Strong Foundation Childcare

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

On 07/13/2023, I reviewed the incident report along with Child Care Staff Member (CCSM) 1 and CCSM 2's written statements regarding the incident with Child A. The incident report indicated that on 07/11/2023 at 10:50 AM, licensee designee/program director Kim Lindsey found Child A in the preschool classroom alone. All classrooms were outside at this time. Child A had transitioned outside with her preschool classroom, and she entered back into the center 2 unbeknownst to CCSM 1 and CCSM 2. Child A is believed to have been in the center alone for one to two minutes. CCSM 1's written statement: "I, CCSM 1, was helping teacher CCSM 2 with an indoor camp song. We then lined up to go through the toddler room to go out the ramp and have another camp song. The kids all lined up with Child A as the line caboose. I was holding Child A's hand through the classroom and to the door to go outside. I let go of her hand to hold the door open for the other students. Child A was with me at the door. I was helping another child who was having trouble following directions when Child A must have gone back inside. I scanned the classroom to make sure that we had the children. I did not see Child A in the room. We were outside less than two minutes when I noticed Child A was missing." CCSM 2's written statement: "We got the children in line ready to go outside. I called out to make sure our line leader was in the front of the line, and that our caboose was at the end of the line. They were both in the right spots. I counted the children in the line at that moment, had the right number, and lead them to the door. I opened the door and let the children outside onto the wheelchair ramp. I failed to count them as they were exiting. I moved in front of them after my co-worker had the door and told the children they could spread out on the ramp, but that they must all stay on the ramp. We sang a "camp sing" and once the song was over, I had the children line back up. I again called out to check that my line leader and caboose were where they should be, only to discover our caboose, Child A, was not. We called Child A's name and did not get a response, neither of us had eyes on her. I told the children to stay where they were in line on the ramp and ran to the front door of the building to check the missing child inside. As I entered the doorway, another co-worker was walking out with Child A." On 07/17/2023, I made an unannounced onsite inspection at Strong Foundations. Upon arrival, I interviewed licensee designee/program director Jessi Hoard. The center is made up of three classrooms: infant classroom, toddler classroom, and preschool classroom. On 07/11/2023 around 10:50 AM, the preschool classroom was transitioning to outdoor play. The preschool classroom exited out of the front door and the children were lined up on the ramp entrance. Child A was in the back of the line with CCSM 1 and CCSM 1 had been holding Child A's hand. CCSM 1 went to address a situation with Child B, and she let go of Child A's hand. Child A was able to get back in the center unbeknownst to CCSM 1 and CCSM 2. Licensee designee/program director Kim Lindsey observed Child A in the preschool classroom alone. Ms. Lindsey directed Child A to the front entrance to have her rejoin the preschool classroom. CCSM 2 was walking back in the center looking for Child A while Ms. Lindsey was walking Child A back to her classroom outside. She believes that Child A was separated from her classroom for a minute to two minutes. She confirmed that there were no other adults present in the preschool classroom with Child A. I took pictures of the preschool attendance sheet for July 11, I took pictures of the child information cards, and I took several pictures of the preschool classroom, the entrance door way, and the outdoor play area. 3 On 07/18/2023, I made an unannounced onsite inspection at Strong Foundations where I interviewed CCSM 1 and CCSM 2. I first interviewed CCSM 1. On 07/11/2023, CCSM

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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 06/16/2023, a telephone interview with Child A's Father about the allegations. He stated that it sounded like what happened to Child A was a freak accident. CCSM 1, who is also his sister and Child A's aunt, works in the preschool classroom and was present when the accident happened. CCSM 1 told him that on the afternoon of 06/13/2023, she was getting ready to leave and was giving program director Ms. Hoard a shift report, when Child A climbed on the cubbies to get her socks, and within a split second, the cubbies started to tip over. The cubbies landed on Child A before anyone could stop it from happening. CCSM 1 called him immediately. He was working in another county, so CCSM 1 took Child A to the hospital right away. Child A's Father met them at the hospital. Child A was evaluated for concussion and had a CAT scan to make sure there was no bleeding on her brain. She had an abrasion on her forehead and a large goose egg that caused her to have two black eyes, but no concussion. The next day, she wanted to go back to preschool and was back to her usual self. Child A's Father thinks that the situation was handled appropriately. CCSM 1 and Ms. Hoard called him right away to let him know what was going on. He has no concerns about the level of care and supervision at the center and is grateful that his sister CCSM 1 was right there and could take Child A to the hospital. Child A's Father reported that under court order, he has full physical and legal custody of Child A. On 06/16/2023, I conducted an unannounced onsite inspection at the center. I interviewed licensee designee and program director Ms. Hoard about the allegations. She stated that there were six children in care on 06/13/2023 when Child A was injured. At the time, she and CCSM 1 were across the room from the cubbies. She was about to take over for CCSM 1, who was briefing her about the day as part of their shift change protocols. As they were talking, Ms. Hoard saw Child A start to climb up on the cubbies. She called out to Child A for her to stop, and immediately started running over to her. Within seconds, the cubbies started to tip over, pinning Child A underneath before she could reach her. The top shelf of the cubbies hit Child A in the forehead when they fell over. Ms. Hoard picked the cubbies up off of Child A and hugged her. She noticed that Child A's face was beginning to swell so she applied an icepack to Child A's head. As soon as they realized the swelling was growing, they called Child A's Father who asked CCSM 1 to take Child A to the hospital. Just before the accident, Ms. Hoard had told Child A to get ready to go outside. She did not realize that someone had placed Child A's 3 socks on top of the cubbies, and that the reason she had been climbing on them was because she was trying to reach her socks. Afterwards, Ms. Hoard talked to all of the staff and told them not to put children's belongings on top of the cubbies. When the incident happened, the cubbies were placed at a right angle to the wall with the short side against the wall, and a low shelf positioned along the back side. Since then, Ms. Hoard removed the low shelf that was behind the cubbies. This was the first time the cubbies tipped over from a child climbing on them. On 06/16/2023, I conducted an interview with CCSM 1. She stated that she was present when the Child A was injured on 06/13/2023. Ms. Hoard had just come in to the preschool space to relieve CCSM 1 for the day. CCSM 1 told Child A to go get her socks on when Ms. Hoard told them to get ready to go outside. Ms. Hoard shouted, "No, Don't!" when she saw Child A climbing on the cubbies but they were already coming down on her. At the time, CCSM 1 did not realize that someone had placed Child A's socks on top of the cubbies, so she had no way of knowing that Child A was about to climb on them. After picking Child A up and comforting her, they applied an icepack to her head, then assessed her injuries. Once they noticed swelling

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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.

