3270.94(a) · The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that the critera specified in §3270.95Ia)(1)- (a)(9) are met

The facility lacked a fire drill log to ensure specific criteria in §3270.95Ia)(1)- (a)(9) is being met

Corrected Corrected by Dec 2, 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 files for Staff #3 and #4 contained Health and Safety Basic training at the time of the Renewal Inspection, but it was observed they did not obtain Health and Safety Basic training within 90 days of hire.

Corrected Corrected by Dec 15, 2025

Category: ratio. Marked corrected in the state record.

3270.18(a) · The legal entity shall have comprehensive general liability insurance to cover the persons who are on the premises. A current copy of the insurance policy shall be on file at the facility.

The facility did not provide documentation of general liability insurance.

Corrected Corrected by Dec 15, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.24(a) · A staff person shall provide to agents of the Department immediate access to the facility, the children and the files and records.

On November 11, 2025, at 4:00 PM, Cert Rep arrived at facility to conduct a Renewal Inspection. Staff were able to provide the child files, but it was stated that the staff files were taken out of the facility and not present for review. Multiple requests were made to obtain the staff files, but only partial information was shared. Untimely responses to the requests resulted in a delay to the inspection process and violations for lack of documentation.

Corrected Corrected by Dec 1, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The files for Staff #2, #4, and #5 lacked an Emergency Plan training that was conducted within the past 12 months.

Corrected Corrected by Dec 19, 2025

Category: recordkeeping. Marked corrected in the state record.

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

Staff person #2 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 (10/2025). Documentation of updated Pediatric first aid and CPR training is not on file.

Corrected Corrected by Jan 30, 2026

Category: ratio. Marked corrected in the state record.

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

The file for Staff #2 lacked Fire Safety Training.

Corrected Corrected by Dec 12, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.32(a)/3270.192(4) · TIERED LIS: 1. The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #5 and #6 may not work in a childcare position at the facility. (This portion of the plan shall have an immediate correction date.) 2. The facility director will attend in-person Existing Provider Training on January 21, 2026. (The operator shall provide a date for when this training will be complete.) 3. Upon completion of the Existing Provider Training, the Director/ responsible person(s) shall participate in an in-person technical assistance session focused on staff onboarding, staff file and CPSL requirements and staff file organization with ELRC #5. (The operator shall provide a date for when this training will be complete.)

The file for Staff #1 contained a National Sex Offender Certificate at the time of inspection, but it was observed they did not have a National Sex Offender Certificate prior to their first day working in childcare. The file for Staff #6 contained a Volunteer Child Abuse Clearance. The file for Staff #5 contained a Nation Sex Offender Registry certificate that had not been updated in the previous 60 months.

Corrected Corrected by Jan 30, 2026

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

3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The files for Staff #2 and #4 lacked annual written evaluations that were conducted within the past 12 months.

Corrected Corrected by Jan 23, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.52 · When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in § 3270.51 (relating to similar age level).

At approximately 4:05 PM, Staff #1 was observed alone in the cafeteria space with 19 school aged children; therefore, at this time ratio was 1:19. When asked if another staff person was present, it was shared that Staff #4 had left to go get something from their car. Staff #4 arrived at the facility at approximately 4:10 PM.

Corrected Corrected by Dec 2, 2025

Category: ratio. Marked corrected in the state record.

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

A child was observed leaving the Liberty Extended Program and entering the school hallway alone and unsupervised at approximately 4:00 PM.

Corrected Corrected by Dec 2, 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.

A child was observed leaving the Liberty Extended Program and entering the school hallway alone and unsupervised at approximately 4:00 PM. A staff was not present with a member of their assigned group during this time.

Corrected Corrected by Dec 2, 2025

Category: supervision. Marked corrected in the state record.

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

The Agreements for Child #1, #2, #3, #4, and #5 lacked the operator and parent's signature.

Corrected Corrected by Jan 9, 2026

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 Child #1, #2, #3, #4, and #5 contained Agreements which did not specify the child's arrival and departure times.

