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

2nd CITATION: In Young Toddler B Room, peeling paint was observed to the right of the mirror on the wall near the baseboard as well as below the #4 sign located underneath the learn and grow sign. Also in Young Toddler B Room, damaged drywall was observed from a wooden baby gate that was attached to the wall. PREVIOUSLY CITED ON: 3/4/25

Corrected Corrected by Jun 11, 2025

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

3270.25(b) · The operator shall post a copy of each inspection summary issued by the Department in a conspicuous location used by parents. The inspection summary shall remain posted until an agent of the Department verifies that each regulatory noncompliance item cited on the inspection summary has been corrected.

The facility's inspection summary from 3/4/25, that contained regulatory noncompliance citations needing verified as corrected, was not posted in a conspicuous location used by parents.

Corrected Corrected by Jun 1, 2025

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.

2nd CITATION: At approximately 11:05am, Staff person #1 was observed in the hallway outside of the Young Toddler A Room returning a red buggy used to transport the toddlers to/from outside playground. Certification Rep. walked past Staff person #1 and entered the Young Toddler A Room where 1 staff with 8 young toddlers was observed thus resulting in a staff: child ratio of 1:8. PREVIOUSLY CITED ON 3/4/25

Corrected Corrected by May 21, 2025

Category: ratio. Marked corrected in the state record.

3270.113(a)(1) · Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises. TIERED LIS: 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. 2. The Legal Entity will arrange for all staff, including leadership, to attend a supervision/ratio training designed and conducted by the ELRC #5. Proof of training will be submitted upon completion. Training hours can count as part of the 12-hour annual training requirement, as applicable. 3. The director will create an onboarding supervision/ratio plan for newly hired regular staff with guidance and support from the program's Quality Coach. The onboarding training will include names of specific online training sessions that newly hired regular staff will be required to complete. The plan will include a specific description of how new staff will be trained on using the facility's system for identifying the specific children for whom each staff is responsible, along with a timeline of when the training items will be completed. This training policy will be submitted to the Department within two weeks of acceptance of the plan of correction. 4. The director will create an onboarding supervision/ratio plan for substitute/ temporary staff with guidance and support from the program's Quality Coach. The onboarding training will include a specific description of how substitute/ temporary staff will be trained on using the facility's system for identifying the specific children for whom each staff is responsible, along with a timeline of when the training items will be completed. This training policy will be submitted to the Department within two weeks of acceptance of the plan of correction.

2nd CITATION: At approximately 11:05am, Staff person #1 was observed in the hallway outside of the Young Toddler A Room returning a red buggy used to transport the toddlers to/from outside the playground. Certification Rep. walked past Staff person #1 and entered the Young Toddler A Room where Staff person #2 and 8 young toddlers were observed. Staff person #1 entered the classroom shortly thereafter. During the onset of supervision and ratio, Staff person #1 identified and named 4 young toddlers and Staff person #2 identified and named 4 young toddlers. Therefore, it was determined that Staff person #1 was observed to not be physically present with their assigned group of children while they were returning the red buddy to the hallway. At approximately 11:15am, Preschool B was observed outside on the playground with 4 Staff and 25 preschool age children who were lined up against the fence and one child being held by Staff person #4. During the onset of supervision and ratio, when staff were asked to identify and name the children whom they were responsible for, Staff person #3 identified and named responsibility for 10 preschool age children, Staff person #4, who was holding the child who was misbehaving asked this cert. rep. if they could give their tags to Staff person #6 so that Staff person #4 could take the child inside the facility. Supervision and ratio check resumed with Staff person #5 who identified and named 7 preschool age children, and Staff person #6, who was responsible for 8 children, responded that she didn't know most of the kids and that she was, "just a sub." Staff person #6 was unable to identify and name the children in her supervision group and needed assistance from Staff person #5 in identifying and naming who they were responsible for. PREVIOUSLY CITED ON 3/4/25

Corrected Corrected by Jul 17, 2025

Category: supervision. Marked corrected in the state record.

3270.183(a) · Child records are confidential and shall be stored in a locked cabinet.

In the director's office, the child records are stored in two mobile file carts. One cart was observed to have the cover opened and the other cart lacked the sliding cover entirely.

Corrected Corrected by May 19, 2025

Category: recordkeeping. Marked corrected in the state record.

3270.113(e) · A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

As a result of a complaint investigation conducted on 3/4/25, based on interviews with staff, it was determined that during naptime a staff person used their leg to restrain a child on their mat because the child kept getting up off their mat and would not nap.

Corrected Corrected by Mar 24, 2025

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). LACKING REQUIRED HIRING DOCUMENTS: Staff Person #1 may not work in a childcare 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. Staff Person #1 may not work in a childcare position at the facility.

The staff file for Staff person #1, who is a substitute staff person, lacked a State Police clearance; the one observed in the file was for another person.

