3280.124(b)(5) · Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation.

The Emergency contact form on file for Child #2 was observed not to include information on the child's special needs.

Corrected Corrected by Jul 18, 2024

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

3280.14/3280.20 · 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 have documentation to address continuity of operations. The facility was observed to not have a written policy for recognition of potential signs/symptoms of shaken baby syndrome and abusive head trauma, strategies for coping with a crying fussing or distraught child and prevention and identification of child maltreatment.

Corrected Corrected by Jul 15, 2024

Category: ratio. Marked corrected in the state record.

3280.75(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.

The red first-aid kit above the cupboard in the kitchen was observed not to contain scissors and tape. The green first- aid kit was observed not to contain scissors and soap.

Corrected Corrected by Jul 18, 2024

Marked corrected in the state record.

3280.102(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 broken plastic container was observed in the outdoor play area.

Corrected Corrected by Jul 15, 2024

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

3280.105(a) · Individual, clean, age-appropriate rest equipment shall be provided for preschool, toddler and infant children as agreed between the child's parent and the operator. The rest equipment shall be labeled for the use of a specific child and used only by the specified child.

It was observed that the sleeping equipment was not labeled for the use of a specific child and used only by the specified child.

Corrected Corrected by Jul 15, 2024

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

3280.124(b)(4)/3280.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The emergency contact form on file for Child #1 was observed not to contain signed parental consent for emergency medical care for the child.

Corrected Corrected by Jul 18, 2024

Category: recordkeeping. Marked corrected in the state record.

3280.124(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 form on file for Child #2 and Child #3 were observed not to have the address of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Jul 18, 2024

Category: recordkeeping. Marked corrected in the state record.

3280.95(a)/3280.95(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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met.

The facility's fire drill log was observed not to be testing the facility smoke detectors every 30 days. This is evidenced by the dates of 2/20/24 to 3/26/24 and 5/9/24 to 6/17/24.

Corrected Corrected by Jul 18, 2024

Category: recordkeeping. Marked corrected in the state record.

3280.14/3280.20 · 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 operator lacked updated sections in their emergency plan that addresses volunteer emergency preparedness training and the operators plans for continuity of operations in response to an emergency to maintain compliance with 45 CFR § 98.41(a)(1)(vii) per Announcement C-22-04.

Corrected Corrected by Jun 29, 2023

Category: ratio. Marked corrected in the state record.

3280.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Staff file #2 contained Mandated Reporter certificates dated 4/19/18 and 5/16/23 which exceeded the 60 months as required for a valid mandated reporter certificate.

Corrected Corrected by Jun 29, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.32(a)/3280.192(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 Persons #3 and #4 may not work in a child care position at the facility.

Volunteer file #3 contained a PDE FBI letter dated 2/7/20 which is not acceptable as a valid DHS FBI Clearance and lacked a copy of the signed Volunteer Disclosure statement in the file. (See LIS CODE SHEET) Staff file #4 lacked a copy of the request for the NSOR Verification Certificate prior to hire at the facility. (See LIS CODE SHEET)

Corrected Corrected by Jul 31, 2023

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

3280.91(a) · Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

The emergency exit from the dining room through the basement door was obstructed with paint cans and buckets on the landing.

Corrected Corrected by Jun 29, 2023

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

3280.123(a)(5)/3280.123(a)(6) · An agreement shall specify the persons designated by a parent to whom the child may be released. An agreement shall specify the date of the child's admission.

Child files #2 and #4 lacked the persons designated by the parents to whom the child may be released and the child's admission date on the agreement forms.

Corrected Corrected by Jun 29, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.124(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.

Child file #1 lacked the health insurance coverage and policy number for the child on the emergency contact form.

Corrected Corrected by Jun 29, 2023

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

3280.124(f)/3280.181(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.

Child files #1, #2, and #3 lacked documentation of review of the emergency contact and the agreement forms by the parent every 6 months or when information has changed.

Corrected Corrected by Jun 30, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.131(d)(5)/3280.131(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). Children #1, #2 and #3 must be dismissed from care by close of business 6/21/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Child file #1 lacked documentation of receipt of the influenza vaccination according to the schedule recommended by the ACIP. Child file #2 has documentation of the following vaccines required: 2 of 3 Hepatitis B, 3 of 4 DTAP, 0 of 4 HIB, 1 of 4 Pneumococcal, 1 of 4 Polio, and no documentation of the following vaccines: Influenza, MMR, Varicella, and Hepatitis A based on the child's age and according to the schedule recommended by the ACIP. (See LIS CODE SHEET) Child file #3 lacked documentation of receipt of the influenza vaccination according to the schedule recommended by the ACIP.