Corrected Corrected by Jan 9, 2026

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 Agreements for Child #1, #2, #3, #4, and #5 lacked the persons designated by a parent to whom the child may be released.

Corrected Corrected by Jan 9, 2026

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 Child #1, #2, #3, #4 and #5 lacked the date of the child's admission.

Corrected Corrected by Jan 9, 2026

Category: recordkeeping. Marked corrected in the state record.

3270.151(a) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem.

The files for Staff #1 and #3 contained Health Assessments at the time of inspection, but it was observed they did not have Health Assessments before their first day working in childcare.

Corrected Corrected by Jan 23, 2026

Category: ratio. 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.

The Health Assessments for Staff #1 and #3 contained tb screening by the Mantoux method at the time of inspection, but it was observed they did not have tb screening by the Mantoux method before their first day working in childcare.

Corrected Corrected by Jan 23, 2026

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

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

Observed the facility did not have written notification of safe routes shall be posted by the operator at a conspicuous location in the childcare facility.

Corrected Corrected by Jan 9, 2026

Marked corrected in the state record.

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

Staff person #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 Dec 4, 2025

Category: health medication. 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 provider did not have their current certificate of compliance posted in a conspicuous location used by parents. The operator did not provide the parents of each child enrolled with information on how to electronically access the regulations.

Corrected Corrected by Dec 2, 2025

Marked corrected in the state record.

3270.27(f) · The operator shall send a copy of the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

Based upon documentation, the operator did not send a copy of the emergency plan to the local or county municipality.

Corrected Corrected by Dec 2, 2025

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 #2 lacked 12 hours of childcare training within the previous year.

Corrected Corrected by Jan 16, 2026

Category: recordkeeping. Marked corrected in the state record.

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

The Agreement in the file for Child #1 lacked the operator's signature.

Corrected Corrected by Nov 25, 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 Agreement for Child #1 lacked the date of the child's admission.

Corrected Corrected by Nov 25, 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 facility's written Shaken Baby Policy did not address the recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma, strategies for coping with a crying, fussing, or distraught child; and addressing the prevention and identification of child maltreatment.

Corrected Corrected by Nov 27, 2024

Category: ratio. 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.

Trash that has been contaminated by human secretions or excrement was observed in a non-lidded, open trash receptacle in the two bathrooms and in the cafeteria space.

Corrected Corrected by Dec 2, 2024

Category: ratio. Marked corrected in the state record.

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

The file for Staff #4 did not contain documentation of receiving training regarding the emergency plan within the past 12 months. The file for Staff #5 contained Emergency Plan trainings that were dated more than 12 months apart.

Corrected Corrected by Dec 3, 2024

Category: recordkeeping. Marked corrected in the state record.

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

The files for Staff #4 and #5 did not contain documentation of training in fire safety in the last year.

Corrected Corrected by Dec 6, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff person(s) shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #4 will have until 12/10/24 to complete the required training. Until such time as the required training has been completed, staff person #-4 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 #4, staff person #4 may not work in a child-care position at the facility.

Staff person #4 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): (Health and Safety Basic Training).

Corrected Corrected by Nov 27, 2024

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.

Although the file for Staff #2 contained Pediatric First Aid/CPR at the time of inspection, it was observed that the file for Staff #2 did not contain Pediatric First Aid/CPR within 90 days of hire.

Corrected Corrected by Nov 25, 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).

Although Staff #5 had current Mandated reporter Training at the time of the Renewal Inspection, it was observed that Staff #5 updated Mandated Reporter Training in an interval greater than 60 months.

Corrected Corrected by Nov 25, 2024

Category: recordkeeping. 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 #3 may not work in a childcare position at the facility.

