3270.21 · Conditions at the facility may not pose a threat to the health or safety of the children.

There were sharp adult scissors in an unlocked drawer in Room 8, accessible to children.

Corrected Corrected by Jul 1, 2025

Category: health medication. 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.

Documentation of the required pre-service health and safety trainings on file for Facility Persons # 3 and #5 indicate the trainings were each completed more than 90 days after their respective start dates.

Corrected Corrected by Jun 18, 2025

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 mandated reporter training completed by Facility Person #2, employed at the facility more than 90 days, was not an approved mandated reporter training.

Corrected Corrected by Jun 25, 2025

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.

Facility Person #1 was classified by a group supervisor. There was documentation of an associates degree in a related field on file for Facility Person #1, but no documentation of child care experience (2 years required for the classification.) Facility Person #4 was classified as a group supervisor based on completion of a related degree. There was a bachelors degree on file for Facility Person #4 but no documentation of the field of study in which the bachelors degree was earned. There was also documentation of at least 30 related credits on file for Facility Person #4, but no child care experience documented. Facility Person #6 was classified as the facility's director with documentation of a related degree on file. There was no child care experience documented and on file for Facility Person #6. (One year required for the classification).

Corrected Corrected by Jun 26, 2025

Category: supervision. Marked corrected in the state record.

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 the Doodleville room, there was an unlocked storage closet with toxics including sunscreen, glass cleaner, disinfectant and cleaning wipes, accessible to children in care. In Room 6 there was diaper cream in an unlocked cabinet under the changing table, accessible to children.

Corrected Corrected by Jun 18, 2025

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

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

There was no daily activity schedule for the group posted in the Doodleville room.

Corrected Corrected by Jun 18, 2025

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

3270.123(a)/3270.182(8) · An agreement shall be signed by the operator and the parent. A child's record shall contain a copy of the initial agreement and subsequent written agreements between the parent and the operator. The parent receives the original agreement.

There was no agreement on file for child #1. The original agreement was on file for child #2.

Corrected Corrected by Jun 18, 2025

Category: recordkeeping. 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.

Documentation of the completed pediatric first aid & CPR trainings on file for Facility Persons #2 and #7 indicate the trainings were each completed more than 90 days after their respective start dates.

Corrected Corrected by Jun 18, 2025

Category: health medication. 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 documentation of smoke detector testing on file indicated that testing was completed on 1/3/25 then next on 2/26/25, and also on 4/10/25 and next on 5/15/25. Testing is required to be completed at least every 30 days.

Corrected Corrected by Jun 18, 2025

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.

Facility Person #1 was classified as an assistant group supervisor. Facility Person #4 was classified as an aide. For each of these staff, there was insufficient documentation of the required child care experience on file based on the staff person's documented education. Facility Person #5 was classified as an assistant group supervisor without the education required to be completed documented on file.

Corrected Corrected by Dec 31, 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). Facility Person # 2 may not work in a child care position at the facility without all completed clearances on file.

There was no NSOR clearance on file for Facility Person #2, employed at the facility more than 45 days..

Corrected Corrected by Dec 12, 2025

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

3270.69(b) · Hot water temperature, in areas accessible to children, may not exceed 110° F.

The hot water temperature at sinks used by children in Room 2 and Room 4 was measured to be 116° F.

Corrected Corrected by Dec 13, 2025

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

3270.151(a)/3270.151(c)(2) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

The TB test completed and on file for Facility Person #3 was completed more than 12 months prior to their start date in a child care position.

Corrected Corrected by Mar 7, 2025

Category: ratio. Marked corrected in the state record.

3270.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The health assessment on file for Facility Person # 2 indicated the staff person had a communicable disease, but did not include further information.

Corrected Corrected by Dec 23, 2025

Category: health medication. 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.

Documentation indicates the emergency plan was reviewed in June of 2022 then again in April of2024.

Corrected Corrected by Jun 27, 2024

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 most recent documentation of emergency plan training on file for Facility Person #6 was dated 5/19/23.

Corrected Corrected by Jun 28, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.27(e) · The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures in subsection (a). The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

The letter to the families explaining the facility's emergency plan does not include information regarding the plan for a lockdown or accommodations in the event of an emergency..

