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 did not maintain CPR and First Aid certification as required by this rule. CPR and First Aid expired for Staff A in July 2023, and in August 2023 for Staff B and Staff C.

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5.1.2 · General Health Examinations: Within forty-five (45) days of enrollment, the licensee shall obtain documentation of the child's age appropriate well care exam from the parent. Documentation shall include information regarding any health conditions and medications that may impact the care of the child.

Of the ten (10) children's files reviewed, seven (7) did not have the general health exam.

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5.8.3 · Staff shall create and file an incident report for each accident, injury or medical emergency that leaves a visible mark, or first aid has been administered, even when medical treatment is not required. An incident report shall include the name of the child, date, description of the injury or medical emergency, how it occurred, adult witnesses, first aid provided, and medical care required. The child's parent shall be provided a copy of the report at pick up that day. Serious injuries, animal bites and death must be reported to the Division as specified in the rules in section 3.2 of these regulations.

Staff confirmed that incident reports are completed when children are injured, but the reports are not offerred or provided to families. A review of the incident report form used finds it does not document witnesses to the event.

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5.8.2 · Staff shall ensure that if an accident or injury occurs to a child, while in attendance, immediate action is taken to protect the child from further harm and notification of the child's parents as quickly as possible.

Recent injuries of children at the program have not resulted in the child's parent being notified as quickly as possible. Staff report that of the recent incident reports reviewed, none of the parents were contacted at the time of the event, to include injuries to children's face/head, and bites causing bruising.

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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.

During this visit, multiple staff indicated they've heard Staff in Classroom A, an infant/toddler group use elevated and harsh tones. Staff reported hearing comments made to children in that group that do not align with where the children in that group are developmentally, such as telling children to stay on their mats after waking from nap, and responding negatively when food falls on the floor during meal times.

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6.2.5.2 · Staff shall appropriately hold, touch, smile and talk to children.

Staff A was observed grabbing children by their arms three (3) times during observations, to include placing children back on their seats, holding on to them to keep them sitting down, and to get their attention. During interviews other staff shared they've observed Staff A grab children by their clothing and by their arms, including lifting children off the ground by their arm.

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3.4.6.5 · Staffing Schedule: A licensee shall maintain a written record of the daily schedule for at least 365 days of all staff including exact days and hours worked and the group of children to whom they are assigned.

During observations, in the Little Saps classroom, there were three (3) staff present, but only one (1) staff had signed in. Upon review of the childrens attendance and staff schedule for the week of 10/24/2022-10/28/2022 in the Saplings classroom, each day there were times when the number of staff reflected did not meet the required number of staff based on the ages of children care was being provided to, or children were reflected in care, but no staff were reflected in the room. Staff B stated there is a master schedule, but staff actual arrivals, breaks and departures are captured on the classroom sign in sheets, as breaks are often determined within the classrooms. Staff confirmed that documenting arrivals, breaks and departures is something the program does not attend to consistently.

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3.7.3 · Emergency Preparedness Training: Within 365 days of opening a CBCCPP, the licensee shall attend emergency preparedness training which shall include content specifically related to sheltering in place in the event of an emergency in which the licensee and children present need to remain in the CBCCPP for an extended period.

Staff A confirmed they had not taken an emergency response training as outlined by this rule.

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

Seven (7) staff have not completed the Protecting Vermont's Children: Reporting Abuse & Neglect training as required by this rule.

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7.4.4 · All staff shall complete fifteen (15) clock hours of annual professional development activities as required in the rule 7.4.2 of these regulations. Substitutes filling a staff position for less than thirty (30) consecutive days within a 365 day period shall be exempt.

Upon review of staff BFIS Quality and Credential accounts, and on-site files it was determined that Staff A, Staff B, and Staff C had not completed the required annual fifteen (15) hours of professional development.