The disclosure statement in the file for Staff #1 lacked a date. Although the file for Staff #2 contained a National Sex Offender Certificate at the time of inspection, it was observed that Staff #2 did not obtain the certificate within 45 days of hire and therefore was incorrectly provisionally hired. The file for Staff #3 lacked a PA State Police Clearance or request for the Clearance. The file for Staff #3 who has lived outside of Pennsylvania in the last five years lacked Maryland's clearances or request for the clearances.

Corrected Corrected by Nov 25, 2024

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

3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The file for Staff 4 did not contain an evaluation completed within the previous 12 months

Corrected Corrected by Dec 5, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.133(5) · Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

The Epi Pen observed at the facility for Child #2 was expired.

Corrected Corrected by Dec 6, 2024

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

3270.133(6) · A parent shall provide written consent for administration of medication or a special diet.

Observed the medication at the facility for Child #1 and Child #2 lacked written parental consent for administration of the medication.

Corrected Corrected by Dec 5, 2024

Category: ratio. Marked corrected in the state record.

3270.151(a) · A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem.

The file for Staff #3 lacked a Health Assessment. The last two health assessments in the file for Staff #5 were dated more than 24 months apart.

Corrected Corrected by Nov 25, 2024

Category: ratio. 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.

The file for Staff #3 lacked tuberculosis screening by the Mantoux method.

Corrected Corrected by Nov 25, 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 #3 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

Corrected Corrected by Nov 25, 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 facility's emergency plan lacked accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Corrected Corrected by Nov 25, 2024

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

3270.27(f) · The operator shall send a copy of the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

Based on conversations with the operator, the operator did not send a copy of the emergency plan to the local or county municipalities.

Corrected Corrected by Nov 25, 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 #4 and #5, lacked documentation of the annual 12 clock hours of childcare training for the 12/22-12/23 training year.

Corrected Corrected by Jan 3, 2025

Category: recordkeeping. Marked corrected in the state record.

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

The agreement forms in the file for child #1 through #5 did not specify the child's date of admission.

Corrected Corrected by Nov 14, 2023

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. Until such time as the required pre-service trainings are completed, staff person #1 and #3 must be supervised, when interacting with children, by an AGS who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person #1 and staff person #3 may not work in a child-care position at the facility.

Staff person #1 and #3 were observed to be caring for children unsupervised. Staff person #1 has not completed the following pre-service training required prior to caring for children unsupervised: Health and safety training. Staff person #3 has not completed the following pre-service training required prior to caring for children unsupervised: Health and safety training and First-aid/CPR training.

Corrected Corrected by Dec 17, 2023

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.

The health and safety training and the First-aid/CPR training in the file for staff person #6 were dated beyond their first 90 days working with children.

Corrected Corrected by Dec 17, 2023

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

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

The mandated reporter in the file for staff person #6 was dated beyond their first 90 days working with children.

Corrected Corrected by Dec 17, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #1 and #2 may not work in a child care position at the facility.

The file for staff person #1, hired provisionally on (SEE LIS CODE DATE) and past their 45-day provisional period, did not include an NSOR clearance. The file for staff person #3, hired provisionally on (SEE LIS CODE SHEET), did not include clearances for North Carolina. Based on review of the file, they had a driver's license from North Carolina issued in 2021 and reference letters regarding experience in North Carolina in 2023. When the operator was asked when the individual moved to Pennsylvania, they stated it was within the last year. At approximately 4:40 pm, staff person #1 and #3 were the only staff outside with a group of children.

Corrected Corrected by Dec 17, 2023

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

3270.35(b)(1)/3270.192(2)(ii) · A group supervisor shall have a bachelor's degree from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field. 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 #2, holding the title of group supervisor, did not include evidence of a bachelor's degree in a related field.

Corrected Corrected by Dec 17, 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 #1 and #6, both holding the title of assistant group supervisor, included a high school diploma, but did not include evidence of 2500 hours of experience.

Corrected Corrected by Dec 17, 2023

Category: supervision. Marked corrected in the state record.

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

The agreement forms in the file for child #1 through #5 were not signed by the operator.

