5.10.4.2 · Exits: Stairways, hallways, windows, and doors from the rooms used by children shall be clear and unobstructed from stored items, non-movable barriers, toys, and other items at all times.

The designated second exit off the playroom is blocked by toys stored in large plastic tubs, an infant/toddler activity cube, stacked cushions, turned over child chairs, and a kitchen play unit. It is not possible to walk from the exit door of the playroom through the play items to the exterior door.

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2.8.1 · The FCCP shall post as directed, site visit reports, notices of violations, or notices of regulatory action for no fewer than fifteen (15) days following receipt by the FCCP in a place where the information is clearly visible to parents.

It was acknowledged that the site visit letter from the 02/09/2022 site visit report was not printed out nor posted in the home in an area vislble to parents.

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5.10.1.2.5 · There shall be at least one (1) easily accessible dry chemical fire extinguisher which has at least a 2-A: 10BC classification. This fire extinguisher shall be maintained in operating condition. It shall bear an official tag, properly signed, attesting to current operating condition.

The 1-A:10 BC sized extinguisher identified by the provider as the extinguisher for the home is not the size required by this rule.

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

In the playroom, there is a paper plate with bread crumbs upon the floor near the toys. There are two pieces of bread crusts upon the playroom rug near play items. There is visible dirt and grime that moved when touched upon the infant toys and the kitchen play unit. There are visible cobwebs upon the fan, window, and ceiling in the playroom. In the bathroom, there is visible dirt and grime build up upon the back of the toilet, base of the toilet, and floor around the toilet. There is dirt and grime building up around and in the sink that comes off the surface when touched. There are visible cobwebs upon the ceiling and doorway of the bathroom. The portable heater plugged in near the bathroom sink has build up dust, dirt, debris upon the top and side of the heater. There is visible dirt, grime, and small particles of building material behind the two visible pipes of the bathroom sink. Children were observed on the couch sitting next to an unstable pile of papers, magazines, books, drink straw wrapper and small toys that too up 1/3 of the sitting area and was the height of the couch cushion to the top of the armrest. The side table between the couch and the recliner has various papers, pens, child activity book, and metal box containing child play item covering and extending past the tabletop surface. The bathroom has multiple pieces of clothing upon a wooden piece directly next to the sink, there are piles of clothing upon the floor near the sink. This is a repeat violation. Failing to maintain a clean and orderly Family Child Care Home was cited on 11/20/2019 and 01/10/2020.

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5.2.1.1 · The FCCP shall ensure that adults and children wash their hands: * Upon arrival at the FCCH; * Before they eat, prepare or handle food; * Before and after handling raw meat; * Before feeding children; * After toileting or diapering; * After cleaning; * After taking out the garbage; * After handling animals; and * After outdoor play.

Three different children were observed getting snacks from their lunchboxes and eating without having washed their hands.

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5.10.1.1 · General Safety: The FCCP shall ensure the physical facilities of the FCCH, grounds, equipment, and toys present no hazard to the health, safety and well-being of the children.

Underneath the bathroom sink is an exposed and accessible area of pink insultation that extend approximately 16 inches under and near the base of the sink. On the other side of the sink, there are visible and accessible metal pipes. Two of the pipes have material upon the exterior of the pipes some of which appears to be rust and came off when touched. One of the pipes has a bluish turquoise material/substance encasing most of the pipe. In the partially open wooden bathroom cabinet are packets (8 pills)of pain relief sinus capsules which are visible on the third shelf which is of a height that could be accessed by preschoolers or school-age children. The capsules are on top of linens and visible from the toilet area of the bathroom. It was confirmed during the visit, that some preschoolers and all school-age children enter and use the bathroom unescorted by the provider.

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3.3.7.3 · Within six (6) months of initial date of employment, the FCCP and all staff 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 sections 7.3 and 7.4 of these regulations shall be submitted to NLCDC to be verified and maintained in BFIS.

Confirmation of completion of training in mandatory reporter requirements is not present in the Provider's BFIS quality and credential account. This training was reportedly completed more than two years ago. Documentation confirming the provider attained a high school diploma or a GED is not within the account as required.