Ms. Hoard did not ensure that the premises were maintained in a condition that did not pose a threat to health or safety. The cubbies that fell on Child A were not anchored to the wall as recommended by the manufacturer.

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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 11/10/2022, I conducted an unannounced onsite investigation at Strong Foundation and discussed the incident with licensee designee and program director Ms. Jessi Hoard. She stated that she was present at the center on 11/09/2022 when Child A and Child B were found unattended outside on the playground by child care staff member (CCSM) Ms. Mariah McDaniel. At the time, she did not know the children were missing because neither of the staff members in the infant room notified her. The incident happened around 8:40 or 8:45 AM, shortly after the infant and toddler rooms split into two groups. Ms. Hoard was in the toddler room until about 8:45 AM, when CCSM Ms. Bailey Pettit arrived. Around that time, Ms. Hoard observed CCSM Ms. Ashley Bird come in to the toddler room to grab something. After that, Ms. Hoard went into the infant room to organize paperwork for a new child who started that morning. While in the infant room, she noticed that Ms. Bird was alone with four children. She asked where Ms. McDaniel was, but Ms. Bird said she did not know. Shortly thereafter, Ms. McDaniel came in with Child A and B in tow. Until that moment, Ms. Hoard was completely unaware of the fact that Child A and B were missing. She did not know how long the children were unattended outside but thought that it was not more than two to five minutes. Ms. Hoard knew that the children in the infant room were able to open the door to the playground because many of them, including her own child who attends that room, have tried to open the door previously. Prior to September, there was a gate in front of the exit door that acted as a barrier to prevent children from getting out, but they had to remove the gate to keep the exit unblocked for fire safety rule compliance. The door to the playground makes no noise when it is opened, so it did not surprise Ms. Hoard that Child A and Child B were able to get out unnoticed. All of the staff asked if they could put a handle cover on the exit door to prevent children from opening it, but that was not possible because it did not meet licensing rules for fire safety exiting requirements. Yesterday, at the suggestion of assistant director CCSM Ms. Kim Lindsey, Ms. Hoard installed a bell on the door to notify staff every time the door to the playground is opened. CCSM Ms. Bird stated that on the morning of 11/09/2022, Ms. Hoard and Ms. Pettit were in the toddler room while she and CCSM Ms. McDaniel were in the infant room with six or seven children. Ms. Bird is the primary caregiver for both Child A and Child B. The incident happened sometime between 8:30 and 9:00 AM. Around that time, Ms. McDaniel was feeding a child and Ms. Bird was on the floor playing and interacting with the infants. They were both facing the door to the playground. It was the first day for one of the children; he was climbing on her, acting clingy, and in need of extra attention. Ms. McDaniel asked her for a water cup, and when she did not immediately see one, she went into the kitchen through the adjacent toddler and preschool rooms to look for it. She was gone for about 30 seconds to a minute. When she came back into the infant room, Ms. McDaniel said that Child A and Child 3 B were missing. Ms. Bird opened the door to the playground and scanned the area, but did not see Child A or Child B. She did not want to step outside completely without checking inside first, so she began searching indoors. She looked in the unoccupied area of the church sanctuary that is divided from the infant area by chairs and movable gates. She first looked for Child A and Child B under the chairs in the sanctuary, then on the stage at the front of the sanctuary, and in the office near the stage. She opened the double doors to the toddler room, poked her head in, and did a scan but did not see them. She looked in all of these places twice, estimating that it took about two minutes to conduct her searches. Ms. Bird did not notify Ms. Hoard about Child A and Child B's ab

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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 01/19/2022, I conducted an onsite inspection at the center. conducted interviews about the allegation with licensee designee/program director Ms. Jessi Hoard and child care staff members Ms. Madeline Laskey, Ms. Amy Colligan, and Ms. Kim Lindsey. Ms. Hoard stated that the incident happened around 4:00 PM on 01/17/2022 when Ms. Laskey and Ms. Colligan were the only staff members present at the center. Ms. Hoard was absent that day because she was quarantining at home due to a COVID exposure. Ms. Lindsey was the acting program director that day, but she was an opener, so she left around 3:00 PM. When Ms. Hoard investigated the matter, she learned that Ms. Colligan was alone outside with eight children including Child A who is two years old. She acknowledged that Ms. Laskey and Ms. Colligan were unaware that the required staff to child ratio should have been 1:4 due to Child A being under 30 months of age. Ms. Hoard took responsibility for not ensuring staff knew that when children of mixed ages are in the same well-defined space, then the ratio is based on the age of the youngest child in the group. Since finding out that the staff were unaware of the ratio and group size requirements, she has added a copy of the ratio table from the child care licensing rule book to her staff orientation binder. 2 Ms. Laskey stated that on 01/17/2022, Ms. Colligan was outside with eight children. Ms. Laskey was getting ready to join the group when Ms. Colligan poked her head inside the door to say that someone she did not know just arrived outside to pick up Child B (three-year-old, male). Ms. Colligan sent the person around to the front door to verify her identity with Ms. Laskey. She then sent Child B inside through the side door adjacent to the fenced playground. As Child B and his guardian were leaving out the front door, Ms. Colligan started coming in through the side door with the remaining children. Ms. Colligan was at the end of the line. Ms. Laskey looked for Child A to help her out of her snow gear, noticed that she was not there, and asked Ms. Colligan where she was. Ms. Colligan immediately said, "Oh!" and ran outside to get Child A. Ms. Colligan estimated that Child A was outside on the playground for about 30 to 40 seconds before Ms. Colligan ran out to get her because that was how long it took for Ms. Colligan and the children to come up the stairs from the side entry. After the incident, Ms. Laskey called Ms. Hoard. When she did not answer, she called the assistant director Ms. Lindsey. Ms. Laskey started working at the center at the beginning of November of 2021. She was unaware of the licensing rule requiring a 1:4 staff to child ratio when a child under 30 months of age was mixed in with a group of older children. Ms. Colligan stated that 01/17/2021 was her fourth full day on the job and the first time Ms. Hoard was not present at the end of the day. That afternoon, she took eight children outside to play. She was alone outside with all the children for about half an hour when someone came to the gate to pick up Child B. Ms. Colligan sent the person inside to verify her identity with Ms. Laskey because she had never met them before. A few minutes after that, she gathered the remaining seven children to come inside. She lined them up by the side door and counted each child, noting all seven were present. The location of the door creates a blind corner, so Ms. Colligan did not notice that Child A ran back to the play area after being counted. The same thing happened with another child last week, but she saw them run off. Ms. Colligan held the door open and sent the children up the stairs to the classroom. She was at the end of the line as the children went inside. She did not do a second head count as children went up the stairs. As soon as Ms. Colligan brought the children into the child care space, Ms. Laskey asked where Child A was. Ms. Colligan ran back outside and retrieved Child A. She thought Child A was outside on he