Corrected Corrected by Nov 14, 2023

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 information in the file for child #4 did not include the addresses for all 4 release persons.

Corrected Corrected by Dec 17, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.133(4) · Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

The following medications were observed as accessible to children, as they were stored on the steps of the facility's storage area next to the girls' bathroom: an epi-pen, albuterol and OTC allergy medications. The door to the storage area was unlocked at the time.

Corrected Corrected by Nov 14, 2023

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

3270.133(5) · Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

The albuterol for child #7 was expired. The box containing the medication listed 5/31/24 as the expiration date, however, the actual canister listed the expiration date of July 2023.

Corrected Corrected by Dec 17, 2023

Category: ratio. Marked corrected in the state record.

3270.133(6) · A parent shall provide written consent for administration of medication or a special diet.

There was no written parental consent for albuterol belonging to child #6.

Corrected Corrected by Dec 17, 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 health assessment in the file for staff person #1, #2 and #3 was dated after the individual began working with children. The last health assessment in the file for staff person #4, #5 and #7 was dated more than 24 months ago.

Corrected Corrected by Jan 31, 2024

Category: ratio. 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.

The TB screening in the file for staff person #1 was dated after the staff person began working with children.

Corrected Corrected by Dec 17, 2023

Category: health medication. 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.

Based on conversation with the operator and review of the files for child #3 and #4, a third copy of all injury/illness reports were not being retained in the children's files.

Corrected Corrected by Nov 14, 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.

Based on review of the facility's fire drill log, there was one time when fire drills were conducted more than 60 days apart: 11/3/22 and 1/11/23. The drill listed on 12/1/22 was a tornado emergency drill.

Corrected Corrected by Nov 14, 2023

Category: recordkeeping. 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 review of the facility's fire drill log, the hypothetical location of the fire for consecutive drills on 2/6/23 and 3/8/23 was the cafeteria.

Corrected Corrected by Nov 14, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.94(a)(9) · The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that a written record is maintained on file at the facility indicating the specific time of day of the drill, the hypothetical location of the fire, the evacuation time, and the names of the facility persons and the number of children who participate in the fire drill.

Based on review of the facility's fire drill log, there was not an evacuation time listed for drills on 1/11/23 and 2/6/23.

Corrected Corrected by Nov 14, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.27(f) · The operator shall send a copy of the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

Based on conversation with the operator, there was not proof that the most recent updates to the facility's emergency plan were sent to the local and county emergency management agencies.

Corrected Corrected by Dec 17, 2023

Category: physical safety. 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.

2nd citation: The facility's emergency plan was updated with a statement that they had a plan for continuity of operations, but the actual plan was not addressed. The facility's shaken baby sydrome policy did not address the signs/symptoms of shaken baby, how to cope with a crying/distarught child and the identification and prevention of child maltreatment. Previously cited on 12/16/22.

Corrected Corrected by Apr 3, 2023

Category: ratio. 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 updated health report for child #1, which included a statement that the child is able to participate in child care and appears to be free from communicable disease, did not include a name, title or written or electronic signature of the individual who completed the form.

Corrected Corrected by Apr 3, 2023

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

3270.151(c)(3)/3270.151(c)(5) · An adult health assessment must include an examination for communicable diseases and the results of that examination. An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

2nd citation: The health assessment for staff person #7 did not include an examination for communicable diseases and the results of that examination or the physician's or CRNP's assessment of the person's suitability to provide childcare. Previously cited on 12/16/22.

Corrected Corrected by Mar 31, 2023

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.

The hypothetical location was listed as "cafe" for consecutive drills on 1/11/23 and 2/6/23.

Corrected Corrected by Mar 31, 2023

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 facility's emergency plan did not include information regarding continuity of operations. The facility did not have a shaken baby sydrome policy.

Corrected Corrected by Mar 19, 2023

Category: ratio. 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. Until such time as the required pre-service trainings are completed, staff person #2 and #4 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 #2 and #4, staff person #2 and #4 may not work in a child-care position at the facility.

