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.

Medications (Ibuprofen and Anti-Monkey Butt w/Calamine) in the 2YO room were not labeled for the children for whom the medications were intended.

Corrected Corrected by Aug 21, 2024

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

3270.14/3270.21 · A facility shall be operated in conformity with applicable Federal and State laws and regulations.State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children.

The facility's emergency plan did not provide for the continuity of operations. The operator's policy and procedure to identify the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment did not address the identification and prevention of child maltreatment, as per Announcement C-22-03.

Corrected Corrected by Sep 27, 2024

Category: ratio. 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.

Loose sheets were observed in a crib, which posed a potential suffocation risk for the infant who was using the equipment.

Corrected Corrected by Aug 20, 2024

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

3270.27(d) · The operator shall post the emergency plan in the facility at a conspicuous location.

The emergency plan was not posted in the facility.

Corrected Corrected by Aug 21, 2024

Category: physical safety. 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 operator did not provide to the parent of each enrolled child a letter explaining the emergency procedures.

Corrected Corrected by Sep 27, 2024

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

3270.67(d) · Trash that has been contaminated by human secretions or excrement shall be contained in closed, plastic-lined receptacles.

Trash that appeared to have been contaminated by human secretions was contained in a plastic-lined receptacle that was not closed.

Corrected Corrected by Aug 28, 2024

Marked corrected in the state record.

3270.71 · Hot water pipes and other sources of heat exceeding 110° F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

A toaster on the counter in the preschool room was plugged in and accessible to children in care.

Corrected Corrected by Aug 20, 2024

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

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

Written consent for administration of medications (Ibuprofen and Anti-Monkey Butt w/Calamine) observed in the 2YO room were not provided by a parent.

Corrected Corrected by Aug 21, 2024

Category: ratio. Marked corrected in the state record.

3270.91(a) · Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

A door in the infant room that exits to the outside of the building was unable to be opened due to the mulch on the ground outside the door. The hallways throughout the facility that lead from the rooms to the exits from the facility were obstructed with furniture and equipment (2 children's tables, 3 adult benches, a playhouse, 3 cribs, a rocking chair, an infant seat, a toy storage bench, a children's bookshelf, a drying rack, a large storage tub containing blocks and multiple boxes/storage containers of supplies.)

Corrected Corrected by Sep 27, 2024

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.

A plastic storage bin that was cracked with a rough edge was observed under a bench in the hallway, accessible and posing a potential hazard to children in care.

Corrected Corrected by Aug 20, 2024

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.

There were (2) large stuffed animals with removeable eyes and labeled for use by children ages 3 and up observed in the infant room, accessible to children under age 3.

Corrected Corrected by Aug 20, 2024

Marked corrected in the state record.

3270.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Emergency contact information for child #1 did not include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Corrected Corrected by Sep 27, 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.

Emergency contact information for child #1 did not include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Aug 21, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.131(b)(1)/3270.182(1) · The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler. A child's record shall contain initial and subsequent health reports.

The record for child #2 lacked a current health report.

Corrected Corrected by Sep 27, 2024

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 #1 included a current health assessment dated more than 24 months following the date of their previous health assessment.

Corrected Corrected by Aug 20, 2024

Category: ratio. 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 #1 will have until 9/9/2023 to complete the required training. Until such time as the required training has been completed, staff person #1 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 #1, staff person #1 may not work in a child-care position at the facility.

Staff person #1 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Get Started with Center-based Care: Building Blocks for Quality.

Corrected Corrected by Aug 9, 2023

Category: supervision. Marked corrected in the state record.

3270.76 · Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

There were 2 missing toilet bolt covers on the toilet in the Green Square toilet stall in the preschool bathroom.

Corrected Corrected by Aug 9, 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.

There was a cracked bin with sharp edges in the toddler room containing play people figures.

Corrected Corrected by Aug 7, 2023

Category: physical safety. 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.

During a supervision assessment at 1:50 PM, naptime, a young toddler was observed sleeping with a blanket covering her face, so that she was not being properly supervised.

Corrected Corrected by Aug 8, 2023

Category: supervision. Marked corrected in the state record.

3270.123(a)(3) · The services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. The operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information in § 3270.124(f) (relating to emergency contact information).

The child service report on file for Child #2 is not dated, so it is unknown if it was completed timely.

Corrected Corrected by Aug 8, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The emergency contact form on file for Child #1 does not include the child's policy number for the child's health care benefits.

Corrected Corrected by Aug 9, 2023

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

3270.131(b)(2)/3270.182(1) · The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child. A child's record shall contain initial and subsequent health reports.

The two most recent health assessments on file for Child #3, who is a preschool age child, are dated 3/10/22 and 7/12/23, more than 1 year apart.

Corrected Corrected by Aug 7, 2023

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

3270.131(d)(5)/3270.131(e)(3) · 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). ·Child #2 must be dismissed from care by close of business on 8/7/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The immunization record on file for Child #2, who is 20 months old, does not include a current influenza vaccination, recommended annually by the ACIP for a child this age.

Corrected Corrected by Aug 9, 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.

There was a bottle of liquid Tylenol in the Baby Land classroom labeled for use by child #2 which did not have written parental permission to administer.

Corrected Corrected by Aug 8, 2023

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 #2 does not include 2 written non-family references attesting to the staff person's suitability to work in child care.