Corrected Corrected by Jul 26, 2024

Category: physical safety. 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.

Current firesafety training documented and on file for Facility Persons # 1, #3, and #4 was completed more than 12 months after the previous firesafety training.

Corrected Corrected by Jun 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.

Documentation of the required pre-service health & safety training on file for Facility Persons #5, #7, and #8 indicate the training was completed more than 90 days after each facility person's start date.

Corrected Corrected by Jun 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). 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 #5 may not work in a child care position at the facility without all completed clearances on file.

There were no clearances on file from a state in which Facility Person #5 lived within the previous 5 years. The NSOR clearance on file for Facility Person #5 was completed more than 45 days after their start date. The mandated reporter trainings documented on file for Facility Persons #5 and #8 were each completed more than 90 days after their respective start dates.

Corrected Corrected by Jun 27, 2024

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

3270.35(b)/3270.192(2)(ii) · A group supervisor shall have attained one of the qualification levels specified at §3270.35(b)(1)-(4). A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Facility Person #6 was classified as a group supervisor without documentation of the required education for the classification on file.

Corrected Corrected by Jun 27, 2024

Category: supervision. Marked corrected in the state record.

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

The daily activity schedule was not posted in Room 8.

Corrected Corrected by Jun 27, 2024

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

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.

The following toxics, labeled "keep out of reach of children" were accessible to children: -hand sanitizer clipped to the outside of a first aid kit in a cubby in Room 6 -"wound wash" in a cubby in Room 7 -diaper cream n an unlocked cabinet under a changing table in Room 7 -diaper cream in a bin in on a low shelf near the restroom in Room 8

Corrected Corrected by Jun 27, 2024

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

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.

The emergency numbers were not posted by the phone in Room 4 and Room 9.

Corrected Corrected by Jun 27, 2024

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

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

First aid kits were accessible to children in cubbies within their reach in the School-age Room and Rooms 6, 7, 8 and 9.

Corrected Corrected by Jun 27, 2024

Category: health medication. 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 Schoolage Room did not contain scissors.

Corrected Corrected by Jun 27, 2024

Category: health medication. 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.

There were cots in Room 3 that were shared by children who attend on different days and not labeled with their names or cleaned between each use. The mats in Room 8 were labeled with numbers,. but there was no chart in the room to indicate which number corresponded to which child. In Room 9 one child was using a mat that was labeled with another child's name and another child was using a mat that wasn't labeled.

Corrected Corrected by Jul 10, 2024

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

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.

SECOND CITATION; PREVIOUSLY CITED ON 4/25/24: There was one cot in Room 7 and four mats in Room 9 that were in use without at least 2 feet of space on three sides.

Corrected Corrected by Jul 8, 2024

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

3270.113(a) · Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

SECOND CITATION; PREVIOUSLY CITED ON 5/1/24: At approximately 12:40 in the Schoolage room, Facility Persons #9 and #10 were supervising a group of 7 preschoolers and 8 young schoolagers in the gym. There were 3 young schoolagers in a lofted area, sitting with their backs to a wall where they were unable to be seen by the staff in the classroom, due to the positioning of the staff.

Corrected Corrected by Jun 27, 2024

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.

SECOND CITATION; PREVIOUSLY CITED ON 5/1/24: At approximately 10:40 AM, Facility Persons #1 and #11 were supervising 10 young toddlers in Room 3. When Facility Person #11 was asked to identify the children they were supervising , they consulted a list of the names of the children in their group to point out the children. Facility Person #11 misidentified one of child on the list, reading the name incorrectly and pointing out a child by another name, and then said they didn't know which of the children in the room was one of the other children on their list.

Corrected Corrected by Jul 8, 2024

Category: supervision. Marked corrected in the state record.

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

There was no child service report completed in the last 6 months on file for child #6.

Corrected Corrected by Jul 2, 2024

Category: recordkeeping. 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.

The original agreements were on file for children #1 -#8.

Corrected Corrected by Jul 2, 2024

Category: recordkeeping. Marked corrected in the state record.

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 medical emergency transportation plan was not posted conspicuously in Room 4 and Room 9.

Corrected Corrected by Jun 27, 2024

Category: transportation. 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 current health assessments on file for children #2, #3 and #4 were completed more than 12 months after the previous health assessments on file.

