3290.31(f)(4)(i)/3290.192(4) · Competence is the completion of training by a professional in the field of first-aid and CPR. All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. A facility person's record shall include records of training required by the Department.

Staff #2 did not renew training in pediatric CPR and first aid on or before its expiration. The trainings were dated 4/29/22 and 2/19/25. Current training is now on file.

Corrected Corrected by Mar 5, 2025

Category: ratio. Marked corrected in the state record.

3290.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to Child Protective Services). Staff persons #1 and #2 will have 15 days from the date plans of correction are requested to complete the mandated reporter training. Until such time as the required training has been completed, staff persons #1 and #2 must be supervised, when interacting with children, by a primary staff person who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff persons #1 and #2-, staff person #1 and #2 may not work in a child-care position at the facility.

Staff persons #1 and #2 have not completed mandated reporter training within the last 60 months. This is evidenced by the previously documented mandated reporter training on file being dated 2/01/20 for staff #1 and 2/24/20 for staff #2.

Corrected Corrected by Mar 5, 2025

Category: supervision. Marked corrected in the state record.

3290.32(a)/3290.192(3) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

The file for staff #3 contained a signed disclosure statement that was not dated. The file for household member #4 lacked a disclosure statement.

Corrected Corrected by Mar 5, 2025

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

3290.63 · Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.

A power strip in the room at the rear entry lacked protective covers. The power strip was plugged in and was accessible to children 5 years of age or younger.

Corrected Corrected by Mar 5, 2025

Marked corrected in the state record.

3290.118 · Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

Child #5, an infant, observed being placed to sleep in an inclined seat. Based on statements made by staff, the infant has used this rest equipment since their recent enrollment.

Corrected Corrected by Mar 5, 2025

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

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The most recent agreements for children #1, #2, and #3 did not specify the persons designated by a parent to whom the children may be released.

Corrected Corrected by Mar 6, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(6) · An agreement shall specify the date of the child's admission.

The most recent agreements for children #1, #3, #4, and #5 did not specify the date of the child's admission.

Corrected Corrected by Mar 5, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.124(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 forms for children #4 and #5 did not include the name of the child's physician or source of medical care.

Corrected Corrected by Mar 6, 2025

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

3290.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The emergency contact form for child #5 did not include the health insurance policy number.

Corrected Corrected by Mar 6, 2025

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

3290.124(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 forms for children #4 and #5 did not include complete addresses for the individuals designated by the parent to whom the children may be released.

Corrected Corrected by Mar 6, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.124(e)/3290.181(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 emergency contact form and agreement for child #1 was reviewed and signed by the parent at an interval greater than 6 months. The updated signatures were dated 6/06/24 and 1/30/25. The forms are now current.

Corrected Corrected by Mar 5, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.151(a)(2)/3290.192(2) · A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The file for staff #2 contained consecutive health assessments dated more than 24 months apart; 6/30/22 and 9/25/24. The most recent health assessment on file is current.

Corrected Corrected by Mar 5, 2025

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

3290.151(c)(2) · An adult health assessment shall include Tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, CRNP, the Department of Health or a local health department.

The file for staff #3 contained TB tests results obtained more than 12 months prior to initial employment.

Corrected Corrected by Apr 30, 2025

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

3290.24(d) · Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

The facility lacked documentation of an emergency drill conducted in the last 12 months. The last documented emergency drill occurred 2/21/23.

Corrected Corrected by Mar 5, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.18 · A facility shall be operated in conformity with applicable Federal and State laws and regulations. State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children. Until such time as the required pre-service trainings are completed, Staff #3 must be supervised, when interacting with children, by a 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 #3, Staff #3 may not work in a child-care position at the facility.

The facility files lacked a copy of the Shaken Baby, Child Maltreatment, and Abusive Head Trauma policies. Staff #3 was observed to be caring for children unsupervised. Staff #3 has not completed the following pre-service training required prior to caring for children unsupervised: Pediatric First Aid/Pediatric CPR, Mandated Reporter training, and Get Started with Center-based Care: Building Blocks for Quality -- Revised 2022.

