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 most recent health assessment on file for child #1 who is a preschooler is dated 2/28/25, exceeding the 12-month update.

Corrected Corrected by Apr 16, 2026

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

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

The two most current fire safety on file for Staff Person #5 are dated 1/18/25 and 2/12/26, which is more than 12 months apart. The file for Staff Person #13 did not contain fire safety conducted within their 1st year of hire.

Corrected Corrected by Apr 30, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10.

Staff #8, Staff #9, and Staff #11, did not complete the following required pre-service training within 90 days of their hire date (SEE IS CODE SHEET): PA Required Health and Safety for Centers-Group Child Care Part 1 & Part 2. The trainings were completed for Staff #8 on 2/12/26, for Staff #9 on 9/2/25and for Staff #11 on 11/3/25 (Pt 1) and 11/10/25 (Pt 2). Staff #8, Staff #9, and Staff #11 did not complete the following required pre-service trainings within 90 days of their hire date (SEE IS CODE SHEET): Pediatric First Aid/CPR. The trainings were completed for Staff #8, Staff #9 and Staff #11 on 9/15/25. · Staff #13 has not completed the following required pre-service trainings within 90 days of their hire date (SEE IS CODE SHEET): Pediatric First Aid/CPR and PA Required Health and Safety for Centers-Group Child Care Part 1 & Part 2. Staff #14 has not completed the following required pre-service trainings within 90 days of their hire date (SEE IS CODE SHEET): Pediatric First Aid/CPR and PA Required Health and Safety for Centers-Group Child Care Part 2.

Corrected Corrected by Apr 9, 2026

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

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #13 and Facility Person #14- may not work in a child care position at the facility.

The two most recent NSOR certificates on file for Staff Person #15 are dated 4/9/20 and 4/18/25, which are more than 60 months apart. The file for Staff Person #8 contains a Child Abuse Clearance dated 5/15/25, an DHS FBI Clearance dated 2/24/26 and an NSOR Certificate dated 2/12/26, all dated after start date (see LIS code sheet).The file for Staff Person #9, Staff Person #10, Staff Person #12 and Staff Person #14 contains a Disclosure statement that was lacking a witness signature. The file for Staff Person #13 and Staff Person #16 was lacking a signed disclosure statement. The file for Staff Person #9 contains a Child Abuse Clearances dated 5/25/25, A DHS FBI Clearance dated 5/24/25 and a NSOR Certificate dated 9/19/25, all dated after start date (see LIS code sheet). The State Police Clearance on file for Staff Person #11 lacked a dissemination date making it invalid. The file for Staff Person #13 was lacking a Child Abuse Clearance, DHS FBI Clearance, and a NSOR certificate on file by their start date (see LIS code sheet). The file for Staff Person #14 contains a DOE FBI clearance dated 5/6/25 which is an invalid form of an DHS FBI Clearance.

Corrected Corrected by Apr 9, 2026

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

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

The mandated reporter certificate on file for Staff Person #8 is dated 2/12/26, and for Staff Person #11 is dated 11/3/25, which are both dated more than 90 dates after hired date (see LIS code sheet). The file for Facility person #13 has served at the facility for more than 90 days and has not completed Mandated Reporter training. (See LIS CODE Sheet)

Corrected Corrected by Apr 30, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.36(b)(5)/3270.192(2)(iii) · An assistant group supervisor shall have a high school diploma or a general educational development certificate and 2 years experience with children. 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 Person #13 who is classified as an assisted group supervisor was lacking a high school diploma or a general educational development certificate and 2 years experience with children.

Corrected Corrected by Apr 30, 2026

Category: supervision. Marked corrected in the state record.

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 transition and toddler areas it was observed that the toxic cleaning spray bottle was stored on the same shelf as the children's diapers which could potentially leak onto the diapers and become a hazard for the children who would potentially wear the diapers.

Corrected Corrected by Apr 9, 2026

Category: ratio. Marked corrected in the state record.

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

The two most recent health assessments on file for Staff #1 are dated 2/13/24 and 3/9/26, for Staff #2 are dated 2/13/24 and 3/9/26, for Staff #3 are dated 1/14/22 and 10/3/25, for Staff #4 are dated 4/3/23 and 10/23/25, for Staff #5 are dated 5/23/23 and 2/2/26, for Staff #6 are dated 5/17/23 and 1/20/26, and for Staff #7 are dated 3/6/23 and 4/24/25, which are all more than 24 months apart. The health assessment on file for Staff #11 is dated 6/26/25, for Staff #12 is dated 1/18/26 and for Staff #16 is dated 3/2/26, which are all after their start dates (see LIS code sheet).

