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.

SECOND VIOLATION Staff person #3 does not have current pediatric first aid/CPR training. This is evidence by the most recent pediatric first aid/CPR training documented on file at the time of inspection has an expiration date of 8/31/24. Previously cited on SIN-00265871 on 5/8/25.

Corrected Corrected by Jul 25, 2025

Category: ratio. 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.

In the Kitchen area next to the children's restroom, 2 sharp kitchen knives, screws, and adult scissors were observed in an unlocked drawer accessible to children in care.

Corrected Corrected by May 16, 2025

Category: health medication. 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 file for staff person #1 contained documentation of pediatric first/aid CPR training that was not renewed before the expiration date of the most current certification: 10/25/22 and 12/1/24. Staff person #3 does not have current pediatric first aid/CPR training. This is evidence by the most recent pediatric first aid/CPR training documented on file at the time of inspection has an expiration date of 8/31/24.

Corrected Corrected by Jun 13, 2025

Category: ratio. 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 file for staff person #3 did not contain documentation of fire safety training within the last 12 months.

Corrected Corrected by May 25, 2025

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.

The file for staff person #2 contained documentation of completing the following training on 9/13/24 but was not completed within 90 days of hire (See IS Code Sheet): Health and Safety.

Corrected Corrected by Sep 13, 2024

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

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person #4 may not work in a child care position at the facility.

The file for staff person #4 did not contain documentation of current FBI clearance results. The FBI clearance results on file were observed to have expired on 4/4/25.

Corrected Corrected by May 25, 2025

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

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

The file for staff person #3 did not contain documentation of a written evaluation by the director within the last 12 months. The most recent documented evaluation in the file at the time of inspection was dated 4/26/24.

Corrected Corrected by May 12, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.37(b)(3)/3270.192(2)(ii) · An aide shall have a minimum of an 8th grade education 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 person #3 did not contain documentation of two years of experience with children to quality for the position they are performing.

Corrected Corrected by May 12, 2025

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 9:13am in the Preschool Room, Staff Person #4 identified 2 young toddlers, 6 older toddlers, and 3 preschool aged children in their assigned group of children. At approximately 9:18 in the Infant/ Toddler Room, Staff Person #1 identified 2 infants, 4 young toddlers, and 1 older toddler in their assigned group of children.

Corrected Corrected by May 8, 2025

Category: ratio. Marked corrected in the state record.

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

In the Infant/Toddler room, peeling paint was observed on the base board near the door.

Corrected Corrected by May 31, 2025

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

3270.91(a) · Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

In the Infant Room, the door that leads to the basement and serves as an exit was observed not unobstructed as a pack n play was placed in front of the door.

Corrected Corrected by May 8, 2025

Marked corrected in the state record.

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

In the Preschool room, a plastic lid on a bin containing children's toys was observed to be cracked and not in good repair.

Corrected Corrected by May 8, 2025

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.

At approximately 9:15am in the Infant/Toddler room, a pack n play that was observed to be in use lacked 2 feet of space on three sides.

Corrected Corrected by May 8, 2025

Category: physical safety. 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 in the file for child #1 did not contain information on the enrolling parents work address and telephone number.

Corrected Corrected by May 8, 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 in the files for children #2 and #3 did not contain documentation of the addresses of the individuals designated by the parent to whom the child may be released.

Corrected Corrected by May 9, 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.

Emergency contact forms were observed not to be present in the Infant/Toddler room where children were receiving care.

Corrected Corrected by May 8, 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 emergency contact form in the file for child #2 was reviewed and updated by the parent on 8/12/24 and 4/28/25, which is more than 6 months apart.

Corrected Corrected by May 9, 2025

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 file for staff person #3 did not contain documentation of a health assessment conducted within the last 24 months. The most recent health assessment on file is dated 9/6/22.

Corrected Corrected by Jun 3, 2025

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 file for staff person #3 did not contain documentation of two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person at the time of inspection.

Corrected Corrected by May 12, 2025

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.

The operator did not contain documentation of sending the facility's emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

Corrected Corrected by Jun 4, 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 person #3 contained documentation of 0/12 annual clock hours of child care training, and the file for staff person #5 contained documentation of 7/12 annual clock hours of child care training.

Corrected Corrected by Jun 13, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.66(b) · Cleaning materials and other toxic materials shall be stored in an original labeled container or in a container that specifies the content. Toxics shall be stored away from food, food preparation areas and child care spaces.