Corrected Corrected by Mar 22, 2024

Category: supervision. Marked corrected in the state record.

3290.24(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.

The most recent Emergency Plan training on file for Staff #2 is dated 8/5/22, more than 12 months ago.

Corrected Corrected by Mar 8, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.32(a)/3290.192(3) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 3 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 #3 may not work in a child care position at the facility.

The files for Staff #3 and Staff #4 (Household Member) did not contain a Disclosure Statement.

Corrected Corrected by Mar 22, 2024

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

3290.32(a)/3290.192(3) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 3 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 #3 may not work in a child care position at the facility.

The file for Staff #3, who was working alone onsite with 4 toddlers, did not contain a PA State Police clearance, PA Child Abuse clearance, FBI Clearance, and a NSOR. The most recent Child Abuse Clearance (4/27/17) and FBI Clearance (4/25/17) on file for Staff #4 (Household Member) were dated more than 60 months ago. (SEE LIS CODE SHEET)

Corrected Corrected by Mar 22, 2024

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

3290.74(a) · Floors, walls, ceilings and other surfaces, including the facility's outdoor play area, shall be kept clean, in good repair and free from visible hazards.

An unsecured box fan was observed on a mounted stand above a pack and play in the living room, which could be hazardous to children.

Corrected Corrected by Feb 2, 2024

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

3290.102(a)/3290.103 · 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. Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Ripped plastic on a foam climber was observed to be less than 1 inch in diameter and accessible to children who are still placing objects in their mouths.

Corrected Corrected by Feb 2, 2024

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

3290.123(a) · An agreement shall be signed by the operator and the parent.

The financial agreement form on file for Child #2 was not signed by the operator. The file for Child #5 did not contain a Financial Agreement form.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(1) · An agreement shall specify the amount of the fee to be charged per day or per week.

The financial agreement form for Child #2 did not contain a fee amount.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(2) · An agreement shall specify the date on which the fee is to be paid.

The financial agreement form for Child #2 did not contain the date which the fee is to be paid.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(3) · An agreement shall specify 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 at § 3290.124(e).

The files for Child #1 (02/2023), Child #3 (None in file), and Child #4 (11/2022) did not contain Child Service Reports every 6 months after date of enrollment. (SEE LIS CODE SHEET)

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(4) · An agreement shall specify the child's arrival and departure times.

The financial agreement form on file for Child #2 did not contain arrival and departure times.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The financial agreement form on file for Child #2 did not contain persons whom the child can be released to.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(6)/3290.182(2) · An agreement shall specify the date of the child's admission. A child's record must contain the dates of application, admission and withdrawal of the child.

The financial agreement form on file for Child #2 did not contain the date of admission.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(b)/3290.182(8) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement. A child's record must contain a copy of the initial agreement and subsequent written agreements between the parent and the operator. The parent receives the original agreement.

The financial agreement forms for Child #1, Child #2, Child #3, and Child #4 were the original copies and the original was not given to the parents.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(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 for Child #5 did not contain the address and phone number of the physician or medical care.

Corrected Corrected by Mar 22, 2024

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

3290.124(b)(3) · Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

The emergency contact forms for Child #2 did not contain the enrolling parent's home or work address. The emergency contact forms for Child #3 and Child #5 did not contain the enrolling parent's work address and telephone number.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(4)/3290.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The Emergency Contact forms for Child #1 and Child #2 did not contain consent from the parent for emergency medical care.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(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 of CRNP, which is needed in an emergency situation.

The emergency contact form for Child #1, Child #2, and Child #5 did not contain information on the child's disability or special needs

Corrected Corrected by Mar 22, 2024

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

3290.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The emergency contact form for Child #5 did not contain the health insurance coverage and policy number.

Corrected Corrected by Mar 22, 2024

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

3290.124(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 forms for Child #2, Child #3, and Child #4 did not contain complete addresses and telephone numbers for all listed release persons.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(e)/3290.181(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 emergency contact and financial agreement forms for Child #3 (EC: 3/3/23, FA: 3/12/23) and Child #4 (EC & FC: 4/2023) have not been reviewed and signed by the parent every 6 months.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.131(b)(1)/3290.182(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 must contain initial and subsequent health reports.