Corrected Corrected by Apr 9, 2026

Category: ratio. Marked corrected in the state record.

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

The current health assessment on file for Staff person #14 does not indicate if the staff person was assessed for communicable/contagious disease.

Corrected Corrected by Apr 30, 2026

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

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

The health assessment on file for Staff #14 does not include the physician or health care professional's assessment of the staff person's suitability to provide child care.

Corrected Corrected by Apr 30, 2026

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

3270.171(c) · Written notification of safe routes shall be posted by the operator at a conspicuous location in the child care facility.

The facility was lacking written notifications of safe routes posted by the operator at a conspicuous location in the child care facility.

Corrected Corrected by Apr 9, 2026

Marked corrected in the state record.

3270.192(1) · A facility person's record shall include the name, address and telephone number of the facility person.

The file for Staff Person #13 lacked address and telephone number of the facility person.

Corrected Corrected by Apr 30, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.192(2)(i) · A facility person's record shall include verification of age.

The file for Staff Person #13 lacked proof of verification of age.

Corrected Corrected by Apr 30, 2026

Category: recordkeeping. Marked corrected in the state record.

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

The file for Staff Person #13 was lacking two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. The file for Staff Person #14 was lacking one of the two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

Corrected Corrected by Apr 9, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.27(a)(6) · Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

The most recent emergency drill log on file at the facility is dated 12-9-24 which is more than 12 months ago.

Corrected Corrected by Apr 9, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.95(a)/3270.95(b) · Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c)). The Director or designated staff person who is responsible for compliance with this chapter shall ensure the requirements under subsection (a) are met.

The two most current documentation of annual testing of the fire detection system were dated 12-11-24 and 1-28-26 which are more than 12 months apart.

Corrected Corrected by Apr 9, 2026

Category: recordkeeping. Marked corrected in the state record.

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

The file for Staff #13 contained 0 out of 12 childcare training hours within the training timeframe of 2/2025-2/2026.

Corrected Corrected by Apr 30, 2026

Category: recordkeeping. Marked corrected in the state record.

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

The file for Child #2 contains an initial health assessment dated 1/14/26 which is more than 60 days after enrollment (see LIS code sheet).

Corrected Corrected by Apr 9, 2026

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

3270.113(a) · Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises. TIERED LIS: 1. Children must be supervised at all times. (This portion of the plan shall have an immediate correction date.) 2. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training. (The operator shall provide a date for when this training will be completed.)

Based on staff statements at approximately 10:20AM on 2/21/26, Staff Person #1 was observed to be sleeping while caring for 3 preschool aged children.

Corrected Corrected by May 15, 2026

Category: supervision. Marked corrected in the state record.

3270.113(a)(1) · 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.

Based on staff statements at approximately 10:20AM on 2/21/26, Staff Person #1 was observed to be sleeping while caring for 3 preschool aged children.

Corrected Corrected by Feb 21, 2026

Category: supervision. Marked corrected in the state record.

3270.113(a) · Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises. TIERED LIS: 1. Children must be supervised at all times. 2. The legal entity must participate in a minimum of 5 in person technical assistance sessions with the ELRC on how to manage challenging behaviors in the classroom within a 2-month time period. The correction date will be 2 months from the date that the plan of correction is accepted.

Facility self-reported that when Staff Person #1 had a group of 10 preschoolers in line to use the restroom, one child started to climb on a shelving rack. While Staff Person #1 was removing the child from the shelving rack, three children exited the back of the facility through the emergency push bar door. Staff Person #1 immediately called for help to take their group and ran out the door after the children. Child #1 and Child #2 were standing in the empty lot and Staff Person #1 saw Child #3 run into a back door of a business a few doors down. Staff Person #1 gathered Child #1 and Child #2 and then proceeded through the business to look for Child #3. An employee of the business next door took Child #3 directly back to the main facility, as Staff Person #1 returned to the preschool area with Child #1 and Child #2.

Corrected Corrected by Nov 8, 2025

Category: supervision. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)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 not 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 trainings within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid and CPR, and Part 1 and Part 2 of Health and Safety trainings.

