Carol Leone Gymnastics And Daycare

3270.182(7) · A child's record shall contain reports of accidents, injuries and illnesses involving a child in care at the facility. The original report shall be given to the parent on the day of the incident. The second copy of the report shall be retained at the facility in an accident file. The third copy of the report shall be retained at the facility in the child's file.

The parent of Child #1 did not receive an Incident Report on 8.26.25, following a noticed bruise on Child #1.

Corrected by Sep 23, 2025

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

The file for Staff #6 (see IS Code Sheet) contained an NSOR Certificate dated 8.5.25, which exceeded the start date with children. The file for Staff #8 contained NSOR Certificates dated 9.25.19 and 4.9.25, which exceeded the 60-month renewal requirement. The file for Staff #9 contained FBI Clearances dated 2.12.19 and 3.18.24, and NSOR Certificates dated 11.1.19 and 11.5.24, which exceeded the 60-month renewal requirement. The file for Staff #10 (see IS Code Sheet) contained an NSOR Certificate dated 7.30.25, which exceeded the start date with children. The file for Staff #11 (see IS Code Sheet) contained an NSOR Certificate dated 3.13.25, which exceeded the start date with children. The file for Staff #13 (see IS Code Sheet) contained an NSOR Certificate dated 3.18.25, which exceeded the start date with children. The file for Staff #14 contained Child Abuse Clearances dated 9.28.19 and 4.18.25, FBI Clearances dated 10.2.19 and 10.25.24, and NSOR Certificates dated 11.1.19 and 4.9.25, which exceeded the 60-month renewal requirement. The file for Staff #16 contained Child Abuse Clearances dated 7.8.19 and 8.1.24, and NSOR Certificates dated 11.21.19 and 4.10.25, which exceeded the 60-month renewal requirement. The file for Staff #18 (see IS Code Sheet) contained an NSOR Certificate dated 3.25.25, which exceeded the start date with children. The file for Staff #19 contained NSOR Certificates dated 11.6.19 and 4.10.25, which exceeded the 60-month renewal requirement. The file for Staff #23 contained FBI Clearances dated 12.31.18 and 2.13.24, and NSOR Certificates dated 10.9.19 and 12.9.24, which exceeded the 60-month renewal requirement. The file for Staff #24 contained NSOR Certificates dated 9.29.19 and 4.10.25, which exceeded the 60-month renewal requirement.

Corrected by Sep 18, 2025

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

In the Staff Lounge Room, a power strip which was located to the left of Drawer #1, was missing three (3) of the six (6) receptacle covers, which were accessible to children 5 years of age or younger. In the Indoor Gym, two (2) outlet covers were missing from the outlet to the left of the mirror wall, which were accessible to children 5 years of age or younger.

Corrected by Sep 18, 2025

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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.

In an unlocked cupboard in the Dragonfly A Room, the following toxics were accessible to children: 2 Oxi-Clean Carpet & Rug Spray (24 oz. each), 2 Dawn Dishwashing Liquid (5.8 oz. and 90 oz.), Sani Save Cleaner Spray, Clorox Wipes (1 lb. 7oz.), Lysol Cleaner Spray (32 oz.), 2 Windex Spray (23 oz. and 32 oz.), Members Mark Hand Soap (80 oz.), Super Sorb (12 oz.), Oxy-Steam Carpet (96 oz.), Scrubbing Bubbles (25 oz.), and 70% Isopropyl Alcohol (32 oz.), all of which stated, "Keep out of reach of children." In an unlocked drawer in the Staff Lounge Room, the following toxics were accessible to children: Diluted Bleach and Sani Save, which stated, "Keep out of reach of children."

Corrected by Sep 17, 2025

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3270.66(b) · Cleaning materials and other toxic materials shall be stored in an original labeled container or in a container that specifies the content. Toxics shall be stored away from food, food preparation areas and child care spaces.

In the white cupboard, on the back wall in the Caterpillar Room, there was a spray bottle marked Changing Table, with unknown contents.

