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 9:20 AM, Facility Person #1 was observed caring for 15 preschoolers in the Pre-K room. Facility Person #2 , who answered the door to allow the certification representative entry to the facility, indicated that they were with the group, supervising children along with Facility Person #1, prior to leaving the group to answer the door. At approximately 9:25 AM, Facility Persons #3 and #4 were observed caring for 10 young toddlers and an older toddler in the Young Toddler room.

Corrected Corrected by Jan 9, 2026

Category: supervision. Marked corrected in the state record.

3270.113(a)(1) · 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. THIS PORTION OF THE PLAN SHALL HAVE AN IMMEDIATE CORRECTION DATE. 2..The legal entity shall ensure that all facility staff complete a supervision training. The training shall be submitted to the certification representative for approval prior to staff taking the training. The completed training shall be documented as per requirements in Chapter 3270.192 and submitted to the certification represented. THE OPERATOR SHALL PROVIDE A DATE FOR WHEN THIS WILL BE COMPLETED 3. A hands-free tangible method for tracking the supervision of children shall be developed and implemented at all times by all staff while supervising children. THE OPERATOR SHALL PROVIDE A DATE FOR WHEN THIS WILL BE COMPLETED 4.The operator shall develop and implement a supervision policy detailing facility procedures and processes to ensure regulatory compliance with supervision regulations. The policy shall include, but not be limited to, the following topics: supervision regulations and definition as per Chapter 3270, processes for completion of tasks outside of the classroom such as retrieving supplies and answering the door while maintaining supervision of children, supervision of children using the restroom, supervision of children during transitions between activities and spaces, and the use of a hands-free tangible method for tracking the supervision of children. The policy shall be submitted to the certification representative for approval. Once approval is received, the policy shall be shared with each facility person. Each facility person shall sign an acknowledgement of the policy, to be retained on file and submitted to the certification representative. The supervision policy shall be included in the staff handbook/resource material for staff. THE OPERATOR SHALL PROVIDE A DATE FOR WHEN THIS WILL BE COMPLETED 5. The operator shall conduct three monthly meetings with all staff for a period of three consecutive calendar months. One agenda item at each meeting shall be related to the proper supervision of children, allowing staff to ask questions, discuss challenges, and provide and receive feedback regarding the supervision of children. The agenda topics, meeting date, and attendees for each meeting shall be documented, retained on file, and submitted to the certification representative after each meeting. THE OPERATOR SHALL PROVIDE A DATE FOR WHEN THIS WILL BE COMPLETED

At approximately 9:25 AM, Facility Persons #3 and #4 were observed caring for 10 young toddlers and an older toddler in the Young Toddler room. When asked to identify which children they were each supervising, Facility Person #3 claimed responsibility for 5 of the children. Then Facility Person #4 claimed responsibility for 5 children, including one child Facility Person #3 previously claimed in their group, resulting in two children not identified by either staff as assigned to either of them for supervision purposes.

Corrected Corrected by Jun 17, 2026

Category: supervision. Marked corrected in the state record.

3270.113(b) · A facility person may not use any form of physical punishment, including spanking a child. The legal entity shall ensure that all facility staff complete an in-person training regarding appropriate behavior guidance of children coordinated through the ELRC. Documentation of completion of the training to include the date of the training and the names of all attendees shall be retained on file at the facility as well as submitted to certification representative upon completion.

CONTINUED NONCOMPLIANCE, PREVIOUSLY CITED ON 2/21/25 AND 5/29/25:: According to staff statements, Facility Person #1 has been observed on multiple occasions handling children roughly. Staff state Facility Person #1 yanks children abruptly by one or two arms to move them. The facility's acceptable plan of correction indicated that they had scheduled an in-person training with ELRC for all staff members on appropriate guidance of children and that documentation of the training would be kept in staff files as well as forwarded to our certification representative. The required documentation of completion of this training has not been submitted to the certification representative.

Corrected Corrected by Jan 23, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.113(b) · A facility person may not use any form of physical punishment, including spanking a child. The legal entity shall develop a written procedure for staff members to confidentially report concerns of inappropriate verbal and physical interactions as they relate to the Department's supervision regulations. It should be made clear that the process does not take the place of the responsibilities of a Mandated Reporter. Documentation shall be kept that demonstrates the manner in which each concern was addressed. The written procedure, any templates or logs that will be used to capture the above information shall be forwarded to the Certification Representative for review. Following confirmation of the review, the reporting procedure shall be presented to all staff members. Verification of completion will include copies of signed and dated acknowledgements for all staff, along with evidence that the new procedure has been added to the staff handbook. Documentation shall be forwarded to the certification representative upon completion and kept on file at the facility.