Corrected Corrected by Jul 9, 2025

Category: supervision. Marked corrected in the state record.

3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to 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 childcare 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 Corrected by Jul 9, 2025

Category: supervision. Marked corrected in the state record.

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

The fire drill log on file contained dates of fire drills from 11/1/24-1/10/25, and 1/10/25-4/1/25 which are more than 60 days between fire drills.

Corrected Corrected by Jul 24, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The files for Staff Person #1, #3, #4, #5, #6, #8, and #12, includes verification of Pediatric First Aid/CPR training dated 1/11/25, after the expiration date of 5/31/24. The file for Staff Person #14, includes verification of Pediatric First Aid/CPR training dated 1/11/25, after the expiration date of 4/30/24. The file for Staff Person #15, includes verification of Pediatric First Aid/CPR training dated 1/11/25, after the expiration date of 12/31/24. The file for Staff Person #13, includes verification of Pediatric First Aid/CPR training dated 10/16/24, after the expiration date of 5/31/24.

Corrected Corrected by Apr 15, 2025

Category: ratio. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10.

Staff Person #2, Staff Person #7 and Staff Person #16 did not complete the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid/Pediatric CPR. The training was completed on 10/16/24 for Staff Person #2 and Staff Person #16 and on 2/10/25 for Staff Person #7. Staff Person #2 did not complete the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Health and Safety training.

Corrected Corrected by Apr 15, 2025

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

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

The file for Staff Person #3 includes State Police Clearances dated 2/4/20 and 2/5/25, Child Abuse Clearances dated 2/13/200 and 3/5/25. The file for Staff Person #4 includes FBI Clearances dated 9/26/19 and 1/30/25, all more than 60 months apart.

Corrected Corrected by Apr 15, 2025

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

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

Staff Person #2 did not complete the mandated reporter training within 90 days of their date of hire (see LIS code sheet); the training was completed on 6/27/24. The two most recent mandated reporter training certificates on file for Staff Person #6 are dated 9/29/19 and 1/13/25, more than 60 months apart.

Corrected Corrected by Apr 15, 2025

Category: recordkeeping. Marked corrected in the state record.

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

It was observed in the bathrooms by the preschool area that there was a garbage can without a lid.

Corrected Corrected by Apr 15, 2025

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

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

The two most recent updates on the emergency contact information and the financial agreements are dated for Child #1 12/14/23 and 12/17/24, for Child #2 11/20/23 and 1/2/25, for Child #3 11/20/23 and 9/23/24, for Child #4 1/31/24 and 9/17/24, for Child #6 11/20/23 and 12/10/24, for Child #7 10/19/23 and 9/19/24, and for Child #8 11/27/23 and 9/27/24. Which are all updated more than 6 months apart.

Corrected Corrected by Apr 15, 2025

Category: recordkeeping. Marked corrected in the state record.

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

It was observed that in the locked medicine box in the toddler area that there was a bottle of cough medicine that was not labeled for a specific child.

Corrected Corrected by Apr 15, 2025

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

3270.134(a) · A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

While observing a diaper change in the toddler area, it was observed that the children's hands were not washed following the diaper change.

Corrected Corrected by Apr 15, 2025

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

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

The two most recent health assessment on file for Staff Person #4 are dated 6/16/22 and 1/27/25, for Staff Person #6 are dated 3/22/22 and 1/31/25, for Staff Person #9 are dated 11/8/22 and 1/31/25, for Staff Person #10 are dated 3/29/21 and 2/13/24, for Staff Person #11 are dated 3/20/21 and 2/13/24, and for Staff Person #12 are dated 2/20/22 and 1/16/25. All more than 24 months apart.

Corrected Corrected by Apr 15, 2025

Category: ratio. Marked corrected in the state record.

3270.131(a)/3270.182(1) · 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. The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP. Child #5 must be dismissed from care by close of business 2/24/25 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The file for Child #5 who has been enrolled longer than 60 days (see LIS code sheet for enrollment date) does not contain a child health report with current immunizations.

Corrected Corrected by Apr 15, 2025

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

3270.113(a)(1) · 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.

At approximately 11:20 AM it was observed that Staff Person #1 and Staff Person #2 were in the preschool side of the facility with 15 preschoolers. Staff Person #1 named and identified 9 children and Staff Person #2 named and identified 2 children, leaving 4 children unaccounted for. Given a second attempt Staff Person #1 named and identified 9 children and Staff Person #2 named and identified 4 children, again leaving 2 children unaccounted for.

