles and light switches throughout the day. She stated that the last time that a child in the preschool classroom was reportedly 61

• Violation

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

  The premises is maintained in a clean and safe condition to not pose a threat to health or safety.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  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.

  During my unannounced onsite inspection on June 15, 2022, Jamie Linderman, program director, was not available. Lisa Andrews, receptionist, showed me the classroom. The room appeared safe and appropriate for 3-year-old children. Jada Robinson, child care staff member, stated that it was towards the end of the day and she and Alex Hallandal lined the children up in the classroom to go outside. Ms. Robinson counted the children using the face to name method as they left the classroom. She counted again in the hallway as they exited the building. Ms. Robinson said she counted the correct number on both occasions. Ms. Robinson stated that she either counted wrong the second time or a child moved in the line and was counted twice. She did not remember using the name to face method the second time. Ms. Robinson said she knows that Child A was in line to exit the 2 classroom. Mr. Hallandal was at the back of the line with the water bottles. Ms. Robinson said the only thing she believes could have happened is that Child A turned back and went through the classroom door before it closed. Mr. Robinson stated that Ms. Lindeman went outside with Child A, four to five minutes after the class went to the playground, she added that Child A's Parents were notified right away, and an incident report was completed. Ms. Robinson stated that they are now counting more often and always with the face to name method. They are also using a ring rope to transition from one location to the next. Alex Hallandal, child care staff member in the preschool room, stated that he and Ms. Robinson got the children ready to go outside. They lined up inside the classroom and the children were counted. While they were lining up, Mr. Hallandal got the water bottles and the "go bag". They exited the room and walked down the hall to the exterior door. Mr. Hallandal saw Ms. Robinson counting children as they left the building. Mr. Hallandal stated he did not see Child A go back into the building. There are also big windows to the classroom, and he did not see her through those. Mr. Hallandal stated that they are using the ring rope and also doing roll call, so the children have to answer. He is taking the end of the line and doing a "room sweep" before they move the children down the hall. Lisa Andrews, receptionist, stated that she and Jamie Lindeman were at the reception desk when they heard crying. Ms. Lindeman walked down the hall and then returned with Child A. She checked the cameras and saw the preschool room outside on the playground. Ms. Lindeman took Child A outside to her class. The cameras at the center do record, but they record to the main office. As a result, I could not review the footage to determine how Child A was left in the classroom. During my telephone interview with Jamie Lindeman, program director, she explained that on the afternoon of June 15, 2022, she was at the reception desk when she heard a child crying. She went down the hall and found Child A alone inside her classroom. Ms. Lindeman walked Child A to the reception desk where she viewed the live-feed cameras and located Child A's class on the playground. After taking Child A to the playground, Ms. Lindeman called Child A's Parents to inform them of what happened. Child A's Father stated that he believes his daughter receives good care at the center. He described the situation of her being left in the classroom as a "small mistake". He was certain it would not happen again. Child A's Father said she was not harmed in anyway. I interviewed Kerry Barr, licensee designee. Her office is located in the main headquarters for Tutor Time and she had access to the video feed for 30 days. I interviewed her regarding what she observed on the video feed. Ms. Barr explained that she could see all the children lined up to leave the classroom. It appeared that Ms. Robinson was counting children. As the children were going through the door, Child A, turned back and stood behind a bookcase. The time sta

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  Appropriate care was not provided when child care staff member Angel Tower did not serve Child A the correct bottle, which was provided for him by his family but served him Child B's bottle which contained breast milk.

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  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.