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7.4.4 · All staff, with the exception of substitutes, shall complete fifteen (15) clock hours of annual professional development activities as required in the rule 7.4.2 of these regulations.

Provider acknowleged not completing any of the required 15 hours of annual development for 2021.

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3.6.1.1 · The FCCP shall develop and maintain a written Emergency Response Plan to respond to a full range of emergencies both natural and man-made. A complete plan shall include how the FCCP will address and manage the following situations and responsibilities: * Evacuations or other emergencies such as leaving the premises and lockdown situations; * Specific concerns related to the location of the program, such as proximity to a nuclear reactor, an area prone to flooding or power loss; * Notifying the local authorities of the emergency; * A system for notifying the parents of the emergency; * Notifying the local emergency planning committee regarding the location of the FCCH and using the committee as a resource in emergency planning for the program; * A system of identifying the children and staff present at the time of the emergency and maintaining knowledge of their whereabouts; * A system for handling infants, toddlers, and children with special needs; * An established evacuation meeting location within walking distance of the FCCH; * A system to account for all children and staff at evacuation meeting place; * An process for relocation if necessary including safe transportation; * A system for sheltering in place if the FCCP and children present need to remain in the FCCH for an extended period; and * Staff chain of command and individual staff roles and responsibilities, (if applicable) during emergencies.

An Emergnecy Response Plan was not available for review. Provider reported that she believed she had one at a point in time, but could not remember what was in the plan nor produce a copy of the plan.

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7.1.2.1 · The FCCP shall have successfully completed pediatric first aid and CPR prior to being licensed and must remain currently certified.

Provider acknowledged that CPR/1st aid certification has expired.

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5.10.4.5.6 · Exterior stairs, walks, ramps and porches shall be cleared of ice and snow or other environmental hazards that may block exits.

During the visit, the, porch and stairs to teh emergency exit located off of the room known as the children s playroom, were not cleared of ice and snow. The exterior door to the porch could not be opened. THIS IS A REPEATE VIOLATION.

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

During the visit, there was a large amount of dirt, dust and food crumbs on the floor of the areas used by children. The 11 month old infant in care was observed to put at least three small pieces of food andor dirt in his mouth throughout the visit. The sink in the bathroom used by children had a layer of dirt and grime. There were large amounts of cobwebs hanging from the ceiling and walls of all of the areas used by children. THIS IS A REPEAT VIOLATION.

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6.1.4.1.1 · Toys, materials and equipment shall be varied and available in a quantity that allows all children to benefit from their use, allows a range of choices, and reduces conflicts between children.

During the visit, the toys that were out and available were: several matchbox car and trucks ( intended for children 3 years and up), two superhero figurines, three stuffed animals, and three interactive toys that appeared to be intended for infants. The toys available did not offer a varied range of choices for infants, toddlers, preschoolers, or school age children. There appeared to be a larger variety of toys stored on shelves. Judy stated that these toys are not avilable to the children due to the dangerous behaviors of an enrolled child. THIS IS A REPEAT VIOLATION.

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6.1.3.1 · The FCCP shall develop, document and implement a consistent daily routine that includes a balance of: * Opportunities for individual, small group and full group play and learning; * Opportunities for child-directed as well as provider-directed activities; * Active and quiet play; * Rest or quiet time as appropriate; and * Indoor and outdoor play.

During the visit, Judy provider a copy of the daily schedule. Judy stated that the schedule has not been followed since the Spring of 2019, due to the enrollment of a child with behvioral issues and the enrollment of an infant.

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5.4.1.1 · The FCCP shall ensure that each child, except school age children, has an individual crib, port-a-crib, cot, mat, or bed that is safe for the child's age and development, in good repair, and used by only one child each day. No child shall nap directly on the floor or on furniture not designed for sleeping. Cribs or port-a-cribs shall be used for children under the age of twelve (12) months. Children shall not nap in cribs or port-a-cribs if they are physically able to climb out unassisted.

Judy stated that the 11 month old in care sleeps on a rest mat on the floor. Judy stated that the child has slept on a rest mat for the last 3-4 weeks and prior to that slept only in her arms.