Corrected Corrected by Sep 20, 2024

Category: supervision. Marked corrected in the state record.

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

When child #1 becomes physically aggressive to children and staff, staff #1 and 2 have put the child in the top of the tree house in the Toddler Room or in the diaper changing area of the Toddler room where staff sit at the opening and child #1 is not permitted to leave said area.

Corrected Corrected by Sep 20, 2024

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

3270.61(h) · The capacity established for an indoor space may not be exceeded.

At approximately 10:35 AM, it was observed that 90 children, ranging in age from infant to school age, were accounted for in the Main Room where the capacity of the Main Room is 84.

Corrected Corrected by Sep 20, 2024

Category: ratio. Marked corrected in the state record.

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

The first aid kit in the indoor play space where children were in care was located on a low cubby making it accessible to the children.

Corrected Corrected by Feb 27, 2024

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

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

The one-hour health and safety professional development update for Staff Person #8 was dated 2/7/24, which is after the deadline of 12/30/22.

Corrected Corrected by Feb 27, 2024

Category: ratio. Marked corrected in the state record.

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

The emergency plan training on file for Staff Person #2, Staff Person #12, Staff Person #13 and Staff Person #14 was not completed within 90 days of starting at the facility. The training was completed for Staff Person #2 on 2/1/24, for Staff Person #12 on 1/28/24, for Staff Person #13 on 1/29/24 and Staff Person #14 on 1/28/24 (see LIS code sheet for start dates).

Corrected Corrected by Feb 27, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10.

The file for Staff Person #2, Staff Person #7, and Staff Person #9, was observed not to have completed the required pre-service training within 90 days of their hire date (see LIS code sheet): Get Started with Center-based Care; Building Blocks for Quality Revised 2022. Staff Person #2's certificate was dated 9/24/23, Staff Person #7 dated 9/1/23, and Staff Person #9 dated 10/23/23. Staff Person #12 and Staff Person #14 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Get Started with Center-based Care; Building Blocks for Quality Revised 2022. Staff Person #11 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid/Pediatric CPR.

Corrected Corrected by Feb 27, 2024

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

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person # 7 may not work in a child care position at the facility. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #7 may not work in a child care position at the facility.

The NSOR on file for Staff Person # 2 was dated 2/2/24 and Staff Person #9 was dated 2/7/24 both more than 45 days after their start dates (see LIS code sheet). The disclosure statements on file for Staff Person #4 was dated 1/30/24, Staff Person #5 was dated 1/28/24, Staff Person #11 was dated 1/31/24, Staff Person #13 was dated 1/29/24, and Staff Person #14 was dated 1/28/24 all after their start dates (see LIS code sheet). The file for Staff Person #7 did not contain a child abuse clearance. The file for Staff Person #10 includes criminal history clearance and child abuse clearance dated 2/1/24, which is after start date (see LIS code sheet). The file for Staff Person #14 includes a child abuse clearance dated 1/4/24, which is after start date (see LIS code sheet).

Corrected Corrected by Feb 27, 2024

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

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

Staff Person #2, Staff Person #7 Staff Person #8, and Staff Person #9 did not complete their mandated reporter training within 90 days of their date of hire (see LIS code sheet), the trainings were completed on 9/25/23 for Staff Person #2, on 9/8/23 for Staff Person #7, on 2/9/24 for Staff Person #8, and on 2/5/24 for Staff Person #9. Staff Person #12 and Staff Person #14 have not completed the mandated reporter training within 90 days of their date of hire (see LIS code sheet).

Corrected Corrected by Feb 27, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The file for Staff Person #6, who was identified as an GS, lacked verification of Bachelor's degree in Education or a related human services; or a Bachelor's degree with 30 credit in education or a related human service field and 1 year of verified child care experience; or an Associates' degree in Education or a related human service field and 2 years child care experience. The file for Staff Person #7 and Staff Person #12 who were identified as an AGS, lacked verification of 2500 hours of child care experience to qualify them for the position. The file for Staff Person #2 and Staff Person #3, who was identified as an AIDE, lacked verification of a high school diploma or general educational development certificate; or a minimum of an 8th grade education and 2 years of child care experience..

Corrected Corrected by Apr 26, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The first aid kit in the indoor play space was lacking an assortment of adhesive bandages, sterile gauze pads, tweezers, tape, scissors and disposable, nonporous gloves.