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R 400.8182 · 1 R 400.8182 Ratio and group size requirements. (7) If there are children of mixed ages in the same room or well- defined space, then the ratio and group size is determined by the age of the youngest child, unless each group of children is clearly separated and the appropriate child care staff member- to-child ratios and group sizes, if applicable, for each age group are maintained.

Licensee designee Ms. Hoard did not maintain appropriate child care staff member-to-child ratios based on the age of the youngest child in the group when children of mixed ages were in the same well-defined space. On 01/17/2022, eight children, including Child A who is 25 months old, were present with one child care staff member on the playground. Based on Child A's age, the required staff-to-child ratios were 1:4. REPEAT VIOLATION ESTABLISHED SIR 2021D 0717018 Dated 09/23/2021 Corrective Action Plan Dated 10/13/2021

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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 caregivers to children, including children related to a staff member or the licensee, shall be the following: (a) For infants and toddlers, there shall be 1 caregiver for 4 children and a maximum group size of 12. (b) For preschoolers 30 months of age until 3 years of age, there shall be 1 caregiver for 8 children and a maximum group size of 16.

On 11/16/2021, I interviewed the Complainant by telephone. The complainant stated that the center frequently fails to follow appropriate child care staff member to child ratios in the infant/toddler classroom and the preschool classroom, but more so in the infant/toddler classroom. The center is typically in violation of ratio requirements during morning an evening transitions and staff lunch breaks. The center does not have enough staff to ensure ratio requirements are followed at all times. The Complainant could not recall specific dates of non- compliance. On 11/17/2021, I completed an on-site inspection. I interviewed program director Jessi Hoard and child care staff members Madeline Laskey, Mackenzie O'Donnell, and Kimberly Lindsey. Ms. Hoard stated she does not believe the allegation to be true. She now requires parents of enrolled children to provide her with set drop off and pick up times to ensure enough child care staff members are scheduled. She turned a child away last Wednesday because the child was not scheduled. Lately, the center has been overstaffed. This morning there were three child care staff members present with four children. Ms. Laskey, Ms. O'Donnell, and Ms. Lindsey stated they have no knowledge of the center operating with inappropriate child care staff member to child ratios. Ms. O'Donnell and Ms. Lindsey stated the center has been overstaffed lately. On 11/19/2021 and 12/16/2021, I received requested staff and children attendance records from Ms. Hoard via email, but the records did not provide complete information. For instance, hashtags were in place of dates and arrival and departure 3 times. I advised Ms. Hoard of the issue and requested complete attendance records for staff and children. On 12/22/2021, I received staff and children attendance records from 10/19/2021 to 11/17/2021 from Ms. Hoard via email. Based on these records, the center failed to provide appropriate child care staff member to child ratio on 10/26/2021, 10/28/2021, and 11/11/2021 as outlined in the charts below. 10/26/2021 Child/CCSM Arrival Departure CCSMs CCSMs Present Required CCSM Jessi Hoard 7:09am 4:54pm Child H (8-month-old, female) 7:18am 4:31p m 1 1 CCSM Mariah McDaniel 7:23am 5:22pm Child 1 (11-month-old, male) 7:23am 5:04pm 2 1 Child J (3-year-old, female) 7:23am 5:22pm 2 1 Child K (31-month-old, male) 7:23am 5:22pm 2 1 Child L (10-month-old, female) 7:45am 4:05pm 2 2 Child M (17-month-old, female) 7:48am 4:40pm 2 2 Child N (4-year-old, male) 7:52am 4:54pm 2 2 Child G (9-month-old, male) 7:52am 4:44pm 2 2 Child B (3-year-old, male) 7:56am 3:24pm 2 3 CCSM Kimberly Lindsey 8:10am 5:37pm Based on this information, child care staff members Jessi Hoard and Mariah McDaniel were present with four infants, one toddler, and four preschoolers from 7:56am until 8:10am; at least three child care staff members were required whether the children were combined or separated into groups. 10/28/2021 Child/CCSM Arrival Departure CCSMs CCSMs Present Required CCSM Jessi Hoard 7:04am 5:12pm Child F (6-month-old, female) 7:12am 5:12pm 1 1 Child H (8-month-old, female) 7:14am 4:49pm 1 1 Child 1 (11-month-old, male) 7:21a m 9:41a m 1 1 CCSM Mariah McDaniel 7:22am 1:00pm Child J (3-year-old, female) 7:22am 3:20pm 2 1 Child K (31-month-old, male) 7:22am 3:20pm 2 2 Child L (10-month-old, female) 7:44am 3:56pm 2 2 Child G (9-month-old, male) 7:47am 4:48pm 2 2 Child M (17-month-old, female) 7:47am 4:54pm 2 2 Child B (3-year-old, male) 7:47am 4:30pm 2 3 4 Child N (4-year-old, male) 7:49am 4:49pm 2 3 CCSM Kimberly Lindsey 7:50am 12:29pm Based on this information, child care staff members Jessi Hoard and Mariah McDaniel were present with five infants, one toddler, and four preschoolers from 7:47am to 7:50am; at least three child care staff members were required whether the children were combined or separated into groups. 11/11/2021 Child/CCSM Arrival Departure CCSMs CCSMs Present Required CCSM Kimberly Lindsey 6:58am 3:16pm Child H (9-month-old, f

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R 400.8113 · R 400.8113 Program director qualifications; responsibilities. (3) All program directors are responsible for the general management of the center, including the following minimum responsibilities: (a) Developing, implementing, and evaluating program and center policies. (b) Administering day-to-day operations, including being available to address parent, child, and staff issues. (c) Monitoring staff, including an annual evaluations.