Corrected Corrected by Aug 9, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.14/3270.21 · A facility shall be operated in conformity with applicable Federal and State laws and regulations.State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation.Conditions at the facility may not pose a threat to the health or safety of the children.

The current emergency plan on file does not include the required updated of volunteer emergency preparedness training and continuity of operations, which were required as of 7/1/22, as per Announcement C-22-04.

Corrected Corrected by Oct 5, 2022

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 person #2 includes a signed disclosure statement that is not dated, making it invalid.

Corrected Corrected by Aug 19, 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.

There was an outlet cover missing on the 2 year old room in the dramatic play area.

Corrected Corrected by Aug 19, 2022

Marked corrected in the state record.

3270.76 · Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

There was a fence pole in the upper corner of the outside play space that did not have a cap on it, with sharp edges on the exposed metal pipe and a sharp metal fence wire sticking up several inches from the middle of the fence pole.

Corrected Corrected by Aug 25, 2022

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.

There was no handwashing sign at the first sink in the first bathroom.

Corrected Corrected by Aug 19, 2022

Category: health medication. 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 on file for Child #1 does not include the work address or telephone number for the enrolling parent.

Corrected Corrected by Aug 25, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.131(b)(2) · The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

The most recent health assessment on file for Child #4, who is 3 years old, is dated 2/24/21, more than 12 months ago.

Corrected Corrected by Aug 25, 2022

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

3270.131(d)(5)/3270.131(e)(1) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP.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 current immunization record on file for Child # 2, who is 16 months old, includes 3 of 4 Pneumococcal vaccinations recommended for a child this age by the ACIP. The most recent influenza vaccination on file for Child #4, who is 3 years old, is dated 11/14/19, more than 1 year ago, which is recommended annually by the ACIP.

Corrected Corrected by Nov 16, 2022

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

3270.131(e)(2)(i) · Exemption from immunization for religious belief or strong personal objection equated to a religious belief shall be documented by a written, signed and dated statement from the child's parent or guardian. The statement shall be kept in the child's record.

The file for Child #3, who has no immunizations, does not include a written exemption from the parent, citing a religious belief or strong personal objection equating to a religious belief.

Corrected Corrected by Aug 25, 2022

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

3270.94(a)(1) · The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that fire drills are conducted at least once every 60 days.

According to the submitted fire drill log, fire drills were held on 12/23/21 and 3/1/22; and 9/23/21 and 11/24/21, more than 60 days apart.

Corrected Corrected by Aug 19, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.95(a)/3270.95(b) · 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 Director or designated staff person who is responsible for compliance with this chapter shall ensure the requirements under subsection (a) are met.

According to the submitted 30 day test log for the interconnected smoke detectors, the detectors were tested on 10/19/21 and 11/19/21, more than 30 days apart.

Corrected Corrected by Aug 19, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.95(a)/3270.95(b) · 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 Director or designated staff person who is responsible for compliance with this chapter shall ensure the requirements under subsection (a) are met.

The fire detection system 30 day test log included 30 day tests dated 3/19/21 and 4/29/21, more than 30 days apart; and 5/26/21 and 7/20/21, more than 30 days apart.

Corrected Corrected by Oct 14, 2021

Category: recordkeeping. 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. Facility Person #1 may not work in a child care position at the facility.

The current criminal history clearance on file for Staff person #1, with an application date of 1/3/20, did not include the dissemination date and stated it was still under review.

Corrected Corrected by Aug 25, 2021

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.

There was peeling paint on the yellow spiral ladder on the play structure on the outside playground.

Corrected Corrected by Aug 25, 2021

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

3270.131(d)(5)/3270.131(e)(1) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP.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 influenza vaccination on file for Child #1 is dated 1/28/19, more than 1 year ago. The most recent influenza vaccination on file for Child #2 is dated 11/28/16, more than 1 year ago. The most recent influenza vaccination on file for Child #3 is dated 12/13/19, more than 1 year ago.

Corrected Corrected by Aug 30, 2021

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 most recent health assessment on file for Staff person #1, dated 4/7/20, is dated more than 24 months after the previous health assessment, dated 2/19/18.

Corrected Corrected by Aug 25, 2021

Category: ratio. Marked corrected in the state record.

3270.151(c)(3)/3270.192(3) · An adult health assessment must include an examination for communicable diseases and the results of that 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 current health assessment on file for Staff person #1 and #2 does not include information that the staff person was examined for communicable disease.

Corrected Corrected by Sep 24, 2021

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

3270.151(c)(5)/3270.192(3) · An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.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 current health assessment on file for Staff person #1 and #2 does not include the health care professional's assessment that the staff person is suitable to provide child care.

Corrected Corrected by Sep 24, 2021

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

3270.27(a)(1) · The facility shall have an emergency plan that provides for accommodations for shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises.

The emergency plan was updated to include lock down procedures on 6//19/21, after the 12/19/20 deadline for the required updates.

Corrected Corrected by Aug 25, 2021

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

3270.27(a)(2) · The facility shall have an emergency plan that provides for accommodations for evacuation of children from the facility building and evacuation of children to a location away from the facility premises. The evacuation routes and evacuation plans to exit the building may be the same as those required by §3270.94 (relating to fire drills).

The emergency plan was updated to include accommodations for infants, toddlers, children with disabilities and children with chronic medical conditions on 6//19/21, after the 12/19/20 deadline for the required updates.

Corrected Corrected by Aug 25, 2021

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