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2.3.8.3 · The FCCP shall ensure that the FCCP; all individuals residing in the home; staff; and any individuals who are left alone with children have met ongoing background check requirements by submitting at least once every five (5) years a Records Check Authorization form to the Division and as required shall submit to fingerprinting.

While Judy has completed her records check, she has not yet submitted to fingerprinting. The fingerprint authorization certificate was sent to Judy on 04/23/2018. Judy stated that she believed that she needed to wait for someone from the division to call her regarding an appointment. The requirement for Judy to call to make her own appointment was reviewed.

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3.2.3 · It is the responsibility of the FCCP to ensure that staff and partner staff working with children in the FCCH understand that abuse and/or neglect of children is against the law and that all child care workers are legally required to report suspected child abuse or neglect as specified in the rule 3.2.2 of these regulations.

Judy stated that she had taken a child abuse training many years ago, but that she had not yet taken the acceptable online mandated reporter training.

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

Judy stated that she had not yet completed an Emergency Response Preparedness training.

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7.1.2.1 · The FCCP shall have successfully completed pediatric first aid and CPR prior to being licensed and must remain currently certified.

While Judy is currently certified in CPR, she is not curerntly ceritifed in first aid. Judy stated that she has not been able to find a first aid training in her area. THIS IS A REPEAT VIOLATION.

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5.10.1.2.4 · The FCCP shall ensure that each floor of the home, and in the corridor to access the home in an apartment building, has an operating smoke detector as well as a smoke detectors in the immediate vicinity where children sleep. The FCCP shall ensure carbon monoxide monitors are located outside of rooms were children sleep.

There was not a smoke detector in the livingroom where the children sleep. There was not a carbon monoxide monitor located outside of the livingroom. Judy stated that she has a smoke detector just up the stairs from the livingroom and that she has a carbon monoxide detector that is usually in the dining room which is beside the livingroom, however she was not able to find it during the visit.

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2.3.8.6 · The FCCP shall maintain on site evidence of continuous insurance as defined in the rule 2.3.7.6 of these regulations.

Judy stated that she does not currently have liability insurance coverage for her program.

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3.3.3 · The FCCP shall establish a system for taking attendance, including documentation of the time when each child arrives and departs each day he/she attends the FCCH. The FCCP 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.

The attendence record showed that no children were signed in for this week, 11/18-11/20/2019.

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6.1.4.1.1 · Toys, materials and equipment shall be varied and available in a quantity that allows all children to benefit from their use, allows a range of choices, and reduces conflicts between children.

There was not an adequate amount of toys in the spaces where children play. In the play room there was a table with four chairs and seven small toys on the floor. In the livingroom, there were 2 children's books and 2 small toys on the floor. Judy stated that she had removed the remainder of the toys from those areas on 11/19/2019, when one of the children in care became to rough and threw the toys. There was a small chest of toys inaccessible to children in the dining room and several large toys inaccessible to children in the entry to the play room.

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5.10.1.1.1 · The FCCP shall ensure that children are protected from electrical outlets, such as by using protective covers, tamper-proof outlets, or other devices manufactured for this purpose.

In the livingroom, where children play and rest, there were two electrical outlets that were accessible to children and did not have protective covers.

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

The floors in the livingroom where children play had substantial amounts of visible dirt, dust and food crumbs. During the visit, a child in care picked up a dead mouse and handed it to Judy. Judy stated that the mouse was likely dragged in by the cat. A scan of the refrigerator, where the children's food is stored, revealed a large amount of , sticky food drippings and an odor of spoiled food.

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3.3.4.1 · The FCCP shall maintain a complete and up-to-date enrollment file on-site for each child enrolled in the FCCH. 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 FCCH and the days and hours the child is regularly scheduled to attend the FCCH; * 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 FCCH; * 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 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 FCCP 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 FCCP to transport the child, if transportation is provided, as required in section 5.10.6.6.1 of these regulations; * Written permission from parents for 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 3.5.4 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.

Judy stated that she has five children enrolled. There were only four children's file's on site. Judy stated that she had not yet received any paperwork for one of the children in her care and that this child has been in care for at least two weeks.

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