5.11.6.5 · Bottles shall be individually labeled with the infant's name and refrigerated immediately after preparation by staff or upon arrival if prepared by a parent.

In the infant refrigerator there were two (2) bottles, and one (1) bottle on the shelf; none of them were labeled as required by this rule.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

7.2.1 · The licensee shall ensure that any new individuals regularly present at the CBCCPP submit a Records Check Authorization form to the Division prior to working with children in the CBCCPP.

Individual A was present at the program and working with children. When asked how long they've been part of the program, they stated for several months, and they are present two (2) times a week.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.10.4.5.1 · The program director shall ensure that the CBCCPP, its furnishings, and toys are kept in a clean and orderly condition.

In the infant classroom, dirt, dust, and debris, including emply water bottles were found on both sides of the refrigerator. The refrigerator was found with crumbs and other identified particles on all the shelves and bottom. Crackers and other food crumbs were found next to the garbage can; review of the menu noted that crackers were not served on the day of the visit. The rug under the cribs had rice and other particles on it. Staff E confirmed that the rice bin had not been used the day of the visit. Toys were found with dirt and grime. The changing table had dirt and hair underneath and along the edges of the mat. The baseboards in the hallway outside the infant classroom were found with dust and dirt.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.10.4.5.2 · All interior and exterior walls, roofs, chimneys, floors, doors, ceilings, windows, skylights, stairways, ramps, and porches shall be maintained in good repair.

In the outdoor play area, a section of vinyl siding was cracked, and the foam board around the exterior wall was exposed with holes. Exterior trim work around windows observed from the outdoor play area were rotting and portions of the wood were flaking and found on the windowsill. The exterior door from the run room to the outdoor play area was found with brown/orange erosion.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.10.1.8 · Childhood Lead Poisoning Prevention The licensee shall comply with the requirements of 18 V.S.A. Chapter 38 Vermont Lead Law and shall ensure that Essential Maintenance Practices (EMP) is performed. This includes but is not limited to protecting children from peeling or chipping paint, and dust build up from the friction of moving doors or windows.

Wood trim approximately twelve (12) inches off the ground on the exterior of the building within the outdoor play area was found to have peeling paint.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.10.4.5.5 · Hard surfaces accessible to children shall be smooth, non-porous, and easy to clean. See the rules in section 5.2.6 of these regulations for a schedule for cleaning, disinfecting, and sanitizing of specific surfaces and items.

Tumbling mats located in the run room, and infant classroom were found with tears and fraying exposing the material beneath. Children were observed using the tumbling mats in the infant classroom, and Staff D confirmed that the tumbling mats in the run room were used by children in care. The picnic tables in the outdoor play area were found with peeling paint exposing the raw wood. The plastic covers on the table top portion of the picnic tables were torn and trayed. The tumbling mats and picnic tables were compromised making them no longer non-porous and easy to clean as required by this rule.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.10.3.3 · Safe Use Zones For all play equipment that is thirty (30) inches or higher from the ground, including climbing equipment, slides, swings and other similar equipment, the licensee shall ensure that the surface under and around the equipment, including recommended use zones, is of approved resilient material that protects children if they fall. * Materials in the use zone shall consist of wood chips, pea stone, mulch, engineered wood fibers, sand, safety-tested shredded or rubber like material or rubber mats designed for protective cushioning; * Materials used in the use zone shall follow the recommendations listed in the most recent publication of U.S. Consumer Product Safety Commission's Public Playground Safety Handbook regarding critical depth of tested materials determined by the height of the highest climbing surface of the equipment; * Materials used in the use zone shall be installed and maintained according to the manufacturer's instructions; * If the loose material such as sand, mulch, or shredded rubber is used in use zones, the licensee shall ensure that the material is raked regularly and replenished to maintain depth and resilience; and * If the resilient material in use zones freezes, staff shall ensure that children will not play on the equipment until the resilient material has thawed and is once again resilient.

