R 400.8143 · R 400.8143 1 Children's records. (6) Within 30 days of a child's initial attendance, a center shall obtain, keep on file, and make accessible in the center a record of a physical evaluation of the child that notes any restrictions and is signed by a physician or the physician's designee... The physical evaluation must be performed within one of the following time limits: (c) For preschoolers within the preceding 12 months.

On 2/24/22, the department received a complaint stating that Child A had not received his physical exam in a timely manner. The complainant stated that the child is medically neglected since he has not received a physical exam in 3 years. On 2/25/22, I left a voice message for the complainant and did not receive a return phone call for any further information. On 3/2/22, I interviewed assistant director, Ms. Watts who stated that the center had received the physical evaluation for Child A after they had enrolled Child A in the program. Child A was enrolled into the program on 4/18/21. There is a physical evaluation conducted on 4/23/21 at Wellness Pediatrics. The doctor notes that there 2 are no essential findings deviating from a normal physical exam. I reviewed the health appraisal for Child A to confirm the same. On 4/22/22, program director Ms. Lewis forwarded a physical evaluation conducted on 8/5/20 by a licensed Nurse practitioner in Ohio. The physical evaluation stated that Child A had a normal physical exam.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8143 · R 400.8143 1 Children's records. (4) When a child under school-age whose immunizations were not up-to-date at the time of enrollment has been in attendance for 4 months, an updated certificate showing completion of all additional immunization requirements as specified by DHHS must be kept on file, unless there is a signed statement by a licensed health care provider stating immunizations are in progress.

On 2/24/22, the department received a complaint stating that Child A did not have any medically recommended vaccinations. On 2/25/22, I left a voice message for the complainant for further information and did not receive a return call. On 3/2/22, I conducted an onsite visit at the center and reviewed the immunization history for Child A and noted the following: DTaP The doses are up to date and the next dose is due on 7/7/22. Hib Completed required doses. Polio The doses are up to date and the next dose is due on 7/7/22. MMR The doses are up to date and the next dose is due on 7/7/22. Hepatitis B Complete. 3 Varicella Completed 2 doses and the next is due on 7/7/22. Hepatitis A Complete. Pneumococcal PCV 13 Complete. The immunization history indicated that all the immunization were up-to-date at the time of enrollment and thereafter.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

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

On 1/18/22, I received a phone call from the program director/licensee designee stating that Child A had received medical treatment for a bump that occurred at the center on 1/14/22. Ms. Lewis said that the incident report would be sent in an email following the phone conversation. Ms. Lewis said that she did not know that Child A's mother had taken Child A for medical treatment until last evening. She said that she was calling the department as soon as she became aware of this. On 1/18/22, I received the incident report which stated that on Friday 1/14/2022 Child A ran out of the classroom into the bathroom with a parachute. Ms. Spring asked Child A to return to the classroom with the parachute. Child A refused and began to laugh and act out towards Ms. Spring. Ms. Spring asked Child A to hand her the parachute, and he said no and continued to laugh. Ms. Spring informed Child A that she was going to have to take the parachute away from him, and he continued to say no and laugh. Ms. Spring went to retrieve the parachute from Child A, and as she began to take it away, she did not notice he was standing on the parachute. Ms. Spring took the parachute out of his hand causing him to slip, falling onto his bottom and then fell back hitting the back of his head onto the bathroom stall. Child A began to cry and yell at Ms. Spring for taking away the parachute and 3 causing him to fall. Ms. Spring then got on his level to check on him and monitored for bumps; she found no bumps at the time. They then walked back to the classroom discussing the situation and were able to work through the issue. Ms. Spring was providing a break for the school age staff member. When the school age staff member returned, Ms. Spring went back to her classroom to write the incident report. Child A's mother arrived shortly after to pick up Child A, and Ms. Lewis walked Child A's mother back to Child A's class. When they arrived in the classroom, Child A began to tell his mom that a staff member ripped a parachute out of his hand purposely making him fall. Ms. Lewis then went and found Ms. Spring and kindly asked to talk with Child A's mother about the situation that happened. On 1/17/22, at 7:25pm Ms. Lewis received a text message from Ms. Kay, school age director, with a doctor's note stating Child A was diagnosed with a concussion and Child A's mother said that this had happened due to the incident that occurred in the after- school care at the child care center. On 1/18/22, I interviewed Child A's mother who stated that she went to the center at about 4 pm to pick up Child A from the latchkey program on 1/14/22. When she went into the classroom, Child A told her that Ms. Spring had pulled out the parachute from under his feet and made him fall on purpose. Child A told her that he fell on the bathroom floor since he ran into the bathroom with the parachute. Child A's mother said that she immediately checked for bumps and found one at the base of his skull in the neck area. Child A's mother stated that Ms. Lewis called for Ms. Spring to ask her about the situation since the after-school age staff member, Ms. Gipson, did not know anything about the incident. Ms. Spring came back into the classroom and explained to her that Child A had issues with listening, and he would not listen to her instructions to come back into the classroom with the parachute. Child A's mother said that she showed her the bump in the neck area and asked Ms. Spring to mention that in the incident report. The incident report was not ready at the time of pick up and Ms. Spring said that she would send that to her. Child A's mother took Child A to the pediatrician and was advised to look out for any symptoms that may occur over the next 2 days. The pediatrician informed Child A's mother to bring Child A back if there were any symptoms like vomiting, headaches, and dizziness. On 1/16/22, Child A said that he felt funny and had nausea and dizziness. Child A also complained that his ears hu