Corrected by Sep 18, 2025

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

In the Dragonfly A Room, the first-aid kit was located in a drawer with a broken latch, which made the first-aid kit accessible to children. In the Staff Lounge Room, the first-aid kit was located in unlocked drawer #4, which was accessible to children.

Corrected by Sep 17, 2025

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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.

In the Staff Lounge Room, on the blue wall, peeling wallpaper was located near the baseboard.

Corrected by Sep 18, 2025

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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 Roly Polies Nap Room, on the left side of the wall, white paint was flaking near the baseboard.

Corrected by Sep 23, 2025

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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.

A handwashing sign was not posted at the toilet in the Bumble Bee Annex restroom.

Corrected by Sep 18, 2025

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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 Grasshopper Room, in the clear, plastic bin containing Barbie Dolls, which was approximately 24" x 18", the plastic was broken, which created a scraping/cutting hazard for children in care.

Corrected by Sep 19, 2025

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

The file for Child #1 did not include the enrolling parent's work phone number.

Corrected by Sep 18, 2025

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3270.133(6)/3270.133(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.

In the Dragonfly B Room, the Medication Log for Child #2 had expired, and the medication was still available for administering to the child, without valid, written parental consent.

Corrected by Sep 19, 2025

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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 two (2) most recent Health Assessments in the file for Staff #9, Staff #12, and Staff #22 exceeded the 24-month renewal requirement.

Corrected by Sep 17, 2025

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3270.31(e)/3270.192(2)(iii) · A staff person shall obtain an annual minimum of 12 clock hours of child care training. 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 #1 contained documentation of four (4) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #2 contained documentation of two (2) hours of child care training between 11.4.23 and 11.3.24, which did not meet the annual minimum of 12 hours. The file for Staff #3 contained documentation of four (4) hours of child care training between 12.19.23 and 12.18.24, which not meet the annual minimum of 12 hours. The file for Staff #5 contained documentation of two (2) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #7 contained documentation of two (2) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #8 contained documentation of three (3) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #9 contained documentation of eight (8) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #14 contained documentation of four (4) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #16 contained documentation of four (4) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #17 contained documentation of eight (8) hours of child care training between 11.8.23 and 11.7.24, which did not meet the annual minimum of 12 hours. The file for Staff #19 contained documentation of seven (7) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #20 contained documentation of one (1) hour of child care training between 8.25.24 and 8.24.25, which did not meet the annual minimum of 12 hours. The file for Staff #21 contained documentation of six (6) hours of child care training between 8.1.24 and 7.31.25, which did not meet the annual minimum of 12 hours. The file for Staff #22 contained documentation of two (2) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours. The file for Staff #23 contained documentation of four (4) hours of child care training between 12.19.23 and 12.18.24, which did not meet the annual minimum of 12 hours.

Corrected by Sep 17, 2025

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

Based on discussion with staff and video evidence, on 7/16/2025, staff #1 picked child #1 up off the floor by their arm and carried the child by the arm approximately 3 to 4 yards to another area of the classroom. This occurred after Child #1 was believed to have bitten or pinched another child in the classroom.

Corrected by Jul 17, 2025

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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. Until such time as the required pre- service trainings are completed, staff persons #1 and #2 must be supervised, when interacting with children at a minimum by, an AGS, who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #1 and #2, staff persons #1 and #2 may not work in a child-care position at the facility.

Staff persons #1 and #2 were observed to be caring for children together in the Bumblebees Annex classroom unsupervised. Staff person #1 has not completed the following pre- service training required prior to caring for children unsupervised: Pediatric first aid and pediatric CPR Staff person #2 has not completed the following pre- service training required prior to caring for children unsupervised: Pediatric first aid and pediatric CPR, mandated reporter and health and safety topics

Corrected by Jul 21, 2025

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3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10 or (g)1-10. Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children at a minimum by, an AGS who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) 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): Pediatric first-aid/CPR training.