CONTINUED NONCOMPLIANCE, PREVIOUSLY CITED ON 2/21/25 AND 5/29/25: According to staff statements, Facility Person #1 has been observed on multiple occasions handling children roughly. Staff state Facility Person #1 yanks children abruptly by one or two arms to move them. The facility's acceptable plan of correction indicated that the operator will develop a procedure for staff members to confidentially report concerns of inappropriate verbal and physical interactions as they relate to the supervision regulations including that it will be made clear to all staff that this does not take the place of mandated reporter responsibilities. The acceptable plan indicated that the procedure will be sent to the certification representative for review and approval. Once approved it would be reviewed by all teachers at a staff meeting and signed off on by all staff members after they review it. The acceptable plan indicated documentation of the acknowledgement will be forwarded to the certification representative along with any forms or templates used to demonstrate the manner in which each concern was addressed and evidence the procedure will be added to the staff handbook. The procedure was submitted to the certification representative, but the required documentation of review of the procedure with staff, forms or templates developed for tracking concerns reported, and evidence the procedure was added to the staff handbook have not been submitted.

Corrected Corrected by Jan 30, 2026

Category: supervision. Marked corrected in the state record.

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 reach of children in the kitchen/eating area of the preschool/Pre-K room.

Corrected Corrected by May 29, 2025

Category: health medication. 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.

There was no documentation of emergency plan training on file for Facility Person 7, employed at the facility more than 90 days.

Corrected Corrected by Jul 30, 2025

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 parents explaining the emergency plan does not address all requirements under 3270.27(a).

Corrected Corrected by Aug 8, 2025

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

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

The current first aid training documented and on file for Facility Person #12 was completed after the expiration of the prior first aid training documented and on file for Facility Person #12.

Corrected Corrected by Jul 30, 2025

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 provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. 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 Persons #1, #2, #3, #6. #7, #8, #11 and #13 must removed from a child care position until they have all completed clearances/signed disclosure statements on file.

There were no NSOR clearances on file for Facility Persons #1, #2, and #3.The criminal history clearance on file for Facility Person #7 was incomplete as the format in which it was printed does not show the entire clearance. The disclosure statement on file for Facility Person #6 was not signed by a witness. There was no signed disclosure statement on file for Facility Person #8, observed caring for children unsupervised on 5/29/25.There was no child abuse clearance on file for Facility Person #11.There was no staff file at the facility for Facility Person #13. The most recent child abuse, FBI, and NSOR clearances reviewed and on file for Facility Person #13 were more than 60 months old.

Corrected Corrected by Aug 8, 2025

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.

Facility Persons #4 and #8 were classified as aides. The documentation of the required education for the classification on file for Facility Persons #4 and #8 were foreign degrees/diplomas without documentation of the U.S. educational equivalencies from an approved agency. Facility Persons #5 and #12 were classified as assistant group supervisors based on completion of high school and 2 years of child care experience. There was less than 2 years (2500 hours) of documented child care experience on file for Facility Persons #5 and #12. Facility Person #6 was classified as an assistant group supervisor based on completion of 15 credits in human services and 1 year of child care experience. There was less than 15 credits in human services documented and on file for Facility Person #6.

Corrected Corrected by Aug 22, 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 preschool/Pre-K room, on the Pre-K side, there was deodorant labeled "keep out of reach of children," in an unlocked drawer in reach of children.

Corrected Corrected by May 29, 2025

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.

There was a first aid kit in the older toddler room without soap. There was a second first aid kit in the older toddler room without soap and tweezers. There was no soap in the first aid kit in the infant room.

Corrected Corrected by May 30, 2025

Category: health medication. 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 were no handwashing signs at the changing area, or at a low sink in the older toddler room.

Corrected Corrected by Jul 30, 2025

Category: health medication. 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 on file for child #9 did not include the health insurance policy number.

Corrected Corrected by Jul 30, 2025

Category: health medication. 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 approved developmental assessment completed and a copy given to parents in the previous 6 months on file for children #1, #3, #5, and #6. The current assessment on file for child #2 was completed more than 6 months after the previous assessment on file.

Corrected Corrected by Aug 8, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The current agreement on file did not specify the arrival/departure times for child #3.

Corrected Corrected by Jul 30, 2025

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 current agreement on file for child #3 did not specify the release persons.

Corrected Corrected by Jul 30, 2025

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.

Original agreements were on file for children #1-#9.

Corrected Corrected by Jul 30, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.124(a) · Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency .

There were no emergency contact forms on file at the facility for children #4,#10, #11, #12, #13, #14, and #15,

Corrected Corrected by Jul 30, 2025

Category: recordkeeping. 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 forms on file for children #2, #3, #6 and #9 did not include the work addresses and telephone numbers of the enrolling parent.

