3270.67(a) · Trash shall be removed from the facility at least once per day.

Per staff statements, the trash in the black room had not been removed from the previous day.

Corrected Corrected by Nov 30, 2024

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 did not address Continuity of Operations as required by Announcement C-22-04 which states to maintain full compliance with 45 CFR § 98.41(a)(1)(vii), child care facilities must have requirements for continuity of operations including information regarding how they will pay for repairs, pay staff, and pay bills during the aftermath of the disaster.

Corrected Corrected by Nov 30, 2024

Category: ratio. 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 #--- may not work in a child care position at the facility.

The most recent FBI clearances on file for Staff Person #2 are dated 7/26/19 and 10/5/24 more than 60 months apart. The file for Staff Person #3 contained the following clearances that were more than 60 days apart: PA State Police clearances dated 3/20/19 and 4/16/24; PA Child Abuse clearances dated 3/28/19 and 4/18/24; and DHS FBI clearances dated 3/28/19 and 4/7/24.

Corrected Corrected by Nov 30, 2024

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

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

In the yellow room, the electrical outlet accessible to children 5 years of age or younger lacked a receptacle cover.

Corrected Corrected by Nov 30, 2024

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.

The wooden floor in the purple room has a 6 inch section missing creating a gap which presents a tripping hazard.

Corrected Corrected by Nov 30, 2024

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

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

There were multiple areas of peeling paint in the facility, including: behind the door and to the lower right of the TV in the purple room; the wall under the window in the blue room; the walls by the bulletin board in the orange room; the wall above the toy box in the yellow room.

Corrected Corrected by Nov 30, 2024

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

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

The agreement form for Child #4 lacked arrival and departure times.

Corrected Corrected by Nov 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.123(b)/3270.182(8) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement. 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.

The files for Child #1, Child #2, Child #3, Child #4, Child #5, Child #6, and Child #7 contained the original agreement form.

Corrected Corrected by Nov 30, 2024

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 #7 lacked the name and address of the physician or source of medical care.

Corrected Corrected by Nov 30, 2024

Category: health medication. 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 #5 lacked the address for the individual designated by the parent to whom the child may be released.

Corrected Corrected by Nov 30, 2024

Category: recordkeeping. 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.

In the Red Room at approximately 1:00pm, Staff Person #6 was observed changing a diaper. Staff Person #6 placed the soiled diaper on the changing pad, then completed the diaper change and clean up before discarding the soiled diaper into a plastic-lined, hands-free covered can.

Corrected Corrected by Nov 30, 2024

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

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

The current health assessment on file for Staff Person #1 was dated more than 24 months after the previous health assessment (1/17/22 and 3/20/24).

Corrected Corrected by Nov 30, 2024

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

3270.151(c)(2) · 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.

Current TB test results on file for Staff Person #4 were obtained more than 60 days after initial employment. The initial TB test results were completed more than 12 months prior to initial employment.

Corrected Corrected by Nov 30, 2024

Category: health medication. 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 #4 and staff #5 lacked one of the two required written, nonfamily references.

Corrected Corrected by Nov 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.27(a)(5) · The facility shall have an emergency plan that provides for accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

The Emergency Plan lacked accommodations for children with disabilities and chronic medical conditions.

Corrected Corrected by Nov 30, 2024

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

3270.95(a) · 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 fire alarm testing log includes test dates that were more than 30 days apart (12/1/23 - 1/1/24 and 1/1/24 and 2/1/24).

Corrected Corrected by Nov 30, 2024

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

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

The file for Staff Person #1 lacked 9 of the required 12 hours of training for the most recent annual review period (December 19, 2022 - December 19, 2023).

Corrected Corrected by Dec 13, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.131(a)/3270.182(1) · The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility. A child's record shall contain initial and subsequent health reports.

The file for Child #4 contained a health report dated more than 60 days following the first day of attendance at the facility.

Corrected Corrected by Nov 30, 2024

Category: health medication. 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.

At approximately 8:20 AM Facility Person #1 was observed leaving the Yellow Room and crossing the hall to the Red Room where Facility Person #2 was observed. There were 5 infants present in the room. Staff stated that the fifth child in the Red Room arrived a minute or two earlier, and Facility Person #2 was the only staff person supervising the children in that room until Facility Person #1 came into the room.

Corrected Corrected by Jul 12, 2024

Category: supervision. Marked corrected in the state record.

3270.61(c) · Indoor child care space is measured within permanent stationary partitions or walls. The allowable number of children in a space is determined by dividing the total square feet in a space by 40.

SECOND CITATION; CITED PREVIOUSLY ON 2/27/24: In the toddler room (Yellow Room) at approximately 8:00 AM, there were 20 children in total receiving care in the space. The maximum capacity of the classroom, based on the measured room size, is 9 children.