Corrected by Apr 14, 2025

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3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to Child Protective Services). Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children at a minimum by, an AGS who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) 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 mandated reporter training within 90 days of their date of hire (see LIS code sheet).

Corrected by Mar 23, 2025

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3270.51 · When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30.

During the supervision and ratio check a sleeping infant aged child was left in the Rolly Polly Left side room sleeping alone, while staff person was in Rolly Polly Right side room with 3 other infants. This made the ratio in the Rolly Polly Left side room 0:1.

Corrected by Feb 18, 2025

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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 the supervision and ratio check a sleeping infant aged child was left in the Rolly Polly Left Side room sleeping alone, while staff person was in Rolly Polly Right Side room with 3 other infants. This left the child in the Rolly Polly Left Side Room unsupervised.

Corrected by Feb 18, 2025

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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.

Staff #1 put his arms and upper body over child #1 to restrict his movement on his cot.

Corrected by Feb 18, 2025

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3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Staff #7, Staff #9, Staff #17, and Staff #18 may not work in a child care position at the facility.

The file for Staff #3 (see IS Code Sheet) contained an NSOR Certificate dated 4.8.24, with no application available, which exceeded the first date of working with children. The file for Staff #7 (see IS Code Sheet) contained an NSOR application dated 7.8.24, which exceeded the first date of working with children. The files for Staff #7 (see IS Code Sheet) and Staff #9 (see IS Code Sheet) did not contain any out-of-state clearances, and the 45-day provisional hire period has been exceeded. The file for Staff #10 (see IS Code Sheet) contained an FBI Clearance dated 4.5.24, and an NSOR Certificate dated 5.20.24, with no application available, which exceeded the first date working with children. The file for Staff #13 contained Child Abuse Clearances dated 4.26.19 and 5.1.24, which exceeded the 60-month renewal requirement. The file for Staff #17 contained an invalid FBI Clearance dated 8.19.24, as it was not issued by DHS, and the previous one dated 9.3.19 has expired. The file for Staff #18 did not contain a valid FBI Clearance.

Corrected by Oct 14, 2024

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3270.74 · The telephone number of the nearest hospital, police department, fire department, ambulance and poison control center shall be posted by each telephone in the facility.

Emergency telephone numbers were not posted by the telephone in the Dance Floor room.

Corrected by Sep 27, 2024

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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.

The First-Aid kit, located in the Dance Floor room, did not contain band-aids.

Corrected by Sep 27, 2024

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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.

Sharp, loose wire, at the bottom of the fence along the road-side, in the Infant Play Area, created a scraping/cutting hazard for children in care. A hole was located on the surface of the Infant Play Area, which created a tripping hazard for children in care.

Corrected by Nov 22, 2024

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

Peeling paint was located by the door frames in the Toddler Play Area.

Corrected by Nov 22, 2024

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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.

Mats, located in the Dance Floor room, contained rips and exposed foam, which were not in good repair.

Corrected by Sep 27, 2024

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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.

Several small stones, less than 1 inch in diameter, were located in the Toddler Play Area, and were accessible to children who are still placing objects in their mouths.

Corrected by Sep 27, 2024

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3270.123(a) · An agreement shall be signed by the operator and the parent.

The Agreement, in the file for Child #5, did not contain the signature of the operator.

Corrected by Sep 30, 2024

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

The Agreement, in the file for Child #1, did not specify the child's arrival or departure times.

Corrected by Sep 30, 2024

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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, in the files for Child #2 and Child #3, did not contain the phone number of the child's physician or source of medical care.

Corrected by Sep 30, 2024

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3270.124(e) · A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency shall be displayed conspicuously in every child care space and shall accompany a staff person who leaves on an excursion with children.

An Emergency Transportation Plan was not displayed in the Dragonfly A or Dance Floor rooms.

Corrected by Sep 27, 2024

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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 Health Assessment, in the file for Child #4, was dated 6.30.23, and none thereafter, which exceeded the 12-month requirement.