  On September 3, 2021, I spoke to, Child A's Mother. She stated that on Augst 24, 2021, she observed a picture of Child A on Brightwheel eating breakfast. Brightwheel is an electronic application system for parents to review. Child A's Mother stated that she observed Cheerios and a cup of cow's milk on Child A's tray. She also observed some of the milk to be spilled on his tray. Child A's Mother stated that she was concerned, as she provided breast milk in a personal sippy cup to the child care center to serve to Child A. Child A's Mother called the child care center and spoke to Lisa Andrews, assistant director. Child A's Mother asked Ms. Andrews if Child A drank the cow's milk. Ms. Andrews told her that Amara Fink, child care staff member stated that he may have drunk, "only a little." Child A's Mother stated that Child A returned to the child care center from August 25-26, 2021. Ms. Lindeman called her September 2, 2021, to check on Child A, and she asked if she took Child A to the doctor. Child A's Mother told Ms. Lindeman that Child A had diarrhea, but she did not take him to the doctor. She also told Ms. Lindeman that she felt it was best to disenroll Child A from the child care center. On September 8, 2021, I completed an unannounced on-site inspection at the child care center. I individually interviewed program director Jamie Lindeman, assistant director Lisa Andrews, and child care staff members Melissa Sauceda and Brooklyn Polk. Ms. Lindeman, program director stated that she was not present at the child care center during the time of the allegation, as her daily schedule is 9:30 a.m.-6:30 p.m., and the incident occurred prior to this time. Ms. Andrews, assistant program director initially spoke to Child A's Mother and the child care staff members about the allegation. Ms. Lindeman stated that she called Child A's Mother the day of the incident and apologized to her and listened to her concerns. Ms. Lindeman called Child A's Mother again on September 2, 2021, to check on Child A. She asked Child A's Mother if she took him to the doctor. Child A's Mother told her that Child A had diarrhea, but she did not take him to the doctor. Child A's Mother also told her that Child A would not be returning, as felt it was best to disenroll him from the child care center. Ms. Andrews, assistant director stated that she was present at the child care center at the time of the allegation. She stated that she received a telephone call from Child A's Mother regarding the picture posted on Brightwheel of Child A eating breakfast. Child A's Mother asked her if Child A was given cow's milk, as she provided breastmilk to the child care center to serve him. Ms. Andrews stated that she followed up with Amara Fink, child care staff member, as she uploaded the picture on Brightwheel. Ms. Andrews asked Ms. Fink if she served Child A cow's milk. She stated, "Yes, was I not supposed to"? Ms. Andrews replied, "yes, he's not 1." Ms. 3 Andrews then asked Ms. Fink if Child A drank the milk. She stated," I don't know, I only saw him playing with the cup." Ms. Andrews stated that she called Child A's Mother back and told her that Ms. Fink did not think that Child A drank the milk, and he may have only played with the cup. After Child A's Mother's telephone call the cow's milk was taken from Child A, and he was given his breastmilk. During the time of the allegation Melissa Sauceda, infant lead child care staff member was out of the room doing lesson planning the classroom has children ages 10 months -1 year. Melissa Sauced, infant lead child care staff member stated that during the time of the allegation she was out of the room doing lesson planning. Amara Fink, child care staff member and Alyssa McGallaird, child care staff member were present in the room during the time of the allegation. Ms. Sauced stated that she asked Ms. Fink if she gave Child A cow's milk. Ms. Fink stated that she did, but Child A did not drink it, and was only playing with the mi

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R 400.8185 · R 400.8185 Primary care. ..... .......................................... (4) Information regarding a child's food, health and temperament must be shared daily between primary caregivers when more than 1 primary caregiver is assigned to the any infant or toddler.

  Infant lead child care staff member, Melissa Sauced was in non- compliance when she did not communicate to child care staff member, Ms. Fink or child care staff member, Ms. McGallaird that Child A had breastmilk in the refrigerator before leaving the room.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  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.

  During my onsite inspection on June 21, 2021, I interviewed Jaime Lindeman, program director. Ms. Lindeman was in the process of transitioning from another child care center to Tutor Time as the program director. On June 16, 2021, Child A had an allergic reaction. Ms. Lindeman was aware of the situation but was not at the Tutor Time location when it occurred. Her knowledge of the situation was second-hand. Ms. Lindeman was cooperative in providing contact information for former child care staff members and copies of the safety policies. 2 The safety policy pertaining to allergic reactions states, "In all cases of a reaction, parent/guardian must be notified immediately after seeking appropriate medical treatment and must sign a completed incident report." Caylee O'Connor, child care staff member, reported that she called Child A's Father when she was informed that Child A's lips and tongue were swollen. Child A's Father said he would call his wife and she would pick up Child A. He did not think it was necessary to call an ambulance. He returned a call to the center and informed Ms. O'Connor that his wife would be there in approximately 20 minutes to pick up Child A. Ms. O'Connor stated that Child A's Father told her that Child A did not have any known allergies. While they waited for Child A's Mother to arrive, Roseann Davis, Child A's primary caregiver, took Child A to the lobby and held him. Lisa Andrews, assistant director, helped monitor Child A and she stayed near the phone in case they needed to call 911. Ms. O'Connor said that she and Ms. Andrews thought the swelling was going down, but then Child A developed a rash. Ms. Andrews "was in the process" of calling 911 when Child A's Mother arrived. Ms. Andrews suggested Child A be taken to the hospital. Child A's Mother quickly left with him. Lisa Andrews, assistant director, reported that she was working in a classroom on June 16, 2021, when Caylee O'Connor came in and told her that Child A was having an allergic reaction. Ms. Andrews went to see Child A and observed that his tongue and lips were swollen. He was being held by Roseann Davis, his primary caregiver. Ms. O'Connor telephoned Child A's Father. Ms. Andrews stated that she did not like how Child A's breathing sounded and she was in the process of calling 911 when his mother arrived. Child A's Mother immediately left with him for urgent care. Roseann Davis, child care staff member, and Child A's primary caregiver said Child A began having issues eating his sun butter and pita. She picked him up and realized his breathing was labored. She continued to hold him while she had Heather McDowell observe him. Ms. McDowell is the "safety captain" for the child care. Ms. Davis said she continued to hold and comfort Child A while Ms. Mc Dowell called the office and informed Ms. O'Connor of the situation. Ms. O'Connor then informed Lisa Andrews. Both went to observe Child A for themselves. Ms. Davis told them that she felt Child A was having difficulty breathing and his lips and tongue were swollen. She said an ambulance should be called. Ms. Davis said Ms. McDowell supported that decision. Angela Miller, child care staff member, was also present and said numerous times that an ambulance should be called because Child A was not breathing right. But Ms. Andrews and Ms. O'Connor said that Child A's Mother was on the way, and they would wait for her. Heather McDowell, child care staff member, said she was the "safety captain" for the child care. She went to safety training each month. Ms. McDowell informed me that Roseann Davis initially noticed a change in Child A's behavior and breathing. She immediately picked him up to comfort him. Ms. McDowell said she called the office and Ms. O'Connor then informed Lisa Andrews. By the time they arrived in the 3 classroom to observe Child A, his lips and tongue were swelling, and his breathing was noticeably labored. At this time, Ms. McDowell felt that 911 should be called. Ms. O'Connor