Corrected Corrected by Jun 27, 2024

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

3270.135(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.

There was a changing table in Room 7 outside of a restroom. The trash can used for diaper disposal when children are changed on the changing table was located inside the restroom, resulting in the need to open the door to the restroom to dispose of the diaper. This process is not hands-free.

Corrected Corrected by Jun 27, 2024

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

3270.135(e) · A staff person shall check a child's diaper at least every 2 hours and whenever the child indicates discomfort or exhibits behavior that suggests a soiled diaper. A staff person shall change a child's diaper when the diaper is soiled.

According to documentation in the classrooms and confirmation by staff in the following circumstances children's diapers were not checked and changed if necessary at least every 2 hours: -In Room 1 there was a child whose diaper was changed/checked at 10:40 and then again at 1:00. -In Room 2 there was a child whose diaper was changed/checked at 9:25 then again at 12:00. -In Room 4 there were two children changed/checked at approximately 9:05 than again at 11:43 and 11:54. -In Room 6 there was a child changed/checked at 9:05 and then at 11:30.

Corrected Corrected by Jul 1, 2024

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

3270.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The health assessment on file for Facility Person #2 did not include the information regarding the exam for communicable disease.

Corrected Corrected by Jul 24, 2024

Category: health medication. 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.

A bottle of milk was in a child's lunch box in Room 8. The child retrieved the bottle to take it to their rest mat at naptime.

Corrected Corrected by Jun 28, 2024

Category: nutrition. Marked corrected in the state record.

3270.166(4) · Disposable nursers and bottles shall be labeled with the child's name.

There was an infant's bottle not labeled with the child's name in Room 2.

Corrected Corrected by Jun 27, 2024

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 agreement on file for child #6 was not reviewed and updated by a parent in writing in the previous 6 months.

Corrected Corrected by Jul 2, 2024

Category: recordkeeping. 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.

Documentation of pediatric first aid & CPR training on file for Facility Person #7 indicate the training was completed more than 90 days after their start date.

Corrected Corrected by Jun 27, 2024

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 #7 will have until 15 days from the POC requested date to complete the required training. Until such time as the required training has been completed, staff person #7 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 #7, staff person #7 may not work in a child-care position at the facility.

Staff person #7 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. Staff person #2 completed the following required pre-service training on 12-27-23 that was over 90 days after their date of hire (see LIS code sheet): Health and Safety Training in the topics of 3270.31(f)(1-9). Staff person #3 completed the following required pre-service training on 12-29-23 that was over 90 days after their date of hire (see LIS code sheet): Health and Safety Training in the topics of 3270.31(f)(1-9). Staff person #4 completed the following required pre-service training on 2-23-24 that was over 90 days after their date of hire (see LIS code sheet): Health and Safety Training in the topics of 3270.31(f)(1-9). Staff person #6 completed the following required pre-service training on 2-22-23 that was over 90 days after their date of hire (see LIS code sheet): Health and Safety Training in the topics of 3270.31(f)(1-9). Staff person #7 completed the following required pre-service training on 12-22-23 that was over 90 days after their date of hire (see LIS code sheet): Health and Safety Training in the topics of 3270.31(f)(1-9). Staff person #1 and #5 completed the following required pre-service training on 10-5-23 that was over 90 days after their date of hire (see LIS code sheet): Pediatric first-aid/CPR training.

Corrected Corrected by Apr 30, 2024

Category: supervision. Marked corrected in the state record.

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.

In room #5 during naptime, there were 3 children observed on cots that lacked 2 feet of space on three sides. In room #8 during naptime, there were 2 children observed on cots that lacked 2 feet of space on three sides.

Corrected Corrected by Apr 26, 2024

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

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

According to the log, the operator did not manually test the interconnected fire detection system in the facility at least once every 30 days on multiple occasions within the last year.

Corrected Corrected by Apr 26, 2024

Category: recordkeeping. Marked corrected in the state record.

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. The required staff:child ratios must be maintained at all times.

Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by Apr 18, 2024

Category: ratio. Marked corrected in the state record.

3270.51 · * Postings will be placed at both sides of all doorways of rooms, restrooms, and play spaces, reminding staff to check to ensure all children are present before transition begins.

* Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by Apr 18, 2024

Category: ratio. 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.

Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by Apr 18, 2024

Category: supervision. Marked corrected in the state record.

3270.113(a) · * All staff members, including the director, will individually complete the one-hour Better Kid Care training, "Supervision: Moving Children". If a staff member had previously completed, "Supervision: Moving Children," the staff member will complete "Supervision: What's Required?" or "Supervision Positioning: Where Do I Stand?". This training is permitted to be included as part of the staff annual training requirements. Training should be completed by all staff within two (2) weeks of the acceptance of the Plans of Correction.

* Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by May 7, 2024

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.

Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by Apr 22, 2024

Category: supervision. Marked corrected in the state record.

3270.113(a)(1) · * The legal entity shall create and implement a tangible/physical identification system for each staff to identify the specific children in their supervisory group. All staff will utilize the identification method at all times while supervising children. The identification system method will be submitted to DHS prior to its use within two (2) weeks of the acceptance of the Plan of Correction and utilized by all staff for a minimum of three (3) months after submission. Multiple unannounced inspections may be conducted to assess ongoing compliance with usage of the system.

* Child #1 was left unattended in the classroom, for a period of 11 minutes, when Staff #1 and Staff #2 were transitioning the children from the classroom to the gym. During that time, the staff to child ratio was 0:1.

Corrected Corrected by Jul 30, 2024

Category: supervision. 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 site does not include provisions regarding continuity of operations, required as of 7/1/22, as per Announcement C-22-04.

Corrected Corrected by Jul 19, 2023

Category: ratio. Marked corrected in the state record.

3270.31(e)(1)(iii)/3270.192(2)(iii) · Training conducted in conferences or workshops is acceptable and may count toward the annual requirement for 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 person #8, did not include verification of 12 hours of annual training between 3/18/22-3/18/23, as per Announcement C-21-09.

Corrected Corrected by Jul 19, 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.

Staff person #1 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 and Get Started with Center-based Care: Building Blocks for Quality. Pediatric First Aid/Pediatric CPR was completed on 12/15/22 and Get Started with Center-based Care: Building Blocks for Quality was completed on 5/15/23. Staff person #2 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 5/26/22 Staff person #3 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 12/15/22. Staff person #7 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 5/2/23. Staff person #9 did not complete 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; the training was completed on6/1/23. Staff person #10 did not complete 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.; the training was completed on 5/11/23. The file for Staff person #6 includes verification of First Aid/CPR training dated 5/2/23, after the expiration date of 12/31/22.

Corrected Corrected by Jun 27, 2023

Category: ratio. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development in the topics of 3270.31(f)(10), within 90 days of hire. Staff person #9 must do one of the following: provide documentation that the trainer has become PQAS-certified or at least is on the waiting list, request the instructor provide documentation, such as their Pediatric First-Aid/CPR Instructor Card from the PQAS-approved organization or the approved curriculum organization, that the instructor is approved to offer Pediatric First-Aid/CPR training on behalf of their organization, or receive pediatric first-aid/CPR training in an approved curriculum by a PQAS-certified trainer.

Staff person #9 has acceptable pediatric first aid/CPR training in an approved curriculum; however, the trainer has not provided documentation that they are PQAS-certified in that training topic.

Corrected Corrected by Jul 19, 2023

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.

A child was observed receiving care in Room 4 without their emergency contact form being in the classroom.

Corrected Corrected by Jun 21, 2023

Category: recordkeeping. 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 #3 did not complete the mandated reporter training within 90 days of their date of hire (see LIS code sheet); the training was completed on 12/16/22. The Disclosure statement on file for Staff person #5 is not dated, making it invalid. The 2 most recent mandated reporter training certificates on file for Staff person #11 are dated 10/7/17 and 12/9/22, more than 60 months apart. The file for Staff person #11 includes criminal history clearances dated 9/18/17 and 9/25/22; child abuse clearances dated 9/25/17 and 10/17/22; and FBI clearances dated 9/26/17 and 9/27/22, all more than 60 months apart. The Disclosure statement on file for Staff person #12 is dated after the hire date (See LIS Code Sheet).

