6.2.7.4.2 · No form of inappropriate discipline or corporal punishment shall be used with children such as but not limited to: Restricting a child's movements or actions through use of physical force, binding, tying, use of any other mechanical restraint, or using medication without written parental permission, without following the medicine's label, and/or without following medical prescription;

Based on interviews with staff it was identified that Partner Staff A was observed restricting Child A's movements through use of physical force on two (2) occassions.

Open Not marked corrected in the state record

Open / not marked corrected.

5.11.8.4 · As long as appropriate documentation is provided, staff shall consistently accommodate special nutritional requests and restrictions from parents. Staff shall know and accommodate children's food allergies.

Based on interviews with staff, it was identified that Partner Staff A served food to Child A in which the child is allergic to.

Open Not marked corrected in the state record

Open / not marked corrected.

6.2.7.4.2 · No form of inappropriate discipline or corporal punishment shall be used with children such as but not limited to: Restricting a child's movements or actions through use of physical force, binding, tying, use of any other mechanical restraint, or using medication without written parental permission, without following the medicine's label, and/or without following medical prescription;

Based on interviews with staff it was identified that Staff A had restricted Child A's movements by grabbing and pulling them by the leg in order to keep the child in one location.

Open Not marked corrected in the state record

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5.4.3.2 · Children shall not be required to sleep. Children who do not nap shall be provided space and equipment for quiet play.

Based on staff interviews it was identified that at the time of this incident, Staff A was requiring Child A to remain on their nap mat. Staff statements reflected that the typical practice in the classroom was for children to remain on their nap mats for thirty (30) minutes with no equipment/materials prior to allowing them to choose a quiet activity.

Open Not marked corrected in the state record

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5.10.1.1.2 · Children shall be protected from choking hazards presented by cords on window coverings, electric or electronic appliances or equipment and telephones.

There were several loose electrical cords observed in three (3) classrooms. In the two (2) year old room a cord belonging to a light table and several cords just above where the construction paper is stored were observed and accessible to children. In the "Innovator" classroom there was a charger cord, and cords to a light, radio, and air conditioner observed and accessible to children. In the "Adventurer" room, there were two (2) cords belonging to air conditioners observed and accessible to children.

Open Not marked corrected in the state record

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7.1.2.2 · Staff who are counted in the staff/child ratios and auxiliary staff left alone with children and/or counted in staff/child ratio as specified in the rule 6.2.1.8 of these regulations shall obtain training in pediatric first aid and in infant and child CPR within three (3) months of beginning work in the CBCCPP and remain currently certified.

Three (3) staff members had expired pediatric First Aid and infant and child CPR certifications. The staff members have been working with the program, counting in staff/child ratio for more than three (3) months.

Open Not marked corrected in the state record

Open / not marked corrected.

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.

Children were identified by staff as being dysregulated while in the Literacy Center and called for additional staff assistance as a result. Staff decided to transition children outdoors to the playground. Staff A took a group of six (6) children, who were identified by staff as a challenging combintation for one (1) staff member to have on their own. During the transition, two (2) of the children present bolted from Staff A resulting in them needing to attempt maintaining supervision and safety for the entire group by themselves. Three (3) staff remained inside with three (3) children, and no staff accompanied the group outdoors until after the two (2) children had bolted, at which time Staff called out for Child G until they came from behind the dumpster in the parking lot. During interviews with staff, it was determined that the groups did not identify which children were going out with Staff A and which children remianed behind. Despite knowing the children were dysregulated, the staff did not discuss ensuring adequate supervision was provided during the transition.

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3.4.3 · A system for taking attendance, including documentation of the time when each child arrives and departs each day he/she attends the CBCCPP, shall be established. The licensee shall save all daily attendance records identifying the hours of children's attendance for at least twelve (12) months from the date that care is provided.

