3270.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

The emergency contact form for Child #2 lacked the address of the child's physician.

Corrected Corrected by Feb 10, 2025

Category: health medication. Marked corrected in the state record.

3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

The Mandated Reporter training on file for Staff Person #2 was identified to be for continuing nursing education, making it invalid.

Corrected Corrected by Jan 15, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(3) · Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

The emergency contact form for Child #1 lacked the work address and work phone number for the enrolling parent.

Corrected Corrected by Jan 13, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.36(b)(1)/3270.192(2)(iv) · An assistant group supervisor shall have a high school diploma or a general educational development certificate and 30 credit hours from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field. A facility person's record shall include acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

The record of the required education on file for Staff Person #3 to be classified as an assistant group supervisor was an international diploma, not evaluated by an approved evaluator with no equivalency on file.

Corrected Corrected by Jan 16, 2025

Category: supervision. Marked corrected in the state record.

3270.75(c) · A first-aid kit must contain the following: soap, an assortment of adhesive bandages, sterile gauze pads, tweezers, tape, scissors and disposable, nonporous gloves.

In the Giraffe Room, the first aid kit lacked adhesive bandages.

Corrected Corrected by Jan 9, 2025

Category: health medication. Marked corrected in the state record.

3270.77(a) · Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

In the Sea Turtle Room, peeling paint was observed in the dramatic play area by the children's sink/stove.

Corrected Corrected by Jan 10, 2025

Category: physical safety. Marked corrected in the state record.

3270.82(h) · A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

The changing table located in the bathroom connected to the Lions Room lacked a handwashing sign.

Corrected Corrected by Jan 9, 2025

Category: health medication. Marked corrected in the state record.

3270.123(a)(1) · An agreement shall specify the amount of the fee to be charged per day or per week.

The agreement form for Child #2 lacked the fee amount.

Corrected Corrected by Jan 13, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.123(a)(4) · An agreement shall specify the child's arrival and departure times.

The agreement forms for Child #2 and Child #3 lacked the arrival and departure times.

Corrected Corrected by Feb 10, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(4)/3270.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The emergency contact form for Child #2 lacked a parent's signature consenting to emergency medical care.

Corrected Corrected by Jan 13, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.151(a)/3270.192(3) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The health assessment on file for Staff Person #4 was dated 5/5/23, more than12 months prior to the date of hire. (SEE LIS CODE SHEET)

Corrected Corrected by Jan 24, 2025

Category: ratio. Marked corrected in the state record.

3270.151(c)(2)/3270.192(3) · An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The TB test on file for Staff Person #1 was dated 10/10/15, more than 12 months prior to the date of hire. (SEE LIS CODE SHEET)

Corrected Corrected by Jan 31, 2025

Category: health medication. Marked corrected in the state record.

3270.182(5) · A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The emergency contact form for Child #2 lacked signed parental consent for administration of minor first aid procedures by facility staff.

Corrected Corrected by Jan 13, 2025

Category: ratio. Marked corrected in the state record.

3270.133(5) · Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

In a locked medication bin in the main office, an Infant Tylenol for Child #1 was observed to be expired with an expiration date of 7/2024.

Corrected Corrected by Aug 15, 2024

Category: ratio. Marked corrected in the state record.

3270.192(5) · A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

The file for Staff Person #1 did not include 2 written non-family references attesting to the staff person's suitability to work in childcare. The file for Staff Person #2 only contained 1 written non-family reference attesting to the staff person's suitability to work in childcare.

Corrected Corrected by Sep 5, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)(4)(i) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.

The file for Staff person #1 includes verification of Pediatric First Aid/CPR training dated 4/23/24, after the expiration date of 3/8/24. Staff person #2 does not have current pediatric first-aid/CPR training. This is evidenced by the previously documented pediatric first-aid/CPR training expiration date of 6/22/24.

Corrected Corrected by Jul 17, 2024

Category: ratio. Marked corrected in the state record.

3270.37(b)/3270.192(2)(ii) · An aide shall have attained one of the qualification levels specified in §3270.37(b)(1)-(3). A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Staff #3, who was working as an aide, file did not contain proof of education or experience.

Corrected Corrected by Jul 24, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.192(5) · A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

The files for staff #3 and #4 did not contain 2 written nonfamily references from individuals.

