3280.26(f) · The operator shall send a copy of the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

At the time of the inspection, there was no documentation that the emergency plan was sent to the local municipality and to the county emergency management agency.

Corrected Corrected by Jan 26, 2024

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

3280.31(e)/3280.192(2)(iii) · A staff person shall obtain an annual 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 of staff #1 lacked documentation of completing 12 annual clock hours of child care training by 12-19-23 due to the fact 10 hours were completed 1-1-2024.

Corrected Corrected by Jan 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3280.119 · Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

At approximately 10:40 a.m., CR observed child #1, an infant sleeping in a highchair with the back of the highchair reclined.

Corrected Corrected by Jan 22, 2024

Category: health medication. 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.

The files of children #1 and #2 lacked financial agreements with the children's dates of admission.

Corrected Corrected by Jan 22, 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 file of child #4 lacked an emergency contact form with the full address of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Jan 22, 2024

Category: recordkeeping. 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.

The files of children #3 and #4 lacked documentation of parent reviewing the files every 6 months due to the fact parent signatures were dated 2-2023 and 12-2023. Therefore, more than 6 months apart.

Corrected Corrected by Jan 22, 2024

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.

Observed the hands of 3 younger toddlers, 2 older toddlers, and 1 preschool-age child washed for lunchtime by the use of baby wipes while the children sat at the dining room table, rather than the able children washing their hands at the facility's sink located in the diapering area.

Corrected Corrected by Jan 22, 2024

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.

Observed staff #1 dispose a diaper by placing it in a plastic grocery bag sitting at the end of the changing table, rather than directly into the plastic-lined, hands-free covered can.

Corrected Corrected by Jan 22, 2024

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

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

Immediately after changing the diaper of child #1, staff #1 did not wash their hands. In addition, staff #1 opened the gate to child care space, retrieved a bouncer, carried it to the diapering space, closed the gate, then placed child #1 in the bouncer and properly secured the child. Therefore, cross contamination occurred many times.

Corrected Corrected by Jan 22, 2024

Category: health medication. 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 smoke detection system was not tested every 30 days based on the following dates documented: 4-3-23 to 5-8-23 = 35 days and 8-1-23 to 9-1-23 = 31 days.

Corrected Corrected by Jan 31, 2024

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 of child #2 lacked an emergency form with the written consent signed by a parent for emergency medical care.

Corrected Corrected by Mar 24, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.131(b)(2)/3280.182(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 must contain initial and subsequent health reports.

The file of child #1 lacked a current health assessment due to the fact the most recent one on file was dated 10-21-21.

Corrected Corrected by Mar 24, 2023

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 of child #2 lacked an emergency contact form with signed parental consent for administration of minor first-aid procedures by facility staff.

Corrected Corrected by Mar 24, 2023

Category: ratio. Marked corrected in the state record.

3280.20 · Conditions at the facility may not pose a threat to the health or safety of the children.

Based on photo documentation, observed an infant sleeping in a bouncer seat placed on top of an exersaucer.

Corrected Corrected by Dec 8, 2022

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

3280.105(j) · The operator will contact ELRC 6 to arrange for Start Up TA to come to the facility to conduct a minimum of 4 classroom observations over the period of 4 months and will follow recommendations of ELRC 6 Staff.

**Based on photo documentation, an infant was observed sleeping in a pack and play with a boppie pillow and toys with rest mats and blankets above the infant's head.

Corrected Corrected by Apr 17, 2023

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

3280.105(j) · Toys, bumper pads, or pillows may not be present in a crib while an infant is sleeping in the crib.

*Based on photo documentation, an infant was observed sleeping in a pack and play with a boppie pillow and toys with rest mats and blankets above the infant's head.

Corrected Corrected by Dec 8, 2022

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

3280.113(d) · A facility person may not use harsh, demeaning or abusive language in the presence of children.

Based on interviews, Staff #1 used inappropriate language around the children.

Corrected Corrected by Dec 8, 2022

Marked corrected in the state record.

3280.119 · The legal entity must arrange with ELRC 6 for all facility staff to receive training regarding safe sleep practices with infant aged children.

**Based on photo documentation, observed an infant sleeping in a pack and play with a boppie pillow and toys with rest mats and blankets above the infant's head; and an infant sleeping in a bouncer seat placed on top of an exersaucer.

Corrected Corrected by Jan 5, 2023

Category: recordkeeping. Marked corrected in the state record.

3280.119 · Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

*Based on photo documentation, observed an infant sleeping in a pack and play with a boppie pillow and toys with rest mats and blankets above the infant's head; and an infant sleeping in a bouncer seat placed on top of an exersaucer.

Corrected Corrected by Dec 8, 2022

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.