In the Infant room, disinfectant wipes, disinfectant spray bottles, and an unlabeled spray bottle that staff person #1 identified contained disinfectant spray were observed stored on a shelf located above children's food.

Corrected Corrected by Jan 27, 2025

Category: ratio. Marked corrected in the state record.

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

In the Preschool room, a children's toy bin was observed to be cracked with rough edges and was not in good repair.

Corrected Corrected by Jan 27, 2025

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

3270.31(f) · Staff person(s) shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #1 will have until 9/26/24) to complete the required training. Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children, by an AGS or primary staff person who has completed the required training related to this citation. If there are no staff available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility.

Staff person #1 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Health and Safety Training.

Corrected Corrected by Sep 13, 2024

Category: supervision. Marked corrected in the state record.

3270.14/3270.21 · A facility shall be operated in conformity with applicable Federal and State laws and regulations. State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children. Until such time as the required pre-service trainings are completed, staff person #1 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, staff person #1 may not work in a child-care position at the facility.

Staff person #1 was 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 Basic Training).

Corrected Corrected by May 28, 2024

Category: supervision. Marked corrected in the state record.

3270.14/3270.21 · A facility shall be operated in conformity with applicable Federal and State laws and regulations.State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children.

The facilities Emergency Plan did not address Continuity of Operations.

Corrected Corrected by Jun 21, 2024

Category: ratio. 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.

In the Outdoor PlaySpace standing water was observed in multiple toys including over two inches of water in a play table.

Corrected Corrected by May 28, 2024

Category: health medication. 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 files for Staff #3 and #4 contained Pediatric First Aid and CPR certification obtained on 5/25/24. Their previous certificate expired on 3/2024, creating a lapse in their First Aid and CPR training.

Corrected Corrected by May 25, 2024

Category: ratio. 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 file for Staff #2, who has been employed for more than 12 months, did not contain documentation of training in fire safety.

Corrected Corrected by May 21, 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 #1 may not work in a child care position at the facility.

The file for Staff #1 lacked a Child Abuse Clearance, and therefore Staff#1 was incorrectly hired. Staff #1 was observed working unsupervised on the day of the inspection.

Corrected Corrected by May 28, 2024

Category: supervision. Marked corrected in the state record.

3270.36(b)(5)/3270.192(2)(iv) · 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 acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

The file for Staff #2, acting as an Assistant Group Supervisor, lacked proof of education and/or documentation of 2 years' experience with children.

Corrected Corrected by May 28, 2024

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 12:00 PM, Staff #2 left Staff #1 alone in the Infant Classroom with 5 infants. Therefore, at the time ratio was 1:5.

Corrected Corrected by May 28, 2024

Category: ratio. Marked corrected in the state record.

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

In the entranceway there was a loose baseboard that was coming off of the wall creating a pinching hazard. There were two missing ceiling tiles observed in the front classroom. In the Infant Classroom there was a bulletin board that was leaning against a wall creating a toppling hazard for the children in care. The doorknob on the door leading from the Infant Classroom to the kitchen was not secured in the door and created a pinching hazard. In the Outdoor Play space, the plastic fencing along the dumpster area and the two air conditioners were bunched up and created a tripping/tangling hazard to the children in care. In the Outdoor PlaySpace there was a rusty curtain rod that had fallen to the ground and was accessible to the children. There were various pieces of trash that created tripping hazards in the Outdoor PlaySpace. There was a nail sticking up from the floor in the children's restroom that created a cutting hazard for the children in care.

Corrected Corrected by May 28, 2024

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

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

In the Outdoor Play Space, a broken blue slide was observed creating a pinch point. In the Outdoor Play space there were two broken bookshelves that were leaning and created a toppling hazard for the children in care.

Corrected Corrected by May 28, 2024

Category: physical safety. 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.

In the Front Classroom there was a large bottle of glue on the floor that had the warning "Choking Hazard." There was a Healthy Habits Game on a low shelf in the Front Classroom that was labeled as a choking hazard as it contains small pieces. In the Infant Classroom there was a container of bubbles that were labeled " Choking Hazard." In the Outdoor Play space there was ripped black foam mats and a water bottle lid. All of these items were accessible to children who are still placing items in their mouths.