Corrected Corrected by Jul 24, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.102(a) · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

In the Polar Bear room, a couch and a chair was observed with ripped plastic covering with exposed foam that could be hazardous to children.

Corrected Corrected by Jan 19, 2024

Category: physical safety. Marked corrected in the state record.

3270.27(c) · The operator shall assure that each facility person receives training regarding the emergency plan at the time of initial employment, on an annual basis and at the time of each plan update. The operator shall document the date of each training and the names of all facility persons who received the training and kept on file at the facility.

The two most recent Emergency Plan trainings for Staff #3 are dated 11/29/22 and 12/21/23, more than 12 months apart.

Corrected Corrected by Dec 21, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.27(e) · The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures. The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

The facility lacked a letter to parents in the emergency plan addressing the following topics: 1. Shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises, 2. Evacuation of children from the facility building and evacuation of children to a location away from the facility premises, 3. A method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises, 4. A method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children, and 5. Accommodations for infants, toddlers, children with disabilities and children with chronic medical conditions.

Corrected Corrected by Jan 23, 2024

Category: physical safety. Marked corrected in the state record.

3270.31(e)(4)(i) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.

The file for Staff #5 contained a First Aid/CPR training dated 10/21/23 that is not Pediatric, making it unacceptable.

Corrected Corrected by Feb 1, 2024

Category: ratio. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

The file for Staff #6 (SEE LIS CODE SHEET) contained a disclosure statement dated 6/19/23 from a different legal entity.

Corrected Corrected by Jan 18, 2024

Category: background checks. Marked corrected in the state record.

3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

The file for Staff #6 did not contain a request for West Virginia Sex Offender clearance prior to start date (SEE LIS CODE SHEET) required for provisional hiring under CPSL. The clearance was dated 1/18/24.

Corrected Corrected by Jan 18, 2024

Category: background checks. Marked corrected in the state record.

3270.77(a) · Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

In the Giraffe room, damaged plaster was observed surrounding a lock gate attached to the wall to the right of the closet.

Corrected Corrected by Feb 4, 2024

Category: physical safety. Marked corrected in the state record.

3270.102(a)/3270.103 · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts. Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Carboard binoculars in the Sea Turtle room and cardboard books in the Giraffe room were observed peeling with ripped pieces less than 1 inch in diameter and were accessible to children who are still placing objects in their mouths.

Corrected Corrected by Jan 18, 2024

Category: physical safety. Marked corrected in the state record.

3270.105 · High chairs shall have a wide base and a T-shaped safety strap.

In the Ducklings classroom, a child was observed not strapped into a high chair using the T-shaped safety strap.

Corrected Corrected by Jan 18, 2024

Marked corrected in the state record.

3270.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

The Emergency Contact form for Child #1 did not contain the address and phone number of the Physician or Medical Care Provider.

Corrected Corrected by Feb 5, 2024

Category: health medication. Marked corrected in the state record.

3270.124(b)(7) · Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

The Emergency Contact forms for Child #1 and Child #4 did not contain complete addresses for all listed release persons.

Corrected Corrected by Feb 5, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.124(f)/3270.181(c) · The parent shall update in writing emergency contact information once in a 6-month period or as soon as there is a change in the information. A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

The file for Child #2 contained Emergency Contact and Financial Agreement forms that were reviewed by the parent and dated 01/30/23 & 8/1/23, more than 6 months apart.

Corrected Corrected by Jan 18, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.151(c)(1)/3270.192(3) · An adult health assessment must include a physical examination. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The file for Staff #1 contained a health assessment that was older than 24 months, dated 11/2/21.

Corrected Corrected by Feb 5, 2024

Category: health medication. Marked corrected in the state record.

3270.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The current health assessment on file for Staff #3 did not indicate that the staff person was examined for communicable diseases, but had 'N/A' next to the question.

Corrected Corrected by Jan 23, 2024

Category: health medication. Marked corrected in the state record.

3270.182(5) · A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The Emergency Contact form for Child #3 did not contain parental consent for the facility to administer minor first-aid.

Corrected Corrected by Feb 2, 2024

Category: ratio. Marked corrected in the state record.

3270.31(e) · A staff person shall obtain an annual minimum of 12 clock hours of child care training.

The file for Staff #2 contained 9 of 12 annual training hours within the time period of 10/4/22-10/4/23.

