3290.32(a)/3290.192(3) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

The file of staff #2, lacked a current DHS FBI clearance due to the fact the one on file was dated 6-18-24 and there was a DOJ FBI clearance on file dated 3-31-25. The file of staff #2 also lacked a Disclosure Statement.

Corrected Corrected by May 1, 2025

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

3290.123(a)(3) · An agreement shall specify 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 at § 3290.124(e).

The file of child #5 lacked an agreement with the services to be provided to the family and the child.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The files of children #1 and #3 lacked agreements with the persons designated by the parents to whom the children may be released.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(6)/3290.182(2) · An agreement shall specify the date of the child's admission. A child's record must contain the dates of application, admission and withdrawal of the child.

The files of children #1 and #2 lacked agreements with the child's date of admission.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(3) · Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

The files of children #2 and #3 lacked emergency contact forms with the full, complete home addresses of the enrolling parent(s). The file of child #4 lacked an emergency contact form with the full, complete work address of the enrolling parent.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(5) · Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant of CRNP, which is needed in an emergency situation.

The file of child #3 lacked an emergency contact form with information on the child's special needs, or "NA" if not applicable.

Corrected Corrected by Apr 29, 2025

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

3290.124(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 file of child #2 lacked an emergency contact form with the full and complete address of the individual designated by the parent to whom the child may be released.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.151(c)(2) · An adult health assessment shall include Tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, CRNP, the Department of Health or a local health department.

At the time of the inspection, the file lacked documentation of staff #1 receiving the Tuberculosis screening by the Mantoux method at initial employment.

Corrected Corrected by Apr 30, 2025

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

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

Based on documentation of the smoke detection testing log testing occurred more than 30 days apart on the following dates: 1-20-25 to 2-20-25 = 31 days.

Corrected Corrected by Apr 29, 2025

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(2) · Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Child #6 file did not contain the address of the child's source of medical care.

Corrected Corrected by Apr 30, 2024

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

3290.123(a)(6)/3290.182(2) · An agreement shall specify the date of the child's admission. A child's record must contain the dates of application, admission and withdrawal of the child.

The files for child #3 and #6 did not contain the date of the child's admission.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.123(a)(5) · An agreement shall specify the persons designated by a parent to whom the child may be released.

The financial agreements for Child #1, 4, 5, & 6 did not contain individuals designated by the parent to whom the child may be released.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.18 · Conditions at the facility may not pose a threat to the health or safety of the children.

Staff #1 file did not have the 1-hour health and safety update that needed to be completed by 12/30/22.

Corrected Corrected by May 10, 2024

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

3290.103 · Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

A clear bin of small character toys some toys less than an inch in diameter were in the unlock corner cabinet making them accessible to children who are still placing objects in their mouths.

Corrected Corrected by Apr 29, 2024

Marked corrected in the state record.

3290.123(a)(3) · An agreement shall specify 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 at § 3290.124(e).

The current child service report on file for Child #1 is dated 1/10/24 which was longer than 6 months from the time of enrollment.(SEE LIS Code Sheet)

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(4)/3290.182(3) · Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

The file for child # 1 did not contain written consent signed by a parent for emergency medical care.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.124(b)(5) · Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant of CRNP, which is needed in an emergency situation.

Child #1 and #5 emergency contact form did not contain any information on the special needs of the child.

Corrected Corrected by Apr 30, 2024

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

3290.124(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.

Child # 2 emergency contact form did not contain a house # or street name for a release person. Child #3 emergency contact form did not contain any address for release persons. Child #4 emergency contact form was missing an address for one release person. Child #6 emergency contact form did not contain any release persons information.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.131(b)(2)/3290.182(1) · The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child. A child's record must contain initial and subsequent health reports.

The most recent health assessment in child #2 file was dated 2/16/23 which was more than 12 months old. Needs an updated health assessment.

Corrected Corrected by May 2, 2024

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

3290.182(4) · A child's record must contain signed parental consent for administration of medications or special dietary needs.

The file for child #1 and #5 did not contain signed parental consent for administration of medications or special dietary needs.