On 11/16/2021, the Complainant stated that Ms. Hoard is typically present at the center from 8am to 5pm and Ms. Lindsey from 6am to 2pm daily. However, Ms. Hoard has left early many times after Ms. Lindsey has left for the day, leaving the center with no program director present. Ms. Hoard is unable to effectively administer day-to day operations including being available to address parent, child, and/or staff issues, develop, implement, or evaluate program and center policies, or monitor staff because they are in the classroom all day. The Complainant could not recall specific dates of non-compliance. The Complainant stated that new child care staff members do not know basic center policies, practices, or licensing requirements. For example, child care staff member Mariah Hicks was not aware that she needed to clean and sanitize the nap mats needed using the 3-step method. Ms. Hicks also was not aware that children could not have bottles on their nap mat. On 11/17/2021, I completed an on-site inspection. I interviewed program director Jessi Hoard and child care staff members Madeline Laskey, Mackenzie O'Donnell, and Kimberly Lindsey. Ms. Hoard stated that she is stretched thin between her lead caregiver and program director responsibilities, but she believes she fulfills her responsibilities for both roles. Some staff issues she cannot handle immediately, but she addresses any issue brought to her attention in a timely manner. Ms. Hoard provides new staff with an orientation that covers center policies and practices and licensing rules. She is not aware of any issues regarding new staff members. Ms. Laskey stated she had prior child care experience, but she believes Ms. Hoard adequately prepared her for her position at the center prior to caring for the children. Ms. O'Donnell stated that Ms. Hoard gave her papers to read when she was hired, but she did not review them with her. She sat with her and asked her if she had any questions. Over the past few weeks, Ms. Lindsey has pulled the licensing rule book out to review various requirements as with her. Ms. Hoard always handles issues with staff and parents on the Brightwheel app. It is hard for Ms. Hoard to focus on her program director responsibilities when she is in the classroom most of the day. Scheduling has been difficult for Ms. Hoard at times. Ms. Lindsey helps Ms. Hoard with billing when needed. Ms. Lindsey stated that sometimes new staff do not know some of the licensing requirements, but as the lead caregiver she will review licensing requirements with new staff as necessary. Ms. Lindsey has no concerns with Ms. Hoard fulfilling her program director responsibilities. Ms. Hoard communicates with her via texts throughout the day and with parents via Brightwheel app. On 11/19/2021, Ms. Hoard sent me verification of new staff orientation for child care members Tiffany Hiatt, Madeline Laskey, Brandi Sweetman, Mackenzie O'Donnell, and Ashley Bird. The verification states that the orientation covered center policies and procedures and administrative rules as well as the following topics: health policies and procedures, emergency procedures, child abuse and neglect reporting procedures, planned daily activities and routines, child guidance and discipline, 7 communicable disease recognition and prevention, developmentally appropriate practices, blood borne pathogens, safe sleep, and shaken baby training. On 01/18/2022, I interviewed Child A's Mother, Child R's Mother, and Child D's Mother by telephone. They stated that they have no concerns with Ms. Hoard managing the center. Ms. Hoard is always quick to respond to them via email or Brightwheel. Child R's Mother stated she is actually impressed by how quickly Ms. Hoard responds to her. Child A's Mother stated that, although some of the new staff members could have been more attentive to the children, she never had concerns with safety. Child R's Mother stated that some of the newer staff members have not lasted long enough

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R 400.8131 · R 400.8131 Professional development requirements. (1) The center shall provide an orientation about the center's policies and practices and these administrative rules for all personnel hired after the effective date of these rules and before unsupervised contact with children.

On 11/16/2021, the Complainant stated that Mariah Hicks is the current lead caregiver in the infant/toddler classroom, but she does not have a high school diploma, nor does she meet any of the other lead caregiver requirements. On 11/17/2021, I completed an on-site inspection. I interviewed program director Jessi Hoard and child care staff members Madeline Laskey, Mackenzie O'Donnell, and Kimberly Lindsey. Ms. Hoard stated that Ms. Hicks became the substitute lead caregiver in the toddler classroom on 10/08/2021. Ms. Hicks does not possess a high school diploma or a GED. Ms. Hicks does not meet any of the additional educational requirements of a lead caregiver. Ms. Hoard understands that a substitute lead caregiver must qualify as a lead caregiver within 90 days.

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R 400.8122 · R 400.8122 Lead caregiver; qualifications; responsibilities. (4) Lead caregivers shall have both of the following qualifications: (b) Have a high school diploma or GED. rj

