A Touch of Home Child Care - Gladys

Applicant; licensee; licensee designee; requirements. (1) The licensee or licensee designee shall do all of the following: (c) Be responsible for compliance with the act and these rules.

Program Administrator was responsible for compliance with the act and rules based on interviews with Program Administrator, Staff-in-Charge, Lead Teacher 1, Lead Teacher 2, Teacher 1, Teacher 2, Child A's Mother, Child C's Mother, and Child D's Father.

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Child accidents and incidents; child and staff illness (1) A center shall develop and implement a written plan for how and when a parent is notified if program staff or volunteers observe any of the following: (b) A child experiences an accident, injury, or incident.

The child care center has an appropriate written plan for parent notification of incidents based on my review and interviews with Program Administrator, Staff-in-Charge, Lead Teacher 1, Lead Teacher 2, Teacher 1, Teacher 2, Child A's Mother, Child C's Mother, and Child D's Father.

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R 400.8530(10) · R 400.8530(10) Hazard Areas (10) The center shall not store combustible materials within the central heating plant or fuel-fired water heater rooms or in basements containing fuel-fired heating equipment, without a proper fire separation. Bureau

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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. 4

On December 29, 2022, I made telephone contact with Child A's mother. She reported that on the day that Child A fell she received two messages through Brightwheel the center's app used to communicate with parents. Both messages were from child care staff member, Sydney Lambdin. Ms. Lambdin messaged first around 9:00am saying that she is aware Child A is still recovering from an illness, but that she has been very hard to console and wants to be held. 2 Child A's mother responded saying that she may just be upset because she wants to be at home. The second message from Ms. Lambdin came in around 11:30am and said that Child A is struggling to stay awake and is very lethargic. She asked if she could be picked up early if possible. Child A's mother said that her mother, Child A's grandmother, picked Child A up around 2:00pm. The grandmother called Child A's mother from the car and said Child A was very upset and something was going on. Child A's grandmother brought Child A to see Child A's mother at work and she could immediately see that her lip was swollen, gums were swollen, and when she looked in her mouth it appeared her teeth were pushed into her gums. Child A's mother said she was never notified of a fall prior to pick up. She called the center around 3:00pm and asked if Child A had fallen that day. She was told that Child A did have a minor fall in the morning and cried for a while, but then resumed normal activity. Child A was taken to the emergency room and was diagnosed with tooth displacement. She was placed on an antibiotic to help prevent infection and will need ongoing dental care. Child A's mother reported being upset that she was not notified at the time of the fall because it delayed care that her child needed. On January 3, 2023, I completed an unannounced onsite inspection at the center and interviewed the owner, Andrea Lopez, and child care staff members, Sydney Lambdin and Kimora Harper. Ms. Lopez reported that she was not present on the day of the incident with Child A, but she was aware of the incident. She said the program director was on maternity leave on the day of the incident, so they had program director, Nicole Sheteron, from another facility filling in. Ms. Lopez understanding was that Child A was just returning to the facility after being out sick. The child care staff did notify Child A's mother regarding Child A being tired and hard to console, but they believed it to be from her illness, not from the minor fall that happened during snack time. Ms. Lambdin reported that when Child A fell, she was in the bathroom changing diapers and Ms. Harper was in the room handing out snack. Child A was crying when she came out of the bathroom and Ms. Harper was comforting her. Approximately five minutes after Child A's fall Ms. Harper noticed some blood on Child A's lip and cleaned it up. Ms. Lambdin did not observe any swelling. Shortly after the fall Child A was inconsolable and appeared lethargic, that is why she sent Child A's mother a message asking if she could be picked early. Ms. Lambdin believed Child A was acting this way due to her illness, not due to the fall. She went down for a nap around 11:45am and Child A's grandmother picked her up around 2:15pm. She reported Child A was sleeping and appeared fine when she left with her grandmother. Ms. Lambdin believes the swelling may have happened while Child A was napping. Ms. Harper stated that she was getting morning snack ready, and she heard Child A start crying. She did not see her fall, but she was next to a chair, so she assumed she fell out of the chair or bumped into it. Ms. Harper noticed some blood on her lip and cleaned it up. She reported looking in Child A's mouth and did not see anything. She gave Child A some cuddles, and she recovered quickly. Ms. Harper said 3 approximately 30 minutes later Child A was inconsolable. After trying to comfort her for some time, Ms. Lambdin sent her mother a message through Brightwheel asking if she could

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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.

The center did not provide an accurate daily record for Child A when they put in Brightwheel that she ate lunch at 12:02pm.

