Grand Traverse Academy

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

School age children attending the Quality Care after school program on early release Friday did not wash their hands before lunch. Children in grades 3 through 6 went from the school day to lunch in the small gym without washing their hands before eating.

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R 400.8134(4) · R 400.8134(4) Hand washing. Guidelines for hand washing must be posted in food preparation areas, in toilet rooms, and by all hand washing sinks. 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.

On 02/12/2021, I received an incident report from program director and licensee designee Ms. Sharon Swartz stating that Child A had a food reaction to peanut butter in a small amount of candy. On 02/17/2021, I spoke with Child A's Mother about the incident. She stated that Child A is allergic to peanuts and tree nuts. Sometime around noon on 02/11/2020, preschool lead caregiver Ms. Stephanie Winowiecki called her several times, but she was on another call and could not answer. Child A's Mother called Ms. Winowiecki back and was told that Ms. Winowiecki administered Child A's epi-pen about 20 minutes earlier because he had eaten candy with peanut butter in it. Child A's Mother arrived at the school within a short amount of time to pick Child A up and take him home. She was with Child A when he went through a second wave of anaphylaxis that included full-body hives. She called 911 and when the ambulance arrived, they had to administer emergency CPR to resuscitate Child A due to the severity of the second reaction. Child A's Mother took Child A to the hospital where he stayed overnight for observation. She did not know why staff members did not call 911 when Child A had the first reaction. She was unsure sure where the candy came from, or how Child A was able to eat it without anyone noticing. Child care staff were aware of Child A's peanut allergy, but unlike the rest of the school, the preschool program did not offer him a peanut-free classroom. Instead, Child A either sat at a different table during meals and snacks or sat farther away from children or staff who were eating peanut butter. When Child A started in the program in 2019, Child A's Mother talked to child care staff about his allergy and the epi-pen use. She and the staff did not discuss any type of care plan for Child A in the event of accidental ingestion of peanuts or tree nuts. She might have completed a medication permission form for Child A when he first enrolled, but she could not recall for certain. Child A has not been back to preschool since the incident because the family is on vacation. Child A's Mother loves Ms. Winowiecki and thinks she is a great teacher. Her hope is that the program will take this opportunity to implement a peanut-free classroom policy so something like this does not happen again. On 02/17/2021, I conducted an unannounced onsite inspection and discussed the incident and special investigation with program director and licensee designee Ms. Sharon Swartz. I conducted interviews with Ms. Winowiecki, and child care staff members Ms. Dorlene Page, and Ms. Shawna Cole. On 02/17/2021, Ms. Winowiecki stated that on 02/11/2021, Child A's class had their Valentine's Day party and children passed candy out to their classmates. After everything was passed out, she allowed children to have one piece of candy from their Valentine bag. Child A presented Ms. Winowiecki with a Dum-Dum sucker 3 asking if he could have it and she said, "Yes." He also asked if he could have a Hershey's bar, but she said to wait on eating it because it was made in a facility that also processes peanuts. They have never had an issue with Child A's peanut allergy before because he is usually good about asking staff what he can or cannot eat. Ms. Winowiecki thinks that Child A may have went behind the pretend kitchen area of the classroom by his locker and bent down out of sight to get another piece candy out of his bag. Another child who attends the program half-day was getting ready to leave when Child A came to Ms. Winowiecki crying. This behavior was not typical, and he was unable to get his words out about what was wrong. He finally said that he ate a piece of chocolate and that something was wrong with his mouth. At this point Ms. Winowiecki knew that he had eaten something with peanuts in it. She told program director Ms. Swarts what happened, and she took the rest of the children into the preschool room next door. Child care staff member Ms. Cole stayed behind with C

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R 400.8110 · R 400.8110 Applicant; licensee; licensee designee; requirements. (11) The records required by the act and these rules must be retained for a minimum of 2 calendar years or longer as specified in these rules and made available to the department upon request.

Ms. Swartz and Ms. Winowiecki did not ensure that the records required by child care licensing rules were retained for a minimum of 2 calendar years and made available to the department upon request. On 02/11/2021, Ms. Winowiecki administered Child A's epi-pen after he had an allergic reaction to peanut butter. Ms. Swartz stated that they had a signed medication administration form from Child A's Mother, but they sent it home with his epi-pen. They did not retain a copy of the completed form for Child A's file.

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R 400.8152 · R 400.8152 Medication; administrative procedures. (9) A center shall maintain a record as to the time and the amount of medication given or applied, with the exception of medications described in subrule (8) of this rule, on a form provided by the department or a comparable substitute approved by the department. One form per medication is required. The signature of the child care staff member administering the medication must be included. rj

Ms. Swartz and Ms. Winowiecki did not maintain a record as to the time and the amount of medication given on a form provided by the department or a comparable substitute approved by the department that included the signature of the child care staff member administering the medication included. Ms. Winowiecki administered Child A's epi-pen on 02/11/2021. She did not record the time or amount of medication given to Child A on the department's medication permission form that included her signature.

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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.

Ms. Swartz and Ms. Winowiecki did not ensure that written procedures for the care of children and staff for serious accidents, illness, or injuries was implemented. On 02/17/2021, I reviewed the center's emergency procedures for serious accidents and illnesses. The plans stated that a staff member will call 911 before calling the child's parent. On 02/11/2020, Child A has a severe illness reaction after consuming peanut butter at the center. Ms. Winowiecki did not implement the center's serious illness emergency plan by calling 911. Instead, she called Child A's Mother first, then administered the epi-pen without calling 911.

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R 400.8161 · R 400.8161 Emergency procedures. (2) The written procedures must include all of the following: (h) A plan for how children with chronic medical conditions will be accommodated during each type of emergency. 10

Ms. Swartz and Ms. Winowiecki did not ensure that written emergency procedures included a plan for how children with chronic medical conditions will be accommodated during each type of emergency. Child A has a severe allergy to peanuts and tree nuts. Staff did not have a plan to accommodate Child A during an illness brought on by his allergic reaction.

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