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7.3.1.3 · The program director of a CBCCPP licensed to serve thirteen (13) - fifty-nine (59) children shall be qualified as a teacher associate, and shall have completed either: * A Vermont Early Childhood and Afterschool Program Director Step One (1) Certificate; or * Successful completion of a three (3) college credit course in program management for early care and education or for school age care and education, or in staff supervision related to early care and education of children; and a three (3) college credit course in curriculum.

Upon review of Staff A's BFIS Quality and Credential account, and confirmation from Staff A that all educational documents are reflected in their account, it was determined that they do not meet Program Director qualifications serving thirteen (13)- fifty nine (59) children.

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7.6.2 · When there is a personnel change designating a new/different business manager, the licensee shall notify the Division prior to the change. The Division shall determine whether the new/different business manager meets qualifications as required in the rule 7.6.1 of these regulations, approve a time limited variance, or approve the program director as required in the rules in section 7.3.1 of these regulations.

Staff B is listed as the Business Manager, but does not meet qualifications for this position. The program's previous Business Manager, Staff C, left employment on 03/31/2020; the Division was not notified as required by this rule.

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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.

Upon review of the Associated Parties list with Staff A, it was determined that nineteen (19) inviduals listed are no longer affiliated with the program, and ten (10) individuals did not reflect the correct title.

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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.

Observations were made of furnishings, and toys in the program. Nine (9) shelving units, the cover to the sand table in Classroom A, and the changing table in the common area, have sections with worn paint resulting in exposed wood. Eight (8) cushion blocks found in the infant ball pit were found with rips and tears.

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5.10.4.5.8 · Mobile baby walkers shall not be used unless deemed medically necessary by a qualified health practitioner.

In the classroom with Staff C, a mobile walker was being used by children. Staff A was asked if a doctor had required the mobile walker for any child; Staff A stated no.

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7.3.2.2 · Teacher Associate A teacher associate is at least twenty (20) years of age, is a high school graduate or has completed a GED, and meets one (1) of the following qualifications: * At least a Vermont Early Childhood Career Ladder Level Three (3) Certificate; or * At least an associate degree from an accredited college with a major or concentration in Early Childhood, Child or Human Development, Elementary Education, or Child and Family Services and at least twelve (12) months experience working with groups of children from grade three (3) or younger; or * At least a Certificate of Completion from the Registered Child Care Apprenticeship Program; or * At least a Child Care Certificate from the Community College of Vermont and at least twelve (12) months experience working with groups of children from grade three (3) or younger; or * At least successful completion of twenty-one (21) college credits with an early childhood or school age focus and at least twelve (12) months experience working with groups of children from grade three (3) or younger.

In a technical assistance report dated 5/7/2019, it was identified that Staff B does not meet qualifications for teacher or teacher associate. In the 5/21/2019 technical assistance report, the program was advised under regulation 6.2.4.3, that it requires that each group of children be led by a staff member who is at least qualified as a teacher associate for at least 75% of the hours of operation. On 07/31/2019, Staff B was identified by Staff A as the lead teacher of the toddler classroom.

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4.7 · The licensee, in consultation with the program director, shall establish written policies and procedures. Written information provided to parents of all children enrolled in the CBCCPP shall include, at minimum: * Assurance that parents have access to the CBCCP and their child(ren) without prior notice and have access to their children's records as required in the rule 3.4.4.6 of these regulations; * A description of information needed from parents for child's enrollment file as required in the rule 3.4.4.1 of these regulations; * A typical daily schedule of activities; * Information about fees and payment policies; * Information about hours of operation and closings; * Procedures for signing children in and out; * Procedures for emergencies as required in the rules in section 3.7 of these regulations; * Information about the nutrition, meals and meal preparation at the CBCCPP; * Safe sleep policies, as applicable; * No smoking policy; * Information about results from the test for lead in the drinking water and any plan for remediation; * CBCCPP policies on field trips, other off-site activity and transportation; * CBCCPP health policies including illness exclusions, administration of medication, and immunizations; * CBCCPP policies and practice regarding positive guidance and behavior management; * Assurance that confidentiality of child and family information is maintained; * Information about the requirement to report suspected child abuse and/or neglect as required in the rules in section 3.3 of these regulations; * Assurance that non-discrimination and respect for each child's family and culture is maintained; * CBCCPP approach to ensure wholesome growth and positive developmental experiences for children enrolled; * CBCCPP policies related to the inclusion of children with special needs and disabilities; * A description of religious activities, if any; * Information on how to access these CBCCPP regulations and other information about child development on-line; * Information concerning complaint procedures; * Information about the Child Care Consumer Line, including the telephone number (1-800-649-2642); and * CBCCPP policies and procedures related to the expulsion of children.