Corrected Corrected by Aug 6, 2025

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 forms on file for children # 1, #3, and #7 did not include the addresses of all release persons listed.

Corrected Corrected by Aug 8, 2025

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.

There were no emergency contact forms in the eating area of the preschool/Pre-K room for the older toddlers eating lunch in that space.

Corrected Corrected by Aug 6, 2025

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 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 agreements on file for children #1-#6 and the emergency contact form on file for child #5 were not reviewed and updated by a parent in writing in the previous 6 months. The current emergency contact form on file for child #3 was reviewed and updated by a parent more than 6 months after the previous emergency contact form on file.

Corrected Corrected by Aug 8, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The current health assessment on file for child #1, a preschooler, was completed more than 12 months after the previous health assessment on file.

Corrected Corrected by Aug 8, 2025

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

3270.166(1) · A written statement giving the formula and feeding schedule for an infant shall be obtained from the parent.

There were no written feeding schedules from the parents of 3 of the infants enrolled.

Corrected Corrected by Aug 6, 2025

Category: nutrition. Marked corrected in the state record.

3270.181(a) · An operator shall establish and maintain an individual record for each child enrolled in the facility.

There were no files at the facility for children # 10-#17.

Corrected Corrected by Aug 6, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.182(3) · A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

There was no signed parental consent for emergency medical care for the child on file for children #4 and #10-#15.

Corrected Corrected by Aug 8, 2025

Category: recordkeeping. 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.

There was no signed parental consent for administration of minor first-aid procedures by facility staff on file for children #4 and #10-#15.

Corrected Corrected by Aug 8, 2025

Category: ratio. Marked corrected in the state record.

3270.191 · An individual record is required for each facility person.

There was no record at the facility for Facility Person #13.

Corrected Corrected by Aug 8, 2025

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.

There were no nonfamily written references on file for Facility Persons #1, #2, #3, #4, #5. #7, #8 , #9 and #10,

Corrected Corrected by Aug 8, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The most recent emergency drill was documented as conducted on 12/10/24, more than 12 months after the prior drill documented as conducted on 9/28/23.

Corrected Corrected by Jul 30, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.131(a) · The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.

The initial health assessment on file for child #5 was completed more than 60 days after their first day in care at the facility. The only health assessment on file for child #9, enrolled more than 60 days, was not dated.

Corrected Corrected by Jul 30, 2025

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

3270.113(b) · 1. A facility person may not use any form of physical punishment, including spanking a child. 2. The legal entity shall develop a written procedure for staff members to confidentially report concerns of inappropriate verbal and physical interactions as they relate to the Department's supervision regulations. It should be made clear that the process does not take the place of the responsibilities of a Mandated Reporter. Documentation shall be kept that demonstrates the manner in which each concern was addressed. The written procedure, any templates or logs that will be used to capture the above information shall be forwarded to the Certification Representative for review. Following confirmation of the review, the reporting procedure shall be presented to all staff members. Verification of completion will include copies of signed and dated acknowledgements for all staff, along with evidence that the new procedure has been added to the staff handbook. Documentation shall be forwarded to the certification representative upon completion and kept on file at the facility. 3. The legal entity shall ensure that all facility staff complete an in-person training regarding appropriate behavior guidance of children coordinated through the ELRC. Documentation of completion of the training to include the date of the training and the names of all attendees shall be retained on file at the facility as well as submitted to certification representative upon completion. 4. The facility director shall conduct an observation of staff-child interactions in each classroom/group and document each observation, weekly for a period of 8 weeks, then biweekly for a period of 6 weeks. The documentation format shall be submitted along with this plan of correction to the certification representative for approval prior to beginning the observations. Documentation of observations shall be retained on file at the facility, made available upon request to the certification representative, and submitted to the certification representative upon completion.

SECOND CITATION; PREVIOUSLY CITED ON 2/21/25: According to staff statements, Facility Person #1 has been observed on multiple occasions handling children roughly. Staff state Facility Person #1 yanks children abruptly by one or two arms to move them.

Corrected Corrected by Dec 26, 2025

Category: supervision. Marked corrected in the state record.

3270.113(d) · A facility person may not use harsh, demeaning or abusive language in the presence of children.

SECOND CITATION; PREVIOUSLY CITED ON 2/21/25: According to staff statements, Facility Person #1 has been observed on multiple occasions using a harsh tone of voice with the children.

Corrected Corrected by May 29, 2025

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 or (g)1-10. Until such time as the required training has been completed, staff person #5 must be supervised, when interacting with children at a minimum by, an AGS who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #5, staff person #5 may not work in a child-care position at the facility.