Corrected Corrected by Jan 18, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.113(b) · A facility person may not use any form of physical punishment, including spanking a child.

On 10/10/23, Child #1 ran out of the Polar Bear classroom and needed escorted back into the room. Once the child returned to the classroom, Staff #1 forcefully picked the child up under the arms and carried the child to a table where staff person #1 was leading an activity. Staff #1 wrapped their arms around the child and chair while the child was crying and attempting to get out of the seat. The child was held in the chair for over 5 minutes per the video that was viewed.

Corrected Corrected by Mar 11, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.113(b) · A facility person may not use any form of physical punishment, including spanking a child.

On 10/10/23, Child #1 ran out of the Polar Bear classroom and needed escorted back into the room. Once the child returned to the classroom, Staff #1 forcefully picked the child up under the arms and carried the child to a table where staff person #1 was leading an activity. Staff #1 wrapped their arms around the child and chair while the child was crying and attempting to get out of the seat. The child was held in the chair for over 5 minutes per the video that was viewed.

Corrected Corrected by Oct 27, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.113(e) · A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

On 10/10/23, Child #1 ran out of the Polar Bear classroom and needed escorted back into the room. Once the child returned to the classroom, Staff #1 forcefully picked the child up under the arms and carried the child to a table where staff person #1 was leading an activity. Staff #1 wrapped their arms around the child and chair while the child was crying and attempting to get out of the seat. The child was held in the chair for over 5 minutes per the video that was viewed.

Corrected Corrected by Mar 11, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.113(e) · A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

On 10/10/23, Child #1 ran out of the Polar Bear classroom and needed escorted back into the room. Once the child returned to the classroom, Staff #1 forcefully picked the child up under the arms and carried the child to a table where staff person #1 was leading an activity. Staff #1 wrapped their arms around the child and chair while the child was crying and attempting to get out of the seat. The child was held in the chair for over 5 minutes per the video that was viewed.

Corrected Corrected by Oct 27, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.95(a) · Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. §  1016(c)).

The fire alarm 30-day test log includes test dates 5/1/23-6/19/23, 7/10/23-8/10/23, and 9/9/23-10/26/23, more than 60 days apart.

Corrected Corrected by Oct 30, 2023

Category: physical safety. Marked corrected in the state record.

3270.27(c)/3270.192(2)(iii) · The operator shall assure that each facility person receives training regarding the emergency plan at the time of initial employment, on an annual basis and at the time of each plan update. The operator shall document the date of each training and the names of all facility persons who received the training and kept on file at the facility. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The file for staff #13 lacked emergency plan training within 90 days of hire. SEE LIS CODE SHEET. There is now current emergency plan training on file and dated 11/16/22.

Corrected Corrected by Mar 1, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)(4)(i)/3270.192(2)(iii) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The CPR/FA on file for staff #5 expired in January 2022. CPR/FA was taken on 2/4/22 after the expiration of the previous training. The CPR/FA on file for staff #9 expired 8/11/22. CPR/FA was taken on 10/11/22 after the expiration of the previous training.

Corrected Corrected by Mar 1, 2023

Category: ratio. Marked corrected in the state record.

3270.31(f)/3270.192(2)(iii) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The file for staff #2, 7 and 9 lacked CPR/FA within 90 days of hire. SEE LIS CODE SHEET. There is now current CPR/FA on file and dated 6/22/22 for staff #2 and 7 and staff #9 dated 2/4/23.

Corrected Corrected by Mar 1, 2023

Category: health medication. Marked corrected in the state record.

3270.31(f) · Staff person(s) shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #7, 10 and 12-- will have until 15 days from POC requested date to complete the required training. Until such time as the required training has been completed, staff person #7, 10 and 12- must be supervised, when interacting with children, by an AGS, who has completed the required training related to this citation. If there are no staff available to supervise staff person #7, 10 and 12-, staff person#7, 10 and 12 may not work in a child-care position at the facility.

Staff person #7, 10 and 12 have not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Staff #7 - Health and Safety Training. Current Health and Safety training dated 1/17/2019 is the 6 hour training which was valid from 9/30/16 thru 6/30/18. Staff #10 - Health and Safety Training. Current Health and Safety Training dated 1/18/2019 is the 6 hour training which was valid from 9/30/16 thru 6/30/18. Staff #12 - Health and Safety Training dated 1/20/2019 is the 6 hour training which was valid from 9/30/16 thru 6/30/18.