Corrected Corrected by May 18, 2024

Category: ratio. Marked corrected in the state record.

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

There was no documentation on file that Facility Person #1, who has been employed at the facility more than 90 days, had completed the required pre-service health and safety training.

Corrected Corrected by Mar 4, 2024

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).

There was no documentation on file that Facility Person #1, who has been employed at the facility more than 90 days, had completed mandated reporter training.

Corrected Corrected by Mar 3, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.61(c) · Indoor child care space is measured within permanent stationary partitions or walls. The allowable number of children in a space is determined by dividing the total square feet in a space by 40.

In the toddler room (Red Room) at approximately 8:20 AM, there were 22 children in total receiving care in the space. The maximum capacity of the classroom, based on the measured room size, is 8 children.

Corrected Corrected by Mar 4, 2024

Category: ratio. 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.

3270.113(a)(1) -- In the Toddler Room (Red Room) at approximately 8:20 AM, Facility Persons #1-#5 were supervising 2 infants, 7 young toddlers, 6 older toddlers and 7 preschoolers. Each staff person was asked to identify the children for which they were responsible supervising. None of the five staff in the room claimed responsibility for the 6 older toddlers. When asked who was assigned to supervise these children, staff stated that their teachers had not yet arrived.

Corrected Corrected by Mar 4, 2024

Category: supervision. Marked corrected in the state record.

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

The last fire drill recorded on the facility's fire drill log was documented as occurring on 9/11/23.

Corrected Corrected by Mar 4, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The last smoke detector testing recorded on the facility's smoke detector testing log was documented as occurring on 10/1/23. Testing is required at least every 30 days.

Corrected Corrected by Mar 4, 2024

Category: recordkeeping. 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 files for staff persons #1, #2, #3, #4 and #5 who were hired prior to October 4, 2022 lacked the Pennsylvania Health and Safety Update 2022 training.

Corrected Corrected by Dec 1, 2023

Category: ratio. 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 #1, whom was hired as the director on (See LIS Code Sheet), lacked state police and child abuse clearances that were completed 60 months from the previous clearance. The state police clearances in the file were dated 4/13/18 and 7/27/23. The child abuse clearances in the file were dated 4/21/18 and 7/31/23. The file for staff person #6, whom was hired as an assistant group supervisor on (See LIS Code Sheet), lacked an FBI clearance that were completed 60 months from the previous clearance. The FBI clearances in the file were dated 9/1/18 and 10/13/23.

Corrected Corrected by Oct 23, 2023

Category: supervision. Marked corrected in the state record.

3270.36(b)(5)/3270.192(2)(ii) · An assistant group supervisor shall have a high school diploma or a general educational development certificate and 2 years experience with children. A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

The file for staff person #7 lacked a high school diploma.

Corrected Corrected by Oct 23, 2023

Category: supervision. 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 file for child #1 lacked emergency contact information that included the work address and work telephone number of the enrolling parent.

Corrected Corrected by Oct 31, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(5) · Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation.

The file for child #1 lacked emergency contact information that included information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation.

Corrected Corrected by Oct 31, 2023

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

3270.151(c)(1) · An adult health assessment must include a physical examination.

The file for staff person #7 lacked an adult health assessment that included a physical examination.

Corrected Corrected by Nov 1, 2023

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 file for staff person #7 lacked an adult health assessment that included an examination for communicable diseases and the results of that examination.

Corrected Corrected by Nov 1, 2023

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

3270.151(c)(4)/3270.151(c)(5) · An adult health assessment must include information on medical problems that might threaten the health of the children or prohibit a staff person from providing adequate care to children. An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

The file for staff person #7 lacked an adult health assessment that included information on medical problems that might threaten the health of the children or prohibit a staff person from providing adequate care to children and the physician's or CRNP's assessment of the person's suitability to provide child care.

Corrected Corrected by Nov 1, 2023

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

3270.182(8) · 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.

The file for child #2 lacked a copy of the initial agreement.

Corrected Corrected by Nov 24, 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 file for child #2 lacked an initial health report.

Corrected Corrected by Nov 24, 2023

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

3270.31(f)/3270.192(2)(iii) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10. 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 #1 lacked training in health and safety topics numbers 1-9 as listed in the regulation 3270.31(f).

Corrected Corrected by Oct 3, 2022

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 file for child #1 lacked a child health report that was updated 6 months prior to the current child health report. The child health reports in the file are dated 7/8/21 and 8/14/22.

Corrected Corrected by Oct 3, 2022

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

3270.131(e)(1)/3270.182(1) · The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP. A child's record shall contain initial and subsequent health reports.