Corrected Corrected by May 28, 2024

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

3270.105 · High chairs shall have a wide base and a T-shaped safety strap.

In the Front Classroom an Older Toddler was observed not buckled in the highchair.

Corrected Corrected by May 28, 2024

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 May 28, 2024

Category: physical safety. 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 12:00 PM, Staff #2 left Staff #1 alone in the Infant Classroom with 5 infants. During this time Staff #2 was not physically present with her assigned group of children. At approximately 2:40 PM, Staff #2 was only able to identify 5 of the 6 children that were in her assigned group.

Corrected Corrected by May 28, 2024

Category: supervision. Marked corrected in the state record.

3270.119 · Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

In the Infant Room at approximately 11:30 AM, one infant was observed sleeping in a car seat and another infant was observed to be sleeping in a bouncy seat that had been placed inside a pack n play.

Corrected Corrected by May 28, 2024

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).

The file for Child #2 lacked a child service form that provides information to the family about the child's growth and development in the context of the services being provided.

Corrected Corrected by May 28, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

The Emergency Contact Form for Child #3 lacked the name and phone number of the child's physician.

Corrected Corrected by May 28, 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 #1, #2, and #3 lacked the complete address of the individual designated by the parent to whom the child may be released. The Emergency Contact Form for Child #4 lacked the phone number and address of the individual designated by the parent to whom the child may be released.

Corrected Corrected by May 28, 2024

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 #2, lacked documentation of 11 hours of the required 12 annual clock hours of childcare training.

Corrected Corrected by May 28, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.131(d)(5)/3270.131(e)(3) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in childcare group settings). Child #2 must be dismissed from care by close of business 5/28/24 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The file for Child #2, enrolled for more that 60 days at the facility, did not contain documentation of a 4th dose of the DTAP vaccination as required based on the child's age as per the ACIP recommended schedule.

Corrected Corrected by Jul 5, 2024

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

3270.134(a) · A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

In the Infant room, Staff #2 was observed changing an Infant's diaper. Staff #2 did not ensure the child's hands were washed after being diapered.

Corrected Corrected by May 28, 2024

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

3270.152 · A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

In the Infant Room, Staff #2 was observed changing a diaper. Staff #2 did not wash their hands after the diaper change was completed.

Corrected Corrected by May 28, 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 #2, lacked two written, nonfamily references from individuals attesting to the suitability to serve as a facility person.

Corrected Corrected by May 28, 2024

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 last documented Emergency Drill occurred on 5-5-23.

Corrected Corrected by May 28, 2024

Category: recordkeeping. 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.

Upon review of the facility's Fire Drill log, the following tests were observed to have been conducted more than 60 days apart: 11/6/26-1/8/24 (63 days), and 3/10/24-5/23/24 (74 days).

Corrected Corrected by May 28, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.166(6) · Neither an infant nor a toddler is permitted to sleep with a bottle in his mouth.

An infant in the Back Classroom was observed to be sleeping in their pack n play with a bottle in their mouth.

Corrected Corrected by May 18, 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 operator lacked a letter or other means of providing information regarding the emergency procedures to parents of enrolled children.

Corrected Corrected by May 18, 2023

Category: physical safety. 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 #2 has not completed the following required pre-service training by the compliance date of 12/30/22 as set forth in Announcement C-22-06. (see LIS code sheet): (Pennsylvania Health and Safety Update).

Corrected Corrected by May 16, 2023

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

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

The file for Staff #2 contained an FBI Clearance that had not been updated in the previous 60 months.

Corrected Corrected by Jun 30, 2023

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

3270.63 · If unsafe areas or conditions are in or near an outdoor play space, fencing or natural barriers are required to restrict children from those unsafe areas or conditions.

Observed the bungie cord in the Outside Play space which is used to secure the gate leading from the facility to the street has become stretched to the point where a child could fit through the gate and access the street.

Corrected Corrected by May 30, 2023

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

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

In Front Classroom, there were three electrical outlets on a surge protector that lacked protective receptacle covers. This surge protector was accessible to children 5 years of age and younger who were receiving care in this classroom.

Corrected Corrected by May 18, 2023

Marked corrected in the state record.

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

First-aid supplies used to restock the facilities first-aid kits were on a low file cabinet and accessible to the children in care.

Corrected Corrected by May 18, 2023

Category: recordkeeping. Marked corrected in the state record.