Corrected Corrected by Mar 4, 2025

Category: background checks. 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 12:20pm two staff and twenty preschool age children were observed transitioning back into the facility from being outside on the playground. Three preschool age children, who were in the front of the line, were observed to have walked down the hall, around the corner out of eyesight of Staff person #2 and Staff person #3. Those three preschool age children were observed to enter the elevator by themselves and the elevator door closed behind them without any staff present in the elevator thus resulting in the staff: child ratio to be 0:3. A few other children were observed lining up at the elevator with no staff present.

Corrected Corrected by Mar 24, 2025

Category: ratio. Marked corrected in the state record.

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

In the Preschool Room, in the lunch area, an electrical outlet located to the left of the kitchen door and an electrical outlet located under the audio center sign were each observed to lack one protective receptacle cover. Also in the Preschool Room an electrical outlet located behind the light table was observed to lack one protective receptacle cover.

Corrected Corrected by Mar 24, 2025

Marked corrected in the state record.

3270.66(a) · Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

In the Preschool Room, two Purell hand sanitizers labeled 'Keep Out of Reach of Children' were observed on a shelf near the language arts center accessible to the preschool age children in care. In the Indoor Play Space one Purell hand sanitizer was observe to the left of the doorway on the window ledge accessible to children in care.

Corrected Corrected by Mar 24, 2025

Category: physical safety. 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 School Age Building the following were observed to not be in good repair: in the Gym part of the black cove base was observed to be detached from the wall, a wall plate covering an electrical outlet was observed to be cracked at the top and broken off, a long vertical tear of the wallpaper in the hallway leading to the Gym was observed to be detached from the wall, and in Room 009 one ceiling tile to the left of the light was observed to not be kept clean as evidence by having water damage from a previous leak.

Corrected Corrected by Apr 30, 2025

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

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

In Young Toddler B Room, peeling paint was observed to the right of the mirror on the wall near the baseboard as well as below the #4 sign located underneath the learn and grow sign. Also in Young Toddler B Room, damaged drywall was observed from a wooden baby gate that was attached to the wall.

Corrected Corrected by Apr 30, 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 1:10pm in the Young Toddler B Room, during naptime, the following mats were observed to not have at least 2ft of space on 3 sides while in use: a toddler was observed sleeping on a mat that was placed approximately 1.5 feet from a shelving unit as well as 10 inches from a toy sink and another mat used by a toddler was placed up against the other side of the toy sink set and placed approximately 1 foot from the wall.

Corrected Corrected by Mar 24, 2025

Category: physical safety. 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 12:20pm two staff and twenty preschool age children were observed transitioning back into the facility from being outside on the playground. Three preschool age children, who were in the front of the line, were observed to have walked down the hall, around the corner out of eyesight of Staff person #2 and Staff person #3. Those three preschool age children were observed to enter the elevator by themselves and the elevator door closed behind them and a few other children were observed lining up at the elevator without being supervised by any staff person. At approximately 1:10pm, during naptime in the Young Toddler B Room, upon certification entering the room, Staff person #4 was observed on their cell phone and not able to see, direct or assess the toddlers in their care. Also, where Staff person #4 was positioned in the room they could not adequately supervise three of the napping toddlers due to the diaper changing table obstructing the Staff's ability to see, direct, and assess those toddlers that were napping on the opposite side.

Corrected Corrected by Mar 24, 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.

At approximately 12:20pm two staff and twenty preschool age children were observed transitioning back into the facility from being outside on the playground. Three preschool age children, who were in the front of the line, were observed to have walked down the hall, around the corner out of eyesight of Staff person #2 and Staff person #3. Those three preschool age children were observed to enter the elevator by themselves and the elevator door closed behind them and a few other children were observed lining up at the elevator without a staff person being physically present with those children.

Corrected Corrected by Mar 24, 2025

Category: supervision. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development in the topics of 3270.31(f)(10) within 90 days of hire. Staff person #4 must receive pediatric first aid/CPR training in an approved curriculum by a PQAS-certified trainer. Staff person #4 will have until 10/19/24 to complete the required training. Until such time as the correction is implemented, 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): Pediatric first aid/CPR training; the first aid/CPR training on file was not an approved curriculum.

Corrected Corrected by Oct 8, 2024

Category: supervision. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Staff Person #1 may not work in a childcare 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. Staff Person #1 may not work in a childcare position at the facility.

The staff file for Staff person #1 lacked a valid DHS FBI clearance. The staff file for Staff person #5 contained a current State Police clearance dated 10/24/23 which was not renewed within 60 months of the previously dated 10/18/18 State Police clearance expiring. The staff file for Staff person #6 contained a current State Police clearance dated 8/9/24, a current Child Abuse clearance dated 8/21/24 and a current FBI clearance dated 8/7/24 all of which were not renewed within 60 months of the previously dated 4/25/29 State Police clearance, the 5/3/19 Child Abuse clearance and the 5/10/19 FBI clearance expiring.