The file for child #1 lacked updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to a toddler in accordance with the schedule recommended by the ACIP.

Corrected Corrected by Oct 3, 2022

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

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

The Fee Agreement form for Child #5 lacks the amount of the fee to be charged.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.123(a)(2) · An agreement shall specify the date on which the fee is to be paid.

The Fee Agreement Form for Child File #1 & #5 lack the date on which the fee is to be paid.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

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

The Fee Agreement Form for Child File #4 and #5 lacked the Arrival and Departure Time.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The Fee Agreement Form for Child File #4 and #5 lacked the Release Person's Name.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.123(a)(6)/3270.182(2) · An agreement shall specify the date of the child's admission.A child's record shall contain the dates of application, admission and withdrawal of the child.

The Fee Agreement Form for Child File #4 and #5 lacked the Date of Admission.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.27(a) · The facility shall have an emergency plan.

The facility lacked an Emergency Plan.

Corrected Corrected by Nov 22, 2021

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

3270.27(d) · The operator shall post the emergency plan in the facility at a conspicuous location.

A copy of the facility's Emergency Plan was not posted in a conspicuous place.

Corrected Corrected by Nov 22, 2021

Category: physical safety. 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).

The file for staff #2 lacked a PA criminal history record. A request for the record, dated 6/22/18, was in the file.

Corrected Corrected by Nov 22, 2021

Category: background checks. 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 Orange Room, a tube of A&D Ointment labeled, "Keep out of the Reach of Children" was found on the dorm sized refrigerator and accessible to children. In the children's restroom, a tube of A&D Ointment labeled "Keep out of the reach of children" was located in a small basket on a low shelf of the changing table. The ointment was accessible to children.

Corrected Corrected by Nov 22, 2021

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

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

The refrigerator, in the blue room, used for childcare was lacking an operating thermometer.

Corrected Corrected by Nov 22, 2021

Category: nutrition. Marked corrected in the state record.

3270.108(c) · Styrofoam cups and plates may not be used.

Through conversation with the owner/director, the Styrofoam cups found in the yellow and purple rooms were used for drinking and not permitted for children in care.

Corrected Corrected by Nov 22, 2021

Marked corrected in the state record.

3270.123(b)/3270.182(8) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement.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.

The original Fee Agreement Form was located in child files #1-6. The operator stated that she had given the parents a copy of the agreement.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. 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 for Child #5, lacked the child's Date of Birth.

Corrected Corrected by Nov 22, 2021

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 for Child #5 lacked Address of the Physician or Medical Care Provider.

Corrected Corrected by Nov 22, 2021

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 for Child #1, #3, #4, and #6 lacked a completed work address and phone number for the enrolling parent. The Emergency Contact Form for Child #5 lacked the enrolling parents work address.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. 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 Emergency Contact form for child #5 & #6 lack written parental consent for emergency medical care.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(6) · Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The Emergency Contact Form for Child #1 and #5 lacked the Health Insurance/MA Coverage and Health Insurance/MA Policy Number. The Emergency Contact Form for Child #6 lacked the Health Insurance/MA Policy Number.

Corrected Corrected by Nov 22, 2021

Category: health medication. 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 for child #5 lacked the address of the listed release person. The Emergency Contact form for child #6 lacks the address and phone number of the listed release person.

Corrected Corrected by Nov 22, 2021

Category: recordkeeping. Marked corrected in the state record.

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

The immunization record of Child # 1 lacked any Influenza shot with no Letter of Exemption in the File. The immunization record of Child # 1 lacked any Influenza shot with no Letter of Exemption in the File. Child file #5, lacked updated written verification of ongoing administered vaccines. Child file #6 lacked updated written verification of the following ongoing administered vaccines: Hepatitis A (1 Dose), DTAP (3 Doses), PCV (3 Doses), ROTA Virus (1 Dose), HIB (3 Doses) and IPV (2 Doses).

Corrected Corrected by Nov 22, 2021

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

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

Staff #1 began working with children on 10/21/20. The initial health assessment for Staff #1 was dated 10/12/21.

Corrected Corrected by Nov 22, 2021

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 Emergency Contact Form for Child #1, #5 and #6 lacked a signature for Consent for Minor First Aid.

Corrected Corrected by Nov 22, 2021

Category: ratio. Marked corrected in the state record.

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

The file for Staff # did not include proof of qualifications.

Corrected Corrected by Nov 30, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.31(f)(10)/3270.31(h) · Certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR). All staff persons shall complete the professional development under subsection (f): Pediatric First Aid and Pediatric CPR.

It was determined that the FA/CPS training present in the file for Staff #1 - 3 were not approved training. The First Aid/CPR did not cite Pediatric First Aid/CPR.

Corrected Corrected by Dec 18, 2021

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