Corrected by Nov 22, 2024

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

In the Butterflies Room, expired medication was observed: Infant Tylenol which expired on 8/24, Equate Children's Pain Reliever which expired on 7/24, and Ibuprofen 100-Dye Free which expired on 6/24.

Corrected by Sep 27, 2024

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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 #18 (see IS Code Sheet) did not contain documentation of a tuberculosis screening at initial re-employment, as the one in the file is dated 6.3.16.

Corrected by Sep 30, 2024

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3270.31(e)/3270.192(2)(iii) · A staff person shall obtain an annual minimum of 12 clock hours of child care training. 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 #1 did not contain 12 hours of child care training during 12 months, as only 8 hours were documented from 12.19.22 to 12.18.23. The file for Staff #2 did not contain 12 hours of child care training during 12 months, as only 10 hours were documented from 12.19.22 to 12.18.23. The file for Staff #4 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #5 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 6.13.23 to 6.12.24. The file for Staff #6 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #8 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #11 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 5.23.23 to 5.22.24. The file for Staff #12 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #13 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #14 did not contain 12 hours of child care training during 12 months, as only 8 hours were documented from 12.19.22 to 12.18.23. The file for Staff #15 did not contain 12 hours of child care training during 12 months, as only 8 hours were documented from 12.19.22 to 12.18.23. The file for Staff #19 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #20 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #21 did not contain 12 hours of child care training during 12 months, as only 6 hours were documented from 12.19.22 to 12.18.23. The file for Staff #22 did not contain 12 hours of child care training during 12 months, as only 11 hours were documented from 8.30.23 to 8.29.24.

Corrected by Nov 29, 2024

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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.

The electrical box, mounted approximately 4' high, in Room #2-#3, had sharp, metal corners, creating a scraping/cutting hazard for children in care.

Corrected by Jul 22, 2024

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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 most recent Emergency Plan trainings in the files for Staff #1, Staff #2, Staff #4, Staff #8, Staff #9, Staff #10, Staff #11, Staff #16, Staff #19, Staff #21, Staff #24, Staff #28, and Staff #34 were dated 8.23.23, while the previous Emergency Plan trainings were dated more than a year prior to that date. The most recent Emergency Plan trainings in the files for Staff #3, Staff #5, Staff #6, Staff #7, Staff #12, Staff #13, Staff #14, Staff #17, Staff #18, Staff #20, Staff #25, Staff #26, and Staff #27 were dated 8.21.23, while the previous Emergency Plan trainings were dated more than a year prior to that date. The most recent Emergency Plan training in the file for Staff #15 was dated 8.18.23, while the previous Emergency Plan training was dated more than a year prior to that date. The most recent Emergency Plan training in the files for Staff #22 and Staff #29 were dated 8.28.23, while the previous Emergency Plan trainings were dated more than a year prior to that date. The most recent Emergency Plan training in the file for Staff #23 was dated 8.24.23, while the previous Emergency Plan training was dated more than a year prior to that date.

Corrected by Oct 6, 2023

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3270.107 · A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45° F or below. An operating thermometer shall be placed in the refrigerator.

A thermometer was not located in the refrigerator in the Staff Lounge, child care space.

Corrected by Oct 9, 2023

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3270.31(e)(4)(i)/3270.192(2)(ii) · 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 prior to service at the facility.

The file for Staff #33 contained documentation of Pediatric First-Aid/CPR training dated 4.2.21 and 9.1.23, which exceeded the renewal requirement.