On 11/29/22, staff person #2 and #4 were observed to be caring for children unsupervised. Staff person #2 and #4 has not completed the following pre-service training required prior to caring for children unsupervised: Mandated reporter.

Corrected Corrected by Nov 29, 2022

Category: supervision. Marked corrected in the state record.

3270.18(a) · The legal entity shall have comprehensive general liability insurance to cover the persons who are on the premises. A current copy of the insurance policy shall be on file at the facility.

The liability insurance on file at the facility at the time of the inspection expired 8/21/22.

Corrected Corrected by Nov 30, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The last documented review of the emergency plan was more than 12 months ago.

Corrected Corrected by Nov 30, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The last emergency plan training in the file for staff person #2 and #3 was 9/15/21. The last emergency plan training in the file for staff person #4 was 9/16/19. There was no emergency plan training in the file for staff person #5, #6 and #7, all working with children more than 90 days.

Corrected Corrected by Nov 30, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The last two fire safety trainings in the file for staff person #1, #2, #3, #4 and #6 were dated 10/21/21 and 12/14/22. The only fire safety training in the file for staff person #7, hired 10/7/21, was dated 11/17/22.

Corrected Corrected by Mar 19, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff person(s) shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #3 and #5 will have until 3/4/23 to complete the required training. Until such time as the required training has been completed, staff person #3 and #5 must be supervised, when interacting with children, by an AGS who has completed the required training related to this citation. If there are no staff available to supervise staff person #3 and #5, staff person #3 and #5 may not work in a child-care position at the facility.

Staff person #3 has not completed the following required pre-service training within 90 days of their date of hire: First-aid/CPR. Staff person #5 has not completed the following required pre-service training within 90 days of their date of hire: First-aid/CPR and Health and safety training.

Corrected Corrected by Nov 29, 2022

Category: supervision. 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 #2 and #4 will have until 3/4/23 to complete the mandated reporter training. Until such time as the required training has been completed, staff person #2 and #4 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#2 and #4, staff person/facility person #2 and #4 may not work in a child-care position at the facility.

Staff person #2 and #4 has not completed mandated reporter training within the last 60 months. This is evidenced by the previously documented mandated reporter training on file being dated 9/20/17 for staff person #2 and 11/4/16 for staff person #4.

Corrected Corrected by Nov 29, 2022

Category: supervision. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person #2, #5, #6 and #7 may not work in a child care position at the facility. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #2, #5, #6 and #7 may not work in a child care position at the facility.

The last state police clearance and FBI clearance for staff person #2, who who was observed caring for children, were dated 9/13/17 and 9/18/17 respectively. The file for staff person #5, hired provisionally and beyond their 45-day provisional period, did not include a signed disclosure statement or state police clearance and based on conversation with the operator, was caring for children. The file for staff person #6, who was hired provisionally and beyond their 45-day provisional period, lived out of state in the previous 5 years and did not include the child abuse or sex offender registry for that state or a signed disclosure statement. The file for staff person #7, whose date of hire was 10/7/21 and was not listed on the previous year's staff sheet, did not include a signed disclosure statement.

Corrected Corrected by Nov 29, 2022

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

3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

The last evaluation in the file for staff person #2 was dated 9/20/21. The last evaluation in the file for staff person #3 was dated 9/15/21. The last evaluation in the file for staff person #4 was dated 10/26/21. There was no evaluation on file for staff person #7, employed more than 12 months.

Corrected Corrected by Mar 19, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.35(b)(1)/3270.192(2)(ii) · A group supervisor shall have a bachelor's degree from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field. A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Based on conversation with the operator, staff person #7, holding the title of group supervisor, has a bachelor's degree in Sociology, but there no proof of the degree on file.

Corrected Corrected by Mar 19, 2023

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.

At approximately 5:05 pm, an older schoolager was observed leaving the cafeteria unsupervised. When asked where the child was going, staff stated that the child was walking to the gym, which is at the other end of the first floor hallway.