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

On the back door of the facility that is used to enter the outdoor play space there was peeling paint.

Corrected Corrected by May 18, 2023

Category: physical safety. 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.

Observed a Health Helping Activity Mat labeled Ages 4+ that had small pieces that was on a low shelf in the Front Classroom where children who are still placing objects on their mouths were receiving care. Observed playdough labeled "Not suitable for children under 36 months due to small parts that may cause choking hazard," that was on a low shelf in the Front Classroom where children who are still placing objects in their mouth were receiving care.

Corrected Corrected by May 18, 2023

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

3270.106(b) · Bed linens may not be used alone as age-appropriate rest equipment.

Observed a child in the Front Classroom that was using bed linens as rest equipment.

Corrected Corrected by May 18, 2023

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

3270.113(c) · A facility person may not single out the child for ridicule, threaten harm to the child or the child's family and may not specifically aim to degrade the child or the child's family.

Observed a staff member who singled out and ridiculed a child for not laying on their rest equipment and took their rest equipment away from them as a source of discipline.

Corrected Corrected by May 18, 2023

Category: physical safety. 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 Child #3, #4, and #5 lacked child service forms that provide information to the family about the child's growth and development in the context of the services being provided.

Corrected Corrected by May 26, 2023

Category: recordkeeping. 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.

The facility lacked written statements provided by the parents giving the formula and feeding schedule for the infants in care.

Corrected Corrected by May 18, 2023

Category: nutrition. Marked corrected in the state record.

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

The Emergency Contact Form in the file for Child #4 lacked written consent signed by a parent for emergency medical care.

Corrected Corrected by May 18, 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 Form for Child #3 lacked the address and telephone number of the individual designated by the parent to whom the child may be released.

Corrected Corrected by May 18, 2023

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.

The Emergency Contact information was not present in the Back Classroom for the four children who were present and receiving care in the room.

Corrected Corrected by May 19, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.124(e)/3270.181(c) · 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. 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 file for Child #3 contained an emergency contact form that had not been updated within the last 6 months.

Corrected Corrected by May 22, 2023

Category: transportation. Marked corrected in the state record.

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

The file for Child #3, a young toddler, did not contain a Health Report completed within the previous 6 months. The file for Child #3, a young toddler, contained Health Reports updated in an interval greater than 6 months.

Corrected Corrected by May 27, 2023

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

3270.131(d)(5)/3270.131(e)(3) · A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in childcare group settings). Child #1, #2, #3, and #4 must be dismissed from care by close of business 5/18/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The files for Child #1, #2, and #4, enrolled more than 60 days at the facility, did not contain documentation of an influenza vaccination as required based on the child's age as per the ACIP recommended schedule. The file for Child #3, enrolled more than 60 days at the facility, did not contain documentation of an influenza vaccination, four DTAP vaccinations, four pneumococcal vaccinations, and three polio vaccinations as required based on the child's age as per the ACIP recommended schedule.

Corrected Corrected by May 18, 2023

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

3270.134(a) · A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

In the Back Classroom, staff was observed changing a toddler's diaper. Staff did not ensure the child's hands were washed after being diapered.

Corrected Corrected by May 18, 2023

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

3270.135(a)(3) · If disposable diapers are provided by a parent or by a facility, a soiled diaper shall be discarded by immediately placing the diaper into a plastic-lined, hands-free covered can.

The trash can in the diapering area in the Back Classroom was observed to have broken foot pedal, resulting in the can no longer being hands-free.

Corrected Corrected by May 18, 2023

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

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

The file for Staff #3 lacked a Health Assessment.

Corrected Corrected by May 26, 2023

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 #1 lacked a Health Assessment completed within the previous 24 months.

Corrected Corrected by May 18, 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 did not contain the results of a tuberculin skin test, x-ray or other medical documentation necessary to confirm freedom from communicable tuberculosis.

Corrected Corrected by May 6, 2023

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

3270.152 · A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

In the Back Classroom, staff was observed changing a diaper. Staff did not wash hands after the diaper change was completed.

Corrected Corrected by May 18, 2023

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

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

The file for Child #3 contained a financial agreement form that was not updated within 6 months of the previous update.

Corrected Corrected by May 23, 2023

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.

The Emergency Contact Form in the file for Child #4 lacked signed parental consent for administration of minor first-aid procedures by facility staff.

