R 400.8137 · R 400.8137 Diapering; toileting. (6) Diapers and training pants must be checked frequently and changed when wet or soiled.

On October 07, 2022, Child A's Mother stated that Child A attended the center for approximately three weeks. On the second day when he was picked up, he didn't have any pants on. The staff's explanation was that they couldn't find his clothes, which seemed odd. He had allegedly peed through his diaper, so they took them off. During the three weeks there he was sent home with a rash in his buttocks area and some feces still on him one day. It was obvious that the staff were not cleaning him adequately or changing him enough. Child A's Mother immediately reported the concerns to the owner and licensee Emily Jones. At first Ms. Jones seemed to care and worked with her, but when she reported the issue with the diapering and rash, Ms. Jones told her that she needs to find another place for him because it wasn't working out. She has decided not to send him to the center anymore. On October 11, 2022, Child A's Mother forwarded me some text message exchanges between herself and the staff. In the text message she stated that she was aware Child A was having "blowout diapers" but that he came home with a rash on his privates and his leg. The response from the staff was "I am really sorry we really try to do the best that we can, and it was an honest mistake, especially with the blow out diapers something may have been missed." On October 12, 2022, I completed an unannounced onsite inspection at the center. I interviewed Ms. Jones. Ms. Jones stated that Child A's Mother was extremely difficult to work with and overreacted about everything. They attempted to work with her about communicating about Child A, but she was very picky. She sent him to the center with a list of her demands and they even met with her one on one to address her concerns. The center's policy is to change diapers at least every two hours, if not sooner if needed. She did not recall Child A not being changed as needed or having any rash on his bottom. On the second day, Ms. Jones diaper him herself and his mother made a huge deal out a wet spot on his pants that he had on him from having a pee through diaper. He was not wet all day and they had changed him. He was only there for a few weeks and each day it seemed like she had a different concern. On October 12, 2022, I interviewed program director Melody Vanconant. She stated that beginning the first day, Child A's Mother was questioning everything about the daycare center's daily routines and procedures. Child A had peed through his diaper the second day and they didn't have extra clothes that she had sent for him. They didn't just "lose" his clothes. It had happened near the end of the day, and they left him in his onesie since he was being picked up soon. They routinely checked his diaper (at least every hour) and cleaned him up well. In addition, Child A's Mother never told the center staff that he was on antibiotics, and this was causing him to have "blowout" diapers all 3 week. The staff did the best they could changing him as often as needed and cleaning him up well. On his second day there they already had agreed to meet with Child A's Mother to discuss her concerns. She came with a list of her needs and wants for the child care center and that should have been a red flag about her being extremely picky and worrisome; however, they agreed to accommodate her. From there it just worsened. By the time she accused them of not changing his diaper enough or well enough is when Ms. Jones told her they might not be a good fit for her, even though Child A was a great baby and no problem at all. On October 12, 2022, I interviewed child care staff worker Hayleigh Trombley. She was a primary caregiver for Child A when he attended the center. She denied that they didn't change his diaper often or well enough. He had been sick and was having a lot of extra bowel movements that were really messy. She did not recall any rashes on him. Their policy is to check diapers at least once an hour and change as often as needed. On Oct

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

R 400.8146 · R 400.8146 Information provided to parents. (3) For infants and toddlers, a center shall provide parents with a written daily record that includes at least the following information: (a) Food intake time, type of food, and amount eaten. (b) Sleeping patterns indicating when and how long the child slept. (c) Elimination patterns, including bowel movements, consistency, and frequency. (d) Developmental milestones. (e) Changes in the child's usual behaviors.

On October 07, 2022, Child A's Mother stated that she did not receive daily documentation of Child A's feedings, diaper changes, sleep patterns and other daily routines. She was told that the center uses a website app that records all of this, but that they have terrible service, and it never works. She never received any daily recordings on his care. They did not use a paper copy when it did not work, so she was unclear when he ate, what he ate, when he was changed, slept etc. On October 12, 2022, Ms. Jones stated that the center utilizes a website application called ProCare that they use to record daily feedings, diapering's, meals, sleep patterns etc. They enter this information through their phones and the parents get informed through the web application. She acknowledged that there are times that the service in the school building is not the best and there are days that the data is not captured for parents. During those times they do not complete a paper back-up. She knows that she and her staff can do better with this, and they are working on it. She had agreed to do a paper copy of the daily sheet for Child A after his mother complained about it. She is not sure if one was done each time but acknowledged that there were a few times that she probably did get a written record of his care for the day. On October 12, 2022, Ms. Trombley stated that the center uses a web app to record daily care. She acknowledged that the app does not always work and they were not using a paper back up. On October 26, 2022, Ms. Pardy stated that they center uses an app for the daily care records for infants and toddlers. Sometimes it does not work and sometimes it does. They try to enter all the information for each child each day, but sometimes they get really busy. She acknowledged that Child A might not have gotten one at times. On October 26, 2022, Child B's Mother stated that she has never received a daily sheet regarding Child B's day. She has no idea when her child naps or how the day goes. The staff have actually admitted that they could do a better job with this. They are supposed to have a website application, but the staff don't update it, or they say it has spotty service. They will utilize a special notebook to communicate Child B's medical issues because she has some special needs, but it doesn't capture feedings, diapering, milestones etc. On October 26, 2022, Child C's Mother stated that the center uses an app, and that it will document diapering and meals, but they do not record naps. If the app does not have anything recorded and she asks, the staff usually will tell her they had a crazy day and did not have time to update it. 5 On December 09, 2022, Ms. Jones stated that the school fixed their internet access and that the website application for daily information on infants and toddlers has been corrected.