Corrected Corrected by Sep 26, 2024

Category: background checks. 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 School Age Building, the following rooms were observed to have ceiling tiles with visible water damage and/or mold: Room 009 with 6 tiles, Room 019 with 3 tiles, Gym with 11 tiles, Hallway to left of Room 011 with 6 tiles, Hallway to right of Gym with 5 tiles, Room 010 with 2 tiles, Room 011 with 7 tiles, Room 010 with 5 tiles, and Room 011 with 7 tiles.

Corrected Corrected by Oct 31, 2024

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

3270.82(h) · A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

In the School Age Building two sinks located in the girl's restroom was observed to lack handwashing signs.

Corrected Corrected by Sep 25, 2024

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

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

The child file for Child #5, who is a preschool age child, was observed to contain health reports that were conducted more than 12 months apart; those health report dates are dated 8/30/23 and 9/1/24.

Corrected Corrected by Sep 25, 2024

Category: health medication. 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 child file for Child #2 was observed to contain a current health report dated 8/29/24 that lacked a statement that the child is able to participate in childcare and is free from contagious or communicable disease.

Corrected Corrected by Oct 1, 2024

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

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

The staff file for Staff person #2, lacked a valid health assessment and TB test results; the health assessment and TB test results on file are more than 12 months old.

Corrected Corrected by Sep 27, 2024

Category: ratio. 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 child file for Child #1 contained a current emergency contact form that were not reviewed and signed by the parent every 6 months; the two most recent reviews of the emergency contact form were signed on 9/26/23 and 4/29/24.

Corrected Corrected by Sep 25, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.182(8) · A child's record shall contain a copy of the initial agreement and subsequent written agreements between the parent and the operator. The parent receives the original agreement.

The child file for Child #4 was observed to lack a financial agreement form.

Corrected Corrected by Sep 27, 2024

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 staff file for Staff person #3 was observed to lack one nonfamily reference.

Corrected Corrected by Oct 4, 2024

Category: recordkeeping. Marked corrected in the state record.

3270.136(b) · The operator shall inform parents of enrolled children when there is a suspected outbreak of a communicable disease or an outbreak of an unusual illness that represents a public health emergency in the opinion of the Department of Health.

During a complaint investigation conducted on 7/10/24, it was disclosed during staff interviews that only parents of those children receiving care in the effected classrooms were notified of a suspected outbreak of a communicable disease.

Corrected Corrected by Aug 26, 2024

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

3270.137 · An operator who observes an enrolled child with symptoms of a communicable disease or infection that can be transmitted directly or indirectly and which may threaten the health of children in care shall exclude the child from attendance until the operator receives notification from a physician or a CRNP that the child is no longer considered a threat to the health of others. The notification shall be retained in the child's file. Diseases and conditions which require exclusion are specified in 28 Pa. Code Chapter 27 (relating to communicable and noncommunicable diseases).

During a complaint investigation conducted on 7/10/24, it was disclosed during staff interviews that children who were excluded from care for having a communicable disease were permitted to return without a doctor's note indicating that they were able to return to care.

Corrected Corrected by Aug 26, 2024

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

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

Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 5/30/24 to 7/3/24 (34 days).

Corrected Corrected by Aug 26, 2024

Category: recordkeeping. Marked corrected in the state record.

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

2nd CITATION: Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 10/26/23 to 11/27/23 (32 days). PREVIOUSLY CITED on 12/19/23

Corrected Corrected by Feb 8, 2024

Category: recordkeeping. Marked corrected in the state record.

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

Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 10/26/23 to 11/27/23 (32 days).

Corrected Corrected by Dec 20, 2023

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 staff file for Staff person #7, Staff person #8, and Staff person #9 lacked documentation of having received training regarding the facility's emergency plan with in 90 days of hire.

Corrected Corrected by Sep 22, 2023

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.

The staff file for Staff person #7 lacked valid pediatric first-aid/CPR; the certification on file dated 4/7/21 has expired. The staff file for Staff person #9 lacked valid pediatric first-aid/CPR; the certification on file dated 7/30/21 has expired.

Corrected Corrected by Sep 15, 2023

Category: ratio. 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 #2 will have until 9/30/23 to complete the required training.

Staff person #1 had not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid/CPR. Staff person #1 completed Pediatric First Aid/CPR on 9/1/23. Staff person #2 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 Oct 14, 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.

The staff file for Staff person #3 was observed to contain a signed disclosure statement that was not dated thus unable to determine if it was signed at time of hire. The staff file for staff person #4 lacked a signed disclosure statement.

Corrected Corrected by Sep 22, 2023

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 staff file for Staff person #4, Staff person #5, and Staff person #6 contained current staff evaluations completed in July 2023 which were more than 12 months from their previously dated June 2022 staff evaluations on file.

Corrected Corrected by Sep 15, 2023

Category: recordkeeping. Marked corrected in the state record.

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

In the Toddler 2 Room, a six-outlet surge protector power strip located on the windowsill to the left of the refrigerator was observed to be missing two protective outlet covers was accessible to children 5 years of age or younger. In the Preschool Room, an electrical outlet located in the eating area and to the left of the sand table was observed to lack one protective outlet cover and was accessible to children 5 years of age or younger.