Corrected Corrected by Nov 29, 2022

Category: supervision. Marked corrected in the state record.

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

At approximately 5:05 pm, an older schoolager was observed leaving the cafeteria unsupervised. When asked where the child was going, staff stated that the child was walking to the gym, which is at the other end of the first floor hallway.

Corrected Corrected by Nov 29, 2022

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 4 pm, staff person #2 and #4 were observed in the cafeteria with 22 schoolagers. When asked to identify for whom they were responsible, staff person #2 identified 8 children and staff person #4 identified 11 children, leaving 3 children unidentified. Staff were not able to identify which 3 children were missed. The staff were asked to identify their groups again and the children's names were read back to them for clarification. 3 children were still unidentified and staff were not able to identify which 3 children were missed. This certification representative pointed to each child in the cafeteria and asked their names and at that time, the certification representative was able to identify the 3 children who were not identified. At approximately 5:05 pm, an older schoolager was observed leaving the cafeteria unsupervised. When asked where the child was going, staff stated that the child was walking to the gym, which is at the other end of the first floor hallway.

Corrected Corrected by Nov 29, 2022

Category: supervision. 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 in the file for child #1 did not specify the amount of the fee to be charged per day or per week.

Corrected Corrected by Nov 29, 2022

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 agreement in the file for child #1 did not specify the date on which the fee is to be paid.

Corrected Corrected by Nov 29, 2022

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 file for child #2 did not include the written consent signed by a parent for emergency medical care.

Corrected Corrected by Mar 19, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The health report in the file for child #1 did not include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Corrected Corrected by Mar 19, 2023

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

3270.133(2) · A staff person shall administer a prescription medication only if written instructions are provided from the individual who prescribed the medicine. Instructions for administration contained on a prescription label are acceptable.

There was no written instructions or prescription for the epi-pen belonging to child #3.

Corrected Corrected by Mar 19, 2023

Category: ratio. Marked corrected in the state record.

3270.133(5) · Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

The epi-pen belonging to child #2 was expired.

Corrected Corrected by Mar 19, 2023

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

3270.133(6) · A parent shall provide written consent for administration of medication or a special diet.

There was no written parental consent for the epi-pen belonging to child #2 and #3.

Corrected Corrected by Mar 19, 2023

Category: ratio. Marked corrected in the state record.

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

The health assessment for staff person #7 did not include an examination for communicable diseases and the results of that examination.

Corrected Corrected by Mar 19, 2023

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

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

The file for staff person #7 did not include the physician's or CRNP's assessment of the person's suitability to provide child care.

Corrected Corrected by Mar 19, 2023

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

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

The file for child #2 did not include the written consent signed by a parent for minor first-aid.

Corrected Corrected by Mar 19, 2023

Category: ratio. Marked corrected in the state record.

3270.94(a)(9) · The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that a written record is maintained on file at the facility indicating the specific time of day of the drill, the hypothetical location of the fire, the evacuation time, and the names of the facility persons and the number of children who participate in the fire drill.

The fire drills documented on the log since 12/16/21 did not specify the time of day or the hypothetical location of the fire.

Corrected Corrected by Mar 19, 2023

Category: recordkeeping. Marked corrected in the state record.

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

The file for staff person #2 included 10 hours of child care training between 12/19/20 and 12/19/21.

Corrected Corrected by Mar 19, 2023

Category: recordkeeping. 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 at the facility, staff have not received emergency plan training on an annual basis or prior to returning to their child care positions after the program was closed due to covid-19. Previous training documentation was not on file. The files for staff #3 and staff #5 lack current emergency plan training. All other staff now have current training on file.

Corrected Corrected by Feb 11, 2022

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.

Based on documentation on file, staff #1, #2, #3, #5, and #6 did not renew certification in pediatric CPR and first aid on or before the expiration of their previous certification or prior to returning to child care positions when the program reopened after being closed due to Covid-19. The files for staff #1, #2, #5 and #6 now contain current certification. The file for staff #3 lacks documentation of current certification in pediatric CPR and pediatric first aid.