Staff persons #2, #3, and #4 have not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet) and were observed to be alone in ratio with children: staff #2, CPR/First Aid not completed by a PQAS trainer; staff #3 and #4 no pediatric CPR/First Aid on file and observed alone in ratio with children. At the time of the inspection, there was not a policy for prevention and recognition of Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment.

Corrected Corrected by Oct 28, 2022

Category: ratio. 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.

The file of staff #2 had invalid PA State Police clearances due to the fact the DOB listed was incorrect. The file of staff #5 had late PA State Police and FBI clearances due to the fact they were dated: 5-31-17 and 9-18-22; 5-7-17 and 9-22-22.

Corrected Corrected by Oct 26, 2022

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

3280.32(a)/3280.192(2)(iii) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). 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 of staff #1 lacked mandated reporter training timely due to the fact the current and previous training documents on file were more than 60 months apart: 6-1-17 and 7-9-22.

Corrected Corrected by Oct 26, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.105(j) · Toys, bumper pads, or pillows may not be present in a crib while an infant is sleeping in the crib.

At the time of the inspection, observed 2 toys present in the crib in which child #3, an infant was sleeping.

Corrected Corrected by Oct 26, 2022

Category: physical safety. 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.

The files of children #1 and #2 lacked agreements with the dates of admissions.

Corrected Corrected by Oct 26, 2022

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 file of child #2 lacked an emergency contact form with the full address of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Oct 26, 2022

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.

Based on documentation of the smoke detection testing, testing was done more than 30 days apart: 9-1-22 to 10-2-22.

Corrected Corrected by Oct 26, 2022

Category: recordkeeping. Marked corrected in the state record.

3280.24(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.

At the time of the inspection, information on how to access the regulations in this chapter electronically was not posted.

Corrected Corrected by Oct 26, 2022

Marked corrected in the state record.

3280.31(e)(4)(i) · Competence is the completion of training by a professional in the field of first-aid and CPR. All staff persons shall renew their certification in pediatric first-aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.

The files of Staff #2 and #3 lacked documentation of pediatric first-aid.

Corrected Corrected by Nov 1, 2021

Category: ratio. Marked corrected in the state record.

3280.103 · 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.

On 10/7/21 observed binder clips with a diameter of less than 1 inch in a plastic bin on the shelf to the right of the desk located at the bottom of the steps which were accessible to children who are still placing objects in their mouths.

Corrected Corrected by Nov 1, 2021

Marked corrected in the state record.

3280.119 · Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

At approximately 9:20 AM on 10/7/21 Certification Staff observed Child #5 sleeping in a bouncer seat.

Corrected Corrected by Nov 1, 2021

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

3280.123(b)/3280.182(8) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement. A child's record must contain a copy of the initial agreement and subsequent written agreements between the parent and the operator. The parent receives the original agreement.

The file of Child #5 contained the original agreement. The facility did not make a copy for the file and give the original to the parent.

Corrected Corrected by Nov 1, 2021

Category: recordkeeping. Marked corrected in the state record.

3280.124(c) · When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Emergency contact information was not present for Children #2, #6, #7, and #8 while they were in care in Room B.

Corrected Corrected by Nov 1, 2021

Category: recordkeeping. Marked corrected in the state record.

3280.131(e)(1) · The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

The files of Children #1 and #4 lacked a current influenza immunization in accordance with the schedule recommended by the ACIP. The file of Child #3, a 29 month old, lacked DTAP/DTP/TD, Pneumococcal, Hepatitis A, and influenza immunizations in accordance with the schedule recommended by the ACIP. The file of Child #3 contained documentation of 3 DTAP/DTP/TD immunizations, 3 Pneumococcal immunizations, and 1 Hepatitis A immunization.

Corrected Corrected by Nov 1, 2021

Category: health medication. 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.

The file of Staff #1 lacked a health assessment conducted every 24 months. The file of Staff #1 contained a health assessment dated 9/30/19. The file of Staff #2 lacked a health assessment conducted within 12 months prior to providing initial service in a child care setting. The file of Staff #2, with a start date of 5/11/21, contained no health assessment.

Corrected Corrected by Nov 1, 2021

Category: ratio. 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.

From 12/19/20 until updated on 5/1/21 the facility's emergency plan did not provide for accommodations for infants, toddlers, and children with chronic medical conditions.

Corrected Corrected by Nov 1, 2021

Category: physical safety. 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 was unable to provide a written record that the fire detection system was manually tested at least every 30 days since 12/11/20. The facility provided a written record that the fire detection system was manually tested on 6/21/21, 7/8/21, 7/12/21, 8/1/21, 9/4/21, 9/30/21, and 10/4/21.

Corrected Corrected by Nov 1, 2021

Category: recordkeeping. Marked corrected in the state record.