Upon requesting a copy of the 2/6/24 attendance sheet, Staff A with assistance from Staff B and Staff C, struggled to locate the document. Staff A provided Supervisor Sheldrick-Humphires the document for review. It was observed that the time out for Child A was blank but was filled in once the photocopy was provided back to Supervisor Sheldrick-Humphries. Child A's attendance was not recorded in the moment, but rather eight (8) days later. At no time during the struggle to find the attendance, or in subsequent conversations or debrief did any program staff indicate another form or system used for maintaining attendance.

Open Not marked corrected in the state record

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2.4.1 · When violations are found to exist, the Division will offer the licensee the opportunity to develop a program improvement plan whereby the violations will be corrected within a time period mutually agreeable to the Division and the licensee.

On 10/25/2021 the program was found not in compliance to rule 3.4.7.3, which required corrective action to be completed by 12/10/2021. On 02/04/2022 the program was requested to attend a meeting to discuss the overdue corrective action. As of 2/11/2022, the program had not meet compliance to BFIS Quality and Credential accounts being up-to-date.

Open Not marked corrected in the state record

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3.7.1.2 · The licensee shall ensure that all staff are trained on the Emergency Response Plan and are aware of where to find the written plan in the CBCCPP.

Child A was left behind during an evacuation drill. Interviews with staff found that the Emergency Response Plan was not followed as outlined; staff did not refer to the attendance and account for children prior to leaving the building, staff were unable to identify their specific duties during a drill, a sweep of the classroom was not done to ensure that all children were evacuated, staff and children re-entered the building prior to Child A and Staff B evacuating resulting in the evacuation not being complete.

Open Not marked corrected in the state record

Open / not marked corrected.

6.2.6.1 · Staff shall be able to hear all children of pre-kindergarten age and younger at all times, shall be able to see the children with a quick glance, and shall be able to physically respond immediately.

Staff B, upon arrival to the playground noted that Child D, who was previously present was no longer there. Staff B went back inside to look for Child D, while Staff C went out the gate to look for Child D. Child D was found in a different playground with an unknown adult, accessed by walking through a parking lot, which is next to a busy intersection. Child D was unattended up to five (5) minutes. This is a serious violation.

Open Not marked corrected in the state record

Open / not marked corrected.

3.4.7.3 · Within six (6) months of the initial date of employment; staff and auxiliary staff left alone with children and/or counted in staff/child ratio as specified in the rule 6.2.1.8 of these regulations, and the program director shall maintain an up-to-date BFIS Quality and Credential Account. Documentation, verification of qualifications, and all annual professional development activities as specified in the rules in sections 7.3 and 7.4 of these regulations shall be submitted to Northern Lights at CCV to be verified and maintained in BFIS.

Upon review of staff BFIS Quality and Credential accounts, they were found not up-to-date as required by this rule. Eighteen (18) staff were missing one (1) or more required documents in their BFIS Quality and Credential accounts. Confirmation was received from Northern Lights at CCV that the missing documentation had not been received by the program. This is a repeat violation.

Open Not marked corrected in the state record

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6.2.6.1 · Staff shall be able to hear all children of pre-kindergarten age and younger at all times, shall be able to see the children with a quick glance, and shall be able to physically respond immediately.