Corrected Corrected by Sep 22, 2023

Marked corrected in the state record.

3270.69(b) · Hot water temperature, in areas accessible to children, may not exceed 110° F.

The water coming from the sink located to the right of doorway in Room 011 was observed to measure 133° F.

Corrected Corrected by Oct 14, 2023

Category: physical safety. 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 Indoor Play Space one large yellow interlocking foam play mat located on the wall to the left of the doorway was observed to be detached from the wall.

Corrected Corrected by Oct 7, 2023

Category: physical safety. 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 child care group settings). Child #1 must be dismissed from care by close of business 9/11/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The child file for Child #1 lacked a flu shot for 2022.

Corrected Corrected by Oct 6, 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 staff file for Staff person #4 contained a current health assessment dated 7/27/22 which was conducted more than 24 months from the previously dated 3/14/20 health assessment on file. The staff file for staff person #6 lacked an updated health assessment; the most recent health assessment on file is dated 6/10/21 which is more than 24 months old.

Corrected Corrected by Oct 14, 2023

Category: ratio. 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.

The file for Staff person #1 contained a current health assessment dated 1/17/23 that lacked an examination for communicable diseases and the results of that examination as well as a doctor or CRNP's assessment of Staff person #1's ability to provide childcare.

Corrected Corrected by Oct 14, 2023

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

3270.175(c) · Manufacturers' instructions for use of safety restraints shall be kept in the vehicle at all times.

The manufacturer's instructions for use of safety restraints were observed to not be in the 2020 Chevrolet Micro Bird nor in the 2019 Dodge Caravan that the facility uses to transport children in care.

Corrected Corrected by Sep 29, 2023

Category: transportation. 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.

An annual emergency drill conducted on 5/22/23 lacked the total number of staff, total number of children who participated, the time it took to complete drill, special accommodations the facility used for any category of children, and any problems encountered that is required to be documented when conducting the emergency drill, per announcement C-22-04.

Corrected Corrected by Oct 6, 2023

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.

Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 8/10/23 - 9/11/23 (32 Days).

Corrected Corrected by Sep 15, 2023

Category: recordkeeping. 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 Indoor Play Space two large interlocking foam play mats located on the walls nearest the doorway were observed to be detached from the wall.

Corrected Corrected by Feb 15, 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.

Staff person #2 and Staff person #5 lacked the one-hour Pennsylvania Health and Safety Update 2022 training by 12/30/22 as required per announcement C-22-06. Staff person #6, Staff person #10, and Staff person #14 had not completed the one-hour Pennsylvania Health and Safety Update 2022 training by 12/30/22 as required per announcement C-22-06; all staff completed the one-hour training in January 2023.

Corrected Corrected by Feb 15, 2023

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 Infant 2 Room, the sheets being used in five of the cribs used by an infant in care was observed to be loose fitting thus allowing them to bunch up and cause a potential suffocation hazard.

Corrected Corrected by Feb 15, 2023

Category: health medication. 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 staff file for Staff person #3 through #7 and Staff person #9 through #18 had not participated in annual fire safety training; the two most recent trainings were dated 1/18/23 and 12/28/21.

Corrected Corrected by Feb 15, 2023

Category: recordkeeping. Marked corrected in the state record.

3270.31(f) · Staff person shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #8 will have until 3/8/23 to complete the required training. Until such time as the required training has been completed, staff person #8 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 #8, staff person #8 may not work in a child-care position at the facility.

Staff person #8 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 and Pediatric First Aid/CPR.

Corrected Corrected by Mar 3, 2023

Category: supervision. Marked corrected in the state record.

3270.75(c) · A first-aid kit must contain the following: soap, an assortment of adhesive bandages, sterile gauze pads, tweezers, tape, scissors and disposable, nonporous gloves.

The first aid kit located in Room 11 was observed to lack tweezers.

Corrected Corrected by Feb 15, 2023

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 child file for Child #4 contained an emergency contact information form that lacked the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Feb 15, 2023

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, and Child #3, must be dismissed from care by close of business 2/14/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

The child file for Child #1, Child #4, and Child #5, who are preschool age children, lacked a flu shot for 2022. The child file for Child #2, who is an 8mo old infant, and Child #3, who is a young toddler, lacked a flu shot for 2022.

Corrected Corrected by Feb 15, 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 staff file for Staff person #5, contained a current health assessment dated 3/15/22 which was conducted more than 24 months from the previously dated 7/30/19 health assessment on file.

Corrected Corrected by Feb 15, 2023

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.

Upon entry in to the Preschool Room, the restroom located on the right side of the class room was observed to have broken loose tile pieces around the sewer lid that have separated from the floor causing the floor not to be in good repair.