Corrected Corrected by Mar 1, 2023

Category: supervision. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 14 may not work at the facility. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

The file for staff #2 lacked the correct State Police clearance form on or before initial start date in a child care position. There is now a correct State Police clearance form on file and dated 2/10/23. There was more than 60 months between the previous and most current FBI clearance on file for staff #4. Dates are as follows: 3/6/17 and 3/31/22.The file for staff #14, who has lived in Florida and Virgin Islands within the past 5 years, lacks a Florida Child Abuse and Sex offender registry check and a Virgin Islands Criminal History, Child Abuse and Sex offender check. The file for staff #15 lacked a State Police, Child Abuse, FBI and NSOR on or before initial start date in a child care position. There are now current clearances on file and dated- State Police 11/2/22, Child Abuse - 1/4/23, FBI - 11/3/22 and NSOR 11/8/22.

Corrected Corrected by Mar 1, 2023

Category: background checks. Marked corrected in the state record.

3270.33(a)/3270.192(2)(ii) · A staff person or a substitute staff person shall meet one of the applicable staff qualifications for the position in which the person is performing. A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

The file for staff #1, who holds the title of aide, lacks verification of an 8th grade education. There are 2 years of child care experience on file. The file for staff #2, who holds the title of assistant group supervisor, lacks 1250 hours of childcare experience. There are 18 college credits in the human service field on file. The file for staff #3, who holds the title of group supervisor, lacks verification of 30 credit hours in the human service field and lacks 168 hours of child care experience. There are 1082 hours of child care experience and a Bachelor of Science degree on file. The file for staff #5, who holds the title of group supervisor, lacks verification of a bachelor's degree with 30 credit hours in the human service field. There are 10 years of experience on file. The file for staff #6, who holds the title of group supervisor, lacks verification of a Bachelor's Degree in the Human Service field. There are 3 years of experience on file.

Corrected Corrected by Mar 1, 2023

Category: supervision. Marked corrected in the state record.

3270.66(d) · Toxic plants are not permitted in a child care space.

In the Room #9, observed a toxic plant known as "Bird of Paradise".

Corrected Corrected by Mar 1, 2023

Category: physical safety. Marked corrected in the state record.

3270.102(a) · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

In Room #8, observed a 3-tiered shelf which wobbled when touched. In room #10, observed a 4-tiered towel shelf which wobbled when touched. In the outside plan area, observed that the top of the turtle "play box" had multiple cracks.

Corrected Corrected by Mar 1, 2023

Category: physical safety. Marked corrected in the state record.

3270.103 · Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

In the Infant Room, observed that a blue mat, which the infants use, has tiny pieces which are less than 1 in diameter which have been picked off, on the top of the mat. Based on a conversation with staff, the infants pick at the mat and pull the tiny pieces off.

Corrected Corrected by Mar 1, 2023

Marked corrected in the state record.

3270.123(a)(6) · An agreement shall specify the date of the child's admission.

The most current updated fee agreements on file for children #1, 2 and 3 lack the date of the child's admission.

Corrected Corrected by Mar 1, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.131(d)(5)/3270.131(e)(3) · Child #4 must be dismissed from care by close of business on 2/27/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter. A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings).

The file for child #4 contains 0 DTAP, HIB, Pneumococcal and Polio vaccinations when 1 of each is recommended by the ACIP.

Corrected Corrected by Mar 1, 2023

Category: health medication. Marked corrected in the state record.

3270.133(3) · The label of a medication container shall identify the name of the medication and the name of the child for whom the medication is intended. Medication shall be administered to only the child whose name appears on the container.

In Room #6, observed triple antibiotic in the first aid kit which lacked a label with the name of the child for whom the medication was intended.

Corrected Corrected by Mar 1, 2023

Category: health medication. Marked corrected in the state record.

3270.133(6) · A parent shall provide written consent for administration of medication or a special diet.

The Epi Pens for children #5 and 6 lacked parental consent for administration.

Corrected Corrected by Mar 1, 2023

Category: ratio. Marked corrected in the state record.

3270.151(a)/3270.192(3) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

There was more than 24 months between the previous and most current and updated health assessment on file for staff #1 and 9. The file for staff #6 lacked an health assessment on or before initial start date in a child care position. SEE LIS CODE SHEET. There is now a current health assessment on file.