A self-report from the program was made to the Division on 02/10/2020, informing that Child A was out of the classroom unsupervised on 02/07/2020 for an undetermined amount of time. Upon interviews with Staff, it was determined that Child A was out of the classroom unsupervised between five (5) and twenty (20) minutes. Staff A confirmed that Child A left the classroom while she was responsible for his whereabouts. Prior to this event, the program began documenting concerns with Staff A's ability to appropriately interact and supervise children, starting on 09/05/2019, through 01/29/2020. Twenty-one (21) notes regarding Staff A were documented. Eleven (11) of the twenty-one (21) notes were of feedback provided to management from Staff, or Partner Staff, in which they raised concerns with Staff A's supervision, professionalism, and interactions with children. Nine (9) of the twenty-one (21) entries noted supervision that Staff B held with Staff A. Of those nine (9) supervision entries, one (1) entry identified action steps for Staff A to improve her performance, while seven (7) entries documented gathering information from Staff A on her side of situations, and/or management stating their expectations of Staff A. Lastly, one (1) of the supervisions was to conduct the New Hire Onboard meeting, which occurred two (2) months after Staff A began work at the program, and the remaining one (1) entry documented a training Staff A participated in related to positive interactions and relationship building with children and staff. Though immediate corrective action occurred; Staff A was terminated, and gates were placed in the doorways of the classroom, the steps taken prior to this incident were inadequate to address concerns with Staff A's supervision of children. The program did not identify a plan to ensure that Staff A increased her skill building, nor was there a solid mentoring plan identified, as well as a lack in planning to ensure in the absence of another teacher in the classroom, Staff A would not be left solely responsible for the children in care. While no harm occurred during this incident, it was aggreges due to the length of time Child A was unsupervised, that Child A had the ability to exit the program to the outdoors without staff being aware, and the programs lack of Staff A obtaining skill building, mentoring or planning for Staff A to not be left alone with children.

Open Not marked corrected in the state record

Open / not marked corrected.

7.1.2 · First Aid and CPR Staff who are counted in the staff/child ratios shall obtain training in pediatric first aid and infant and child CPR within six (6) months of beginning work in the CBCCPP and remain currently certified.

Upon review of staff quality and credential accounts and on-site files, it was found that two (2) staff have not obtained CPR/First Aid certification.

Open Not marked corrected in the state record

Open / not marked corrected.

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 classroom A and B, the window sills were found to have dust and dirt. Book cases, toy buckets, step stools, chairs and baseboards were found with dirt and grime. Tables and book cases had sticky residue on them. Classroom A's toy sink had dirt and grime build up, and Classroom B had a toy cash register tray containing dirt particles. The insect rug in Classrom B had several dark spots, confirmed by Staff B as stains.

Open Not marked corrected in the state record

Open / not marked corrected.

3.4.7.3 · Within six (6) months of the initial date of employment, staff working with children and the program director shall maintain an up- to-date BFIS Quality and Credential Account. Documentation, verification of qualifications and all annual professional development activities as specified in the rules in sections 7.3 and 7.4 of these regulations shall be submitted to NLCDC to be verified and maintained in BFIS.

Upon review of staff quality and credential accounts within BFIS, they were found to be incomplete. Twenty (20) staff had missing or incomplete documentation of qualifications. Of the twelve (12) staff missing documentation of Orientation training, seven (7) staff had documentation on site. Of the twenty-seven (27) staff missing documentation of the Reporting Abuse & Neglect training, twenty-five (25) staff had documentation on site. Of the twenty-four (24) staff missing documentation of CPR/First Aid certification, twenty-two (22) staff had documentation on site. Of the eight (8) staff missing documentation of fifteen (15) hours of professional development hours, four (4) staff had documentation on site.

Open Not marked corrected in the state record

Open / not marked corrected.

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.

Upon review of fire drill records, it was found that the program is not meeting all required components to this rule. The program has identified that they practice one (1) or two (2) annual fire drills involving the entire program, and that all other drills are done by classroom. Of the classroom fire drill documents, it was found that two (2) of the five (5) classrooms didn't identify if the drill was done during rest time. Of the fifty-six combined drills from all classrooms, it was found that the length of time to evacuate the building was only documented thirteen (13) times, and the number of children and staff present were not accounted for.

Open Not marked corrected in the state record

Open / not marked corrected.

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.

Bookcases and shelves in Classroom A and B were found to have peeling paint or surface area without paint. Twenty-eight (28) of the forty-two (42) nap mats assessed were found to have rips and tears.

Open Not marked corrected in the state record

Open / not marked corrected.