Continued Non-Compliance: On 2/21/25 a complaint investigation was conducted at the facility. Staff person #5 had 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. The facility's acceptable plan of correction indicated the correction would be implemented by (4/1/25). On (5/1/25) an unannounced inspection was conducted. Staff person #5 still has not completed the following required pre- service training: Pediatric First Aid and CPR

Corrected Corrected by Apr 23, 2025

Category: supervision. 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.

SECOND CITATION, PREVOUSLY CITED ON 3/18/25: The operator self-reported that on 3/28/25, at approximately 4:40 PM, Facility Persons #1 and #2 were supervising children in the 2's room, including Child #1, an older toddler. They walked the children they were supervising from the 2's room, through the Pre-K room, and into the Toddler 1 room. Shortly after this occurred, a parent of another enrolled child entered the facility with Child #1, who they say they found outside of the entrance to the facility. Staff state they suspect the child followed a parent who was picking up their child out of facility. Staff estimate the Child #1 was away from their group for approximately 2-3 minutes.

Corrected Corrected by Apr 10, 2025

Category: supervision. Marked corrected in the state record.

3270.113(a) · 1. 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. 2. The legal entity shall ensure that all facility staff complete an in-person supervision training, coordinated through the ELRC, that include a component relating to supervision during times of transition. Training documentation must be retained on file that includes the date of the training and the names of the attendees. 3.The legal entity shall ensure facility staff complete a supervision technical assistance program coordinated through the ELRC. The program shall focus on supervision of children during times of transition. Documentation of the completion of the technical assistance program shall be retained on file.

The operator self-reported that on 3/28/25, at approximately 4:40 PM, Facility Persons #1 and #2 were supervising children in the 2's room, including Child #1, an older toddler. They walked the children they were supervising from the 2's room, through the Pre-K room, and into the Toddler 1 room. Shortly after this occurred, a parent of another enrolled child entered the facility with Child #1, who they say they found outside of the entrance to the facility. Staff state they suspect the child followed a parent who was picking up their child out of facility. Staff estimate the Child #1 was away from their group for approximately 2-3 minutes.

Corrected Corrected by Aug 25, 2025

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.

The operator self-reported that on 3/28/25, at approximately 4:40 PM, Facility Persons #1 and #2 were supervising children in the 2's room, including Child #1, an older toddler. They walked the children they were supervising from the 2's room, through the Pre-K room, and into the Toddler 1 room. Shortly after this occurred, a parent of another enrolled child entered the facility with Child #1, who they say they found outside of the entrance to the facility. Staff state they suspect the child followed a parent who was picking up their child out of facility. Staff estimate the Child #1 was away from their group for approximately 2-3 minutes.

Corrected Corrected by Apr 10, 2025

Category: supervision. Marked corrected in the state record.

3270.55(a) · 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.

At approximately 12:15 PM, Facility Person #1 was supervising 11 young toddlers in the Toddler 1 room as they were napping.

Corrected Corrected by Apr 10, 2025

Category: supervision. Marked corrected in the state record.

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

SECOND CITATION, PREVIOUSLY CITED ON 2/21/25: The last fire drill documented was completed on 12/10/24.

Corrected Corrected by Apr 28, 2025

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.

At approximately 10:35 AM while assessing supervision and ratio, Staff Person #1 named and identified 11 preschool aged children in their group which made them have a ratio of 1:11 (one staff to11 preschool aged children).

Corrected Corrected by Mar 19, 2025

Category: supervision. Marked corrected in the state record.

3270.182(7) · A child's record shall contain reports of accidents, injuries and illnesses involving a child in care at the facility. The original report shall be given to the parent on the day of the incident. The second copy of the report shall be retained at the facility in an accident file. The third copy of the report shall be retained at the facility in the child's file.

On 3/3/25 child #1 fell and hit their head. Staff #1 wrote an accident report for the fall. The report was not given to child #1's parent on the day of the incident.

Corrected Corrected by Mar 4, 2025

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.

Per multiple staff statements, Staff #1 was observed during naptime, grab a child by the arms and roughly tossed the child back down on their cot causing the child to become injured with a split lip.

Corrected Corrected by May 5, 2025

Marked corrected in the state record.

3270.113(d) · A facility person may not use harsh, demeaning or abusive language in the presence of children.

Per multiple staff statements, Staff #2 has been observed to harshly yell at the children in their care on an ongoing basis. It was observed by multiple staff that during the week of 2/10/25-2/14/25 staff #2 yelled so harshly at a child that the child hid in the bathroom, was shaking, and would not come out until another staff arrived and staff #2 left.