On 11/16/2021, the Complainant stated he/she "just threw out a number" when I asked for the names of the five children injured on the playground. Several children have been injured on the playground, but he/she does not know how many. Child A, Child B, and Child C were injured on the playground while child care staff members were on their cell phone. It is against center policy for staff members to use their cell phone while caring for children, but Ms. Hoard is too nice to confront staff. On 11/17/2021, I completed an on-site inspection. I interviewed program director Jessi Hoard and child care staff members Madeline Laskey, Mackenzie O'Donnell, and Kimberly Lindsey. Ms. Hoard stated that staff use their cell phones to document daily child information in the Brightwheel app. The center does have a policy prohibiting staff from using their cell phones while caring for children, but the tablet meant to be used for Brightwheel frequently does not have internet connection, so she makes an exception to the policy for this reason. Sometimes staff use their cell phones during rest time, which she often overlooks. She does not recall a child being injured while staff were on their phones. Ms. Hoard agreed to provide incident reports for all playground injuries for the past two months via email. Ms. Laskey, Ms. O'Donnell, and Ms. Lindsey stated they have no knowledge of any playground injuries that occurred when child care staff members were on their phones. On 11/19/2021, I received incident reports from Ms. Hoard via email. Based on the incident reports, ten injuries occurred between 07/06/2021 and 11/18/2021, with only two of them occurring on the playground. Each incident report provides a detailed description of how the injury occurred and the name of the child care staff member who witnessed and handled the incident. Neither of the playground incident reports included Child A, Child B, or Child C. On 01/18/2021, I interviewed Child A's Mother, Child R's Mother, and Child D's Mother by telephone. They stated that they never observed staff on their telephones during arrival or pick up. They have no concerns with care and supervision while children are outside or otherwise. Child D's Mother stated that Child D has sustained 11

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R 400.8122 · 1 R 400.8122 Lead caregiver; qualifications; responsibilities. (5) Lead caregivers shall meet 1 of the following qualifications shown in Table 3: TABLE 3 Lead Caregiver Qualifications Education Coursework in Early Hours of Childhood Education, Experience Child Development, or a Child-Related Field (a) Bachelor's degree or higher in early childhood education, child development, or a child- related field (b) Montessori credential 480 hours with (c) Associate's degree or higher in early childhood education or child development (d) Valid child development 480 hours associate credential with (e) High school diploma or 12 semester hours 960 hours GED with and (f) High school diploma or 12 semester hours, 18 1,920 hours GED with CEUs, or a combination to equal 18 clock hours with (g) High school diploma or 6 semester hours, 9 3,840 hours GED with CEUs, or a combination to equal 90 clock hours with

On 11/16/2021, the Complainant stated that Ms. Hoard and Ms. Lindsey allow sick children to return to care even though they are still sick, and they do not send sick children home. For example, Child D was allowed to attend although he was infected with the Coxsackie Virus (Hand, Foot, and Mouth Disease. Ms. Hoard and Ms. Lindsey did not notify parents of the exposure in a timely manner. A couple of weeks later, the center had a "huge" outbreak of the Coxsackie 13 Virus. Ms. Hoard and Ms. Lindsey did not notify parents of the outbreak in a timely manner. Infants and toddlers who have fevers are not sent home and often parents are not notified of the fever. The Complainant could not recall names of specific children who were not sent home due to a fever. On 11/17/2021, I completed an on-site inspection. I interviewed program director Jessi Hoard and child care staff members Madeline Laskey, Mackenzie O'Donnell, and Kimberly Lindsey. Ms. Hoard stated that Child D was not permitted to return to care until he was noncontagious. Ms. Hoard stated that Child E, Child F, and Child G were sent home last week due to having a fever. Ms. Laskey, Ms. O'Donnell, and Ms. Lindsey stated that no child has remained in care if he or she were contagious. Ms. O'Donnell stated that Child E, Child F, and Child G were sent home last week with a fever. Ms. Lindsey stated that Child D did not attend for two weeks when he was recently sick. Ms. Laskey stated that Child E and Child F were sent home last week with a fever. On 11/19/2021, Ms. Hoard sent me the center's illness exclusion policy for children via email. The policy states that a child who becomes ill while in care will be separated from the other children and a parent or an emergency contact will be called to pick up the ill child. The center's policy lists the following as reasons a child should not be in attendance: severe sore throat, temperature above 100 degrees (can return after being fever free for 24 hours), earache/discharge, communicable diseases (head lice, pink eye, chicken pox etc.), nausea or vomiting (can return 24 hours after vomiting), contagious skin rash, swollen glands, overly tired, excessive diarrhea, inflamed eye/discharge, or sores on the skin such as impetigo, scabies, or ringworm. On 01/18/2022, I separately interviewed Child G's Mother, Child E's Mother, Child D's Mother, and Child A's Mother by telephone. They affirmed that their children were recently sent home due to illness. Child G's Mother and Child E's Mother stated that they recently had to pick up their children due to them running a fever. Child D's Mother stated that Child D was excluded from care in the fall when he had Hand, Foot, Mouth Disease. Child A's Mother stated she was called on one occasion to pick up her child due to multiple episodes of diarrhea. They all believe the center follows its illness exclusion policy for children.

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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.

Child care staff members provided appropriate care and supervision of ten children who were injured between 07/06/2021 and 11/18/2021. Each child has a detailed incident report on file outlining the nature of the injury, how the injury occurred, where the injury occurred, and which child care staff member witnessed and handled the incident.

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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. I

There is no evidence to establish that staff failed to use positive methods of discipline.

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R 400.8140 · R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: (i) Time out must not be used for children under 3 years of age.

There is no evidence to established that staff placed children under 3 years of age in time out.

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R 400.8155 · R 400.8155 1 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: (a) Changes in a child's health. (b) A child experiences an accident, injury, or incident. (c) A child is too ill to remain in the arouo. 14

There is no evidence to establish that staff failed to follow the center's illness exclusion policy for children. Child D did not return to the center until he was noncontagious. Child E, Child F, and Child G were sent home last week due to having a fever.

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R 400.8140 · R 400.8140 Discipline. (2) All of the following means of punishment are prohibited: (i) Time out must not be used for children under 3 years of age.