Corrected Corrected by Sep 12, 2022

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), 3280.31(f) (1-10), or 3290.31(g) (1-10) within 90 days of hire. Staff person #1 will have until 8/23/22 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, primary staff person, or family child care home staff person) who has completed the required training related to this citation. If there are no staff available to supervise staff person #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): Staff person #1 has not completed pediatric first-aid/CPR training within the last 24 months. This is evidenced by the previously documented pediatric first-aid/CPR training on file being dated 3/9/20.

Corrected Corrected by Aug 23, 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: Staff Person #1 -- may not work 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. Staff Person #1- may not work at the facility.

The file for Staff person #1 was observed not to contain a National Sex Offender Registry (NSOR) certificate.

Corrected Corrected by Aug 8, 2022

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

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

The staff file for Staff person #2 contained current mandated reporter training dated 12/29/21 which was not renewed within 60 months from the previously existing mandated reporter certificate dated 5/29/15.

Corrected Corrected by Aug 3, 2022

Category: recordkeeping. Marked corrected in the state record.

3270.51 · When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30.

3rd CITATION: At approximately 10:10am, Staff person #5 was observed transitioning a group of young school-age children from Room 002 to the hallway. Staff person #5 was then observed leaving the hallway and returning to Room 002 to retrieve the remaining children in their group. At this point, staff: child ratio was exceeded, as no staff were present with the children while they were in the hallway. PREVIOUSLY CITED ON: 5/4/22 and 6/13/22

Corrected Corrected by Aug 15, 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.

In Room 0002 ten bottles of sunscreen labeled, 'Keep Out of Reach of Children' were observed on ledge accessible and in reach of the children in care.

Corrected Corrected by Aug 4, 2022

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 10:10am, Staff person #5 was observed transitioning a group of young school-age children from Room 002 to the hallway. Staff person #5 was then observed leaving the hallway and returning to Room 002 to retrieve the remaining children in their group. As a result, the children who were left in the hallway were unsupervised as Staff person #5 was not present to properly see, hear, direct, and access those children.

Corrected Corrected by Aug 15, 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.

2nd CITATION: In the school age building, at approximately 10:00am, Staff person #4 answered the door to let this certification representative into the building thus causing Staff person #4 to not be physically present with their 12 young school age children that they were responsible for supervising in Room 0002. Upon entry into Room 002 at the outset of supervision and ratio, two staff and 24 young school age children were observed. Staff person #4 identified and named 9 children and Staff person #5 identified and named 9 children thus leaving 6 children unaccounted for. Staff were given a second opportunity to name the children whom they were responsible for and Staff person #4 identified and named 11 children and Staff person #5 identified and named 9 children thus still leaving 4 child unaccounted for. On a third opportunity all children were accounted for. PREVIOUSLY CITED ON: 6/13/22

Corrected Corrected by Aug 15, 2022

Category: supervision. 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 toddlerA child's record shall contain initial and subsequent health reports.

The child file for Child #1, who is a young toddler, was observed to lack an updated health report at least every 6 months; the most recent health report on file is dated 11/10/22.

Corrected Corrected by Aug 31, 2022

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

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

The child file for Child #2 and Child #3 lacked a flu shot for 2021.

Corrected Corrected by Aug 31, 2022

Category: health medication. 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 staff file for Staff person #3, contained a current health assessment dated 2/21/22 which was conducted more than 24 months from the previously dated 9/13/19 health assessment on file.

Corrected Corrected by Aug 3, 2022

Category: ratio. Marked corrected in the state record.

3270.182(1) · A child's record shall contain initial and subsequent health reports.

The child file for Child #3 lacked a flu shot for 2021.

Corrected Corrected by Aug 31, 2022

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

3270.61(h) · The capacity established for an indoor space may not be exceeded.

2nd CITATION: At approximately 10:00am, 2 staff and 24 young school aged children were observed to be utilizing Room 002 that has a maximum capacity of 10. PREVIOUSLY CITED ON 6/13/22

Corrected Corrected by Aug 12, 2022

Category: ratio. Marked corrected in the state record.

3270.51 · The director will conduct random assessments of the preschool room at least once daily, at various times of the day, for the next 3 months following the approval of this plan of correction. During the assessment, the director will go into the preschool classroom, ask each staff person in the classroom to identify the children that are in their group, and are therefore, responsible for. The director will document in a log, the date, time, number of staff persons, number and ages of children in each assigned group. The director will confirm continuing compliance by sending copies of the documentation to the Western Region Office on a weekly basis for a period of three months after DHS approves the documentation format. The log will be made available to OCDEL-DHS representatives upon request.

***2nd CITATION: At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who named responsibility 7 preschool age children in their assigned group, was observed at one point to no longer to be outside and subsequently was observed to be returning outside from inside of the building. At that point ratio was 3:35. According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio anywhere between 4 to 13 preschool age children through out each day during that week. Also during the week of June 7-10, 2022, staff disclosed that the school age building, which cares for young school age children only, was also over ratio on Wednesday (1:13), on Thursday (1:14), and on Friday(1:15) during that week. These staff statements are supported by the weekly attendance schedule provided by the director. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling documentation of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22.