Corrected Corrected by Jun 27, 2023

Category: background checks. 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 file for Staff person #2 includes a staff evaluation dated 12/22/22, more than 12 months after hire (See LIS Code sheet). The two most recent staff evaluations on file for Staff person #8 are dated 7/20/21 and 3/18/23, more than 12 months apart.

Corrected Corrected by Jun 27, 2023

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 Room 4, Room 6, and Room 7 did not include tape. The first aid kit in Room 8 did not include gauze. or scissors

Corrected Corrected by Jun 30, 2023

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

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

There were two holes in the poured surface of the preschool playground, near the climber and the trash can. There was a plastic guard on the outer side of the fence near the dumpster area in the preschool playground that was broken and frayed.

Corrected Corrected by Jul 3, 2023

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

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

There was no written daily activity schedule in Room 3 and Room 4.

Corrected Corrected by Jun 28, 2023

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

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 on file for Child #5 does not include the telephone number for the child's pediatrician or source of medical care.

Corrected Corrected by Jun 30, 2023

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

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

The most recent health assessments on file for Child #4, who is a Young Toddler, is dated 11/14/22 and 9/20/22, more than 6 months ago.

Corrected Corrected by Jun 30, 2023

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

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

The two most recent health assessments on file for Child #2, who is a preschool age child, are dated 12/30/20 and 3/16/22, more than 1 year apart and more than 1 year ago,

Corrected Corrected by Jun 27, 2023

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

3270.131(d)(5)/3270.131(e)(3) · ·Child #1 and #4 must be dismissed from care by close of business on 6/21/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter. A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings).

The most recent influenza vaccination on file for Child #1, who is 4 years old, is dated 10/25/21, more than 1 year ago, and is recommended annually by the ACIP. The immunization record on file for Child #4, who is 13 months old, includes 2 of 3 DTAP vaccines recommended by the ACIP for a child this age; 2 of 3 HIB vaccines recommended by the ACIP for a child this age; and 2 of 3 Pneumococcal vaccines recommended by the ACIP for a child this age; and includes 0 influenza vaccinations, recommended annually by the ACIP.

Corrected Corrected by Jul 20, 2023

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 2 most recent health assessments on file for Staff person #4 were dated 10/14/20 and 4/19/23, more than 24 months apart. The 2 most recent health assessments on file for Staff person #8 were dated 3/10/21 and 4/28/23, more than 24 months apart.

Corrected Corrected by Jun 27, 2023

Category: ratio. Marked corrected in the state record.

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 person #1 was observed not to contain the results of a Tuberculosis test result being completed within 12 months prior to date of hire (See LIS CODE SHEET).

Corrected Corrected by Jul 24, 2023

Category: health medication. 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 #12 indicates that the staff person has a communicable/contagious disease, with no additional information given.

Corrected Corrected by Jul 21, 2023

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 most recent 6-month review signature for the financial agreement on file for Child #1, #2, #3, #5, #6, is dated more than 6 months ago. The most recent 6-month review signature for the financial agreement on file for Child #7 is dated more than 6 months after the previous 6-month review signature.

Corrected Corrected by Jul 24, 2023

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 #3 includes only 1 written nonfamily reference.

Corrected Corrected by Jul 21, 2023

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 on file for Child #6, with an enrollment date of 6/5/22, is dated 10/25/22, more than 60 days after enrollment.

Corrected Corrected by Jun 27, 2023

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

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

Based on a self-report and investigation, it was confirmed that staff person #1 picked up Child #1 by the arm, lifting him approximately 2-3 feet off the ground, to remove him from another child when they were fighting over a toy.

Corrected Corrected by May 23, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.52/3270.55(a) · When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in § 3270.51 (relating to similar age level). The staff:child ratio while toddlers and preschoolers are napping is one staff person to 10 young toddlers, one staff person to 12 older toddlers, one staff person to 20 preschool children

During a ratio review during an unannounced monitoring inspection on 9/12/22, at approximately 1:30 PM, a staff member in Room #5 was observed alone with 3 young toddlers and 8 older toddlers during naptime, making her over ratio.

Corrected Corrected by Sep 13, 2022

Category: ratio. Marked corrected in the state record.

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

There was a cracked yellow bucket in the sandbox in the preschool/school age playground with sharp edges that could cause injury.