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

  R400.8161 · R400.8161 Emergency procedures. .................................... .... ..................................... (1) Written procedures for the care of children and staff for each of the following emergencies must be developed and implemented: (d) Serious accident, illness, or injury.

  The child care staff members did not follow the written procedures developed by the child care center for emergency situations involving allergic reactions.

  Open Not marked corrected in the state record

  Category: health medication. Open / not marked corrected.

• Violation

  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. I

  Caylee O'Connor, child care staff member, informed me that she was the child care staff member who walked Child A and Child B to their classrooms on May 17, 2021, after their mother dropped them off later than usual. Ms. O'Connor said she was having trouble with Child B going into her classroom, which was across from Child A's classroom. As she tried to leave Child B in her classroom, Child B slipped back out. While guiding her back to her classroom, Child A went into his classroom and shut the door. Ms. O'Connor said she then turned and opened the door to Child A's classroom. He had walked over to the window and was looking at his classmates outside. She stayed at the door while a child care staff member opened the exterior door from the outdoor play area for Child A to join the classroom outside. I informed Ms. O'Connor that the complaint was that Child A was left unattended in his classroom for 23 minutes. She appeared genuinely shocked and said that was not true. Ms. O'Connor added that maybe it was as long 2 as 30 seconds, but she was right outside the door in the hallway. I provided technical assistance to Ms. O'Connor explaining she should have kept Child A with her while dropping off Child B to her room. If that was becoming difficult, she should have requested assistance. Heather McDowell, child care staff member, said she was unaware of any child being left unattended in a classroom. Ashlynn Anderson, child care staff member, works in Child A's classroom. She said she logged his arrival at 9:53a.m. He was logged in at the front desk by his mother at 9:47am. The longest he could have been without supervision is 6 minutes. But he was walked to his room by Ms. O'Connor, which would have taken approximately 2 to 3 minutes for small children. She dropped off Child B to her classroom first, with some difficulty from Child B. She then turned to Child A's classroom. It is unknown how fast Child A went into his classroom alone or how long it took Ms. O'Connor to open the door so she could directly see him. Ms. Anderson saw children wave at Child A through the window, so she opened the door for him to join the class outside. Based on the time frames provided by Ms. Anderson, the longest Child A may have been without supervision was approximately 2 minutes. Kim Lyon, child care staff member, heard that Child A was left unattended in his classroom. She did not know any details other than it was Caylee O'Connor who walked him to his room. During my interview with Heather Hilla, she said she did not have any information on any children being left unattended at the center. She did not know if she would hear about it if it happened. Ronda Gillett, program director at the time of this incident, told me that she was unaware of a child being left unattended in the classroom. She knew that Ms. O'Connor walked Child A and B to their classrooms but believed that Ms. O'Connor stayed at Child A's classroom door until he was let outside to join his class. She did not believe he was ever left without supervision. Child A and B's Mother stated that she was notified that her son "slipped" into his unoccupied classroom while her daughter gave Caylee O'Connor a difficult time in the hallway. Child B did not want to go into her classroom. Child A and B's Mother said she was told that Ms. O'Connor was able to get Child B into her room and immediately opened the door to Child A's room. At that time she could see a child care staff member walking up to the outside door. Child A and B's Mother felt both of her children were safe. The Complainant did not return my telephone call. 3

  Open Not marked corrected in the state record

  Category: supervision. Open / not marked corrected.