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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

On 1/18/22, Child A's mother stated that on 6/17/21, Child A was served milk at breakfast even though he is allergic to milk. Child A's mother said that this happened during the summer camp. Child A was given lactose free milk with his cereal; he is allergic to milk, not lactose. It was claimed that they "didn't understand why milk was in there since it's lactose free". On 1/25/22, I interviewed Ms. Lewis who stated that there was no incident report regarding this incident in the file. However, she could recall that staff members gave Child A milk for breakfast. According to the attendance records, the staff members working were Ms. Seeley and Ms. Blake. Ms. Lewis said that Ms. Blake called Child A's mother and informed her about what had occurred. Child A's allergic reactions 7 are not severe, but Child A's mother said that his belly hurts, and he needs to use the bathroom several times. On 1/25/22, I interviewed Ms. Blake who said that there was no cook present that day and she had everything ready. She noticed that Child A was allergic to milk and therefore served him the lactose free milk thinking that he would be fine with that. After about an hour she realized that Child A got the wrong type of milk and she called Child A's mother. Child A's mother said that she would send the medication to be administered to Child A, but Ms. Blake did not receive anything. In fact, Child A's mother did not come into the center at all, and Child A went on a field trip with the rest of the children. Ms. Blake said that she checked on Child A at the field trip and was told that he was doing fine. On 2/3/22, I interviewed Ms. Seeley who said that she does not recall any time when Child A was given the wrong milk. She always looked at the label and made sure that Child A was given the right food since he has dietary restrictions.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8330 · R 400.8330 1 Food services and nutrition generally. (4) A center shall ensure a child who has special dietary needs is provided with snacks and meals in accordance with the child's needs and with the instructions of the child's parent or licensed health care provider.

On 1/18/22, Child A's mother stated that on 6/18/21, Child A came out with a big gash on his nose. It was red but was not bleeding. She asked the staff members about it, and nobody knew anything about the incident. She said that she did not get an incident report. On 1/25/22, I interviewed Ms. Lewis who said that she had not heard of any such incidents with Child A. She said that she could not find any incident reports for that day either. The staff members that worked that afternoon were Ms. Seeley and Ms. Farstvedt. On 2/3/22, I interviewed Ms. Seeley and Ms. Farstvedt who said that they were not aware of any such incident occurring with Child A. They said that they went to the park that day since Fridays were park days. They don't recall Child A coming to them with any injury or complaint of any kind. On 2/3/22, I interviewed Ms. Roukounakis who said that she recalled Child A having a scratch on his nose. She said that she had not gone out to the park with the children that day, but she was the closer and noticed the scratch when Child A returned to the center. It was not bleeding, and it looked as if Child A had scratched himself. During summer of 2021, parents were not allowed into the building; therefore, a staff member from the front office had asked her about the scratch and said that Child A's mother wanted to know about it. She said that she did not know anything about it. Ms. Roukounakis said that she did not think that the scratch had happened that day. It looked as if it had happened a few days prior. She said that she did not have a conversation with Child A's mother or do an incident report for the same.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