Corrected Corrected by Mar 1, 2023

Category: ratio. Marked corrected in the state record.

3270.151(c)(2)/3270.192(3) · An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The file for staff #9 lacked a TB test within 12 months prior to providing initial service in a child care setting. SEE LIS CODE SHEET. There is now a current TB test on file and dated 1/20/22.

Corrected Corrected by Mar 1, 2023

Category: health medication. Marked corrected in the state record.

3270.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The health assessment for staff #3 did not include an examination for communicable diseases and the results of that examination.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.21 · Conditions at the facility may not pose a threat to the health or safety of the children.

A pair of sharp, adult scissors were observed in a storage container that was accessible and posed a threat to the health and safety of the children in room #6.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.31(e)(4)(i) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.

Staff #7 renewed their certification in pediatric first aid and pediatric CPR on 6/10/2021, following the expiration of their previous certification in 3/2021.

Corrected Corrected by Feb 1, 2022

Category: ratio. Marked corrected in the state record.

3270.31(e)(4)(ii) · Staff persons shall participate, at least annually, in fire safety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.

Staff #8 did not participate, at least annually, in fire safety training. Staff #13 did not participate, at least annually, in fire safety training between 09/29/2020 and 10/11/2021. Staff #19 did not participate, at least annually, in fire safety training between 12/11/2020 and 1/7/2022. Staff #20 did not participate, at least annually, in fire safety training between 9/22/2020 and 10/7/2021.

Corrected Corrected by Feb 7, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development in the following topics within 90 days of hire:

Staff person #18 completed professional development in the following health and safety training topics: 3270.31(f) (1-10) on 6/26/2021, more than 90 days following their first day working in child care on 3/15/2021.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

The record for staff #5 included an FBI clearance dated 2/19/2021, more than 60 months following previous FBI clearance dated 9/16/2015. The record for staff #15 included poof of fingerprinting and FBI clearance dated 10/8/2021, which was following their first day working in child care on 10/5/2021.

Corrected Corrected by Jan 20, 2022

Category: background checks. Marked corrected in the state record.

3270.65 · Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.

In room #6, a 6-outlet adapter was plugged in to the electrical outlet in the wall accessible to children 5 years of age and younger and receptacle covers were not placed in the 5 unused outlets on the adapter.

Corrected Corrected by Jan 20, 2022

Marked corrected in the state record.

3270.66(a) · Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

A sensory bottle containing baby oil, which is a toxic material, was observed on a shelf accessible to children in room #7 and it was not secured with a child-proof lid.

Corrected Corrected by Jan 20, 2022

Marked corrected in the state record.

3270.66(a) · Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

A bottle of dry erase board cleaning spray labeled keep out of the reach of children was located on a cart accessible to children in room #8. A bottle of hand sanitizer labeled keep out of the reach of children was attached to the outside of a child's bookbag hanging on a coat hook accessible to children in room #6. In Room #1, a bottle of laundry detergent was observed in the lower cabinet accessible to children.

Corrected Corrected by Jan 20, 2022

Marked corrected in the state record.

3270.75(b) · A first-aid kit must be inaccessible to children.

In Room #11, the first aid kit was hanging on a low hook making the first aid kit accessible to children.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.81 · A visual strip or other visual identification shall be placed on glass located in a traffic area, a child care space or a play space.

In Room #2, the glass door did not have a visual strip or visual identification placed on the glass door located in a traffic area.

Corrected Corrected by Jan 21, 2022

Category: physical safety. Marked corrected in the state record.

3270.82(i) · A toilet area, training chair area, diapering area and sink area shall be equipped with a clean, lidded waste receptacle.

The bathroom used for toileting and diapering children in room #8 and #9 was not equipped with a lidded waste receptacle.

Corrected Corrected by Jan 21, 2022

Category: health medication. Marked corrected in the state record.

3270.102(a) · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

A cracked blue plastic bin with sharp corners was located in Room #11, and broken plastic laundry baskets were located in Room #5 were not in good repair.

Corrected Corrected by Jan 20, 2022

Category: physical safety. Marked corrected in the state record.

3270.103 · Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

In Room #10, foam building blocks were observed to have bite marks and accessible to children who are still placing objects in their mouths.

Corrected Corrected by Jan 20, 2022

Marked corrected in the state record.