• Violation

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

  Caylee O'Connor stated that child care staff members ride the bus with Ronda Gillett as helping hands to pick up the school-age children. The child care staff members are usually from the two preschool classrooms. They are gone from the center for approximately 15-20 minutes. The child care staff members who ride along are on their breaks and have a choice if they wish to ride to the school to pick up the school-age children. Ms. O'Connor said that the only time a child care staff member is asked if they would like to ride to the school is if their classroom has enough child care staff member coverage to maintain ratio. Heather McDowell was not aware of child care staff members riding on the bus to pick up the school-age children. She had never been asked. But she did not think Ms. Gillett would have asked for riders if it would have left any of the classrooms out of ratio. Ashlynn Anderson said she accompanied Ms. Gillett to Hiawatha Elementary School to pick up children on two occasions. Another child care staff member rode with them, so in total it was Ms. Gillett and two additional child care staff members. Ms. Anderson stated it takes approximately 15 minutes to make the round-trip drive. She was on her break and her room had adequate coverage to remain in ratio. Kim Lyon stated that she was aware that child care staff members rode the bus with Ronda Gillett to pick up school age children. She thought there were days when 3 or 4 child care staff members would ride the bus. If this was the case, then some classrooms must have been out of ratio. Ms. Lyon did not have any information on the days this would have occurred or who the child care staff members were on those days. Heather Hilla said she knew nothing about child care staff members riding the bus to pick up the school-age children. She thought it was only Ronda Gillett. Ronda Gillett was the program director at the time of this complaint. During my telephone interview with her, she informed me that if child care staff members are on break, she does ask them if they want to ride with her to pick up the school age children. Based on the time of the transports, the child care staff members that are available are from the preschool classrooms. Ms. Gillett stated that both classrooms are within the required child care staff member to child ratio, or she would not have the child care staff members go with her. On May 25, 2021, during interviews with child care staff members, one child care staff member mentioned a concern regarding ratio when child care staff members rode the bus with Ronda Gillett. So I began investigating this as an allegation. Later that same day, a new intake was received regarding ratio issued when Ms. Gillett took staff on the bus with her to pick up school aged children. This intake (179743) was dismissed because I was already investigating the allegation. I continued to investigate it along with intake 179701. 5

• Violation

  R 400.8182 · R 400.8182 Ratio and group size requirements. (3) In each room or well-defined space, the maximum group size and ratio of child care staff members to children, including children related to a staff member or the licensee, must be as shown in Table 4: Age Child Care Staff Maximum Group Size member to Child Ratio c) Preschoolers, 3 years of 1 to 10 Not applicable age until 4 years of age

  The center maintains the required child care staff member to child ratio, while school-age children are being picked up from school.

  Open Not marked corrected in the state record

  Category: ratio. Open / not marked corrected.

• Violation

  R 400.8325 · R 400.8325 Sanitization (1) All tableware, utensils, food contact surfaces, and food service equipment must be thoroughly washed, rinsed, and sanitized after each use. Multipurpose tables must be thoroughly washed, rinsed, and sanitized before and after they are used for meals or snacks.

  The sippy cups in the toddler wobbler room were washed, rinsed, and sanitized at the end of the day. Dirty cups were not given to the children.

  Open Not marked corrected in the state record

  Category: nutrition. Open / not marked corrected.

Caregivers have been observed sleeping during the children's nap time. Children are sent to the infant room as punishment for misbehavior. The center is not cleaned properly after positive COVID-19 cases.

Disposition: Substantiated

Child A, age 3, was left unattended in her classroom.

Disposition: Substantiated

Disposition: Substantiated

Child A (male, age 10 months) was served cow's milk and not the provided breast milk.

Disposition: Substantiated

Child A (17 months old) had an allergic reaction while at child care. He began having breathing issues and medical assistance (911) was not called.

Disposition: Substantiated

Child A (2 year-old male) was left unattended in his classroom. The preschool classrooms are out of ratio while program director, Ronda Gillett, drives the bus to pick up the school age children from school. 4

Disposition: Substantiated

Disposition: Substantiated