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 11/15/2022 an We interviewed child care staff member (CCSM), reported on 11/1112022 Child H ( came into the office with another staff member who reported Child H got into pepper spray. Child H was taken to the bathroom to get washed up then came back to the office and laid on the floor, heard somewhere that milk helps but she was not sure how to keep it from going into Child H's eyes. She goggled it and found wetting towels with milk and washing with baby soap and water help. called Child H's Mother to ick r up. reported the pepper spray belonged to CCSM, p Child was in the school age room at the time of the incident, did where the pepper spray was in the room at the time of the incident. Usually,the pepper spray is kept in a high up cupboard. CCSM; was present that day and assisted with administering first aid. stated they talked about calling poison control, but she was not sure if that happened. Her main focus was contacting Child H's Mother and helping Child H. 04 When asked CCSM, responded Child H's eyes were red and she was crying. They kept putting R -soaked rags on Child H's face until Child H's Mother arrived. Licensee designee, Ms. Danaea Trombley was present and interviewed by ■ " and me at the center on 11/15/2022. Ms. Trombley reported that her unerstanding is the pepper spray was in some sort of locked case on a key chain. Ms. Trombley stated she plans to get lockers for the staff to allow them to lock up hazardous items. Ms. Trombley reported Child H's Mother told them Child H got into a bottle of body spray at home and sprayed the entire bottle on herself, reported that when interviewed by worker, Child H reported she thought the pepper spray was ChaapSntiockt heAM as trying to get it out. CCSM, was interviewed on 11/15/2022 by and me onstte. reported she helped put milk on Child Hs ace. She was not aware of anything else because she was not in the room at the time of the incident. While onsite on and I viewed the video from the incident on 11/11/2022 invo1lvi1ng/ 1C5hi/ld2 H0.2 T2hiee," eo was time stamped 8:00am but the time of the video is an hour ahead. The actual time was 7:00am. On the video i observed the children lined up in the space between the counters. CCSM was turning back and forth between the counters writing on papers. Child H is seen picking something up off the counter. A few seconds later there is commotion, Child H is waving her hands in from of her face. The other children are all turning around to see what happened. CCSM, grabbed Child H by the hand and went around the counter towards the refrigerator where another child got a gallon of milk out and set it on the table, then left the room with the children including Child H. - returned alone then left again and returned with Child H. CCSM was in the room with us setting up the video for us to watch on 11i Menoticed she came into view on the video after the incident just after the children left the room. reported that she was in the preschool room when one of the other children told her Child H got into spray and needed help. went to the office to get CCSM, Whe€'~ arrived, she _ asked where Child H was. She was informed Child was getting on the bus to go to school _ told _ to get Child H off the bus. They googled how to treat the irritation and saw baby soap works. They did not have baby soap, so someone was going to go to the dollar store until another staff member remembered she had some in her car. When asked, reported the tall girl standing by - the door in the video, was Child K. On 11/15/2022 and I interviewed Child I ( . Child I reported they were getting ready for the bus on 11/11/2022. Child H was playing with CCSM, keys. Child H unlocked it and sprayed it on herself. CCSM, ■ told the of the children to leave the area, so they did not get any on C1 them. When asked Child K stated the keys were left on the counter top by CCSM, Normally the keys are in a drawer where the children can not get to them. On 11/23/2022 _, and I complet

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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

On 11/11/2022 pepper spray was left on the counter accessible to children. Child H sprayed herself in the face with the pepper

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.

R 400.8110 · R 400.8110 Applicant; licensee; licensee designee; requirements. (2) The applicant, licensee, and licensee designee shall have the administrative capability to operate the center in order to provide the services and facilities that are conducive to the welfare of children. II ...............................................