On 08/05/2021, 1 conducted an onsite inspection to discuss the allegation with licensee designee/program director Ms. Jessi Hoard. She stated that they only implement time outs for children over age three. If children under age three hit, throw toys, or hurt others, they "take a break." When that happens, staff put the child in a highchair while calming the other child and attending to his/her needs. This is done for the safety of the other children because center staff do not want the child who did the hurting to have access others while the staff member is helping calm the child who is upset. As soon as the situation is under control, the staff member takes the child out of the highchair and redirects them to a different activity. Child B (two- year-old, female) is one of the toddlers who staff have used this technique with because she tends to escalate unwanted behaviors when someone is attending to the child who is upset. On 08/05/2021, I discussed the allegation with program director and child care staff member (CCSM) Ms. Kimberley Lindsey. She stated that they do not do time outs for children under age three. Sometimes staff members have to put a toddler in a highchair for their own safety and the safety of others, but no one thinks of it as a time out. She identified Child B as a child who is occasionally placed in a highchair for this purpose. Child B has a developmental delay that impedes her ability to manage herself in certain situations around other children. On 08/05/2021, I discussed the allegation with CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Each staff member stated that time outs are not used for children under 3 age three. They all identified Child B as a toddler who exhibits challenging behaviors such as throwing toys and having big temper tantrums when she is upset. When this happens, staff pull her aside and try to redirect her. Sometimes staff place her in a smaller highchair on the floor to help her regroup and reset her strong emotions. CCMS 4 stated that the smaller highchair was recommended by Child B's Early On worker as a way to help her gain control over strong emotions because she was putting other children in danger. CCSM 4 used this technique when she was the only staff member working in the toddler room. On 08/23/2021, and 09/01/2021 I conducted telephone interviews with Child A's Father, Child D's Mother, and Child G's Mother. None of the parents have seen toddlers in time out or heard of time out being used with younger children. Child G's Mother stated that she thought staff must use time out because one of the staff members told her that whenever Child G (two-year-old, male) gets into trouble, he always says, "I want my mama." On 09/13/2021, I spoke with Child B's Mother. She stated that Child B has developmental delays including being behind in her speech, sensory issues, and challenges with emotional regulation. Staff at the center have gone above and beyond to help Child B. They ask for advice from Early On and seek her help as a parent to problem-solve issues around Child B's care. Child B's Mother knew that in the past, staff would help Child B take a break when needed by taking her to a quiet area. She feels it would be appropriate for staff to use a highchair to help Child B regroup when she is having sensory difficulties or if she is acting unsafe. She stated, "At home, I have had to set her in a pack and play to keep her safe because she was throwing things." Child B loves attending the center. Child B's Mother is more than happy with the staff and with the care Child B receives.

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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.

On 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that she has no concerns with the way child care staff members interact with children. She works as the lead caregiver in the preschool space. She knows what goes on in the preschool and toddler areas because they are separated by shelving and room dividers. She has not observed overly harsh punishment of children in any of the classrooms. Most of the time, staff use redirection techniques with children. If a child is having trouble managing strong emotions, staff will have the child sit next to them to take a break until they are ready to rejoin the group. Some of the staff use loud voices, but it is not "mean yelling." She recently talked to CCSM 2 and CCSM 4 about their tone of voice because sometimes their loud voices sound harsher than intended when speaking with children. Ms. Lindsey stated she works mostly in the infant room. None of the infant child care staff yell at babies or speak in harsh tones. Ms. Lindsey and Ms. Hoard are working with staff in other classrooms on the tone of voice they use with children. When it comes to discipline, she has not seen anything concerning or punitive. They tell children to stop unwanted or unkind behavior and redirect them to other activities if they are having trouble following the rules. If there is an issue with the way a staff member talks to children, she will pull them aside and address the issue. Within the last two week, she spoke with CCSM 2 about her tone and about trying not to get frustrated or take things personally when children are challenging. On 08/05/2021, CCSM 1 stated that no one has ever expressed concerns to her about discipline or the use of harsh punishment with children. If a child throws toys, staff will pull them aside and play with them to redirect their behavior. The preschool children can be wild, and staff have to raise their voices to get their attention. Sometimes it sounds overly harsh. During recent a staff meeting, Ms. Hoard talked about not yelling at children. Even though she brought it up as an issue, nothing changed, and it did not get any better. CCSM 1 did not like the way some of the staff talked to the older children. She identified CCSM 2 and CCSM 3 as staff who have yelled at children inappropriately. On 08/05/2021, CCSM 2 stated that Ms. Hoard talked to everyone at the last staff meeting about problems with staff yelling at children. She did not single anyone out about anything specific. She just said not to use mean words and not to shout at children to get them to stop misbehaving. CCSM 1 did not recall anyone speaking with her about her tone. Preschool staff tell children to use kind words or to not hit other children. Sometimes staff have children sit next to them to calm down. She does not think staff punish children or act overly harsh with them. 5 On 08/05/2021, CCSM 3 stated that all of the staff are different, but she was not overly concerned with the way staff disciplined children. She does not yell at children, but she does not coddle them either. At the staff meeting in July, Ms. Hoard discussed the tone of voice staff sometimes use. Recently, Ms. Hoard spoke to her about the way she raises her voice when talking with children. She told CCSM 3 that the way she speaks sometimes comes off wrong and she can sound too harsh when she raises her voice. On 08/05/2021, CCSM 4 stated that she has talked to Ms. Hoard about her concerns with the tone of voice other staff members sometimes use with children. She has heard fellow staff members yell at children and did not think it was appropriate. CCSM 4 felt that staff need to remain calm or ask to take a break when children push their buttons. She has never seen staff punish children or act in a punitive manner. They just raise their voices without thinking about how a child or parent would feel about their tone and what they are saying. CCSM 4 thinks that Ms. Ho