The most recent health assessment on file for Child #2, a young toddler, is dated 6/21/23, more than 6 months ago.

Corrected Corrected by Mar 22, 2024

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

3290.131(b)(2)/3290.182(1) · The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child. A child's record must contain initial and subsequent health reports.

The most recent health assessment on file for Child #3, an older toddler, is dated 10/11/22, more than 12 months ago. The most recent health assessment on file for Child #4, an older toddler, is dated 10/4/22, more than 12 months ago.

Corrected Corrected by Mar 22, 2024

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

3290.131(d)(5)/3290.131(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 #3 lacked 2 doses of Hepatitis B, 1 dose of DTAP, 1 dose of Polio, and 1 dose of Hepatitis A without having an exemption form on file. The immunization record on file for Child #5 lacked 1 dose of Pneumococcal without having an exemption on file. Child #3 and #5 must be dismissed from care by close of business on 2/2/24, and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Corrected Corrected by Mar 22, 2024

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

3290.151(a)/3290.192(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 on file at the facility. 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 #3 lacked a Health Assessment and TB Test. (SEE LIS CODE SHEET)

Corrected Corrected by Feb 2, 2024

Category: ratio. Marked corrected in the state record.

3290.182(5) · A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The emergency contact forms for Child #1 and Child #2 did not contain consent form the parent for the facility to administer minor first-aid.

Corrected Corrected by Mar 22, 2024

Category: ratio. Marked corrected in the state record.

3290.31(i) · All staff persons shall complete the professional development under subsection (g). Documentation of the completion of training shall be kept in the facility person's file or maintained in an electronic system as designated by the Department.

The file for Staff #2 did not contain documentation of completion of training in the 10 required health and safety training topics.

Corrected Corrected by Mar 22, 2024

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

3290.94(a)(1) · The operator 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 observed fire drill log contained consecutive fire drills held more than 60 days apart.

Corrected Corrected by Feb 2, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

The facility did not contain an interconnected smoke detection system that is approved by a testing laboratory recognized by OSHA.

Corrected Corrected by Mar 15, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

The facility's smoke alarm test log contained consecutive smoke alarm testing held more than 30 days apart.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.22(a) · The facility's current certificate of compliance shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional child care office posted at the same location.

The provider did not have their current certificate of compliance posted in a conspicuous location used by parents.

Corrected Corrected by Feb 2, 2024

Marked corrected in the state record.

3290.31(f)/3290.192(4) · A staff person shall obtain an annual minimum of 12 clock hours of child care training. A facility person's record shall include records of training required by the Department.

Staff #1 (6 hours) and Staff #2 (2 hours) lacked a minimum of 12 hours of childcare training.

Corrected Corrected by Mar 22, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.91(a) · Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

The door leading directly from the kitchen to outside was partially obstructed by a tall wired shelving unit.

Corrected Corrected by Apr 11, 2023

Marked corrected in the state record.

3290.32(a)/3290.192(3) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #2 may not work in a child care position at the facility. Facility person #1 will not be present in childcare space.

The file for facility person #1, a household member, contained a state police clearance for the purpose of volunteering. The file for staff person #2, hired provisionally, did not include proof of request for a child abuse clearance or the actual clearance.

Corrected Corrected by Apr 11, 2023

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

3290.113(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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in §§ 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio).

During nap time, staff person #3 was supervising 4 children in the nap room at the front of the facility. At approximately 2:30 pm, staff person #3 took 1 child to the bathroom while the other 3 chuildren remained sleeping in the nap room. The bathroom is located down a short hall from the nap room.

Corrected Corrected by Apr 11, 2023

Category: supervision. Marked corrected in the state record.

3290.123(a)(3) · An agreement shall specify 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 at § 3290.124(e).

The last two child service reports in the file for child #1 were dated more than 6 months apart.