Corrected Corrected by Aug 15, 2022

Category: ratio. Marked corrected in the state record.

3270.51 · The Legal Entity will arrange for all staff to attend a minimum of 3 hours of program specific supervision/ratio training conducted by the ELRCs. The training will be submitted to the regional office for approval prior to attendance. Proof of training will be submitted upon completion.

**2nd CITATION: At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who named responsibility 7 preschool age children in their assigned group, was observed at one point to no longer to be outside and subsequently was observed to be returning outside from inside of the building. At that point ratio was 3:35. According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio anywhere between 4 to 13 preschool age children through out each day during that week. Also during the week of June 7-10, 2022, staff disclosed that the school age building, which cares for young school age children only, was also over ratio on Wednesday (1:13), on Thursday (1:14), and on Friday(1:15) during that week. These staff statements are supported by the weekly attendance schedule provided by the director. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling documentation of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22.

Corrected Corrected by Sep 2, 2022

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. Implementation will be verified via two unannounced visits conducted by Western Region.

*2nd CITATION: At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who named responsibility 7 preschool age children in their assigned group, was observed at one point to no longer to be outside and subsequently was observed to be returning outside from inside of the building. At that point ratio was 3:35. According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio anywhere between 4 to 13 preschool age children through out each day during that week. Also during the week of June 7-10, 2022, staff disclosed that the school age building, which cares for young school age children only, was also over ratio on Wednesday (1:13), on Thursday (1:14), and on Friday(1:15) during that week. These staff statements are supported by the weekly attendance schedule provided by the director. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling documentation of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22.

Corrected Corrected by Aug 15, 2022

Category: ratio. 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). Implementation will be verified via two unannounced visits conducted by Western Region.

*4TH CITATION: According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio on Wednesday and Thursday of that week. This is supported by weekly attendance record provided by the director. Upon review of the weekly attendance record for Preschool B, on Wednesday, June 8, 2022 there was 1 staff and 18 preschool and school age children scheduled between the hours of approximately 7:29am to 9:10am and on Thursday, June 9, 2022 there was 1 staff and 15 preschool age and school age children scheduled between the hours of approximately 7:25am to 8:43am. Ratio on Wednesday was 1:18 and ratio on Thursday was 1:15. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling records of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22. PREVIOUSLY CITED ON: 5/4/22, 3/10/22 and 11/22/21

Corrected Corrected by Aug 15, 2022

Category: ratio. Marked corrected in the state record.

3270.52 · The director will conduct random assessments of the preschool room at least once daily, at various times of the day, for the next 3 months following the approval of this plan of correction. During the assessment, the director will go into the preschool classroom, ask each staff person in the classroom to identify the children that are in their group, and are therefore, responsible for. The director will document in a log, the date, time, number of staff persons, number and ages of children in each assigned group. The director will confirm continuing compliance by sending copies of the documentation to the Western Region Office on a weekly basis for a period of three months after DHS approves the documentation format. The log will be made available to OCDEL-DHS representatives upon request.

***4TH CITATION: According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio on Wednesday and Thursday of that week. This is supported by weekly attendance record provided by the director. Upon review of the weekly attendance record for Preschool B, on Wednesday, June 8, 2022 there was 1 staff and 18 preschool and school age children scheduled between the hours of approximately 7:29am to 9:10am and on Thursday, June 9, 2022 there was 1 staff and 15 preschool age and school age children scheduled between the hours of approximately 7:25am to 8:43am. Ratio on Wednesday was 1:18 and ratio on Thursday was 1:15. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling records of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22. PREVIOUSLY CITED ON: 5/4/22, 3/10/22 and 11/22/21

Corrected Corrected by Oct 31, 2022

Category: ratio. Marked corrected in the state record.

3270.52 · The Legal Entity will arrange for all staff to attend a minimum of 3 hours of program specific supervision/ratio training conducted by the ELRCs. The training will be submitted to the regional office for approval prior to attendance. Proof of training will be submitted upon completion.

**4TH CITATION: According to staff statements during the week of June 7-10, 2022 the preschool room was over ratio on Wednesday and Thursday of that week. This is supported by weekly attendance record provided by the director. Upon review of the weekly attendance record for Preschool B, on Wednesday, June 8, 2022 there was 1 staff and 18 preschool and school age children scheduled between the hours of approximately 7:29am to 9:10am and on Thursday, June 9, 2022 there was 1 staff and 15 preschool age and school age children scheduled between the hours of approximately 7:25am to 8:43am. Ratio on Wednesday was 1:18 and ratio on Thursday was 1:15. The director was asked if any other staff were scheduled to work in those rooms and the director responded there could have been other staff in those rooms however was unable to provide the names or scheduling records of other staff who may have been in those rooms. PREVIOUSLY CITED ON 5/4/22. PREVIOUSLY CITED ON: 5/4/22, 3/10/22 and 11/22/21

Corrected Corrected by Sep 2, 2022

Category: supervision. Marked corrected in the state record.

