Child care staff and household members shall not use isolation as a form of discipline.

REPEAT CITATION PREVIOUSLY CITED ON NOVEMBER 19, 2024. The program self-reported an incident that occurred on March 4, 2025. The program reported that Staff A used rough handling, causing a dislocation of Child A's elbow. The licensing coordinator reviewed video footage of the incident, which showed Staff A lift Child A up by one wrist and one ankle, and turn Child A over on their cot. The program put the staff on leave immediately and through the completion of their investigation. Staff A's employment was ended on March 6, 2025 upon the completion of the program's investigation into the matter. Corrective action: After investigating the incident that occurred with rough handling a child on 3/5/25, we shared a video with all staff on Nurse’s elbow, how it occurs, how it is diagnosed, and how adults should and should not be handling children and how to avoid causing nurse’s elbow. We reminded all staff that they need to be vigilant about how they are picking children up, and how they are reacting when children are holding their hand and they fall. We told them that they absolutely should not be pulling them up by their hand/wrist and should always be picking them up under the arm pits. If a child was walking with them while holding their hand and the child went limp or fell, they should let them fall and not jerk them back up by their hand or wrist. In addition, we held a staff meeting on 3/24/25 to discuss children with epi-pen allergies and children diagnosed with nurse’s elbow. We reviewed the expectations of how to pick up children, not rough handling, and also how to react if a child goes limp while walking holding their hand. As mentioned in the video, once a child is diagnosed with nurse’s elbow, it is much easier to reinjure that elbow. With this in mind, we wanted to create additional ways we can ensure anyone working in a classroom with a child who has previously been diagnosed with nurse’s elbow is aware. This is when we agreed to change the wallpaper of the classroom iPad’s so whenever a teacher is checking into the classroom, they will be made aware to be extra vigilant in that classroom for either epi-pen allergies or children with nurse’s elbow. Additionally, we have updated our orientation for new staff members to speak specifically about rough handling, our expectations, explain nurse’s elbow, and discuss licensing rules and regulations as it relates to rough handling of children.