Corrected Corrected by Apr 8, 2025

Marked corrected in the state record.

3270.31(e)(4)(i) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. Until such time as the required training has been completed, staff person #2, 3, and 4 must be supervised, when interacting with children at a minimum by, an AGS who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #2, 3, and 4, staff person #2, 3, and 4 may not work in a child-care position at the facility.

Staff person #2, 3, 4 has not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This is evidenced by the previously documented Pediatric first aid and CPR training on file expiring 9/2024. Documentation of updated Pediatric first aid and CPR training is not on file.

Corrected Corrected by Apr 1, 2025

Category: supervision. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10 or (g)1-10. Until such time as the required training has been completed, staff person #1 and 5 must be supervised, when interacting with children at a minimum by, an AGS who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #1 and 5, staff person #1 and 5 may not work in a child-care position at the facility.

Staff person #1 and 5 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

Corrected Corrected by Apr 1, 2025

Category: supervision. Marked corrected in the state record.

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

The fire drill log contained the following dates 4/29/24-11/19/24 which are more than 60 days apart, and the last drill documented was done 12/10/24 which was more than 60 days ago.

Corrected Corrected by Apr 1, 2025

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 file for staff #11 did not contain documentation of completing the 1-hour training titled Pennsylvania Health and Safety Update 2022 as required by Announcement C-22-06.

Corrected Corrected by Jul 12, 2024

Category: ratio. Marked corrected in the state record.

3270.27(c)/3270.192(2)(iii) · 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. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Based on documentation in staff files staff #1, #5, #11, and #12 did not complete training on the emergency plan on an annual basis. Consecutive trainings were dated more than 12 months apart. Current training is now on file.

Corrected Corrected by Jun 25, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)(4)(i)/3270.192(2)(iii) · Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. 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 #15 does not contain current certification in Pediatric CPR and first aid. Based on statements made by staff, staff #15 occasionally fills in and is counted in ratio in while providing breaks for other staff. Staff #1 and #11 did not renew their certification in pediatric CPR and first aid before the expiration of the previous certification. (Dates: 2/21/22 and 5/09/24)

Corrected Corrected by Jun 25, 2024

Category: ratio. Marked corrected in the state record.

3270.31(e)(4)(ii)/3270.192(2)(iii) · 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. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The files for staff #8 and #11 contained consecutive fire safety trainings dated more than 12 months apart. Current training is now on file.

Corrected Corrected by Jun 25, 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.Staff person #10 ill have until 6/26/24 to complete the required training. Until such time as the required training has been completed, staff person #10 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 #10, then staff person #10 may not work in a child-care position at the facility.

Staff person #10 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric CPR and First Aid.

Corrected Corrected by Jun 25, 2024

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).y. 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. Staff #13 and #14 may not work in a child care position at the facility.

The file for staff #6 contained an FBI clearance dated 11/20/23, which is after the date of hire. The file for staff #9 contained an NSOR certificate dated 4/16/24, which is after the date of hire. The file did not contain dated proof of applying. The file for staff #13 did not contain a completed child abuse clearance, FBI clearance or NSOR certificate. The file for staff #14 did not contain a completed child abuse clearance or FBI clearance.

Corrected Corrected by Jul 12, 2024

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

3270.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to Child Protective Services). Staff person #10 will have until 6/26/24 to complete the mandated reporter training. Until such time as the required training has been completed, staff person #10 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 person(s) available to supervise staff person #10, then staff person #10 may not work in a child-care position at the facility.

Staff person #10 has not completed the mandated reporter training within 90 days of their date of hire (see LIS code sheet).

Corrected Corrected by Jun 25, 2024

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 files for staff #2 and #10, designated as group supervisors on the staff data sheet, did not contain documentation of the qualifications required for the position. The files for staff #4 and #5 designated as assistant group supervisors on the staff data sheet, did not contain documentation of the qualifications required for the position.

Corrected Corrected by Jul 12, 2024

Category: supervision. 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 files for staff #1 and #11 contained written evaluations conducted more than 12 months apart. The files for staff #5 and #12 contained initial evaluations conducted more than 12 months after their dates of hire. Current evaluations are now on file for staff #1, #11, #5, and #12.

Corrected Corrected by Jun 25, 2024

Category: recordkeeping. 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.

Bleach, disinfectant spray, and disinfectant wipes were accessible to children in the cabinet under the sink in the eating area. The cabinet doors do not have knobs, however nothing was in place to prevent them from being opened using the bottom edge of the door.

Corrected Corrected by Jun 25, 2024

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.

Room 5, added during the inspection, did not have emergency phone numbers posted by the telephone.