Corrected Corrected by Jun 24, 2022

Category: physical safety. 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 #2, #5, #6, #7, #10, #12, #13, #14 will have until 8/18/22 to complete the required training. Until such time as the required training has been completed, staff person #2, #5, #6, #7, #10, #12, #13, #14, must be supervised, when interacting with children, by an (AGS, primary staff person, or family child care home staff person) who has completed the required training related to this citation. If there are no staff available to supervise staff person #2, #5, #6, #7, #10, #12, #13, #14 staff person #2, #5, #6, #7, #10, #12, #13, #14 may not work in a child-care position at the facility.

Staff persons #2, #5, #6, #7, #10, #12, #13, #14 have 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. Staff person #9 did not complete 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; the training was completed on 6/8/22.

Corrected Corrected by Aug 4, 2022

Category: supervision. 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), 3280.31(f) (1-10), or 3290.31(g) (1-10) within 90 days of hire. Staff person #7, #15 will have until 8/18/22 to complete the required training. Until such time as the required training has been completed, staff person #7, #15 must be supervised, when interacting with children, by an (AGS, primary staff person, or family child care home staff person) who has completed the required training related to this citation. If there are no staff available to supervise staff person #7, #15 staff person #7, #15 may not work in a child-care position at the facility.

Staff person #7, #15 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 training. Staff person #14 did 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 training; the training was completed 2/26/22.

Corrected Corrected by Aug 4, 2022

Category: supervision. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #1 may not work in a child care position at the facility.

The file for staff person #1 was observed not to contain documentation of application of an Washington state criminal history clearance prior to date of hire (See IS CODE SHEET) required for provisional hiring under the CPSL.

Corrected Corrected by Jun 27, 2022

Category: background checks. 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 #12 and #16 was observed not to contain documentation of application of an NSOR certificate prior to date of hire (See IS CODE SHEET) required for provisional hiring under the CPSL.

Corrected Corrected by Jun 24, 2022

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/facility person/volunteer #7, #9, #14 will have until 8/18/22 from POC requested date) to complete the mandated reporter training. Until such time as the required training has been completed, staff person/facility person/volunteer #7, #9, #14 must be supervised, when interacting with children, by an (AGS, primary staff person, or family child care home staff person) who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person/facility person/volunteer #7, #9, #14, staff person/facility person/volunteer #7, #9, #14 may not work in a child-care position at the facility.

Staff person #6 did not completed the mandated reporter training within 90 days of their date of hire (see LIS code sheet); the training was competed on 3/28/22. Staff person #7, #9, #14 have not completed the the mandated reporter training within 90 days of their date of hire (see LIS code sheet).

Corrected Corrected by Aug 5, 2022

Category: supervision. 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 #4, and #16, classified as a group supervisor, does not include a bachelor's degree in education or a related human services field; a bachelor's degree including 30 credit hours in education or a human services field and 1 year of experience with children; or an associate's degree in education, or a related human services field and 2 years of experience with children; or an associate's degree, including 30 credit hours in education or a related human services field and 3 years of experience with children.

Corrected Corrected by Aug 5, 2022

Category: supervision. 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 Room 3 was observed to not contain scissors. The first aid kit in Room 4 was observed to not contain soap. The first aid kit in Room 8 was observed to not contain tape.

Corrected Corrected by Jun 24, 2022

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

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

There were 4 holes in the wall with exposed plaster/drywall in the school-age room in the cubby area under the television. There were 3 holes in the wall with exposed plaster/drywall in the school-age room in the cubby area on the left above the hooks and one hole on the right wall in the cubby area.

Corrected Corrected by Jun 24, 2022

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

3270.82(h) · A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

There was no handwashing sign at the toilet in the 1st bathroom in Room 9.

Corrected Corrected by Aug 5, 2022

Category: health medication. 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.

Rooms #3, #4, #5, #6, #7, and #8 contained rest equipment that was not labeled for the use by a specific child.

Corrected Corrected by Aug 5, 2022

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

3270.111(a) · A written plan of daily activities and routines, including a time for free play shall be established for each group. The plan shall be flexible to accommodate the needs of individual children and the dynamics of the group.

There was no daily activity schedule posted in Room #6, #8, and the school-age room.