3.3.5 · The licensee, staff, and auxiliary staff shall be trained in prevention, identification and mandatory reporting of child abuse and neglect.

Upon review of staff quality and credential accounts within BFIS and on-site files, it was found that two (2) staff have not completed a training in prevention, identification and mandatory reporting of child abuse and neglect.

Open Not marked corrected in the state record

Open / not marked corrected.

7.1.3 · Orientation of Staff The licensee, in consultation with the program director, shall establish written program policies and procedures and provide these to staff during an orientation training session approved by the Division prior to being left alone with children. Trainees under eighteen (18) years of age shall complete the orientation training within at least one (1) month of their first date of working with children. Complete written information and the orientation training session shall include: * Basic knowledge of child growth and development; * Routine and emergency health protection of children including health related exclusions; * Safety and sanitation requirements including handling and storage of hazardous materials and disposal of bio contaminants; * Positive behavior management; * Supervision of children; * Child accident and injury procedures including building and physical premises safety; * Safe sleep practices; * Administration of medication requirements; * Emergency and evacuation requirements; * Nutrition and food safety including prevention of and response to emergencies due to food and allergic reactions; * Recordkeeping; * Transportation and child passenger safety; * Release of children; * Respectful engagement of families; * Preventing, recognizing, and reporting child abuse and neglect; including information about the signs and symptoms of sexual abuse, sexual violence, grooming processes, recognizing the dangers of child sexual abuse, and other predatory behaviors of sex offenders; * Recognition of and response to the symptoms of common childhood illnesses; * Preventing the spread of infectious disease; * Providing developmentally appropriate activities and experiences for children; * Inclusion of children with special needs; * Guidelines for volunteers, partner staff, auxiliary staff, and business managers; * Responsibility to comply with current applicable licensing regulations; * Staffing requirements to include opening and closing; and * Ensuring children have extra clothes and diapers available.

Upon review of staff quality and credential accounts within BFIS, and on-site files, it was found that five (5) staff have not completed the Vermont Orientation training.

Open Not marked corrected in the state record

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2.3.11.5 · The licensee shall be responsible for compliance with all applicable state and federal laws even when they are more stringent than the rules in this set of CBCCPP regulations.

The Vermont Department of Health sent an email to the program on 09/04/2019 in regard to submitting water test samples, and a phone call was placed on 10/03/2019 as the second reminder. As of 11/13/2019, Staff A stated that the water samples had not yet been submitted.

Open Not marked corrected in the state record

Open / not marked corrected.

5.10.2.3.2 · All food shall be stored in containers that are dated. Food items used by or intended for specific children shall be plainly labeled.

Upon review of the two (2) kitchen refrigerators, the following items stored in containers were not labeled or dated: pineapples, cottage cheese, apples, celery, ham, unknown meat cubes, and unknown food in a tin container.

Open Not marked corrected in the state record

Open / not marked corrected.

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.

Rust was found in each bathroom stall, within each bathroom used by children. Additionally, in each bathroom the radiators had areas of exposed rust. Within classroom A and B, rust was found on the radiators as well as on outlet boxes by the sink.

Open Not marked corrected in the state record

Open / not marked corrected.

6.2.7.3 · Staff shall use positive methods of guidance and behavior management that encourage self-control, self-direction, self-esteem and cooperation.

Staff A was observed holding Child A by the wrist while in the hallway transitioning back into the classroom. Child A was observed trying to free himself from Staff A's hold. Staff B was observed picking Child B up by the torso and removing Child B from the classroom when the child wouldn't talk to Staff B. Child B was observed fighting against being held, and was seen grabbing the door case while exiting the classroom, trying to stay in the room. Staff B pulled on Child B until he lost hold of the door case. Staff A, C, D and F stated that it is common practice for children to be held against their will while being removed from a space in the program, or while being disciplined. Staff E stated that it is common for staff to be hands on with children when addressing challenging behaviors.

Open Not marked corrected in the state record

Open / not marked corrected.