3270.113(a)(1) · The director will conduct random assessments of the preschool room at least once daily, at various times of the day, for the next 3 months following the approval of this plan of correction. During the assessment, the director will go into the preschool classroom, ask each staff person in the classroom to identify the children that are in their group, and are therefore, responsible for. The director will document in a log, the date, time, number of staff persons, number and ages of children in each assigned group. The director will confirm continuing compliance by sending copies of the documentation to the Western Region Office on a weekly basis for a period of three months after DHS approves the documentation format. The log will be made available to OCDEL-DHS representatives upon request.

***At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who was responsible for 7 preschool age children, was observed going back inside the facility causing Staff person #1 not to be physically present with the children in their group. When asked, no other staff claimed to be supervising those 7 preschool age children. Also Staff person #2 was observed sitting outside at a table near the main entrance engaged in an activity with small groups of children. When asked to identify her supervision group, Staff person #2 was unable to locate the children from where she was sitting and had to get up and go look them. Neither Staff Person #1 nor Staff Person #2 were physically present with the children in their assigned groups.

Corrected Corrected by Sep 2, 2022

Category: supervision. Marked corrected in the state record.

3270.113(a)(1) · The Legal Entity will arrange for all staff to attend a minimum of 3 hours of program specific supervision/ratio training conducted by the ELRCs. The training will be submitted to the regional office for approval prior to attendance. Proof of training will be submitted upon completion.

**At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who was responsible for 7 preschool age children, was observed going back inside the facility causing Staff person #1 not to be physically present with the children in their group. When asked, no other staff claimed to be supervising those 7 preschool age children. Also Staff person #2 was observed sitting outside at a table near the main entrance engaged in an activity with small groups of children. When asked to identify her supervision group, Staff person #2 was unable to locate the children from where she was sitting and had to get up and go look them. Neither Staff Person #1 nor Staff Person #2 were physically present with the children in their assigned groups.

Corrected Corrected by Sep 2, 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. Implementation will be verified via two unannounced visits conducted by Western Region.

*At approximately 10:50am, 4 staff and 35 preschool age children were observed outside near the main front entrance. Staff person #1, who was responsible for 7 preschool age children, was observed going back inside the facility causing Staff person #1 not to be physically present with the children in their group. When asked, no other staff claimed to be supervising those 7 preschool age children. Also Staff person #2 was observed sitting outside at a table near the main entrance engaged in an activity with small groups of children. When asked to identify her supervision group, Staff person #2 was unable to locate the children from where she was sitting and had to get up and go look them. Neither Staff Person #1 nor Staff Person #2 were physically present with the children in their assigned groups.

Corrected Corrected by Aug 15, 2022

Category: supervision. Marked corrected in the state record.

3270.61(h) · The capacity established for an indoor space may not be exceeded.

According to staff statements during the week of June 7-10, 2022 room capacity was exceeded in the school age building between the hours 8:30am - 4:00pm during that week. This is supported by weekly attendance records provided by the director.

Corrected Corrected by Jul 22, 2022

Category: ratio. Marked corrected in the state record.

3270.51 · When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30.

At approximately 10:15am in Toddler 3 Room 2 staff and 14 older toddlers were observed. While conducting supervision and ratio both staff identified and named responsibility for all 14 older toddlers therefore, ratio was 1 staff to 14 children thus causing the facility to not be in compliance with staff: child ratios.

Corrected Corrected by Jun 10, 2022

Category: supervision. Marked corrected in the state record.

3270.31(f) · Staff persons shall complete professional development in the following topics within 90 days of hire: (1) Prevention and control of infectious diseases (including immunization); (2) Prevention of Sudden Infant Death Syndrome and use of safe sleep practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Emergency preparedness and response planning for emergencies resulting from a natural disaster or a man-caused event (such as violence at a child care facility); (8) Handling and storage of hazardous materials and appropriate disposal of bio contaminants; (9) Precautions when transporting children.

The staff file for Staff person #2 lacked valid health and safety training; the health and safety training on file dated 9/7/16 was completed prior to 9/30/16 and is no longer considered an acceptable training.

Corrected Corrected by Jun 30, 2022

Category: ratio. 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).

3RD CITATION: At approximately 10:00am in the Preschool Room, while conducting supervision and ratio Staff person #1 identified and named 16 children of mixed ages (preschool age and young school age) therefore, ratio was 1 staff to 16 children thus causing the facility to not be in compliance with staff: child ratios. PREVIOUSLY CITED ON 3/10/22 and 11/22/21

Corrected Corrected by Jun 10, 2022

Category: supervision. 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).

2ND CITATION: According to the majority of staff statements, multiple groups with mixed age levels in the facility are regularly out of ratio at various times throughout the day and week. PREVIOUSLY CITED ON 11-22-21.