Corrected Corrected by Apr 11, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(1) · Emergency contact information must include the name and birth date of the child.

The emergency contact for child #2 did not include the child's birth date.

Corrected Corrected by Apr 11, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The emergency contact information in the file for child #3 did not include the health insurance name or policy number for the child. The emergency contact information in the file for child #4 did not include the health insurance policy number for the child.

Corrected Corrected by Apr 14, 2023

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

3290.124(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 address of one of the release persons on the emergency contact form child #2 included the street name but not the house number.

Corrected Corrected by Apr 11, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.124(e)/3290.181(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 last documented review by a parent on the emergency contact information for child #4 was 8/15/22.

Corrected Corrected by Apr 11, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.131(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 last health report in the file for child #1, a young toddler, was 6/27/22.

Corrected Corrected by Apr 11, 2023

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

3290.131(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 last health report in the file for child #4, a preschooler, was 10/14/21.

Corrected Corrected by Apr 11, 2023

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

3290.131(d)(5)/3290.131(e)(3) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings). i. Child #1, #2 and #4 must be dismissed from care by close of business and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The most recent vaccinations in the file for child #1, a 21 month old, was missing 1 of 4 Act HIB, and 1 of 4 PCV. The last documented flu shot in the file for child #2, a 23 month old, was in 2021. The last documented flu shot in the file for child #4, a 4 year old, was in 2020.

Corrected Corrected by Apr 11, 2023

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

3290.192(3) · A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #2 may not work in a child care position at the facility.

SECOND VIOLATION. The file for Staff #2 lacked a current state police clearance. This clearance was previously documented at a previous inspection. Previously cited on SIN-00214490 on 11/10/22. Staff #2 was observed working in a child care position on 11/18/22.

Corrected Corrected by Dec 5, 2022

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

3290.52(3) · The operator may provide care to no more than five related and unrelated infants and toddlers at any one time. No more than two related and unrelated infants may receive care at any one time. If two infants are in care, three toddlers are permitted.

Upon entry to the facility at 10:30 AM on 11/10/22, 7 children were present - 2 INF, 4 YT (1 related), 1 PS.

Corrected Corrected by Nov 13, 2022

Marked corrected in the state record.

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

SECOND VIOLATION. The files for Child #4 and #5 contained agreements which lacked the release persons for the children. Previously cited on SIN-00210346 on 8/9/22.

Corrected Corrected by Nov 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.124(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.

SECOND VIOLATION. The file for Child #3 contained an emergency contact form which lacked the names, addresses and telephone numbers of individuals designated by the parent to whom the children may be released. Previously cited on SIN-00210346 on 8/9/22.

Corrected Corrected by Nov 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.192(3) · A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #2 may not work in a child care position at the facility.

The file for Staff #2 lacked a current state police clearance. This clearance was previously documented at a previous inspection.

Corrected Corrected by Nov 13, 2022

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

3290.31(g) · Staff person(s) shall complete professional development in the topics 3290.31(g) (1-10) within 90 days of hire. Staff person #3 will have until 11/25/22 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 a 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 #3, staff person #3 may not work in a child-care position at the facility.

Continued Non-Compliance: On 8/9/22, a renewal inspection was conducted at the facility. Staff person #3 had not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): pediatric first-aid/CPR and health and safety training. The facility's acceptable plan of correction indicated the correction would be implemented by 8/15/22. On 11/10/22, an unannounced inspection was conducted. Staff person #3 still has not completed the following required pre-service training: health and safety training.

Corrected Corrected by Nov 13, 2022

Category: supervision. Marked corrected in the state record.

3290.18 · Conditions at the facility may not pose a threat to the health or safety of the children.

Staff #3 was observed to be caring for children unsupervised. Staff #3- has not completed the following pre-service training required prior to caring for children unsupervised: pediatric first-aid and CPR, health and safety training.

Corrected Corrected by Aug 15, 2022

Category: supervision. Marked corrected in the state record.

3290.24(a)(3) · The facility shall have an emergency plan that provides for a method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises.