Corrected Corrected by Feb 14, 2022

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.

Based on documentation at the facility, staff did not receive fire safety training on an annual basis or prior to returning to child care positions when the program reopened after being closed due to Covid-19.The files for staff #1, 2, 3, 5, and 6 now contain current fire safety training documentation.

Corrected Corrected by Dec 20, 2021

Category: recordkeeping. Marked corrected in the state record.

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

The file for staff #4, with a start date of 9/09/21, did not contain documentation of Pediatric first aid and pediatric cardiopulmonary resuscitation.

Corrected Corrected by Dec 24, 2021

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

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

The file for staff #1 contained an FBI clearance which indicated there was a record, however the attachment was not present in the file therefore the clearance is invalid. The file for staff #2 contained out of state clearances which were obtained after their first day in a child care position for this program year. The program year started on 9/03/21 and the Florida Department of Children and Families clearance was not obtained until 10/21/21. The Florida Department of Law Enforcement clearance was obtained on 9/14/21. The file for staff #3, with a start date of 10/13/17, contained an NSOR certificate obtained after their first day in a child care position for this program year after being closed due to covid 19. The program year started on 9/03/21 and the NSOR for staff #3 was dated 11/02/21.

Corrected Corrected by Dec 14, 2021

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

3270.34(a)(6) · A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

Based on documentation, staff have not received written evaluations on an annual basis or upon returning to child care positions when the program reopened after being closed due to covid-19. The files for staff #2, #5, and #6 now contain current evaluations. The files for staff #1 and #3 do not contain current written evaluations.

Corrected Corrected by Feb 1, 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 contained agreements which did not specify the child's arrival and departure times.

Corrected Corrected by Dec 13, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.34(b)(1)/3270.192(2)(ii) · A director shall have attained a bachelor's degree from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field and 1 year of 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 #2, designated as a co-director, did not contain verification of 1 year of experience with children.

Corrected Corrected by Dec 23, 2021

Category: recordkeeping. Marked corrected in the state record.

3270.34(b)(2)/3270.192(2)(ii) · A director shall have attained a bachelor's degree from an accredited college or university, including 30 credit hours in early childhood education, child development, special education, elementary education or the human services field and 2 years of 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 #1, designated as a co-director, did not contain verification of 2 years experience with children.

Corrected Corrected by Dec 9, 2021

Category: recordkeeping. Marked corrected in the state record.

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

The file for child #1 contained an agreement which was not signed by the operator.

Corrected Corrected by Dec 13, 2021

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 file for child #4 contained an agreement which did not specify the amount of the fee.

Corrected Corrected by Dec 20, 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 files or children 1-5 contained agreements which did not specify the date on which the fee is to be paid.

Corrected Corrected by Dec 13, 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 file for child #1 contained an agreement which did not specify the date of the child's admission.

Corrected Corrected by Dec 10, 2021

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 files for children #3 and #5 contained emergency contact information which did not include the work addresses and telephone numbers of the enrolling parent.

Corrected Corrected by Feb 1, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The file for child #4 contained emergency contact information and an agreement which have not been reviewed and updated since 5/11/2017.

Corrected Corrected by Feb 1, 2022

Category: recordkeeping. 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 files for staff #1, #2, and #3 contained health assessments which were not updated within 24 months as required. The most recent health assessments on file for all 3 staff are now current.

Corrected Corrected by Dec 2, 2021

Category: ratio. 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 lacked means of providing parents with information on how to access the regulations in this chapter electronically.

Corrected Corrected by Jan 14, 2022

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 #3 and #5 , both enrolled over the 90 days allowed due to the Covid 19 related regulation suspension, did not contain health reports. The file for child #2 contained a health report which lacked a date therefore compliance could not be determined.

Corrected Corrected by Feb 25, 2022

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