Corrected Corrected by Feb 27, 2024

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

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

In the back preschool space it was observed that there were magnetic tile blocks that were cracked and not in good repair and a toy cash register that was broken.

Corrected Corrected by Feb 27, 2024

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

3270.104(a) · Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

It was observed in the school age space that there was a office chair that had a rip in the cushion and the foam padding was exposed.

Corrected Corrected by Feb 27, 2024

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

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

The file for Child #4, Child #5, Child #6 and Child #7, lacked a signed and dated child service report, providing information to the family about the child's growth and development in the context of the services being provided

Corrected Corrected by Apr 12, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.124(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 for Child #1 was lacking 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 Apr 12, 2024

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

3270.124(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.

Child #9's emergency contact form was not in the childcare space in the Pre-K classroom where the child was receiving care.

Corrected Corrected by Feb 27, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.124(f) · 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.

The emergency contact forms for Child #2, Child #3, Child #4, Child #5, and Child #6, has not being updated within the past 6 months.

Corrected Corrected by Apr 12, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The health assessment on file for Staff Person #1 is dated 1/14/22 which is more than 24 months ago. The health assessment and TB screening on file for Staff Person #10 is dated 3/2/22 which is more than 12 months before hire date (see LIS code sheet).

Corrected Corrected by Feb 27, 2024

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

3270.181(c) · 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 financial agreements on file for Child #2, Child #3, Child #4, Child #5, and Child #6, have not being reviewed and updated within the past 6 months.

Corrected Corrected by Apr 12, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.183(a) · Child records are confidential and shall be stored in a locked cabinet.

It was observed that the child files were located in the office in a unlocked cabinet.

Corrected Corrected by Mar 1, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The initial health assessment for Child #8 was dated 1/29/24 and was received more than 60 days after enrollement date (see LIS code sheet).

Corrected Corrected by Feb 27, 2024

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

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

The emergency plan on file lacked continuity of operation as required by Federal Regulations. The files for Staff Persons # 6 and #7 lacked the required 1 hour health and safety training update by 12.30.22. The health and safety training update on file for Staff Person #7 was dated 1.10.23.

Corrected Corrected by Apr 8, 2023

Category: ratio. Marked corrected in the state record.

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

The file for Staff Person #1 lacked emergency plan training within 12 months prior to 2.2.23. The emergency plan training on file for Staff Person #3 was not completed within 90 days of starting at the facility. The training was completed 125 days after starting at the facility. The documented emergency plan trainings on file for Staff Persons #6, #7, #8 and #9 exceeded 12 months between review. Staff Person #6 completed training on 4.27.21 and 2.3.23. Staff Persons #7 and #8 completed training on 4.27.21 and 2.1.23. Staff Person #9 completed training on 4.27.21 and 2.2.23.

Corrected Corrected by Apr 8, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)(4)(ii) · 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.

The file for Staff Person #6 lacked verification of current fire safety training. The last documented fire safety training on file was dated 2.10.22.

Corrected Corrected by Apr 8, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10.

The files for Staff Persons #2 and #3 lacked completion of their 10 hour health and safety trainings within 90 days of starting at the facility. The 10 hour health and safety training on file for Staff Person #2 was completed 137 days after starting. The 10 hour health and safety training on file for Staff Person #3 was dated 125 days after starting.

Corrected Corrected by Apr 8, 2023

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

3270.31(f) · Staff person(s) shall complete professional development in the topics of 3270.31(f)(1-10) within 90 days of hire. Staff person #3 will have until March 21, 2023 to complete the required training. Until such time as the required training has been completed, staff person #3 must be supervised, when interacting with children, by an AGS, who has completed the required training related to this citation. If there are no staff available to supervise staff person #3, staff person #3 may not work in a child-care position at the facility.

Staff person #3 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): 31(f)(10).

Corrected Corrected by Mar 21, 2023

Category: supervision. Marked corrected in the state record.

3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person #2 and #5 may not work at the facility.