Upon review of the program's parent handbook, it was found that nine (9) required components were missing. Staff A was asked to confirm if the handbook reviewed is the most recent one the program was using; Staff A stated yes.

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5.10.1.2.1 · The licensee shall ensure that the CBCCPP is in compliance with Vermont Division of Fire Safety rules at all times. This includes but is not limited to: * Complying with Vermont Division of Fire Safety inspection reports; * Having regular fire systems inspected with violations identified during the inspection noted as corrected; and * Having fire extinguishers tagged with valid inspection tags.

Three (3) fire extinguishers in the program were observed; all of the inspection tags had expired in May 2019.

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2.4.2 · When violations present an imminent risk of physical, emotional or developmental harm to children, show a pattern of repeated non-compliance, or a licensee fails to comply with corrective action requirements; the Division may choose to take additional regulatory action.

A violation was cited for regulation 5.1.1 on 5/13/2019 requiring corrective action to be received by 7/16/2019. A violation was cited on 6/26/2019 for regulation 6.2.8.4.3 with corrective action due 8/16/2019. As of 8/20/2019 the corrective action for those violations have not been received.

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2.3.9.5 · The licensee shall ensure that all staff have met ongoing professional development requirements as defined in the rules in section 7.4 of these regulations.

Technical assistance was provided to the program on 7/18/2019 identifying required trainings and those staff who had not yet completed them. After reviewing staff quality and credential accounts within Bright Futures and on site files at the program, documentation of completion of the required trainings had not been found. Staff A stated that there wasn't another location where documentation of completed trainings would be. Fourteen (14) staff need to complete the required Child Abuse & Neglect training, three (3) staff need to complete the required Orientation training, four (4) staff need to complete the required CPR training, and five (5) staff need to complete the required first aid training.

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6.2.8.4.3 · When a child is expelled from the program, a full copy of the child's file must be provided to the child's parent(s) on or before the child's last day in the program. The CBCCPP shall retain documentation that the file was provided to the parent.

Staff A stated that the file for Child X was not given to the parent upon the child being expelled from the program. Staff B stated that she didn't believe the file was given to Child X's parent upon expulsion, she stated she didn't advise anyone to do so.

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5.1.1 · The licensee shall ensure that the CBCCPP environment and practices support children's health and safety.

Staff B and Staff D were outdoors with multiple children playing with a parachute. During that time Child Z and Child W were playing with the parachute as a cape; in a manner not designed by the manufacturer. Staff B and Staff D both acknowledged they witnessed both children pulling at the parachute, resulting in Child Z having part of the parachute scrape her neck. Staff D stated that after Child Z was consoled, children continued to play with the parachute as a cape until each child had their turn.