Corrected Corrected by Jun 29, 2023

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

3280.133(6)/3280.133(7) · A parent shall provide written consent for administration of medication or a special diet. An operator is responsible to establish and maintain a medication log if prescription or nonprescription medication is administered.

The facility had a prescription medication for use for Child #5 without a medication log and written parental consent for administration of the medication to the child.

Corrected Corrected by Jun 29, 2023

Category: ratio. Marked corrected in the state record.

3280.151(a) · 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.

Staff file #1 contained a health assessment dated 6/14/21 and lacked a valid updated health assessment conducted within 24 months.

Corrected Corrected by Jul 31, 2023

Category: ratio. Marked corrected in the state record.

3280.151(a)/3280.151(c)(2) · 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. 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.

Volunteer file #3 lacked a health assessment that included the results of TB screening prior to service at the facility.

Corrected Corrected by Jun 29, 2023

Category: ratio. Marked corrected in the state record.

3280.192(2)(ii) · A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Staff file #4 lacked documentation of education and child care experience in the file prior to hire.

Corrected Corrected by Jun 29, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.192(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.

Staff file #4 lacked copies of two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person in the file.

Corrected Corrected by Jun 29, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.61(h) · The capacity established for an indoor space may not be exceeded.

Upon arrival at the facility on 6/21/23, there were 3 staff and 12 children in the main room which exceeded the measured maximum capacity of 10 children.

Corrected Corrected by Jun 29, 2023

Category: ratio. Marked corrected in the state record.

3280.95(a)/3280.95(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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met.

The facility lacked documentation of testing of the fire detection system every 30 days as required by section 1016(c) of the act (62 P.S. §  1016(c))

Corrected Corrected by Jun 29, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.14/3280.20 · 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. Until such time as the required pre-service trainings are completed, staff person #4 must be supervised, when interacting with children, by a primary staff person who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person #4, staff person #4 may not work in a child-care position at the facility.

Staff person #4 was observed to be caring for children unsupervised. Staff person #4 has not completed the following pre-service training required prior to caring for children unsupervised: Get Started with Center Based Care

Corrected Corrected by Sep 8, 2022

Category: supervision. Marked corrected in the state record.

3280.34(c) · A primary staff person shall supervise the performance of a secondary staff person

Staff person #4 was observed to be alone with children and not supervised by a primary staff person.

Corrected Corrected by Sep 8, 2022

Category: supervision. Marked corrected in the state record.

3280.192(2)(ii) · A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Staff file #4 lacked documentation of child care experience prior to service at the facility.

Corrected Corrected by Sep 9, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.26(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.

All staff files reviewed lacked documentation of emergency plan training received since hire at the facility.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.32(a)/3280.192(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 #2 may not work in a child care position at the facility.

Staff file #2 contained the receipt for the PA state Police Criminal clearance but not the valid certificate.

Corrected Corrected by Jul 27, 2022

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

3280.52(c) · When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements at §3280.52(b). The required staff:child ratios must be maintained at all times.

Upon arrival at the facility, it was observed that there were 2 young toddlers, 1 older toddler and 5 preschool children napping in the sun room with no staff person present.

Corrected Corrected by Aug 12, 2022

Category: ratio. Marked corrected in the state record.

3280.102(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 were two toy bins in the sun room where children receive care that were cracked.

Corrected Corrected by Jul 27, 2022

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

3280.152 · A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

Staff person #1 did not wash their hands with soap and water after diapering the children.

Corrected Corrected by Aug 5, 2022

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

3280.113(a)/3280.113(a)(1) · 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. Children must be supervised at all times. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Upon arrival at the facility, it was observed that there were 2 young toddlers, 1 older toddler and 5 preschool children napping in the sun room with no staff person present.

Corrected Corrected by Jul 29, 2022

Category: supervision. Marked corrected in the state record.

3280.123(a)(6)/3280.182(2) · An agreement shall specify the date of the child's admission.A child's record must contain the dates of application, admission and withdrawal of the child.

Child file #2 lacked the admission date on the agreement form.

Corrected Corrected by Jul 29, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.124(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.

Child file #2 lacked the health insurance policy number on the emergency contact form.