The file for Staff Person #2 lacked a Child Abuse Clearance that had been completed for employment purposes. The Child Abuse Clearance on file was completed for Volunteer purposes and is not acceptable for employment in a child care facility. The mandated reporter training on file for Staff Person #2 was not completed within 90 days of starting at the facility. The training was completed 137 days after starting at the facility. The mandated reporter training on file for Staff Person #3 was not completed within 90 days of starting at the facility. The training was completed 125 days after starting at the facility. The file for Staff Person #4 lacked a signed disclosure statement prior to starting in the facility. The disclosure statement on file was dated 155 days after starting in the facility. The file for Staff Person #5 lacked a signed disclosure statement prior to starting in the facility.

Corrected Corrected by Mar 13, 2023

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

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

The file for Staff Person #3, who was identified as an AGS, lacked verification of 2500 hours of child care experience to qualify them for the position. The file only included 909.3 hours of child care experience. Without the verification of experience Staff Person #3 qualifies as an Aide.

Corrected Corrected by Mar 13, 2023

Category: recordkeeping. Marked corrected in the state record.

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 written staff evaluations on file for Staff Person's #1, #6, #7 and #9 exceeded 12 months between evaluations. Staff Person #1's evaluations were dated 2.18.21 and 2.2.23. The last documented Staff evaluations were dated 2.18.21 for Staff Person #6, #7 and #9. The file for Staff Person #8 lacked a written evaluation.

Corrected Corrected by Apr 8, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The files for Children #1, #2, #3 and #4 lacked child service reports that had been completed within the last 6 months.

Corrected Corrected by Apr 8, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.131(b)(1) · The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler.

The file for Child #1, a young toddler, lacked a current health assessment. The last health assessment on file was dated 12.6.21.

Corrected Corrected by Apr 8, 2023

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

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

The file for Child #2, a preschool age child, lacked a current health assessment. The last health assessment on file was dated 7.7.21.

Corrected Corrected by Apr 8, 2023

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

3270.131(d)(5) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP. Children #2 and #4 will be dismissed from the facility close of business on 2.24.23.

The file for Child #2 lacked one of their four recommended Pneumococcal vaccinations. The file for Child #4 lacked documentation of a current influenza vaccination. The last documented influenza vaccination was 11.15.21. Written exemptions were not on file for the children.

Corrected Corrected by Feb 24, 2023

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

3270.131(e)(3) · 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, #4 and #5 will be dismissed from care close of business on 2.24.23.

The file for Child #2 lacked one of their four recommended Pneumococcal vaccinations. The file for Child #4 lacked documentation of a current influenza vaccination. The last documented influenza vaccination was 11.15.21. Written exemptions were not on file for the children. The files for Children #1, a young toddler, #2, a preschool age child, and #5, a young school age child, lacked current health assessments for the children. The last health assessment on file for Child #1 was dated 12.6.21. Updated reports are required every 6 months for a young toddler. The last health assessment on file for Child #2 was dated 7.7.21. Updated reports are required yearly for a preschool age child. The last health assessment on file for Child #5 was dated 11.30.20. The child was in need of a 5 year old assessment as acceptable by a school.

Corrected Corrected by Feb 24, 2023

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

3270.151(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 for Staff Person #3 lacked an initial health assessment within 12 months prior to starting at the facility. The health assessment was dated 125 days after starting. The updates to the health assessment on file for Staff Person #6 exceeded 24 months between examinations on 10.18.19 and 12.14.21. The updates to the health assessments on file for Staff Person #7 exceeded 24 months between examinations on 12.18 and 3.20.21.

Corrected Corrected by Apr 8, 2023

Category: ratio. Marked corrected in the state record.

3270.161(d) · Potentially hazardous food brought from the child's home or provided by the facility shall be refrigerated.

In the Front Classroom in the new Suite a lunchbox containing a bologna sandwich was observed in a child's cubby. The bologna sandwich needed to be refrigerated.

Corrected Corrected by Feb 24, 2023

Category: nutrition. Marked corrected in the state record.

3270.241(b)(10) · An equivalent health report completed by a school is acceptable as documentation of child health for a school-age child.

The file for Child #5, a young school ager, lacked a current health assessment for the child. The last documented health assessment was completed when the child was 3. The child is in need of a health assessment at 5 years of age.

Corrected Corrected by Apr 8, 2023

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

3270.61(h)(2)/3270.62(b) · The capacity established for indoor space may not be exceeded except when older toddler, preschool or school-age children are participating in a program activity. Outdoor or indoor play space shall be measured at 65 square feet per child.

At 10:45am, 17 preschool age children were observed in the indoor gross motor space. The indoor gross motor space has a measured capacity of 11 preschool age children. The indoor space was over the measured capacity.