Corrected Corrected by Apr 30, 2024

Category: ratio. Marked corrected in the state record.

3290.182(5) · A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

The file or child #1 did not contain signed parental consent for administration of minor first-aid procedures by facility staff.

Corrected Corrected by Apr 30, 2024

Category: ratio. Marked corrected in the state record.

3290.94(a)(4) · The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that the hypothetical locations of the fire are rotated around the facility for each drill such that the hypothetical location is never the same for consecutive drills.

The same hypothetical location 65 Ely Rd was used for all fire drills on log form.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

The fire alarm 30-day test log includes test dates that are more than 30 day apart. The dates are 4/18/23-5/24/23, 7/11/23-8/15/23, 9/12/23-10/13/23, 10/13/23-11/30/23, 2/2/24-3/4/24, and 3/4/24-4/4/24.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.24(b) · The operator shall review the emergency plan at least annually and update the plan as needed. Each review and update of the emergency plan shall be documented in writing and kept on file at the facility.

Staff #1 did not have documentation in writing of an annual review of the emergency plan.

Corrected Corrected by May 10, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.24(d) · Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

An annual emergency drill has not been done in over 12 months, and there was no documentation on file.

Corrected Corrected by Apr 30, 2024

Category: recordkeeping. Marked corrected in the state record.

3290.24(f) · The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures described in subsection (a). The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

The operator did not have a parent letter explaining the emergency procedures.

Corrected Corrected by May 2, 2024

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

3290.32(a) · The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Observed staff file #1 did not have the most recent criminal background clearance in the file. Updated criminal background clearance was obtained on the day of the inspection.

Corrected Corrected by Apr 6, 2023

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

3290.102(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.

Observed a damaged purple toy bin with rough edges.

Corrected Corrected by Apr 6, 2023

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

3290.123(a)(3) · An agreement shall specify 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 at § 3290.124(e).

Observed child file #1, 2, and 3 contained the updated child service reports which were completed more than 6 months after the previous child service reports.

Corrected Corrected by Apr 7, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.123(b) · A parent shall receive the original agreement. The facility shall retain a copy of the agreement.

Observed child file #2 and #3 contained original agreements.

Corrected Corrected by Apr 6, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.124(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.

Observed the emergency contact information for child file #3 did not contain the address of a release person.

Corrected Corrected by Apr 6, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.94(a)(5) · The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that evacuation routes are posted in a conspicuous location on each floor of the facility.

Observed the facility did not have an evacuation route posted in a conspicuous location in the basement of the facility.

Corrected Corrected by Apr 6, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.24(d) · Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Observed the facility did not have all of the required documentation/ information for the annual emergency drill conducted.

Corrected Corrected by Apr 6, 2023

Category: recordkeeping. Marked corrected in the state record.

3290.95(a)/3290.95(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 operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

There was no proof of purchase for the smoke detection system which contained the 10 year lithium batteries.

Corrected Corrected by May 20, 2022

Category: recordkeeping. Marked corrected in the state record.

3290.64(a) · 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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

The following were observed in an unlocked closet in the bathroom: Lysol Wipes, Lysol Disinfectant Spray, 2 bottles of hydrogen peroxide, Scrubbing Bubbles Bathroom Cleaner, 2 bottles of Clorox Toilet Cleaner and an 8 pound bag of Epson Salts all of which stated: "Keep out of reach of children" and were accessible to children in care.

Corrected Corrected by May 12, 2022

Category: ratio. Marked corrected in the state record.

3290.131(b)(2)/3290.182(1) · The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.A child's record must contain initial and subsequent health reports.

The file for child #1 who is an older toddler contained a health assessment date of 1-8-2021 and 4-4-2022 which exceeded the mandatory 12 months to receive a health assessment. The file for child #2 who is a preschooler contained a health assessment date of 7-8-2020 and has not received an updated health assessment since.

Corrected Corrected by May 20, 2022

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

3290.151(a)(2)/3290.192(2) · 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 #1 contained a health assessment date of 4-9-2019 and 5-19-2021 which exceeded the mandatory 24 months to receive a health assessment.

Corrected Corrected by May 12, 2022

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