Corrected Corrected by Jul 29, 2022

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

3280.124(f)/3280.181(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 informationA 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.

Child files #1, #3, #4, and #5 lacked a six month review and parental signature on the agreement and emergency contact form.

Corrected Corrected by Jul 29, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.134(a) · A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

Staff person #1 did not wash the children's hands with soap and water after diapering the children.

Corrected Corrected by Aug 5, 2022

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

3280.135(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.

The facility lacked a hands free covered can for disposing of soiled diapers at the diapering area.

Corrected Corrected by Jul 29, 2022

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

3280.94(a)(5) · The primary staff person or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that evacuation routes are posted in a conspicuous location on each floor of the facility.

The second floor of the facility which is not childcare space, lacked a copy of the evacuation routes posted.

Corrected Corrected by Jul 29, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.131(a) · The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.

Child file #4 contained an initial health assessment that was not for that child but for a sibling of the child.

Corrected Corrected by Aug 19, 2022

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

3280.136(b) · The operator shall inform parents of enrolled children when there is a suspected outbreak of a communicable disease or an outbreak of an unusual illness that represents a public health emergency in the opinion of the Department of Health.

The facility did not inform the parents of a suspected outbreak of a communicable disease.

Corrected Corrected by Jul 27, 2022

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

3280.32(a)/3280.192(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 #2 may not work in a child care position at the facility.

The file for staff person #2, whom began working with children on 6/16/21 as a secondary staff person, lacked an FBI clearance and an NSOR verification certificate.

Corrected Corrected by Sep 1, 2021

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

3280.75(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.

The first-aid kits in the kitchen cupboard and in the game closet did not contain soap.

Corrected Corrected by Sep 1, 2021

Marked corrected in the state record.

3280.108(a) · Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

The flat screen television in the living room was observed to not be strapped to the television stand posing a threat of it falling off the stand onto one of the children.

Corrected Corrected by Sep 1, 2021

Marked corrected in the state record.

3280.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

The file for child #2 lacked emergency contact information that included the telephone number of the child's physician.

Corrected Corrected by Sep 1, 2021

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

3280.124(b)(3) · Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

The files for children #1 and #3 lacked emergency contact information that included the work address and work phone numbers of the enrolling parent.

Corrected Corrected by Sep 1, 2021

Category: recordkeeping. Marked corrected in the state record.

3280.124(b)(4)/3280.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The file for child #3 lacked emergency contact information that included written consent signed by a parent for emergency medical care prior to admission.

Corrected Corrected by Sep 1, 2021

Category: recordkeeping. Marked corrected in the state record.

3280.124(b)(5) · Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation.

The file for child #1 lacked emergency contact information that included information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation.

Corrected Corrected by Sep 1, 2021

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

3280.124(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 file for child #3 lacked emergency contact information that included health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Corrected Corrected by Sep 1, 2021

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

3280.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The file for staff person #3 lacked a health assessment that included an examination for communicable diseases and the results of that examination.

Corrected Corrected by Sep 1, 2021

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

3280.151(c)(4)/3280.151(c)(5) · An adult health assessment must include information on medical problems that might threaten the health of the children or prohibit a staff person from providing adequate care to children. An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

The file for staff person #3 lacked a health assessment that included information on medical problems that might threaten the health of the children or prohibit a staff person from providing adequate care to children and the physician's or CRNP's assessment of the person's suitability to provide child care.

Corrected Corrected by Sep 1, 2021

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

3280.182(5) · A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The file for child #3 lacked signed parental consent for administration of minor first-aid procedures by facility staff prior to admission.

Corrected Corrected by Sep 1, 2021

Category: ratio. Marked corrected in the state record.

3280.192(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 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. There was one reference letter in the file.

Corrected Corrected by Sep 1, 2021

Category: recordkeeping. Marked corrected in the state record.

3280.151(c)(2)/3280.192(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 person #1 lacked a tuberculosis screening by the Mantoux method at initial employment.

Corrected Corrected by May 19, 2021

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

3280.26(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.

It was observed that the facility did not have an emergency plan that provided accommodations for infants, toddlers, children with disabilities and children with chronic medical conditions.

Corrected Corrected by May 17, 2021

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

3280.26(a)(1) · The facility shall have an emergency plan that provides 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.

It was observed the facility had an emergency plan that did not provide 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.

Corrected Corrected by May 19, 2021

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