Corrected Corrected by Jun 27, 2022

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.

At 12:44 PM, a child was observed napping in Room 9 with his face covered by a blanket so that his face could not be seen by a staff member.

Corrected Corrected by Aug 1, 2022

Category: supervision. Marked corrected in the state record.

3270.124(b)(1) · Emergency contact information must include the name and birth date of the child.

The emergency contact form on file for Child #4 does not include the child's birthdate.

Corrected Corrected by Aug 5, 2022

Category: recordkeeping. Marked corrected in the state record.

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 on file for Child #3 does not include the address for the child's pediatrician/source for medical care.

Corrected Corrected by Aug 5, 2022

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

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

The emergency contact form on file for Child #1 and #8 does not include the work address and/or telephone number for the enrolling parent.

Corrected Corrected by Aug 5, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.131(d)(7) · A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

The health assessment on file for Child #7 does not indicate if the child is free from contagious disease and may participate in child care.

Corrected Corrected by Aug 5, 2022

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

3270.124(b)(4)/3270.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The file for Child #2 does not include written parental permission for the facility to obtain emergency medical care.

Corrected Corrected by Aug 5, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(7) · Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

The emergency contact form on file for Child #3, #5, #6, and #9 does not include a complete address for all listed release persons.

Corrected Corrected by Aug 5, 2022

Category: recordkeeping. 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.

Two children were observed receiving care in Room 4 without their emergency contact forms being in the classroom. Two children were observed receiving care in Room 8 without their emergency contact forms being in the classroom.

Corrected Corrected by Jun 24, 2022

Category: recordkeeping. 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 informationA parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

The file for Child #4, enrolled 10/11/21, does not include a 6 month review signature for the emergency contact form and financial agreement. The file for Child #8, enrolled 3/4/21, does not include a 6 month review signature for the financial agreement. The file for Child #9, enrolled 5/3/21, does not include a 6 month review signature for the emergency contact form and financial agreement.

Corrected Corrected by Aug 5, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.131(d)(5)/3270.131(e)(1) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP.The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

The immunization record on file for Child #2, who is 16 months old, includes 3 of 4 Pneumococcal vaccines and 0 influenza vaccines recommended for a child this age by the ACIP. The immunization record on file for Child #4, who is 22 months old, includes 3 of 4 DTAP vaccines recommended for a child this age by the ACIP. The most recent influenza shot on file for Child #7, who is 5 years old, is dated 2/12/20, more than 1 year ago, but is recommended annually by the ACIP.

Corrected Corrected by Aug 5, 2022

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 diaper changes in Rooms 3 and 4, it was observed that the children's hands were not washed following the diaper change.

Corrected Corrected by Aug 5, 2022

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

3270.135(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.

While observing diaper changes in Rooms 3, 6, and 8, staff were observed opening the hands free can for diaper disposal with their hands.

Corrected Corrected by Aug 5, 2022

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 2 most recent health assessments on file for Staff person #3 were dated 2/28/20 and 5/11/22, more than 24 months apart. The 2 most recent health assessments on file for Staff person #8 were dated 1/24/19 and 6/14/21, more than 24 months apart. The file for staff person #10 was observed not to contain documentation of a Tuberculosis screening being completed within 12 months prior to date of hire (See LIS CODE SHEET). The Tuberculosis screening on file for staff person #10 was dated 4/11/22.

Corrected Corrected by Aug 5, 2022

Category: ratio. Marked corrected in the state record.

3270.151(c)(3) · An adult health assessment must include an examination for communicable diseases and the results of that examination.

The current health assessment on file for Staff person #15 does not indicate if the staff person was examined for communicable disease.

Corrected Corrected by Aug 5, 2022

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 person #15 does not include the physician or health care professional's assessment of the person's suitability to provide child care.

Corrected Corrected by Aug 5, 2022

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

3270.182(5) · A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The file for Child #2 does not include written parental permission for the facility to administer minor first aid procedures.

Corrected Corrected by Aug 5, 2022

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. A child's record shall contain initial and subsequent health reports.

The initial health assessment on file for Child #4, with an enrollment date of 10/11/21, is dated 2/7/22, more than 90 days after enrollment, as per Announcement C-20-04.

Corrected Corrected by Jun 24, 2022

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