Corrected by Oct 6, 2023

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

The file for Staff #2 (see IS Code Sheet) contained an NSOR Certificate dated 7.1.22, and an Application dated 6.24.22, which exceeded initial service. The file for Staff #5 (see IS Code Sheet) contained an NSOR Certificate dated 7.18.22 and an Application for the NSOR dated 6.9.22, and the Mandated Reporter training was dated 9.3.22 (see IS Code Sheet), which exceeded the requirements. The file for Staff #21 (see IS Code sheet) contained an FBI Clearance dated 11.10.17, which expired on 11.10.22, and was not renewed until 7.20.23, which exceeded the 60-month renewal requirement. The file for Staff #22 (see IS Code Sheet) contained an NSOR Certificate dated 11.21.19 and an NSOR Application dated 9.23.19, which exceeded initial service. The file for Staff #29 (see IS Code Sheet) contained an NSOR Certificate dated 6.21.22 and an NSOR Application dated 6.9.22, which exceeded initial service. The file for Staff #30 (see IS Code Sheet) contained a Child Abuse Clearance dated 11.15.22, which exceeded initial service. The file for Staff #33 (see IS Code Sheet) contained a Child Abuse Clearance dated 6.20.18, which expired on 6.20.23, and was not renewed until 7.25.23, which exceeded the 60-month renewal requirement. The FBI Clearance was dated 6.19.18, which expired on 6.19.23, and was not renewed until 7.20.23, which exceeded the 60-month renewal requirement.

Corrected by Oct 6, 2023

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3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The files for Staff #2, Staff #3, Staff #4, Staff #5, Staff #6, Staff #9, Staff #10, Staff #11, Staff #13, Staff #15, Staff #16, Staff #18, Staff #19, Staff #20, Staff #22, Staff #23, Staff #24, Staff #25, Staff #26, Staff #27, Staff #28, and Staff #29, (see IS Code Sheet) contained documentation of Staff Evaluations dated 8/2023, which exceeded the 12-month requirement, since the previous written evaluations were dated more than a year prior to the current written evaluations.

Corrected by Oct 9, 2023

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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.

Scissors were not located in the first-aid kit in Room 2/Annex.

Corrected by Oct 9, 2023

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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.

In Room 3/Butterflies, a handwashing sign was not posted at the toilet.

Corrected by Oct 9, 2023

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

The Agreement, in the file for Child #1, did not contain the arrival and departure times.

Corrected by Oct 9, 2023

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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 file for Staff #2 (see IS Code Sheet) contained a Health Assessment dated 9.12.22 and a Mantoux test reading on 9.9.22, which was beyond initial service. The file for Staff #3 contained Health Assessments dated 7.30.20 and 8.17.22, which exceeded the 24-month renewal requirement. The file for Staff #5 (see IS Code Sheet) contained a Health Assessment dated 8.7.22 and a Mantoux test reading on 9.4.22, which was beyond initial service. The file for Staff #7 contained Health Assessments dated 5.11.20 and 8.24.22, which exceeded the 24-month renewal requirement. The file for Staff #8 contained Health Assessments dated 7.9.20 and 9.12.22, which exceeded the 24-month renewal requirement. The file for Staff #10 contained Health Assessments dated 2.16.21 and 9.29.23, which exceeded the 24-month renewal requirement. The file for Staff #12 contained Health Assessments dated 6.3.21 and 7.31.23, which exceeded the 24-month renewal requirement. The file for Staff #19 contained Health Assessments dated 8.26.21 and 8.30.23, which exceeded the 24-month renewal requirement. The file for Staff #20 (see IS Code Sheet) contained a Health Assessment dated 9.19.22, and a Mantoux test reading dated 9.15.22, which was beyond initial service. The file for Staff #21 (see IS Code Sheet) contained a Health Assessment dated 8.30.22, and a Mantoux test reading on 8.30.22, which was beyond initial service. The file for Staff #22 contained Health Assessments dated 12.9.20 and 8.24.23, which exceeded the 24-month renewal requirement. The file for Staff #23 contained Health Assessments dated 6.11.20 and 9.13.22, which exceeded the 24-month renewal requirement. The file for Staff #26 contained Health Assessments dated 12.9.20 and 4.20.23, which exceeded the 24-month renewal requirement. The file for Staff #28 contained Health Assessments dated 2.23.21 and 7.20.23, which exceeded the 24-month renewal requirement. The file for Staff #29 (see IS Code Sheet) contained a Health Assessment and Mantoux test reading dated 8.29.22, which was beyond initial service. The file for Staff #31 (see IS Code Sheet) contained a Mantoux test reading dated 11.23.22, which was beyond initial service. The file for Staff #32 (see IS Code Sheet) contained a Health Assessment dated 11.21.22, which was beyond initial service. The file for Staff #33 (see IS Code Sheet) contained a Health Assessment dated 12.14.22 and a Mantoux test reading dated 12.21.22, which was beyond initial service.