On 10127/2022 licensee designee Ms. Lorrie Foor submitted an incident report to child care licensing consultant Mr. Josh Stein. The incident report listed the time of the accident as 1:30pm on 10/26/2022 and the time Child A and Child E's Mother was notified as 1:40pm on 10:2612022. In the incident report Ms. Foor wrote; was carrying (Child A) to the bathroom, when she tripped on the edge !R Ner!Ring horse, causing her to fall forward as Child A flew out of her arms. She did not land on top of (Child A). immediately picked (Child A) up and assessed s) injures. en let him eat snack. After snack brought (Child A) to the office to be looked at. checked d A) over, checked for signs of concussion and touched along limbs for tenderness. (Child A) gave no response to tenderness at this time. We saw no visible injury including concussion. (Child A) returned to class. Accident report has been uploaded to ProCare and (Child A's Mother) picked up at 2:58pm. Parent took child home. On an attached paper Ms. Foor wrote; Parent Messaged ProCare that Child A was in hospital with concussion) (RT). (Ms. Foor) contacted (Child A and Child E's Mother) 1 and found out more details. (Child A and Child Es Mother) reported she went home first, and that evening took (Child A) to , and they transferred (Child A) to I contacted Child A and Child E's Mother on 1012712022 via telephone and interviewed her. Child A and Child E's Mother was at with Child A who has been admitted. On 10/26/2022 an incident report was posted on ProCare saying Child A was dropped by a child care staff member who tripped and Child A landed head first. Child A's Mother expressed concerns with that "story" since Child A does not have a concussion, he has a . The center staff told her Child A was not crying at all. Child A and Child ''!sMoherwent to pick up Child A as soon as she saw the ProCare report, around 2:00pm. Child A and Child E's Mother was never called to inform her Child A had an accident at the center. When she picked Child A up, she was told Child A "threw himself out of (the child care staff members) arms. Child A and Child E's Mother was told Child A had no signs of concussion and they had been watching him for signs of concussion since the fall. Ms. Foor told Child A and Child E's Mother the fall was so loud it was heard across the hall in the other rooms. Child A and Child E's Mother expressed concerns with the differences in the stories of what happened, and the actual injury Child A has. She also expressed concerns that Child A had been injured multiple times before at the center. There are cameras on site at the center. Child A and Child E's Mother reported Child A was sedated to set and . Child A has a on the rights and is in a cast from his his right to his his left . Child A also had a bruise on his fore ead and a hematoma on the back of his neck. On 11/01/2022 1 completed an onsite inspection with = Licensee designees Ms. Danaea Trombley and Ms. Lorrie Foor were both present. Ms. Foor immediately reported to us that the situation was already all over social media, and she was drafting a letter for parents. Ms. Trombley sent us the screenshot of a Facebook post of a former parent. The post indicated; "...they have had four kids with different , a a kid -, and who knows what else...' advised Ms. Foor and Ms. Trombley that we were there to investigate the incident hat occurred on 10/26/2022 involving Child A. Ms. Foor reported that on 10/26/2022 child care staff member, tripped on the corner of the rocking horse. "Child A flew out of her arms and hit the ground." Child A did not act like he was harmed. The next day, 10/27/2022 Child A and Child E's Mother reported she took Child A home first and then took Child A to the emergency room two hours later. The incident report was posted to ProCare. Child A and Child Es Mother saw it right away and came to pick Child A up early. Ms. Foor reported she had a video of the trip and fall on her phone to show us. It was a

Open Not marked corrected in the state record

Category: recordkeeping. 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.

Appropriate care and supervision were not provided on 10/26/2022 after Child A fell face down on the floor during a trip and fall incident while being carried by child care staff member Child Care staff members observed significant changes in Child As typical behaviors and demeanor; however, they did not take appropriate actions to seek medical attention for Child A. In addition, made no attempt to assess Child after his fall incident while sifting on the floor in front of and the bean bag. was observed on video from 1012612022 pulling one unknown toddler away from a cot by his arm. was also observed on video from 111/2612022 grabbing two unknown children by the arms and pulling them off a table. was observed on video from 10/26/2022 watching an unknown toddler fall face first into a rocking horse while she sat on a child sized couch facing the rocking horse. I M head move in a flinch a movement wheonb tsheer tvoedPler s ace t the rocking horse, made no attempt to prevent the toddler from hitting the rocking horse or assessing the toddler for any injuries following the fall. She waited for the toddler to go to her for comforting.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8125 · R 400.8125 1 Staff; volunteer; requirements. (2) All staff and volunteers shall act in a manner that is conducive to the welfare of children. 17

On 10/26/2022 Child A fell face down on the floor while being carried by child care staff member during a trip and fall incident. Child care staff members in interviews, reported at Child A's behavior n demeanor were not typical after the trip and fall incident. Child A was typically an active child. After the initial trip and fall incident Child A did not stand or walk. Child A typically eats and drinks all his snack at snack time. After the trip and fall incident Child A did not eat or drink at snack time. Child A cried off and on for the remainder of the day. should have been able to decern the situation warranted immediate action. Child A's condition was significantly different after the initial fall. Child A was not stable enough to sit up independently as evidenced by his _ fall while sitting on the floor in front of the bean bag. took Child A to multiple child care staff members in other rooms and the office to have them assess Child A's condition. diminished the severity of the incident when they stated things like; Child A did not fall "that hard" or did not hit his head "that hard". In addition, ■ did not immediately take Child A to the office. She waited until Child A was no longer crying. described her thoughts on 10/26/2022 and stated she was very nervous and anxious that (Child A and Child E's Mother) would come in ragging about the incident". stated, "to this day it still bothers me". reported all the staff were nervous and anxious that day. I

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

While the center has a written plan it is not specific enough to be clear to all staff. There are no examples of what to look for in various situations or guidelines of what would require immediate medical attention. It is left to individual interpretation. On 10/26/2022 Child A flew out of arms and landed face down on the floor away from where landed whenM tripped and fell. That fall warranted an immediate ca Child A and E's Mother to notify her of the incident as well as report the observed changes in Child A's typical behavior and demeanor which warranted medical attention.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8161 · R 400.8161 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. i]

The written emergency plan for serious accidents, illnesses, and injuries was not implemented on 10/26/2022. The child care staff members maintained they were told the incident was "minor"; however, they did not even implement their minor medical emergency procedures as written. The minor medical emergency procedure states in part: • Caregiver finding ill or injured child will comfort child as they look into reason for the child's discomfort. Examine the child, noting changes in the child's behaviors and/or bumps or bruises. • Children with minor injuries will be monitored closely throughout the day, with changes in appearance of the area as well as the child's behaviors being noted to ensure that further complications do not arise. Parents will be called and notified immediately if the following occur: • Child is too ill to remain in care • Child experiences an accident and/or injury that warrants the parent's immediate attention • Child needs additional medical attention • Child cannot be calmed by any means of comfort

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.