Bare ground was observed under portions of the swings on the outdoor play structure. The depth of required cushioning was not met as required by this rule.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.2.3.11 · Each diaper changing procedure shall include: * Preparation: assemble supplies, staff member washes hands, prepares changing surface with either a disposable covering or ensure that the surface was recently cleaned and disinfected and bring the child to the diaper changing area. * Dirty Phase: remove soiled diaper, dispose of diaper, and cleanse diaper area of the child. * Clean Phase: put on clean diaper, dress child, and wash the child's hands. * Clean up: clean and disinfect the diaper changing surface, and staff member washes their own hands. * Record diaper change.

Staff A and Staff B were observed changing diapers. Staff A did not wash her hands prior to changing Child C, did not wash Child C's hands after the diaper change, handled Child C's blanket and burp cloth, touched Child C's face, recorded the diaper change, wiped down the changing table then washed their own hands. Staff B was observed changing four (4) diapers. Staff B did not wash their hands prior to changing any of the diapers, nor at the end of any diaper change or cleaning of the mat. Three (3) of the four (4) chldren changed did not have their hands washed after being changed. Two (2) of those children were placed back in the play area, while one (1) of those children were directly placed into a highchair. Staff B was observed recording diapers and placing a pacifier in Child C's mouth without having washed their hands after completing the diaper changes.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

3.4.7.5 · The licensee shall maintain a current list of the licensee or designee, staff, auxiliary staff, and volunteers as in the rules in section 7.7.5 of these regulations, as applicable in BFIS. Any changes shall be reported through BFIS within five (5) working days of the change.

Post visit six (6) staff were removed from the programs Associated Parties list, with end dates ranging from two (2) to thirteen (13) months prior, exceeding the five (5) day notification to the Division as required by this rule.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

6.1.4.1.4 · Furniture and equipment children use for play and daily routines shall be durable and appropriate for the size, abilities, and activities of the children.

Child X who is 2 years old fell from the monkey bar platform and sustained a buckle fracture to the wrist. Child X was on the structure with Child Y aged 1.5 years old. Staff Member A was helping the children climb up the four steps to the platform and then assisting them down the slide. Staff A stated that the slide is large, and she needed to stay next to the slide to hold them as they went down. As she was supporting Child Y, Child X ran down the platform to the monkey bars and proceeded to fall 55 inches or 4 feet 7 inches to the ground below. Staff A stated she could not get to Child X in time to stop her, because she feared Child Y would fall off the slide. The program stated the structure is old and they did not know what the manufacturer's age recommendations are for the structure. The program did not consult the U.S Commissions Public Playground Safety Handbook to see if the fall heights from the structure are appropriate for toddlers. According to the U.S Commission's Public Safety Handbook section 5.3.2.1.2 toddlers should not have access to equipment that exceeds a maximum fall height of 32 inches or 2 feet 6 inches. Child X's injury occurred after falling from a height that exceeds the maximum fall height for this age group by 2 feet. Additionally, in section 5.3.2.4 of the Safety Handbook states horizontal ladders (monkey bars) are not intended for toddlers as toddlers do not have the upper body strength needed for that type of activity. Based on the measurements taken of the structure and the fact that the structure contains monkey bars, the U.S Commission's Public Playground Safety handbook would deem this structure not appropriate for use by toddlers.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

6.2.7.2 · Staff's expectations of children's behavior and responses to children's behavior shall be appropriate to each child's level of development and understanding. Guidance shall be designed to meet the individual needs of each child.