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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 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that at the beginning of July, Child A (five-year-old, male) was injured by another child falling on him while playing outside. He began limping on his foot, so staff informed his father about it when he arrived for pick up. It did not seem like a serious injury, so Child A's Father decided to keep an eye on it at home. The next day when Child A returned to care, he was still limping; Ms. Hoard talked to Child A's Father about it again. Child A's Father reported that he took Child A to the doctor and was found to have a strained muscle. Ms. Hoard did not know why she 7 did not report the injury to child care licensing as required after learning Child A saw a doctor. Ms. Lindsey stated that because she works in the infant room, she does not know what happens on the playground when the older children are outside. She knew Ms. Hoard used the center's internal incident reports because she recently asked Ms. Lindsey for blank forms. On 08/05/2021, CCSM 1 stated that she was not a fan of the stumps that are part of the natural playground because several children have been injured on them. Several children were injured within the last month, including Child I (four-year-old, female) and Child K (four-year-old, male). CCSM 1 is not outside with the older children, so she did not know how closely children are supervised. On 08/05/2021, CCSM 2 stated that staff always have their eyes on children when they are playing outside. She did not think there was a problem with the way staff supervise children outdoors. Child F (two-year-old, male), Child K, and Child L (two- year-old, male), have been injured while playing on the stumps. On 08/05/2021, CCSM 3 stated that staff supervise children appropriately when they play outside. She was only aware of minor playground injuries like children getting scrapes. On 08/05/2021, CCSM 4 stated that most of the playground injuries happen to preschool children. Preschool staff do not always pay close attention to children outside because they are on their phones. During the follow up inspection on 08/10/2021, Ms. Hoard stated that she removed the stumps from the playground because too many children were getting injured. On 08/23/2021, 09/01/2021, and 09/13/2021, I interviewed Child A's Father, Child D's Mother, Child G's Mother, Child I and J's Mother, and Child B's Mother. None of the parents has concerns about their children getting injured, or about the level of staff supervision on the playground. On 09/20/2021, Child A's Father stated that Child A was seen by the doctor sometime in July due to another child falling on his foot. X-rays were taken and nothing was broken. Child A was limping for a few days, but it looked like he just hyperextended his foot. Child I and J's Mother stated that her children are wild and accident prone. When she brought up a concern about her children using balance bikes without wearing helmets, Ms. Hoard immediately addressed the situation. Child I and J's Mother provided helmets, and now her children wear them every time they use the bikes.

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R 400.8158 · R 400.8158 1 Incident, accident, injury, illness, death, fire reporting. (3) A licensee, licensee designee, or program director shall report to the department, via phone, fax, or email, within 24 hours of notification by a parent that a child received medical treatment or was hospitalized for an injury, accident, or medical condition that occurred while the child was in care.

On 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that they were able to "make it work" when it came to staff member to child ratios. In the mornings parents occasionally drop off before their scheduled times, but Ms. Hoard was "pretty sure" the center was "usually" able to maintain appropriate staff-to-child ratios. She clarified that it has been a few weeks since they rj were not "in ratio" in the morning. Recently, Child G had to be moved up to the preschool room. She thought it would be ok because he was 8 days away from turning 33 months old. Most of the time when Child G was present, they were able to follow a 1:8 staff to child ratio in the preschool room. Ms. Hoard also learned that on one of her days off, CCSM 3 left child unattended outside for a few minutes while she came inside to fill up water bottles. Ms. Hoard knew that the incident occurred within the last month, but she did not recall the exact date. When she found out about the situation, she talked to CCSM 3 about it. CCSM 3 did not know it was a problem to leave the playground for a minute for this purpose. Ms. Lindsey stated that because parents do not have set drop off times, it is difficult to predict when they will arrive in the mornings. On one occasion, Ms. Lindsey was over ratio by 2 children for about 10 minutes before the next child care staff member arrived. She was unable to provide an exact date of when this happened. She did not know anything about a staff member leaving children on the playground unattended. CCSM 1 stated that since she started working at the center, she has not been in a situation where they exceeded child to staff member ratios. She knew the preschool classroom followed a 1:10 staff-to-child ratio even though there was a child under 33 months of age in preschool. She was the one to tell Ms. Hoard that they needed to have a waiver to enroll a 33-month-old child in the preschool classroom. CCSM 1 was present when CCSM 3 left children unattended on the playground. She did not know what day this occurred, but knew it was during the first part of July sometime between 4:30 and 5:30 PM. It happened when CCSM 3, CCSM 2, and CCSM 1 were the only staff working at the center. CCSM 2 and CCSM 1 were with the younger children, and CCSM 3 was with the preschoolers. That afternoon, CCSM 1 saw CCSM 3 in the kitchen. No children were with CCSM 3, which meant that the children were outside unattended. She estimated that CCSM 3 was in the kitchen for two to three minutes. CCSM 2 stated that she was working when CCSM 3 left preschool children outside. She did not know the exact date this happened. That afternoon, CCSM 3 was outside with 6 to 8 preschool age children. Ms. Hoard and Ms. Lindsey had already left for the day. CCSM 2 thought it sounded like CCSM 3 was taking a child to the bathroom because she was talking to a child. She estimated that CCSM 3 was inside for 5 to 10 minutes while the rest of the preschoolers were outside by themselves. CCSM 3 stated that they follow proper staff to child ratios at the center. One child who is not yet 3 years old is enrolled in the preschool classroom. They follow a 1:10 staff-to-child ratio in the preschool room. She was unaware of the 1:8 staff-to-child ratios for children ages 30 to 33 months. A few weeks prior, CCSM 3 was on her own outside with fewer than 10 preschoolers. She ran inside to retrieve the tablet they use to check children in and out, but it only took a few seconds. She did not think children were "fully unattended" because she left the door open and could still 10 hear them. Ms. Hoard spoke to her about it and said that if she needed the tablet, she should knock on the door and ask another staff member to get it. CCMS 4 stated that there have been times in the mornings when the center was not able to maintain proper staff-to-child ratios. It happens because they do not have a set arrival time for parents. She

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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 Maximus Group Member to Child Ratio Size (a) Infants an toddlers. birth until 30 1 to 4 12 month Q -------------- -- --------------------------------------------- ---- (b) Preschoolers. 30 months of age Ito 8 - 16 until 3 years of age (c) Preschoolers. 3 years of age until I to 10 Not applicable 4 years of e. (d) Preschoolers. 4 years of age until 1 to 12 Nat applicable school-age {e School a ers 1 to 18 No: a ' Iicab e

On 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that the center provides snack, including milk. She did not know children over 2 years of age were not allowed to have whole homogenized Vitamin D-fortified cow's milk. She found out about the rule when CCSM 1 told her about it. Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4 stated that all of the children are served Vitamin D milk for snack.

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R 400.8182 · R 400.8182 Ratio and group size requirements. (7) If there are children of mixed ages in the same room or well- defined space, then the ratio and group size is determined by the age of the youngest child, unless each group of children is clearly separated and the appropriate child care staff member- to-child ratios and group sizes, if applicable, for each age group are maintained.