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

On 5/9/2019, child X had pictures taken of bruising (to include petechia) around child X's eyes and neck. Staff A, B and C reported that child X had a rough day on 5/9/2019. Child X screamed and hit staff A during nap time; refused to keep shoes on during outside play time; spit at and kicked another child; threw things and tipped things over in the classroom; attempted to run out of the classroom into the hallway; kicked staff A; threw things out of children's cubbies; spit at, hit and kicked staff B; and climbed on a shelving unit. Staff A said that she intervened four (4) times throughout the day by picking up child X which escalated child X's behaviors. When staff brought child X inside early from outside play time due to child X's behavior, child X's behavior continued. Staff C told staff A she didn't know what to do with child X. Staff A said that when she grabbed child X's hand, child X fell to the ground and began kicking staff A. Staff C stated that one time when staff A picked up child X, child X's feet were off the floor and staff A had her arms wrapped around child X's body over child X's arms between child X's shoulders and elbows with child X's arms being held against child X's body (like a bear hug). When staff A put child X down, staff C heard child X say, "that hurts." Upon consultation with Dr. James Metz, Assistant Professor of Pediatrics at the University of Vermont Children's Hospital, he indicated that a bear style hold depending on the tightness of the hold and whether child X was resisting the hold, and displaying escalated behaviors, put child X at risk for injury and could have led to the petechia on child X around her eyes, observed in pictures taken on 5/9/2019. During the time Child X was throwing things, yelling, running away, and tipping things over, techniques such as blowing bubbles, listening to soft music, or playing with a favorite activity were not attempted as methods to calm Child X down. Additionally, children were introduced back into the classroom from being outside while Child X continued to throw things, and tip things over. Previous violations were cited on 4/18/2019 for inappropriate guidance and discipline. As a result, the program had corrective action requiring staff to have trainings, support, and resources to meet the needs of children in the moment who are displaying behaviors such as those by Child X. The program advised on 7/31/2019 the trainings they had stated would occur had not yet been scheduled.

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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.

During the observation of the program, there were two adults not previously known to the licensor. Upon questioning, Staff A identified himself and stated that he is at the program once a week and has been present for over five to six weeks and will be concluding his time with the program at the end of May. Upon review of the associated parties list it was noted that Staff A was not listed. Staff B identified herself and stated she comes to the program to work with Child X. In review of the associated parties list, Staff B was not listed. It is a requirement that all staff submit a record check form to the Division prior to working with children.

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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.

Child X sat on a windowsill while holding onto the cord to the window shades. There are eight (8) windows within the program that have window shades with cords. There is a hook in place to make the cords inaccessible to children while the shades are up. When the shades are down the cord is within children's reach and long enough to present as a choking hazard. Staff didn't intervene and place the cord out of reach of the child observed as required by this regulation.

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6.2.6.5 · Children shall be protected from the harmful acts of other children.

Children threw objects (e.g. chair and bucket) at other children at the same time children ran around the classroom bumping into other children causing them to fall. When a child took all her clothes off and ran around the classroom naked, two (2) other children pulled their pants down and ran around the classroom. There were five (5) staff present during this observation with nine (9) preschool children.

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6.1.4.4.7 · Developmentally appropriate alternatives shall be available when television/video viewing occurs.

Staff A told children three (3) to five (5) years of age to sit three (3) times within a six to eight minute span. Children were to remain seated on the floor with a laptop computer placed on a chair in front of them playing a movie. The children were expected to sit and watch the movie with no alternative play opportunities. Some children of this age have shorter attention spans and need alternatives to a movie. Making all children of this age sit for this length of time is not a developmentally appropriate expectation.

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5.10.1.1.3 · Furniture and equipment shall be sturdy. Furniture and equipment that present a tipping or falling hazard shall be secured.

Child Y climbed on a book shelf which began to tip over. Child Y caught herself and got her feet back on the floor. Child Z was observed climbing the shelf that containers with bedding are stored. The shelf began to fall and Staff E grabbed the rack before it fell. Shelves are required to be secured in a manner that prevents them from tipping to ensure children's safety.

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

From the hall outside the classroom; I heard Staff A's raised voice yelling at children which interrupted me from observing another child care program. I could hear Staff A say to children, you seriously don't know how to behave; you are getting on my nerves; sit, you're going to have to go in the book area; that's it, I'm shutting it off; and thanks for ruining it. Staff A raised her voice even louder when she yelled at a child or children to sit. These comments were made within a six (6)- eight (8) minute period. Staff C and Staff D didn't know about Staff A yelling at children until I shared my observations. At another point, I heard Staff B say I can't handle this anymore to a child she had in the hallway with her which is outside the classroom.

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