Corrected Corrected by Jun 25, 2024

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

3270.75(a) · A first-aid kit shall be in a child care space.

Room 5, added during the inspection, did not have a first aid kit.

Corrected Corrected by Jun 25, 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.

First aid kits observed in the young toddler, pre-k , and older toddler rooms did not contain all 7 required items.

Corrected Corrected by Jun 25, 2024

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

3270.102(a)/3270.103 · 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.

In the young toddler room, multiple foam blocks with bite marks and small pieces missing were observed to be accessible to children on the toy shelves.

Corrected Corrected by Jun 25, 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.

A crib in use by an infant did not have the required 2 feet of space on three sides. One side of the crib was blocked by an adult rocking chair.

Corrected Corrected by Jun 25, 2024

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 two refrigerators in Room 5, added during the inspection, did not have thermometers.

Corrected Corrected by Jun 25, 2024

Category: nutrition. Marked corrected in the state record.

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

Room 5, added during the inspection, did not have a posted written plan of daily activities.

Corrected Corrected by Jun 25, 2024

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

3270.123(a) · An agreement shall be signed by the operator and the parent.

The agreement for child #2 was not signed by the operator.

Corrected Corrected by Jul 12, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The agreement for child #2 did not specify the amount of the fee to be charged.

Corrected Corrected by Jul 12, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The files for children #2 and #3 contained child service reports which were not dated by the parent, therefore compliance could not be determined. The file for child #6 contained a late child service report, however the report is now current.

Corrected Corrected by Jul 12, 2024

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 agreements for children #2 and #4 did not specify the date of the child's admission.

Corrected Corrected by Jul 12, 2024

Category: recordkeeping. 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 #6 did not include the enrolling parent's work address or work phone number.

Corrected Corrected by Jul 12, 2024

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 #6 did not include the health insurance policy number for the child.

Corrected Corrected by Jul 12, 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 for child #6 did not include the phone number of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Jul 12, 2024

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.

Emergency contact information for child #7 was not present in the infant room where the child was observed in care.

Corrected Corrected by Jun 25, 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.

Room 5, added during the inspection, did not have a posted medical emergency transportation plan.

Corrected Corrected by Jun 25, 2024

Category: transportation. 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 files for children #4 and #6 did not contain signed parental consent for administration of minor first-aid procedures by facility staff.

Corrected Corrected by Jul 12, 2024

Category: ratio. Marked corrected in the state record.

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

The files for children #2, #3, and #5 contained emergency contact information and agreements which were not updated within the required 6-month period. The file for child #6 contained emergency contact information and an agreement dated after their first day in attendance. Both documents for children #2, #3, #5, and #6 are now current.

Corrected Corrected by Jun 25, 2024

Category: recordkeeping. 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 file for child #2 lacks a current health report. The most recent report on file is not dated, therefore compliance could not be determined. The file for child #3 contained consecutive health reports dated more than 12 months apart, but is now current.

Corrected Corrected by Jul 12, 2024

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

3270.131(c) · A health report must be written and signed by a physician, physician's assistant or a CRNP. The signature must include the individual's professional title.

The most recent health report for child #2 did not include the professional title of the individual who signed the form.

Corrected Corrected by Jul 12, 2024

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

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

First aid kits observed in the young toddler, pre-k , older toddler, and infant rooms contained antibiotic cream and/or burn cream which were not labeled for use by a specific child.

Corrected Corrected by Jun 25, 2024

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 file for staff #11 lacks a current health assessment. The files for staff #1, #3, #7 contained consecutive health assessments dated more than 24 months apart. The most recent health assessments on file for staff #1, #3, #7 are now current. The file for staff #2 contained an initial health assessment dated after their first day providing service in a child care setting.

Corrected Corrected by Jul 12, 2024

Category: ratio. 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 files for staff #2 and #10 contained only one written reference. The files for staff #12, #13, and #14 did not contain any written references.

Corrected Corrected by Jul 12, 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 files for children #1 and #6 contained initial health reports dated more than 60 days after their first day in attendance.

Corrected Corrected by Jun 26, 2024

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.

The following rooms lacked posted written schedules; preschool, older toddler and Learning Adventures.

Corrected Corrected by Aug 16, 2023

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

3270.114 · Weather permitting, children shall be taken out doors daily.

Based on statements made by staff, the children are unable to go outside daily because they do not yet have replacements for the strollers needed to transport the toddlers to the play ground.

Corrected Corrected by Aug 16, 2023

Category: transportation. Marked corrected in the state record.

3270.27(c)/3270.192(2)(iii) · 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. 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 #1 contained documentation of consecutive emergency plan trainings dated more than 12 months apart. The trainings were dated 3/18/22 and 5/18/23. .