On 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that Child B was accustomed to going to bed with a bottle at home and had difficulty falling asleep for nap without one. In the past, some of the staff gave Child B a bottle on her sleeping mat because they did not know what else to do. After learning about this practice, Ms. Hoard spoke to all of the staff and advised them that children may not have bottles while in sleeping equipment. Ms. Lindsey stated that in the toddler room Child B was given a bottle in a chair, not on a sleeping mat. CCSM 1 stated that the only way Child B will go to sleep is if she has a bottle on her mat. She tried other strategies with Child B, but nothing worked. The last time it happened was with CCSM 4 sometime during the week of 07/26/2021. Ms. Hoard was aware of the situation. She recently told staff none of the children were supposed to have bottles on their mats, but when she found out it happened again with CCSM 4, she did nothing about it. CCSM 2 stated that Child B gets a bottle on her mat because it helps her fall asleep. She did not know this practice was not allowed. None of the other children are given bottles while in cribs or on sleeping mats. CCSM 3 stated Child B gets a bottle on her sleeping mat. CCSM 4 stated that Child B was recently moved from a crib to a sleeping mat. No children, including Child B, are given bottles in cribs or on mats. 15

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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 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that infants are fed on demand and according to feeding schedules based on when they last ate. All infants are fed when they show signs of hunger. Some infants are fed every two to three hours. Feedings are documented on Brightwheel for parents. Ms. Lindsey stated that infants' feeding schedules look different for each child. When parents drop off, staff ask them when their infant last ate. None of the infants go longer than two to three hours between feedings and if they appear hungry, they are fed. CCSM 1 stated that she did not think infants were being fed according to a schedule. CCSM 2 and CCSM 4 stated that infants are fed on demand. CCSM 3 stated that she does not work in the infant room, so she does not know about feeding schedules. During the onsite inspection on 08/05/2021, I viewed daily reports for five infants. All of the reports showed that infants were fed every two to three hours as reported. 16

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R 400.8158 · 1 R 400.8158 Incident, accident, injury, illness, death, fire reporting. (2) A licensee, licensee designee, or program director shall report to the child's parent and the department, directly or via phone, fax, or email, within 24 hours of the occurrence of any of the following: (a) A child is lost or left unsupervised.

On 08/05/2021, I discussed the allegation with Ms. Hoard, Ms. Lindsey, CCSM 1, CCSM 2, CCSM 3, and CCSM 4. Ms. Hoard stated that each situation is different, but in general staff and children follow their illness policies as required. Child M, (one-year-old, female) has a medical condition that causes digestion issues including runny stools. Because this happens daily, she is allowed to attend even though the illness policy states children must be symptom-free for 24 hours after being sent home for diarrhea. She could not recall a time when children were allowed to attend the center without being fever-free for 24 hours, except if it was linked to teething. Ms. Lindsey stated that staff at the center follows their illness policy. She sent one child home today, 08/05/2021, because she had a fever of 100.5. She told the parent that their child could not come back until she was fever-free for 24 hours. Some children have medical conditions that are not true illnesses. In some situations, they allow the child to come back the next day because they are not actually sick. If there is ever as concern that a child is truly ill, they are not allowed to return to care until they are symptom-free for 24 hours. CCSM 1 stated that she knew of two children who had diarrhea and were allowed to come back the next day. She did not know if these children had medical conditions or not. CCSM 2, and CCSM 4 did not recall a time when children were allowed to come back to the center sooner than 24 hours if they were sent home for being sick. CCSM 3 stated that recently a parent dropped a child off the next day after being sent home sick the day before. Staff called the parent and had them come back to pick their child back up. 17 On 08/23/2021, 09/01/2021, and 09/13/2021, I interviewed Child A's Father, Child D's Mother, Child G's Mother, Child I and J's Mother, and Child B's Mother. None of the parents were concerned that children were allowed to attend the center too soon after they were sent home sick. Child B's Mother stated that when Child B has been sent home, she keeps her home until she feels better. She thought it was almost impossible for viruses to not get spread in a child care center. She asserted, "I know they have closed down to clean. I have watched them clean."

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R 400.8335 · R 400.8335 Food services and nutrition; provided by center. (1) Food and beverages provided by a center must be of sufficient quantity and nutritional quality to provide for the dietary needs of each child according to the minimum meal requirements of the child and adult care food program (CACFP), as administered by the Michigan department of education, based on 7 CFR part 226, 1-1-18 edition, (2018) of the United 14 States Department of Agriculture, Food and Nutrition Service, CACFP, and is hereby adopted by reference...

Licensee designee Ms. Hoard did not ensure that food and beverage provided by the center were of sufficient quantity and nutritional quality to provide for the dietary needs of each child according to the minimum meal requirements of the child and adult care food program (CACFP). CACFP Dietary Guidelines recommend that children over two years of age consume fat- free (skim) or low-fat (1%) fluid milk. All children, regardless of age, were served whole homogenized Vitamin D milk for snack. I

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R 400.8330 · R 400.8330 Food services and nutrition generally. (22) Infants or toddlers shall not have bottles, beverage containers, or food in sleeping equipment.

Licensee designee Ms. Hoard, CCSM 1, CCSM 2, and CCSM 3 did not ensure toddlers did not have bottles or beverage containers in sleeping equipment. Ms. Hoard, CCSM 1, CCSM 2, and CCSM 3 stated that Child B takes a bottle while on her sleeping mat.

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

Infant staff ensure that infants are fed on demand as required. Staff and Brightwheel reports confirm that infants are fed every two to three hours, and on demand.

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R 400.8155 · R 400.8155 Child accidents and incidents; child and staff illness. (5) A center shall have a written policy detailing when children, staff, and volunteers will be excluded from the center due to illness.

Evidence does not support the allegation that the center fails to exclude children from the center due to illness. If a child has a known medical conditions that causes diarrhea, they are allowed to attend the center because they are not actually sick. None of the parents interviewed had concerns that children who were sick were being allowed to return to the center too soon. When a parent recently dropped their child off after they were sent home sick the day prior, staff called the parent to have them come back to pick their child up.

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