Corrected by Oct 9, 2023

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

The files for Staff #5, Staff #6, Staff #20, and Staff #29 (see IS Code Sheet), contained documentation of Pediatric First-Aid/CPR training on 9.2.22, which exceeded 90 days of hire. The files for Staff #30 and Staff #31 (see IS Code Sheet), contained documentation of Pediatric First-id/CPR training on 9.1.22, which exceeded 90 days of hire.

Corrected by Oct 9, 2023

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3270.18(b) · The operator shall report to the Department liability insurance claims brought against the operator or a facility person.

In January 2022, when the Legal Entity became aware of an insurance claim, the LE did not report the information to DHS.

Corrected by Jan 26, 2023

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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 #3 (see IS Code Sheet), contained a Child Abuse Clearance dated 5.4.22, which was after date of hire.

Corrected by Nov 4, 2022

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3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The file for Staff #1 contained a written evaluation dated 8.16.21, and none thereafter, which has exceeded the 12-month requirement. The files for Staff #4, Staff #5, Staff #6, and Staff #7 contained written evaluations dated 8.20.21, and none thereafter which has exceeded the 12-month requirement. The file for Staff #9 contained a written evaluation dated 9.1.21, and none thereafter, which has exceeded the 12-month requirement.

Corrected by Dec 1, 2022

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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.

The asphalt surface on the playground, under the movable picnic table, was raised and crumbled, approximately five (5) feet, which created a tripping/falling hazard for children in care. The asphalt/cement surface on the playground, under and around the sand table structure, was uneven, which created a tripping/falling hazard for children in care. Along the playground fence, broken asphalt and cement were observed, along with multiple holes, which created a tripping/falling hazard for children in care. The playground surface, surrounding the sewer caps, was uneven/cracked, which created a tripping/falling hazard for children in care.

Corrected by Apr 1, 2023

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3270.131(e)(1)/3270.182(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. A child's record shall contain initial and subsequent health reports.

The Immunization Record, in the files for Child #1 and Child #2, did not contain documentation of the Influenza Vaccine, according to the ACIP recommendations.

Corrected by Nov 4, 2022

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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 file for Staff #9 (see IS Code Sheet) contained a Health Assessment dated 8.29.22, which exceeded the "start" date.

Corrected by Nov 4, 2022

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3270.31(f)(10) · Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire. Staff #2 will have until 11.11.22 to complete the required training. Until such time as the required training has been completed, Staff #2 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 #2, Staff #2 may not work in a childcare position at the facility.

Staff #2 (see IS Code Sheet) has not completed the following required pre-service training within 90 days of their date of hire: Pediatric First-Aid/CPR.

Corrected by Nov 4, 2022

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3270.25(a) · The facility's current certificate of compliance shall be posted in a conspicuous location used by parents. The operator shall provide the parent of each child enrolled with information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office.

No information was provided to parents, of enrolled children, with information on how to access the regulations in this chapter electronically.

Corrected by Sep 19, 2022

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3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The first written evaluation in the file for Staff Person #1 was conducted 8/16/21, more than 12 months after the staff person's first day working in child care (6/22/20).

Corrected by Oct 6, 2021

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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 annual Emergency Plan Training for the facility exceeded 12 months between trainings: June 2020-July 2021. The initial Emergency Plan Training in the file for Staff Person #6 (July, 2021) was conducted more than one week after the Staff Person's first day working in child care(5/17/21).