Corrected Corrected by May 22, 2023

Category: ratio. 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 lacked a Fire Drill log.

Corrected Corrected by May 18, 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 conversations with the operator, the operator did not send a copy of the emergency plan to the local municipality or the county emergency management agency.

Corrected Corrected by May 22, 2023

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

3270.171(a) · An operator shall notify local traffic safety authorities annually in writing of the location of the facility and the program's use of pedestrian and vehicular routes around the child care facility.

Based on statements made by the operator, the local traffic authorities have not been notified this year in writing of the location of the facility and the program's use of pedestrian and vehicular routes around the day care facility.

Corrected Corrected by Jun 22, 2023

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 12:00 PM, during naptime, Staff #2 was observed alone in the Infant Room with 7 children; 2 infants and 5 young toddlers.

Corrected Corrected by Oct 3, 2022

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.

At approximately 12:00 PM in the Infant Room, during naptime, it was observed to be too dark that Staff #2 could not see, hear, direct, and assess the children in care. The Infant Room had no lights on and it has no windows. The two adjourning rooms also had no lights on and therefore Staff #2 could not see, hear, direct, and assess the children.

Corrected Corrected by Oct 3, 2022

Category: supervision. 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 Health Assessment in the file for Staff #1 lacked tuberculosis screening by the Mantoux method at initial employment.

Corrected Corrected by Oct 20, 2022

Category: health medication. 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 staff person #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, staff person #1 and staff person #3 may not work in a child-care position at the facility.

Staff person #1 and staff person #3 were observed to be caring for children unsupervised. Staff person #1 and staff person #3 have not completed the following pre-service training required prior to caring for children unsupervised: Pediatric First Aid and CPR and Mandated Reporter training.

Corrected Corrected by Aug 6, 2022

Category: supervision. Marked corrected in the state record.

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

The file for Staff #1 contained complete clearances at the time of inspection, it was observed that the file lacked a request for the National Sex Offender certificate dated prior to the date that Staff #1 began working with children. Therefore, she was incorrectly hired. The file for Staff #2 lacked a disclosure statement, proof of application for the National Sex Offender Certificate, and proof of application for FBI clearance. Therefore, staff #2 was incorrectly hired.

Corrected Corrected by Jul 27, 2022

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

3270.34(c) · A director shall be employed by a facility and be present at the facility site a minimum of 30 hours per week.

After conversation with staff, it was stated that the director is not currently present for 30 hours a week.

Corrected Corrected by Oct 25, 2022

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 #1, #2, and #3 lacked Health Assessments.

Corrected Corrected by Aug 11, 2022

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 #1, #2, and #3 lacked tuberculosis screening by the Mantoux method.

Corrected Corrected by Aug 11, 2022

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

3270.192(2)(iv) · A facility person's record shall include acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

The file for Staff #2 lacked verification of education.

Corrected Corrected by Jul 27, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.192(5) · A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person

The file for Staff #1 contained one nonfamily reference attesting to the person's suitability to serve as a facility person. The file for Staff #2 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

Corrected Corrected by Jul 27, 2022

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 #1, #2, #3 and #5 lacked documentation of the annual 12 clock hours of child care training. (See LIS Code Sheet)

Corrected Corrected by Jul 15, 2022

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 #2 lacked the enrolling parents work address and phone number.

Corrected Corrected by May 18, 2022

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 lacked a policy and procedure to identify the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment.

Corrected Corrected by Jun 17, 2022

Category: ratio. 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.

Located on the desk in the Preschool Classroom was a pair of sharp scissors and a stapler. These items were accessible to the children in care.

Corrected Corrected by May 18, 2022

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

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

The last documented review of the emergency plan occurred on 2-14-21.

Corrected Corrected by Jul 15, 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 file for Staff #1 and Staff # 4 did not contain documentation of receiving training regarding the emergency plan within the past 12 months. The file for Staff #2, #3, and #5 contained emergency plan training updated in an interval greater than 12 months. (See LIS Code Sheet)

Corrected Corrected by Jul 15, 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 file for Staff #1, #4, and #5 did not contain documentation of training in Fire Safety in the last year. The file for Staff #3 contained Fire Safety training that was updated in an interval greater than 12 months. (See LIS Code Sheet)

Corrected Corrected by Jul 29, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development in the following topics within 90 days of hire: Pediatric First Aid/CPR.