Corrected Corrected by Aug 16, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The facility's emergency plan was not posted at the facility.

Corrected Corrected by Aug 16, 2023

Category: physical safety. 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. The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

The facility did not have a letter to provide to parents explaining the emergency procedures.

Corrected Corrected by Aug 22, 2023

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

3270.31(e)(4)(ii)/3270.192(2)(iii) · 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. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The files for staff #2 and #3 contained documentation of consecutive fire safety trainings dated more than 12 months apart. The trainings were dated 2/21/22 and 3/08/23.

Corrected Corrected by Aug 16, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The file for staff #4, designated as an assistant group supervisor, lacked documentation of the qualifications required to perform the position.

Corrected Corrected by Aug 17, 2023

Category: supervision. Marked corrected in the state record.

3270.75(a) · A first-aid kit shall be in a child care space.

First aid kids were not located in the preschool room or the Learning Adventures room.

Corrected Corrected by Aug 16, 2023

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 kits in the infant, young toddler, and older toddler rooms did not include soap or tweezers.

Corrected Corrected by Aug 16, 2023

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

3270.82(e) · Toilets and sinks shall be at proper heights for children using them or shall be easily approached by means of platforms or steps.

The sinks in the rear portion of the young toddler room and at the diapering station in the older toddler room lacked steps. Staff indicated these two sinks are intended to be used by children to wash hands after diapering. The sink at the diapering station in the front portion of the young toddler room had steps. but based on statements made by staff, the steps are not tall enough for all children in care in the room to comfortably reach the sink and staff are currently lifting those smaller children when they need to wash hands.

Corrected Corrected by Aug 24, 2023

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

3270.103 · Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

A zip lock bag containing small candies and several empty plastic garbage bags were accessible to children in a low unlocked cabinet in the young toddler room. A set of sponge painting tools, a Dinosaur Discovery Kit with small pieces, and a music triangle labeled for use by children over 3 were observed in the older toddler room.

Corrected Corrected by Aug 16, 2023

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.

Two refrigerators in use lacked thermometers. The refrigerators were located in the young toddler and preschool rooms.

Corrected Corrected by Aug 16, 2023

Category: nutrition. 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 agreements for children #1 and #2 did not specify the amount of the fee to be charged.

Corrected Corrected by Aug 16, 2023

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 agreements for children #1 and #2 did not specify the date on which the fee is to be paid.

Corrected Corrected by Aug 16, 2023

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 agreement for child #1 did not specify the date of the child's admission.

Corrected Corrected by Aug 16, 2023

Category: recordkeeping. 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 contained emergency contact information which did not include the enrolling parent's work phone number.

Corrected Corrected by Aug 16, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.133(3)/3270.133(6) · The label of a medication container shall identify the name of the medication and the name of the child for whom the medication is intended. Medication shall be administered to only the child whose name appears on the container. A parent shall provide written consent for administration of medication or a special diet.

Small packet of triple antibiotic ointment and first aid burn cream were observed in the first aid kits in the infant, young toddler, and older toddler rooms. The medication packets were not labeled for use by a specific child and written parental consent for administration was not on file.

Corrected Corrected by Aug 16, 2023

Category: ratio. Marked corrected in the state record.

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

The file for staff #3 contained consecutive health assessments dated more than 24 months apart. The most recent health assessment on file for staff #3 is now current.

Corrected Corrected by Aug 16, 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 #3, employed since 12/11/2012, did not contain the results of a screening for TB conducted at initial employment. The file for staff #4 contained results of a TB screening dated after their first day in a child care position.

Corrected Corrected by Aug 16, 2023

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 contained only 1 written reference.

Corrected Corrected by Aug 18, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.25(a) · The facility's current certificate of compliance shall be posted in a conspicuous location used by parents. The operator shall provide the parent of each child enrolled with information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office.

The facility's current certificate was not posted at the facility.

Corrected Corrected by Aug 16, 2023

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. IF USING TIERED LIS: The required staff:child ratios must be maintained at all times. The legal entity must submit documentation in a format approved by DHS proving that the facility is maintaining the required staff:child ratios at all times. The legal entity will confirm continuing compliance by sending copies of the documentation to the -------- Region Office on a weekly basis for a period of three months after DHS approves the documentation format.

At approximately 10:45 AM, 2 staff were observed with 18 preschoolers. When asked to identify the children assigned to their supervision, staff #1 initially named 8 children and staff #2 initially named 9 children, which left 1 child unnamed. When asked to name their assigned children a second time, staff #1 named 8 children. Staff #2 named 11 children including a child named by staff #2. At that time, staff #2 stated " I know I named 11."