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 1/18/22 Child A's mother stated that there were several incidents of lack of supervision at the Clarkston center since summer of 2021. She said that the current incident with the parachute reminded her of all the other incidents that have occurred at the center. Child A's mother said that on 6/30/21, Child A was served bagels and honey graham crackers, even though he is allergic to gluten. Child A's mother said rj that this makes him urinate on himself a lot of times. She said that she had to leave her work and go to the site to take care of this problem. Child A also missed his field trip because of this incident. On 1/25/21, Ms. Lewis stated that she did not have an incident report for that incident, and she did not remember any such incident in detail. However, she knows that there was an issue with Child A getting gluten at some point. She said that according to the records, Child A went to the Lake Orion campus by bus and the staff members that accompanied him were Ms. Myers and Ms. Farstvedt. On 1/25/22, I interviewed Ms. Blake who said that one of the new staff members that was working during breakfast served bagels to Child A, even though he is allergic to gluten. Ms. Blake said that she did not remember the staff members involved with this, but she called Child A's mother about it. Child A's mother said to keep an eye on Child A to see if there would be any symptoms. Ms. Blake said that there were no severe reactions for Child A, and she could not recall what happened after that. On 1/25/22, I interviewed the assistant director, Ms. Watts about this incident. She stated that she would always make sure that Child A got gluten free bagels for breakfast. She was not sure how he was served with regular bagels. Ms. Watts said that Child A tended to grab food from other children or from the serving plate even though it was not his. Ms. Watts had seen him grab cupcakes or cheese from the floor. Ms. Watts said that she had seen Child A wet himself very often and they always have extra set of clothes for him. Child A's mother told her that this was because over the weekend he would be at Child A's father's place, and they would serve gluten to him, and Mondays would be hard for Child A. On 2/3/22, I interviewed Ms. Farstvedt, who stated that she does not recall any incident where he was served with bagel or graham crackers. Ms. Farstvedt said that Child A's food would always be labeled for him since he had allergies. She said that Child A tended to eat off the floor or drink from other children's cups. Ms. Farstvedt said that they travelled to Lake Orion campus that day (after breakfast), and she did not recall any such incidents. On 2/3/22, I interviewed school age coordinator, Ms. Kay (Lake Orion campus) who said that she had not heard of any such incident from any of the staff members. She had not spoken to Child A's mother or any other staff member about this. On 2/18/22, I interviewed Ms. Myers who said that she had heard that Child A was served a bagel at the Clarkston campus even though he is allergic to gluten. Ms. Myers said that she was not present at the time, nor does she know of any details about the incident. On 2/18/22 Ms. Roukounakis stated that Child A's food was always labeled, and she made sure that he was not allergic to any food that he was served. She said that she was not aware of a time when Child A was given bagels or graham crackers. 10

R 400.8330 · R 400.8330 Food services and nutrition generally. (4) A center shall ensure a child who has special dietary needs is provided with snacks and meals in accordance with the child's needs and with the instructions of the child's parent or licensed health care provider.

On 1/18/22, Child A's mother stated that the center released Child A to her boyfriend on 6/30/21, even though he was not authorized to pick up Child A. Child A's mother said that she had not authorized her boyfriend to pick up until 7/2/21. On 1/25/22, I interviewed Ms. Lewis who said that Child A's mother's boyfriend came to pick up Child A on 7/2/21 and none of the staff members had seen him before. Ms. Lewis asked him to show his ID and took some time to confirm that he was listed on the emergency card for authorized pick up. Ms. Lewis said that she called Child A's mother to make sure that he could pick up. Child A's mother and her boyfriend were both very upset about the situation. Child A's mother said that the center allowed him to pick up on 6/30/21 and asked why there was a problem that day. Ms. Lewis stated that Ms. Myers released Child A to Child A's mother's boyfriend since she had seen him at pick up time before at the Lake Orion campus. On 7/2/21, Ms. Lewis had not seen him before and therefore wanted to confirm before release. On 1/26/22, I reviewed the child information card signed by Child A's mother on 6/14/21 authorizing Child A's boyfriend to pick up Child A. 11

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

R 400.8110 · R 400.8110 1 Applicant; licensee; licensee designee; requirements. (7) A child shall only be released to persons authorized by the child's parent or guardian.