Staff person #1 and #5 have not completed the following required pre-service training within 90 days of their date of hire. (See LIS code sheet). (3270.31(f)(10).

Corrected Corrected by Jun 1, 2022

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).

Staff person #1, #2, and #4 has not completed mandated reporter training within 60 months. this evidenced by the previously documented mandated reporter training on file being dated. (Staff person #1 6/1/15; Staff person #2 6/30/15 and 9/1/20; and Staff person #4 1/20/17).

Corrected Corrected by Jun 27, 2022

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 #3 may not work in a child care position at the facility.

The file for Staff #1 contained a FBI clearance that has not been updated within the last 60 months. The file for Staff #1 contained a Child Abuse clearance that was updated in an interval greater than 60 months. The file for Staff #2 contained State Police Clearances, Child Abuse Clearances, and FBI Clearances that were updated in intervals greater than 60 months. The file for Staff #3 contained a Child Abuse Clearance that has not been updated in the last 60 months. The file for Staff #4 contained Child Abuse Clearances and FBI Clearances that were updated in intervals greater than 60 months. (See LIS Code Sheet)

Corrected Corrected by Jun 3, 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 file for Staff #1, #4, and #5 did not contain an evaluation completed within the previous 12 months. (See LIS Code Sheet)

Corrected Corrected by Jul 29, 2022

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 11:20 AM Staff #2 left to go prepare lunch and retrieve items from the kitchen. Staff #5 was left alone in the Preschool Room with 10 children; ages 4 older toddlers and 6 preschoolers. At approximately 11:45 AM Staff #2 left the room again to retrieve more items from the kitchen leaving Staff #5 alone with 11 children; 5 preschoolers, 4 older toddlers and 1 young toddler.

Corrected Corrected by May 19, 2022

Category: ratio. 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.

Located on the desk in the Preschool Classroom was hand sanitizer labeled keep out of reach of children. The cabinet in the bathroom had a broken safety lock and contained Clorox and Microban, both labeled keep out of reach of children. All of these toxics were accessible to the children in care.

Corrected Corrected by May 19, 2022

Marked corrected in the state record.

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

Located by wall in the entrance, the far wall in the middle of the Preschool Classroom, and the wall leading to the Infant Room has peeling paint.

Corrected Corrected by May 19, 2022

Category: physical safety. 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.

Located on the wall in the entranceway was tape approximately 2 feet from the ground. The tape was pulling away from the wall and coming off in small pieces and accessible to the children in care still placing items in their mouth.

Corrected Corrected by May 19, 2022

Marked corrected in the state record.

3270.104(a) · Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

A pack n play in use by a toddler was ripped in the four corners. The ripped areas allowed the beam and bolts underneath to be accessible to the child. There was a small file cabinet in the Preschool Room that had a sharp broken drawer that was a scratching hazard to the children in care.

Corrected Corrected by May 18, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.105 · High chairs shall have a wide base and a T-shaped safety strap.

The strap on the booster seat in the infant room was tied in a knot and unable to be used to secure the child in the seat.

Corrected Corrected by May 18, 2022

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 pack n play in use by an infant lacked 2 feet of space on three sides.

Corrected Corrected by May 18, 2022

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

3270.131(e)/3270.131(e)(1) · The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

The Health Reports for the following children lacked verification of ongoing vaccines in accordance with the schedule recommended by the ACIP. The report for Child #1 lacked an influenza vaccination.

Corrected Corrected by Jun 10, 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 facilities emergency plan lacked accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Corrected Corrected by Jul 15, 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 lacked documentation of conducting an annual emergency drill.

Corrected Corrected by Jun 24, 2022

Category: recordkeeping. Marked corrected in the state record.

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

The facility lacked a monthly fire detection log attesting to the operability of the system.

Corrected Corrected by May 19, 2022

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 operator did not provide the parents of each child enrolled with information on how to electronically access the regulations.

Corrected Corrected by Jul 11, 2022

Marked corrected in the state record.

3270.27(a)(1) · The facility shall have an emergency plan that provides for accommodations for shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises.

The facility's emergency plan did not provide details regarding shelter of children during a lockdown, sheltering in place or sheltering at locations away from the facility.

Corrected Corrected by Jul 15, 2022

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

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

The file for Child #3 lacked an initial health report within 60 days of attendance.

Corrected Corrected by May 18, 2022

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