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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 made an unscheduled onsite inspection at A Touch of Home Too on 6/4/2021. Program Director Chrissy Padgett was present and available to discuss the allegations. Ms. Padgett informed me that a neighbor contacted her a few weeks ago with concerns about mowing the lawn while children were playing outdoors. On that particular day, Ms. Padgett was outside with the children and is certain that none of the children were on the track or within close proximity of the lawn mower. Ms. Padgett brought me outside to show that there is a retaining wall separating the track from the play structure. The children were playing on a play structure while the grassy area (track) was being mowed. The lawn is mowed by Licensee Designee Elise Allie's husband. He is only there for about 10 minutes and the days/times vary. Moving forward, she will have child care staff bring the children in if he comes to mow the lawn during child care hours to avoid confrontation with neighbors. I spoke on the telephone with Child A's Mother and Child B's Mother on 6/17/2021. Neither parent expressed any supervision concerns nor had they ever witnessed the lawn being mowed at the child care center. I spoke on the telephone with Licensee Designee Elise Allie. Ms. Allie stated that she spoke with her husband regarding the allegations. He said that the children were not on the track and never came close to the lawn mower. He specifically mows in a direction away from the children to avoid injury. Ms. Allie's husband now tries to mow the lawn during naptime to avoid future complaints.

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

On 08/27/2020, I conducted an unannounced onsite inspection and interviewed Program Director Melissa LaFevere and Licensees Andrea Lopez and Elise Allie. I explained the allegation that children were observed outside by a large opening in the fence while staff had their backs turned to the children. Ms. LaFevere reported that the playground policy includes staff positioned by the fence and the stairs allowing for the entire playground to be visible. This was recently discussed with staff and they receive regular reminders. I asked Ms. LaFevere if there had been any issues brought to her attention regarding a child having a number of bites and or bruises. She explained that she was only aware of an email from one child's mother that had a concern regarding a child that was biting in the wobbler room, however the child that was biting is no longer at the center. When the child was still attending, Ms. LaFevere reported that they worked to keep the child busy and there was extra supervision and they had a second staff member present. The policy the center follows is the staff keep communication open with the parents of the child biting and start a written action plan. After the biting occurs three times in a month, the child will have to be picked up by the parent after any bites or attempts. While onsite, I inspected the playground and the fence that surrounded the playground. The gate was unlocked, to remain in compliance with the fire safety rule to keep egresses unlocked and accessible in the event of an emergency. Ms. Allie replied that there was no hole in the fence, but there is a gate that is not kept open. A few days ago, Ms. Allie said that her husband was fixing it, so it was opened but the only children on the playground were her own children. Licensee Andrea Lopez did not have any additional information to add to this allegation. On 10/7/2020, I interviewed Child A's Mother, Child B's Mother and Child C's Mother. There were no concerns with care and supervision, specifically pertaining to children unsupervised on the playground or excessive bites or bruises occurring.

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

During the unannounced onsite inspection I explained to Program Director Melissa LaFevere that there was an allegation that a child had gone home with dried feces on their bottom. Ms. LaFevere was not aware of any complaints from parents regarding diapering. During the inspection I observed two staff members change children's diapers and one staff member assisted a child during toilet training. On 10/7/2020, when I interviewed Child A's Mother, Child B's Mother and Child C's Mother, they all reported having no concerns with diapering or having their child come home with dried feces in their diapers. Child B's Mother reported that at times Child B may be picked up with a wet diaper, but she added that he most likely soiled his diaper right at pick up and that the child care staff would not have known.

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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 Age Child Care Staff Member to Child Infants and toddlers, (a) birth until 30 months 1 to 4 of age Preschoolers, 30 (b) months of age until 3 1 to 8 years of age Preschoolers, 3 years (c) of age until 4 years of 1 to 10 age Preschoolers, 4 years (d) of age until school- 1 to 12 age (e) School-agers 1 to 18

During the onsite inspection on 08/27/2020, Licensee Andrea Lopez reported parents are not coming into the building during COVID-19 and that enrollment is lower than normal and she felt it would be difficult to be out of ratio with 4 f - - _ -• . i• _ - f _ -ff -i f. r • -f • - • d • i - f f - ••r r f duringf f ff •ff ~• • l f i ' :fi - • fif f - i - i - f f' f • if i i f - ••-. ^i . •i f - •i - ~• - i - J si •'. • • f f !. -• • 0 ••! •I - . • i• - • - f to • R: • A • i i f f f f fi f f i' f - i _ it .f f - - •i •• f

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R 400.8185 · R 400.8185 Primary care. (5) Primary caregiving assignments must be documented and provided to parents.

During the onsite inspection I explained to Program Director Melissa LaFevere that it was reported that Child A's Mother did not know her child's primary caregiver. Ms. LaFevere reported that the information is posted in all of the infant and toddler rooms, however parents are not entering the building due to COVID. I asked if the information was reported on their daily correspondence with infant and toddler parents which is done electronically at the center. Ms. LaFevere checked the online application that is used to correspond with parents, and the information was not being shared with parents. I explained that the rule states that the primary caregivers must be documented and provided to parents. The center has them listed in each room, but the parents are not able to see the documentation. Child A's Mother, Child B's Mother and Child C's Mother reported that they were not aware of their child's primary caregiver. Child B's Mother stated that she thought it was the same as the lead caregiver in the room.

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R 400.8137 · R 400.8137 Diapering; toileting. (7) Guidelines for diapering must be posted in diapering areas.

Diapering guidelines were not posted in the wobbler room or the toddler room.

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