On 1/18/22, Child A's mother stated that on 7/28/21 Child A had a bump on his forehead in the morning and none of the staff members called her about it. Child A's mother saw the bump only at the time of pick up in the evening. Child A's mother said that she did not get an incident report for this at the time of pick up. She sent an email to Ms. Lewis asking about this incident, and Ms. Lewis responded the same evening stating that an incident report was done on the same day and the incident occurred at 8:30 am but nobody called Child A's mother. Ms. Lewis was apologetic on the email but assuring that such incidents would not occur again. On 1/25/22, I interviewed Ms. Lewis who handed over the incident report and stated that Child A's mother was probably nformed about the incident, and Ms. Watts was the manager in charge that day. On 1/25/22 I reviewed the incident report for the incident on 7/28/21. The report stated that Child A came to Ms. Arbogast stating that another child had thrown a water bottle at his head. The other child admitted to what happened and Child A had a bump on the crown of his head. Ms. Arbogast wrote on the report that she consoled Child A and talked to the other child about his unacceptable and unkind behavior. The incident report was signed by Child A's mother on 7/29/21. The report was signed by Ms. Watts on 7/28/21. On 1/25/22, I interviewed Ms. Watts who said that she came to know about the incident after watching the video. This happened on the playground and the staff members applied ice to the bump and told her about it. As per the video, Child A was swinging his water bottle and the other child threw his water bottle at Child A. 12 ' I •f i • -.• • i • • i

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

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

The center did not follow their own policy on when a parent should be notified about a child's head injury. Child A incurred a head injury at 8:30 am and the mother noticed the bump on Child A's forehead only at pick up. The center did not inform the mother about the injury.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

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

On 5/26/20, I received a phone call from the Program director, Ms. Lewis stating that Child A fell from the slide and broke his femur. Ms. Lewis stated that she had contacted Child A's mother, and Child A's grandmother came to the center and picked up Child A and took him to Urgent care. Ms. Lewis said that she would send 2 the incident report the next day when she received all the information about the treatment for Child A. On 5/27/21, I received the incident report which stated that Child A was straddling the top left side of the typhoon slide. Ms. Reaume began to walk towards Child A, when he fell from the side of the slide onto the ground of woodchips. Child A was screaming and crying holding his leg and saying, "I broke my leg". Ms. Reaume started to check Child A's leg to feel for a broken bone in his leg. Ms. Chalut came over and looked at Child A's leg and pointed out that his thigh was swollen. Child A showed many signs that he could not move his leg. A little later Ms. Chalut picked up Child A and carried him inside the building. Ms. Lewis called Child A's mother and grandmother about the incident and grandmother came to the center to pick him up. Child A's mother called to state that they were on their way to Children's Hospital for surgery. On 6/1/21, I called Child A's mother to inquire about the incident. Child A's mother said that Child A's bone in his leg was twisted and not broken according to the doctors. She said that if the bone was twisted, he was probably caught in something for a long time. Child A's mother said that if Child A had just fallen from the slide, the bone would only be broken and not twisted. Child A's mother said that she was in the process of seeing the video to determine what exactly happened that day. Child A's mother said that Child A's grandmother told her that Child A was not positioned right when she went in to pick up Child A. His legs were dangling which probably caused the twisting. On 6/1/21, I interviewed Child A's grandmother who said that she got a call from the center stating that Child A had fallen from the slide and that he was inconsolably crying. Child A's grandmother said that she lived half hour away from the center, and when she went to pick up Child A, he was sitting on a staff member's lap and his legs were dangling. Child A was not crying, and he was watching something on the tablet. Child A's grandmother said that they should have made him lie down instead of sitting him up with his legs dangling. Child A's grandmother said that they did not provide appropriate care when they did not take the precaution of lying him down. Child A's grandmother said that the center should have called an ambulance instead of waiting for her to pick up Child A, especially because she lived half hour away. She said that she did not think of telling them to do so since she did not know that it was serious. On 6/1/21, I interviewed Ms. Lewis who said that as soon she learned about the fall, she went to the playground to help the staff members. She saw Child A with his hands on his thigh and saying, "Don't touch me". Child A was lying down on Ms. Reaum's lap, and Ms. Reaume was sitting on the ground. He was crying and screaming so loudly and none of the staff members could console him. Ms. Chalut decided to bring him into the office and carried him inside. Ms. Chalut supported his thigh and lower back to carry him into the center. Ms. Chalut held Child A on her lap and sat with him on a chair. Ms. Lewis put a small chair under his legs so that his 3 legs would not dangle. Child A continued to scream and did not let anybody touch his leg. After about a few minutes, Child A got comfortable in Ms. Chalut's lap and stopped crying and screaming. Ms. Lewis said that they got him a tablet to watch cartoons on it, and this calmed him down. After about 45 minutes, Child A's grandmother came to pick up Child A. Child A's grandmother could not pick him up physically, therefore, she and Ms. Chalut h

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.