The program self-reported that Child G was injured while in care, and that Child G said they were hurt by Staff A. During the investigation Staff B, when interviewed, reported that Child G had expressed wanting to clean up without any help, but Staff A remained with Child G. Staff B heard Child G crying and the child came to them, saying that Staff A grabbed and dragged them. Child G showed Staff B two (2) parallel marks on the right side of their torso, which were present a minimum of eight (8) days after the incident. When the child was interviewed by FSD Special Investigations Unit, Child G consistently reported that Staff A hurt them. Through interviews conducted with staff it was identified there had been ongoing concerns with Staff A's interactions with children. Staff B stated that Staff A had previously forced a child to eat, had a rough tone when speaking to children, and little patience with children. Staff C stated that Staff A was rough when picking children up and has been observed yanking children to remove them from a situation and had been observed putting sunscreen roughly on children. Staff D reported that Staff A was quick to react with children, and that Staff A's approach to children was aggressive. Staff E stated they had observed Staff A become frazzled when working with children. Staff A's personnel file was reviewed, to include supervision notes. Staff F advised Staff A on 07/06/2020 to use positive language and interactions with children. On 08/17/2020 Staff F advised Staff A that re-direction needed to be used in lieu of discipline, to use a low tone when speaking to children, and to kneel when speaking to children rather than yelling to them across the room. Additional supervision notes were not found in Staff A's file. The concerns with Staff A's interactions with children leading up to the incident with Child G, did not initiate a solid plan to ensure that Staff A increased their skill building, that ongoing supervision was completed and communicated with Staff A, nor was there a solid mentoring plan identified. Staff C, while being interviewed, stated that management had not been doing ongoing observations of staff, to include Staff A, during the months leading up to the incident on 11/02/2020. Staff C stated there was not a plan in place for staff to serve in a mentor role, and identified that there was a change in Director recently, which occurred on 08/28/2020, without any information sharing regarding Staff A when this transition occurred. Staff B stated that Staff A had shown some improvement, but that the two (2) weeks prior to the incident with Child G, Staff A's interactions with children became concerning again. Staff B stated there was not a plan for any limitations or requirements with Staff A's role in the classroom that they were aware of.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

3.4.6.1 · The licensee shall maintain a record of the date of each evacuation drill as required in the rules in section 3.7.2 of these regulations that includes the number of children and staff evacuated, time taken to evacuate, and notation of the drill conducted while children were sleeping or resting. Evacuation records shall be kept for two (2) years.

Documentation was reviewed and it was noted that time taken to evacuate and notation of whether children were resting or sleeping at the time of the evacuation was missing.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

3.4.4.1 · The program director shall maintain a complete and up-to-date enrollment file on-site for each child enrolled in the CBCCPP. A complete file shall contain, at minimum, the following information: * A completed child's admission form signed and dated by the parent that includes the first date the child attended the CBCCPP and the days and hours the child is regularly scheduled to attend the CBCCPP; * The child's name, current home address and current home telephone number; * The child's date of birth; * Name, address and all applicable current telephone numbers for parents; * Name, address and all applicable current telephone numbers for at least two (2) other people designated by the parents as emergency contacts; * Names for all persons authorized to pick the child up from the CBCCPP; * Record of an annual physical and health history as required in the rule 5.1.2 of these regulations that includes the name and telephone number of the child's primary health care and dental care providers (if the child has a dental care provider); * A description of any special medical, developmental, emotional or educational needs of the child including allergies, existing illnesses or injuries, previous serious illnesses or injuries and any prescribed medication including those for emergency situations; * Written authorization from the parent for the CBCCPP to be able to obtain emergency medical care and transportation; * Child's immunization record or Vermont Department of Health approved exemption document as required in the rules in section 5.1.3 of these regulations; * Written permission from parents for the CBCCPP to transport the child, if transportation is provided, as required in the rule 5.10.6.6.1 of the regulations; * Written permission from parents for the child to participate in swimming activities, if swimming activities are a part of the program, as required in the rule 5.10.5.1 of these regulations; * If applicable, a copy of court orders on custody and visitation arrangements as required in the rule 3.6.4 of these regulations; and * If applicable, any obvious injuries discovered and documented on daily health check as required in the rule 5.3.2 of these regulations.

Of the six children's files reviewed four were missing general health examination documentation and immunization records. Three were missing addresses for emergency contacts. Two were missing start dates and one was missing emergency contacts.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record

5.2.1.4 · When hand washing is not practical due to outside activities or being off-site, and hands are not visibly soiled, hand sanitizer may be used by staff, other adults, and children in lieu of washing with soap and warm water. Staff shall ensure that children using a hand sanitizer rub their hands until the sanitizer has dried. Only non-alcohol hand sanitizer shall be used for children under twenty-four (24) months of age.

Ashley Racine confirmed that the children on the field trip to the Pittsford Recreation Park on 06/22/2017 did not wash their hands or use hand sanitizer to clean their hands. During the 11 a.m. to 3 p.m. field trip, children played in the sand, swam in the water, used the playground equipment and ate lunch.

Open Not marked corrected in the state record

Open / not marked corrected.

View state record