3270.113(a) · Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

At approximately 9:52am on January 20, 2022, in room #1, staff #1 and #2 were unable to see and properly supervise children in their assigned group from their positions on the other side of the room with Staff #1 back turned to the children, while Staff #2 vision was obstructed from view of the children, being that one child was on the opposite side of the room and the other one was napping behind a crib.

Corrected Corrected by Jan 20, 2022

Category: supervision. Marked corrected in the state record.

3270.124(b)(4)/3270.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The emergency contact information for child #1 did not include the written consent signed by a parent for emergency medical care.

Corrected Corrected by Feb 1, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.131(d)(7) · A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

The health report for child #2 did not include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Corrected Corrected by Jan 24, 2022

Category: health medication. Marked corrected in the state record.

3270.131(e)(1) · The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

The most recent immunization record for child #2 did not include MMR, Varicella, and Hepatitis A.

Corrected Corrected by Jan 24, 2022

Category: health medication. Marked corrected in the state record.

3270.133(2) · A staff person shall administer a prescription medication only if written instructions are provided from the individual who prescribed the medicine. Instructions for administration contained on a prescription label are acceptable.

There were no written instructions provided from the individual who prescribed an Epinephrine auto injector in room #10 and #11 .

Corrected Corrected by Feb 1, 2022

Category: ratio. Marked corrected in the state record.

3270.133(4) · Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

In Room #11, an Epinephrine auto-injector was not stored in a locked area or an area that is out of the reach of children.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.133(7) · An operator is responsible to establish and maintain a medication log if prescription or nonprescription medication is administered.

The operator did not establish and maintain a medication log for prescription or nonprescription medication being administered.

Corrected Corrected by Jan 24, 2022

Category: health medication. Marked corrected in the state record.

3270.135(a)(3) · If disposable diapers are provided by a parent or by a facility, a soiled diaper shall be discarded by immediately placing the diaper into a plastic-lined, hands-free covered can.

Soiled diapers were not being discarded in a hands-free covered can in the bathroom used for diapering children in room #8 and #9.

Corrected Corrected by Jan 21, 2022

Category: health medication. Marked corrected in the state record.

3270.151(a)/3270.192(3) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The record for staff #7, #8 and #19 included a current health assessment dated more than 24 months following the date of their previous health assessment. The record for staff #11 included a health assessment and results of tuberculosis screening dated more than 12 months prior to providing initial service in a child care setting. The record for staff #16 included a current health assessment dated following providing initial service in a child care setting. The health assessment for staff #3, #11 and #16 included results of tuberculosis screening dated more than 12 months prior to providing initial service in a child care setting.

Corrected Corrected by Jan 20, 2022

Category: ratio. Marked corrected in the state record.

3270.151(c)(3)/3270.153 · An adult health assessment must include an examination for communicable diseases and the results of that examination. A facility person with symptoms of a communicable disease or infection that can be transmitted directly or indirectly and which may threaten the health of children in care shall be excluded from attendance until the facility operator receives notification from a physician or CRNP that the person is no longer considered a threat to the health of others. The notification shall be retained in the facility person's file. Exclusion from the facility is required for diseases and conditions specified in 28 Pa. Code Chapter 27 (relating to communicable and noncommunicable diseases).

The health assessment for staff #12 indicated they had a communicable disease and their record does not include notification from a physician or CRNP that the person is no longer considered a threat to the health of others.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.151(c)(5) · An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

The health assessment for staff #10 did not include the physician's or CRNP's assessment of the person's suitability to provide child care.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.

3270.182(5) · A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The record for child #1 did not contain signed parental consent for administration of minor first-aid procedures by facility staff.

Corrected Corrected by Feb 1, 2022

Category: ratio. Marked corrected in the state record.

3270.27(a)(5) · The facility shall have an emergency plan that provides for accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

The facility's emergency plan did not provide accommodations for infants and toddlers.

Corrected Corrected by Jan 20, 2022

Category: physical safety. Marked corrected in the state record.

3270.31(f)(10) · Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire.

Staff #4 completed professional development in pediatric first aid and pediatric CPR on 9/27/2021, more than 90 days following hire on 3/23/2021. Staff #17 completed professional development in pediatric first aid and pediatric CPR on 9/27/2021, more than 90 days following hire on 6/15/2021.

Corrected Corrected by Jan 20, 2022

Category: health medication. Marked corrected in the state record.