The observed emergency plan lacked a method to contact parents in an emergency.

Corrected Corrected by Aug 15, 2022

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

3290.24(a)(4) · The facility shall have an emergency plan that provides for a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

The observed emergency plan lacked a method to inform parents that the emergency has ended to provide instructions on reuniting with children.

Corrected Corrected by Aug 15, 2022

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

3290.32(a)/3290.192(3) · 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,#2, #3 and #4--- may not work in a child care position at the facility.

The files for Staff #1, #2, #3 and Facility Person #4 lacked disclosure statements. The file for Staff #1 lacked documentation of most recent previous state police clearance, current and most recent previous child abuse clearances and current NSOR clearance - all of which were reviewed at a previous inspection. The file for Staff #2 lacked documentation of current and most recent previous state police clearances, most recent previous child abuse and FBI clearance and current NSOR clearance - all of which were reviewed at a previous inspection. The file for Staff #3 lacked an NSOR clearance or application for NSOR clearance. The file for Facility Person #4 (HH Member) contained a child abuse clearance dated after the 31st day of residence in the FCCH.

Corrected Corrected by Aug 9, 2022

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

3290.75(a) · Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

Damaged plaster was observed on the ceiling of the play room near the piano. Operator reported the ceiling was damaged by water from a leak. Peeling paint was observed on the porch floor and steps.

Corrected Corrected by Sep 6, 2022

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

3290.102(a) · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

A broken toy bin was observed by the door of the playroom, causing a rough edge. A broken bin was observed inside the toy storage bin in the outdoor play space, causing a rough edge.

Corrected Corrected by Aug 9, 2022

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

3290.117(c) · A veterinarian's certificate of current rabies immunization is required for a cat or dog at the facility. The certificate shall be on file when the cat or dog is present.

Rabies immunization documentation was not available at the time of inspection for a dog which was present at the facility on the day of the inspection.

Corrected Corrected by Aug 9, 2022

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

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The files for Child #4 and #5 contained agreements which lacked the release persons for the children.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(6) · An agreement shall specify the date of the child's admission.

The files for Child #1, #2, #3 and #5 contained agreements which lacked the children's enrollment dates.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.124(a) · Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.

The file for Child #2 contained an emergency contact form which lacked the contact information for the emergency contacts for the child.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

The file for Child #2 contained an emergency contact form which lacked the telephone number of the child's medical provider.

Corrected Corrected by Aug 9, 2022

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

3290.124(b)(3) · Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

The files for Child #2 , #3 and #5 contained emergency contact forms which lacked the work addresses and telephone numbers for the enrolling parents.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The file for Child #2 contained an emergency contact form which lacked the policy number for the child's health insurance. The file for Child #4 contained an emergency contact form which lacked the health insurance coverage name and policy number for the child.

Corrected Corrected by Aug 12, 2022

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

3290.182(3) · A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The file for Child #2 contained an emergency contact form which lacked written parental consent for emergency medical care.

Corrected Corrected by Aug 9, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.124(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 files for Child #2 and #3 contained emergency contact forms which lacked the names, addresses and telephone numbers of individuals designated by the parents to whom the children may be released. The file for Child #5 contained an emergency contact form which lacked the addresses for release persons.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.131(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 #3 contained a most recent health report dated more than 6 months ago.

Corrected Corrected by Aug 26, 2022

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

3290.131(e)(1)/3290.182(1) · The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.A child's record must contain initial and subsequent health reports.

The files for Child #3 and #5 contained records of immunization history which lacked current influenza vaccinations.

Corrected Corrected by Aug 15, 2022

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

3290.135(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.

During an observed diaper change, the soiled diaper was set down next to the child until the change was complete.

Corrected Corrected by Aug 9, 2022

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

3290.151(a)(2) · 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 #2 contained a most recent health assessment dated more than 24 months ago.

Corrected Corrected by Aug 20, 2022

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

3290.166(1) · A written statement giving the formula and feeding schedule for an infant shall be obtained from the parent.

A written statement giving the formula and feeding schedule for the infant in care was not available at the time of the inspection.