Corrected by Oct 6, 2021

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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 Pediatric First Aid/CPR Certification for staff hired prior to 12/19/20 expired on 8/30/21. New certification date for these staff was 9/3/21.

Corrected by Oct 6, 2021

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3270.31(e)(4)(ii)/3270.192(2)(iii) · Staff persons shall participate, at least annually, in firesafety 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. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Annual Fire Safety Training was conducted at the facility was conducted on 9/3/21. This exceeded 12 months for 13 of the staff who had completed the approved online training during the pandemic in 2020.

Corrected by Oct 6, 2021

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

The initial Pediatric First Aid/CPR Training in the file for Staff Person #3 was conducted after the 6/30/21 deadline for staff hire prior to 12/19/21 (9/3/21). The initial Pediatric First Aid/CPR Training in the file for Staff Person #6 (9/3/21) was conducted more than 90 days after the staff person's start date (5/17/21). The files for Staff Person #3 and #6, who have been working for more than 90 days, did not include documentation of Health and Safety Training.

Corrected by Oct 6, 2021

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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 #4, 6 and 7 may not work in a child care position at the facility.

The file for Staff Person #4, who was hired as a Group Supervisor, contained a Volunteer Child Abuse clearance. The NSOR Certificate in the file for Staff Person #5 was dated 7/30/21, which was after the 45-day provisional hire end date (7/15/21). The file for Staff Person #6, whose provisional hire end date was 7/1/21, lacked an NSOR Certificate. The application for NSOR (8/27/21) in the file for Staff Person #7 was after the Staff Person's start date (8/19/21). For this reason, Staff Person #7 cannot be considered a provisional hire. The file for Staff Person #7 did not include a Child Abuse Clearance.

Corrected by Oct 6, 2021

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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 Person #7 did not include documentation of education and experience.

Corrected by Oct 6, 2021

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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.

The first aid kit in the Brown Bears B playground bag lacked gloves. The first aid kit for Room 5 lacked tape.

Corrected by Oct 6, 2021

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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.

The baseboard in the Infant Porch Room was peeling. Observed ladders and maintenance equipment in the Indoor Gym.

Corrected by Oct 18, 2021

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

Observed peeling, flaking paint on the outer door frame in the Brown Bears A Room.

Corrected by Oct 18, 2021

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3270.106(f) · At least 2 feet of space is required on three sides of a bed, cot, crib or other rest equipment while the equipment is in use.

Observed in the Infant Porch Room: Infant rocker and infant pop-up play mat, which obstructed two sides of a crib where an infant was napping.

Corrected by Oct 6, 2021

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3270.111(b) · The written plan of daily activities shall be posted in the group space.

The daily activity schedule was not posted in the Infant Nap Room or Infant Porch Room.

Corrected by Oct 6, 2021

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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 in the file for Child #1 did not include the policy number for the child's health insurance coverage.

Corrected by Oct 7, 2021

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3270.124(e) · A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency shall be displayed conspicuously in every child care space and shall accompany a staff person who leaves on an excursion with children.

The Emergency Transportation Plan was not posted in the Infant Nap Room.

Corrected by Oct 6, 2021

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3270.131(e)(1)/3270.182(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. A child's record shall contain initial and subsequent health reports.

The most recent immunization record in the file for Child #2 did not include documentation of a flu shot administered within the past 12 months or a letter of exemption from the parent or physician.

Corrected by Oct 8, 2021

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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 assessments in the file for Staff Person #2 exceeded 24 months between assessments.

Corrected by Oct 8, 2021

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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 #4 contained only one letter of reference. The file for Staff Person #7 lacked two letters of reference.

Corrected by Oct 8, 2021

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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 include accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Corrected by Oct 18, 2021

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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 facility has not documented monthly fire system checks for the interconnected smoke detection systems at the facility. The facility did not have a receipt on file for the interconnected smoke detector system in the Infant House.

Corrected by Oct 13, 2021

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