Corrected Corrected by Feb 24, 2023

Category: ratio. Marked corrected in the state record.

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

The Pediatric First Aid and CPR training on file for Staff Person #2 was not completed within 90 days of starting at the facility. The training was completed 125 days after starting.

Corrected Corrected by Mar 13, 2023

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

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

The file for Staff Person #8 lacked 1 of their 12 hours of child care training during their respective training year.

Corrected Corrected by Apr 8, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The current enrollment agreement for Child #2 lacked the fee amount.

Corrected Corrected by Apr 1, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.27(b) · The operator shall review the emergency plan at least annually and update the plan as needed. The operator shall document in writing each review and update of the emergency plan and kept on file at the facility.

The last dated review of the emergency plan on file was 2/14/21.

Corrected Corrected by Apr 1, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The updates to the emergency plan training on file for Facility Person #2 exceeded 12 months.

Corrected Corrected by Mar 22, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)(4)(i)/3270.31(h) · 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. All staff persons shall complete the professional development under subsection (f).

The files for Facility Person's #1 and #4 lacked verification that they had completed updated Pediatric First Aid and CPR training in an approved Curriculum.

Corrected Corrected by May 26, 2022

Category: ratio. Marked corrected in the state record.

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

The file for Facility Person #3 lacked current fire safety training within the last 12 months.

Corrected Corrected by Apr 25, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The required health and safety training for Facility Person #8 was not completed within 90 days of hire.

Corrected Corrected by Mar 24, 2022

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

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

The file for Facility Person #1 lacked out of state clearances that were required to be on file in accordance with the CPSL. The updates to the State Police, Child Abuse and FBI clearance requests for Facility Person's #1 and #3 exceeded 60 months between update. The file for Facility Person #8 lacked a completed NSOR within 45 days of starting at the facility. The file for Facility Person #6 lacked verification that they had requested their NSOR certificate prior to starting in a child care position at the facility. A completed certificate was not on file upon starting.

Corrected Corrected by Apr 5, 2022

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

3270.32(a)/3270.192(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 for Facility Person's #5 and #6 lacked completion of their mandated reporter training within 90 days of starting at the facility.

Corrected Corrected by Mar 22, 2022

Category: recordkeeping. Marked corrected in the state record.

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 updates to the written evaluations for Facility Person #3 exceeded 12 months between evaluations.

Corrected Corrected by Mar 22, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.106(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.

Several of the sleeping bags intended for use of children in the Front PS classroom were not labeled to identify the name of the child.

Corrected Corrected by Mar 23, 2022

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

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

The file for Children #1 and #4 lacked a current Child Service Report for the child.

Corrected Corrected by Apr 25, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The file for Child #1 lacked verification of a current dated health assessment for the child.

Corrected Corrected by Apr 25, 2022

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

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

The file for Child #4 lacked documentation of a current influenza vaccination. A written exemption was not on file at the time of review.

Corrected Corrected by Apr 25, 2022

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

3270.151(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 updates to the health assessments for Facility Person #1 and #2 exceeded 24 months between examinations.

Corrected Corrected by Mar 22, 2022

Category: ratio. Marked corrected in the state record.

3270.181(c) · 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 updates to the Emergency Contact and Financial Agreement form for Child #3 exceeded 6 months since last review.

Corrected Corrected by Mar 22, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.192(2)(ii) · A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

The file for Facility Person #7 lacked verification of education and experience to qualify them for a position at the facility.

Corrected Corrected by Apr 25, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.192(3) · 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 Facility Person #4 was missing their prior health assessment. The assessment was reported to have been misplaced but had been reviewed at a previous inspection by this Certification Representative.

Corrected Corrected by Mar 22, 2022

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

3270.31(f)(10)/3270.31(h) · Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire. All staff persons shall complete the professional development under subsection (f).

The file for Facility Person #5 lacked Pediatric First Aid and CPR training with an approved provider within 90 days of starting at the facility. The training on file for Facility Person #5 was completed online. The file for Facility Person #6 and #8 lacked Pediatric First Aid and CPR training within 90 days of starting at the facility.

Corrected Corrected by May 26, 2022

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

3270.123(b) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement.

At the time of enrollment the original agreement was not provided to the parent of Child #1.

Corrected Corrected by Jan 4, 2022

Category: recordkeeping. Marked corrected in the state record.