CT DBA AppleTree Grandville/Wyoming

R 400.8213(1)(a) · R 400.8213(1)(a) Staff; volunteer (1) All staff and volunteers present at the center shall: (a) Provide appropriate care and supervision of children at all times.

Teacher 2 did not provide appropriate care and supervision when Child E fell and hit his head on the ground, resulting in a mild concussion.

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R 400.8216(6)(g) · R 400.8216(6)(g) Orientation (6) Within 90 days after being present at the center and before caring for children unsupervised, program staff and unsupervised volunteers shall complete the following trainings, which are allowed to be counted toward annual professional development hours and are available at MiRegistry: (g) Pediatric first aid and pediatric, infant, child, and adult cardiopulmonary resuscitation (CPR) training.

Teacher 2 did not receive training in pediatric first aid and pediatric, infant, child, and adult CPR within 90 days after being present at the center and before caring for children unsupervised.

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R 400.8213(1)(a) · R 400.8213(1)(a) Staff; volunteer (1) All staff and volunteers present at the center shall: (a) Provide appropriate care and supervision of children at all times.

Teacher 1 did not provide appropriate care and supervision to Child A when he went into another classroom through the bathroom and was unsupervised for approximately seven minutes.

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R 400.8213(1)(a) · R 400.8213(1)(a) Staff; volunteer (1) All staff and volunteers present at the center shall: (a) Provide appropriate care and supervision o f children at all times.

Teacher 2 did not provide appropriate care and supervision of Child A when he was left unattended in the classroom for approximately one minute.

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

Appropriate care and supervision were not provided on March 9, 2023, when Child A had a wet diaper in his pant leg for the whole day.

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

On March 30, 2023, 1 spoke with Child A's Mother on the telephone. She stated that on March 12, 2023, she noticed a mark on Child A's lower back. She did not receive an incident report concerning any injuries. On March 29, 2023,*at piicckk up time she noticed a bruise along the side of Child A's . She asked Child A how he received the marks. She said it looked stick or paint, she tried to wipe it off and it did not wipe off. She did not receive an incident report concerning any accidents or injuries. Child A told her that Child D hit him. But Child D was a child in the previous center. He also told her that Child C "hits other" children. Child A's Mother stated she had photographs of the red marks on Child A's back and face. She sent me the photographs via text, and they are on file with this report. On April 4. 2023 an care 3 center. and I spoke with program director, Denise Farris, and CCSM 1, CCSM 2, CCSM 3, CCSM 4, and CCSM S. Denise Farris said Child A's Mother did not mention anything concerning marks or bruises on Child A during any conversations. Ms. Farris says she was recently notified by licensee designee, Elise Bos that Child A's Mother had emailed Ms. Bos concerning marks found on Child A on March 27, 2023. The email states that Child A `has come home with scratches on his lip" and "red marks and scratches on his back." Ms. Farris provided documentation of the emails exchanged. These emails are on file with this report. CCSM I stated they have not seen marks or bruises on Child A. Child A's Mother has not spoken to them concerning any marks or bruises on Child A. CCSM 2 stated they are a staff member in the Adabelle Room. CCSM 2 stated they received a message from Child A's Mother concerning a "cut on Child A's lip" and wondering if he had fallen or gotten hurt. CCSM 2 said they replied to Child A's Mother that they did not observe Child A fall or get hit by another child. CCSM 2 stated they asked CCSM 3, who was in the room also. CCSM 3 replied they had not heard him cry or see him fall or get hurt. CCSM 2 said they informed Child A's Mother with this information. CCSM 2 said, they and CCSM 3 checked Child A's lip and did not see any injury other than his lips were chapped. CCSM 2 could not remember the date of this incident. They have not observed any marks or bruises on Child A's face or back. CCSM 2 is not aware of any incident where he would have received these injuries, asked if there were children with known behaviors that included hitting. CCM 2 sated Child B (male, will sometimes "bop" other children on the head. Child B an w en e gets excited, he will sometimes hit a child next to him. This action is not hard enough to leave marks or bruises. The children will sometimes say "ouch" or cry when Child B bops them. CCSM 2 stated there are no other children in the Adabelle group that hit or bite. CCSM 2 did not recall any incidents when Child A told her he was hit or cried, Child A would let staff know if someone hit or hurt him. Child A only cried on his first day. CCSM 2 stated they have not observed Child A fall or hit his face or back on any equipment. CCSM 3 stated they have not observed any marks or bruises on Child A. CCSM 3 has observed Child A fall, but these falls would not account for the marks or bruises observed on Child A. CCSM 3 has not heard Child A cry to indicate he has been hurt. He has cried if another child takes his toy. CCSM 3 has not written any injury reports for Child A. asked if there were children with known behaviors that included hitting. CCSM 3 stated Child C (male, ) scratches and hits children; the scratches do leave marks or will break the skin. CCSM 3 has not observed Child C hit or scratch Child A. CCSM 4 stated they have not observed any bruises or marks on Child A. On March 29, 2023, Child A's Mother asked CCSM 7 about a mark on Child A's face. CCSM 4 4 said CCSM 7 told her she told Child A's Mother it looked like marker. CCSM 4 did not see the mark on Child A's face. She

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R 400. ..8 ....1 ....3 ....7 ....( ..6) Diapering; toileting. (6) Diapers and training pants must be checked frequently and changed when wet or soiled.