Corrected Corrected by Aug 9, 2022

Category: nutrition. Marked corrected in the state record.

3290.182(5) · A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The file for Child #2 contained an emergency contact form which lacked written parental consent for the administration of first-aid.

Corrected Corrected by Aug 9, 2022

Category: ratio. Marked corrected in the state record.

3290.24(g) · The operator shall send a copy of the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

According to operator report, the observed emergency plan was sent to the local municipality, but not to the county emergency management agency.

Corrected Corrected by Aug 15, 2022

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

3290.24(d) · Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Documentation of an emergency drill being held was not available at the time of the inspection.

Corrected Corrected by Aug 10, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.31(f)/3290.192(4) · A staff person shall obtain an annual minimum of 12 clock hours of child care training.A facility person's record shall include records of training required by the Department.

The files for Staff #1 and #2 contained 6 of the 12 required hours of annual child care training between 12/19/20 and 12/19/21.

Corrected Corrected by Aug 28, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.31(g) · Staff person(s) shall complete professional development in the topics of 3290.31(g) (1-10) within 90 days of hire. Staff person #3 will have until 9/21/22 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 a 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 #3, staff person #3 may not work in a child-care position at the facility.

Staff #3 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): pediatric first-aid and CPR training, health and safety training.

Corrected Corrected by Aug 15, 2022

Category: supervision. Marked corrected in the state record.

3290.32(a)/3290.192(3) · 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 record for staff #1 lacked a PA state police clearance and FBI clearance.

Corrected Corrected by Oct 15, 2021

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

3290.63 · Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.

Protective receptacle covers were not placed in (4) electrical outlets on a power strip that was plugged in by the TV in the front room and accessible to children 5 years of age or younger.

Corrected Corrected by Aug 16, 2021

Marked corrected in the state record.

3290.102(a) · Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

a crack was observed on a large plastic storage container, which was accessible and would pose a potential pinch point for children.

Corrected Corrected by Aug 16, 2021

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

3290.106 · A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45° F or below. An operating thermometer shall be placed in the refrigerator.

An operating thermometer was not placed in the refrigerator.

Corrected Corrected by Aug 26, 2021

Category: nutrition. Marked corrected in the state record.

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The agreement for child #1 and #2 did not specify the persons designated by a parent to whom the child may be released.

Corrected Corrected by Aug 16, 2021

Category: recordkeeping. Marked corrected in the state record.

3290.151(a)/3290.192(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 on file at the facility.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 record for staff #1 lacked a health assessment.

Corrected Corrected by Oct 15, 2021

Category: ratio. Marked corrected in the state record.

3290.191 · An individual record is required for each facility person.

Staff #1 did not have an individual record.

Corrected Corrected by Oct 15, 2021

Category: recordkeeping. Marked corrected in the state record.

3290.94(a)(1) · Fire drills are conducted at least once every 60 days.

Fire drills were not conducted at least every 60 days.

Corrected Corrected by Aug 17, 2021

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

3290.94(a)(5) · Evacuation routes are posted in a conspicuous location on each floor of the facility.

Evacuation routes were not posted in the basement and 2nd floor of the facility.

Corrected Corrected by Aug 16, 2021

Marked corrected in the state record.

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

The operator was unable to provide proof of purchase for fire detection devices and did not document that they were manually tested every 30 days.

Corrected Corrected by Aug 17, 2021

Category: recordkeeping. Marked corrected in the state record.

3290.22(b) · The operator shall provide the parent of each child enrolled in the facility with information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office.

The operator did not provide the parent of each child enrolled in the facility with information on how to access the regulations in this chapter electronically.

Corrected Corrected by Aug 17, 2021

Marked corrected in the state record.

3290.24(a)(1)/3290.24(a)(5) · The facility shall have an emergency plan that provides for accommodations for shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises.The facility shall have an emergency plan that provides for accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

The facility's emergency plan did not provide for accommodations for shelter of children during a lock-down and accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

Corrected Corrected by Aug 18, 2021

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