Corrected Corrected by May 2, 2022

Category: ratio. 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 12:30 p.m. in the transitional preschool area of the preschool room with a total of 14 children, staff person #1 named 6 older toddlers in their group, and staff person #2 named 8 older toddlers in their group, resulting in staff person #2 being out of ratio. According to staff statements, multiple rooms, including the preschool room, have been out of ratio on multiple occasions ranging in time from a few minutes to the entire day.

Corrected Corrected by Nov 29, 2021

Category: ratio. 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 9:20 a.m., there were 8 children, including 2 older toddlers and 6 preschoolers, observed on the Gymagic Bus parked in the front of the building, without a staff person from the facility providing supervision. A staff person from Gymagic Bus was on the bus with the children and is not a facility staff person. According to staff statements, multiple rooms with mixed age levels have been observed out of ratio on multiple occasions ranging in time from a few minutes to the entire day.

Corrected Corrected by Jan 31, 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 9:20 a.m., there were 8 children, including 2 older toddlers and 6 preschoolers, observed on the Gymagic Bus parked in the front of the building, without a staff person from the facility providing supervision. A staff person from Gymagic Bus was on the bus with the children and is not a facility staff person.

Corrected Corrected by Jan 31, 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 9:20 a.m., there were 8 children, including 2 older toddlers and 6 preschoolers, observed on the Gymagic Bus parked in the front of the building, without a staff person from the facility providing supervision. A staff person from Gymagic Bus was on the bus with the children and is not a facility staff person.

Corrected Corrected by Jan 31, 2022

Category: supervision. 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 person #5, #7, and #8 had pediatric first-aid and pediatric CPR training that expired in December 2020 and lacked current training. The files for staff person #1, #2, and #6 lacked current pediatric first-aid and CPR training completed by 6-17-21 as required by the regulations for staff persons with a start date prior to 12-19-20.

Corrected Corrected by Sep 7, 2021

Category: ratio. Marked corrected in the state record.

3270.32(a)/3270.192(4) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Staff Person #3 may not work in a child care position at the facility.

The file for staff person #3, with a start date of 5-12-21, lacked an FBI clearance at their start date and requires a current clearance.

Corrected Corrected by Jul 29, 2021

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

3270.32(a)/3270.192(2)(iii) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Staff person #4, with a start date of 6-15-20, had mandated reporter training dated 9-22-20 that was over 90 days after their start date. Staff person #5 had mandated reporter trainings dated 1-19-15 and 1-26-20 that were over 5 years between trainings.

Corrected Corrected by Jul 28, 2021

Category: recordkeeping. 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 #7 had a staff evaluation that exceeded 12 months between evaluations.

Corrected Corrected by Jul 28, 2021

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.

In the toddler 3 room, there was peeling paint in two spots under the white board.

Corrected Corrected by Aug 27, 2021

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 preschool room in the book reading area, there was a blue fabric cushion that had a hole exposing the stuffing inside, and a red cushion on a chair with a hole in the corner exposing the stuffing inside.

Corrected Corrected by Aug 27, 2021

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 preschool room in the older toddler area, there were multiple pom poms used for art activities that were less than 1 inch in diameter and were accessible to children. In the indoor play space, there was a foam block that was accessible to toddlers and had small pieces coming apart that could be placed in a child's mouth.

Corrected Corrected by Jul 29, 2021

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

3270.106(a) · Individual, clean, age-appropriate rest equipment shall be provided for preschool, toddler and infant children as agreed between the child's parent and the operator. The rest equipment shall be labeled for the use of a specific child and used only by the specified child.

In the indoor play space/nap room, the rest mats used by the children were not labeled for the use of a specific child.

Corrected Corrected by Aug 9, 2021

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

3270.131(e)(1)/3270.131(e)(2)(i) · 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. Exemption from immunization for religious belief or strong personal objection equated to a religious belief shall be documented by a written, signed and dated statement from the child's parent or guardian. The statement shall be kept in the child's record.

The file for child #1, a 4 year old, had an immunization record that lacked verification of the Influenza vaccination being administered within the last calendar year in accordance with the schedule recommended by the ACIP and lacked exemption documentation.

Corrected Corrected by Jul 29, 2021

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.

In the toddler 2 room, a staff person in the room was observed disposing of a wet diaper by opening the lid of the hands-free can with their hand and not using the foot pedal to operate it as a hands-free covered can.

Corrected Corrected by Aug 23, 2021

Category: health medication. 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 person #7 and #8 had a health assessment that exceeded 24 months between assessments.

Corrected Corrected by Jul 28, 2021

Category: ratio. 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.

Written notification of safe routes including pick-up and drop-off procedures were not posted at a conspicuous location in the facility.

Corrected Corrected by Jul 28, 2021

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 a plan that provides for accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Corrected Corrected by Sep 22, 2021

Category: physical safety. 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 parent of each enrolled child were not provided with information on how to access the DHS child care regulations electronically and with instructions for contacting the regional DHS child care office.

Corrected Corrected by Aug 13, 2021

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 lacked a plan that provides for accommodations for shelter of children during a lock-down.

Corrected Corrected by Sep 22, 2021

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