On March 30, 2023, I spoke with Child A's Mother on the telephone. She said that on March 9, 2023, she dropped off Child A at 6:49am. She dropped him off in a diaper. When she picked up Child A from care that evening, she noticed the same diaper stuffed in Child A's pant leg. She knows this because she uses diapers on Child A at home and the center uses pull-ups. The diaper was so saturated with urine the mesh had opened and exposed the gel inside. She sent me a photograph of the diaper. This photograph is on file with this report. Child A's Mother said she spoke with program director, Denise Farris, who told her that CCSM 3 had told her, she asks children to remove and throw away their diapers/pull-ups when they are using the bathroom. Then she will put a new diaper/pull up on the children. This process is followed with children who are potty training. Child A's Mother informed me Child A was not being potty trained currently, and she never told staff to work on potty training with him while he was at the center. Child A's Mother said that at pick up time on March 27, 2023, Child A told her "I'm poopy." There was a staff person present (she could not remember their name) and they did not offer to change Child A's diaper. Later when she changed his diaper, she noticed he was wearing another child's diaper. She knew this because there was another child's initials on the diaper. No one at the center had told her Child A was out of diapers. The center uses a computer application called Sprout About to communicate with parents. There was no communication on the application that Child A was out of diapers. Child A's Mother said she did not receive any diaper notifications on March 27 or 28, 2023. On March 29, 2023, when she picked up X Child A, he had a soiled diaper and she had to change him. She sent me a screen shot of the daily record for March 29, 2023. This communication states Child A had two wet diapers during the day. On April 4, 2023, and I made an unannounced on-site inspection at the child care center. and I spoke with program director, Denise Farris, CCSM 1, CCSM 2, CCSM 3, CCSM 4, and CCSM 5. CCSM 1 (assistant director) stated that they spoke with Child A's Mother on Monday, March 27, 2023, at approximately .4pm. Child A's Mother called the center to ask if Child A's diapers had been changed all day because there were no notifications of the diaper changes on the Sprout About app. CCSM 1 said they told Child A's Mother that CCSM 2, who is the staff in the Adabelle Room was "good about changing diapers." Child A's Mother told CCSM 1 that at pick up time Child A "eras poppy" and she had to change him. CCSM t stated they would follow up with staff that were in the room on March 27, 2023. CCSM I said they did not follow up with Child A's Mother after the phone call because program director, Denise Farris received an email from and followed up with Child A's Mother about the diapering concerns. CCSM 1 stated center policy requires staff to check children's diapers every two hours or when wet/soiled. They communicate diapering on the Sprout About (parent/center communication application). They also have a "five-minute" policy that states that five minutes prior to children being picked up staff are required to check children's hands, face, clothes, and diaper. CCSM 1 has not heard any concerns from other parents concerning diapering in the Adabelle room. CCSM 1 stated that there have been times when a parent picks up and the child soils their diaper before leaving the center, parents will then ask staff to change the child, and staff will change the child's diaper. CCSM 2 stated she is a staff member in the Adabelle Room, CCSM 2 stated they are aware that Child A's Mother had a recent concern because she found a wet diaper in Child A's pant leg when she picked him up. CCSM 2 could not remember the date of the incident. CCSM 2 stated that CCSM 3 changed Child A that day because he was in the Terance Room and CCSM 3 is staff

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R 400.8146(3)(c) · R 400.8146(3)(c) Information provided to parents. (3) For infants and toddlers, a center shall provide parents with a written daily record that includes at least the following information: (c) Elimination patterns, including bowel movements, consistency, and frequency.

Child A's mother did not receive notifications of elimination patterns on March 27 and 28, 2023. CCSM 3 did not record diaper changes as required. The diapering log report does not have any entries concerning elimination patterns for March 27 and 28, 2023.

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

Diapering guidelines state that staff remove the soiled diaper and place them in the diaper pail. Children in the Terance room are taking off their pull ups or diapers and placing them in the diaper pail. The diapering guidelines are not being followed. I also provided technical assistance that children should not be handling hazardous materials including their diapers.

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