Corrected Corrected by May 17, 2023

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.

At approximately 10:45 AM, 2 staff were observed with 18 preschoolers. When asked to identify the children assigned to their supervision, staff #1 initially named 8 children and staff #2 initially named 9 children, which left 1 child unnamed. When asked to name their assigned children a second time, staff #1 named 8 children. Staff #2 named 11 children including a child named by staff #2. At that time, staff #2 stated " I know I named 11."

Corrected Corrected by Mar 17, 2023

Category: supervision. Marked corrected in the state record.

3270.31(f)(10)/3270.192(2)(iii) · Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Staff #3 did not complete pediatric first aid and pediatric CPR within 90 days of hire. The training was completed on 3/15/23, 105 days after hire. (SEE LIS CODE SHEET)

Corrected Corrected by May 12, 2023

Category: health medication. 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 facility was unable to provide documentation of fire drills conducted after 7/07/22.

Corrected Corrected by May 12, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(f)/3270.31(g) · Staff persons shall complete professional development in the following topics within 90 days of hire:Completion of professional development shall be documented by the signature and title of a representative of the professional development entity and include the date professional development was completed. Documentation shall be retained in the facility person's file or maintained in an electronic system as designated by the Department. Documentation of the completion of the professional development under subsection (f) taken from September 30, 2016, forward satisfies this requirement.

The file for staff #4 contained documentation of completing training in the health and safety topics as referenced in 3270.31(f) on 9/14/16 which is prior to the validity date of 9/30/16.

Corrected Corrected by Jul 11, 2022

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.

Operator did not provide proof of purchase or record of installation for the facility's fire alarm system at the time of the inspection.

Corrected Corrected by Jun 24, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(f)/3270.192(2)(iii) · Staff persons shall complete professional development in the following topics within 90 days of hire:A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

The files for staff #2 and #3 lacked documentation of completing training in health and safety topics 1-9 as referenced in 3270.31(f).

Corrected Corrected by Jul 29, 2022

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

3270.123(a) · An agreement shall be signed by the operator and the parent.

The file for child #2 contained an agreement which was not signed by the parent. The files for children #4 and #7 contained agreements which were not signed by the operator.

Corrected Corrected by Jul 11, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The files for children #1, #4, and #5 contained agreements which did not specify the child's arrival and departure times.

Corrected Corrected by Jul 11, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.123(a)(6) · An agreement shall specify the date of the child's admission.

The file for child #7 contained an agreement which did not specify the date of the child's admission.

Corrected Corrected by Jul 11, 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 files for children #1, #3, #4, #5, and #6 contained emergency contact information and agreements which were not updated by the parent within 6 months or by 1/06/22 as stated in Announcement C-21-09 related to the reinstatement of regulations suspended due to covid 19. The documents on file are now all current.

Corrected Corrected by Jul 11, 2022

Category: recordkeeping. 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 file for child #7, an older toddler, contained a health report which has not been updated in over 12 months.

Corrected Corrected by Jul 11, 2022

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

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

The files for children #3 and #7 contained immunization records which did not include documentation of receiving the influenza vaccine in accordance with the schedule recommended by the ACIP. Written exemptions were not on file at the time of the inspection.

Corrected Corrected by Jul 11, 2022

Category: health medication. 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 facility's emergency plan did not include accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Corrected Corrected by Jul 11, 2022

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

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

The facility did not have documentation of conducting an emergency drill.

Corrected Corrected by Jul 11, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(f)(10)/3270.192(2)(iii) · Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire.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 #6, employed for over 90 days, did not contain documentation of completing pediatric CPR/FA. (SEE LIS CODE SHEET) The file for staff #1 contained documentation of completing pediatric CPR/FA on 2/21/22 which is after the 6/17/21 deadline. Staff #1 now has current training.

Corrected Corrected by Jul 11, 2022

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

3270.94(a)(4) · The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that the hypothetical locations of the fire are rotated around the facility for each drill such that the hypothetical location is never the same for consecutive drills.

Based on the facility's fire drill log, the hypothetical location of the fire has not been listed. Instead, several drills indicate the hypothetical location as "Building Alarm".

Corrected Corrected by Jul 11, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(e)/3270.192(2)(iii) · A staff person shall obtain an annual minimum of 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 #5 contained documentation of completing 6 of the 12 required annual training hours.

Corrected Corrected by Jul 11, 2022

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 files for children #1 and #6 contained initial health assessments conducted more than the 90 days allowable under the suspension of the regulation at the time of their enrollment. Both children now have current health reports on file.

Corrected Corrected by Jul 11, 2022

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