R 400.8330 · R 400.8330 Food services and nutrition generally. (19) Formula and milk, including breast milk, left in a bottle or beverage container after a feeding must not be reused.

On October 07, 2022, Child A's Mother stated that she sent Child A to the center for a 10-hour period with three bottles of formula. When she picked Child A up, he had a bottle leftover. No one could tell her why he had a bottle leftover after such a long day. The staff on duty (she could not recall who this was) kept saying they were not there earlier so they had to call and ask Ms. Vanconant about it. That is when she asked to have the meeting with them about his diapering and feedings, combined with the fact that she had not received a daily sheet to tell her what he had gotten. She also requested a paper copy of the daily sheet and they agreed to do that. Then the daily sheets were all handwritten and appeared to the same writing, like they were just prefilling them or writing them out just for her and were not accurate. By then she had already lost trust in the center. On October 12, 2022, Ms. Vanconant recalled Child A's Mother's concerns about the feedings one day and she had a big discussion with her about it. She did not recall which day it was. There ended up being a misunderstanding about the bottles and the feedings. He ate a bottle and table food for breakfast. The staff thought that Child A had already been fed his bottle and he had table foods at lunch. It was clear there was a miscommunication with the parent about what bottles he had already had. Because she questioned what he was fed that day, the next time he had about 6 ounces of his bottle and they saved the leftovers just to show it to her (that he had consumed some of this bottle). It was not because they planned to re-use an old bottle later on after it had already been consumed. Ms. Vanconant stated that her staff know about the bottle- feeding requirements and are trained on when to dispose of a bottle etc. On October 12, 2022, Ms. Jones and Ms. Trombley corroborated Ms. Vanconant statements about the bottle feedings. On October 26, 2022, Ms. Pardy stated that she had only worked with Child A for the one day. What she recalled was a big misunderstanding with his bottle feedings and she thought he had gone a long time without eating, but that was not true. They do not re-use bottles after an hour, from start to finish. They are trained on bottle feeding requirements.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

R 400.8330 · R 400.8330 Food services and nutrition generally. ...... ...... (7) Infants and toddlers shall be fed on demand.

On October 07, 2022, Child A's Mother stated that on September 27, 2022, Child A came home from the center with an unexplained bruise on his arm. She noticed it during a bath. She texted one of the caregivers about it (she could not recall which one). The staff then texted Ms. Vanconant about it and she responded that she had no idea how it could have happened, but Ms. Pardy would have been his other caregiver that day and they will ask her. They supposedly asked her, and she had no idea either. She did not take him for medical treatment because he did not seem harmed by it. Child A is crawling and pulling himself up, so he is somewhat mobile; however, he is only 10 months old, and the staff should be aware of any bruises on him. 7 On October 11, 2022, I received the text messages between Child A's Mother and the staff about it. The comments corroborated what Child A's Mother was told. The text also included a picture of a small nickel sized bruise on his right forearm and small faded bruise on his left shin area. On October 12, 2022, Ms. Vanconant recalled Child A's Mother's concerns about the bruise. She was asked about it by Ms. Trombley or Ms. Pardy. She recalled that he constantly liked to crawl under the jumper and would get stuck there. There was never a child in it when he did that, but he very well could have gotten a mark or bruise while doing this. He was a great baby; he never cried or gave indication of being hurt. They never had to complete an "ouch report" for an injury or boo-boo on him. She tried to tell her that there was no indication of an injury, but she was already upset about other things and did not want to hear any explanation they gave. On October 12, 2022, Ms. Jones and Ms. Trombley corroborated Ms. Vanconant statements about the bruise. Ms. Jones seen the bruise and thought that it looked old. When she tried to tell her that her staff didn't recall any injury, she didn't believe her. On October 26, 2022, Ms. Pardy did not recall Child A ever hurting himself, crying, or having a bruise on him. On October 26, 2022, Child B's Mother denied that Child B had ever had any serious injuries or bruises while at the center. They always document if there are any incidences, like an "ouch report." and explain if they need to. Child B has never been bruised while attending there. On October 26, 2022, Child C's Mother denied recalling Child C ever having a mark or bruise after attending the center.

Open Not marked corrected in the state record

Category: nutrition. Open / not marked corrected.

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

Child A was provided appropriate care and supervision.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

R 400.8176 · R 400.8176 Sleeping equipment. ......................................................................... ....................................................................................................... (6) Car seats, infant seats, swings, bassinets, and play yards are not approved sleeping equipment.

On October 12, 2022, two children were sleeping in unapproved sleep equipment.

Open Not marked corrected in the state record

Category: physical safety. Open / not marked corrected.