A Home Away From Home Christian Daycare Inc

Noncompliance Area: 2ND CITATION: There was broken wheel on a plastic riding car in the gym room causing the toy to be in disrepair. There was a broken plastic toy bin in the gym room causing sharp edges to be accessible to children. PREVIOUSLY CITED 8-26-20

Correction Required: 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.

Noncompliance Area: It was observed that there was a young toddler sitting in a high chair in the infant room who was not buckled in with the attached t-shaped safety strap.

Correction Required: High chairs shall have a wide base and a T-shaped safety strap.

Noncompliance Area: 2ND CITATION: Staff person #4 had a health assessment that did not include an examination for communicable disease and the results of that examination. PREVIOUSLY CITED 8-26-20.

Correction Required: An adult health assessment must include an examination for communicable diseases and the results of that examination.

Noncompliance Area: 2ND CITATION: Staff person #4 had a health assessment that did not include the physician's or CRNP's assessment of the person's suitability to provide child care. PREVIOUSLY CITED 8-26-20

Correction Required: An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Noncompliance Area: There was a stack of staples with sharp edges located on the floor in the upstairs childcare room at the end of the hall that leads from the staircase. There was a plastic bin with push pins with sharp edges accessible to children on a low table in the upstairs green and purple room.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children.

Noncompliance Area: 2ND CITATION: The negative sanction letter issued to the operator was not posted in a conspicuous location used by parents. PREVIOUSLY CITED 8-26-20

Correction Required: The operator shall post a copy of each inspection summary issued by the Department in a conspicuous location used by parents. The inspection summary shall remain posted until an agent of the Department verifies that each regulatory noncompliance item cited on the inspection summary has been corrected.

Noncompliance Area: Staff person #1 had an emergency plan was not dated and therefore it could not be determined if the staff person was trained in the emergency plan within the required time frame.

Correction Required: The operator shall assure that each facility person receives training regarding the emergency plan at the time of initial employment, on an annual basis and at the time of each plan update. The operator shall document the date of each training and the names of all facility persons who received the training and kept on file at the facility.

Noncompliance Area: 2ND CITATION: Staff person #1, with a documented start date with children of 9-8-20, had a disclosure statement was not dated and a child abuse clearance that was designated for volunteer purposes only. Staff person #1 was observed to be working in a room alone with a group of children. PREVIOUSLY CITED 8-26-20

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 1 may not work in a child care position at the facility.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.

Noncompliance Area: 2ND CITATION: Staff person #4, classified as Assistant Director, lacked proof of education to qualify the staff person for that position. Staff person #5, classified as Group Supervisor, lacked proof that the staff person's Bachelor's Degree was in a human services field in order to be considered a group supervisor. PREVIOUSLY CITED 8-26-20.

Correction Required: A staff person or a substitute staff person shall meet one of the applicable staff qualifications for the position in which the person is performing.

Noncompliance Area: There was an uncovered outlet on the wall near the diapering table in the back infant room.

Correction Required: Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.

Noncompliance Area: There was a lamp in the room being used by school agers that had an exposed light bulb and was accessible to children on a low shelf. The light bulb measured 137 degrees F.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: There was mouse glue trap on the floor in the gym room accessible to children next to the arcade video game. There were several mouse droppings on the floor next to a toilet in the far stall of the bathroom next to the gym room. There were several mouse droppings on the floor next to the sink in the bathroom next to the gym room. There was a metal bracket protruding from the wall in the upstairs childcare room near the door to the cafeteria causing a sharp edge to be accessible to the children. The plate covering a hole in the wall in the upstairs purple and green room was missing a screw causing the plate to be detached from the wall on one end and creating a pinch point to be accessible to the children.

Correction Required: Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

Noncompliance Area: There were crumbs observed to be in a child sized potty chair on the landing of the stairwell that leads from the lobby to the second floor. There was a broken art easel in the cafeteria room.

Correction Required: 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.

Noncompliance Area: There were loose screws on a child sized wooden chair in the toddler room causing the chair to be unstable.

Correction Required: Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

Noncompliance Area: There was a food item being stored in an unplugged refrigerator in the kitchen.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.Food stored, prepared or served shall be clean, wholesome, free from spoilage, free from adulteration and safe for human consumption.

Noncompliance Area: At 11:28am it was observed that a young school age child left the infant room unaccompanied by a staff person, walked across the lobby area, and went into the bathroom in the lobby. It was observed that several minutes later, the young school age child exited the bathroom in the lobby, walked across the lobby and went back into the infant room. At no time was the child supervised or accompanied by a staff person.

Correction Required: Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

Noncompliance Area: Staff person #1, with a documented start date of 8-11-20, had an initial health assessment dated 8-1-18, which was expired at initial hire. Staff person #2, with a documented start date of 8-11-20, had an initial health assessment dated 6-7-19 , which was expired at initial hire. Staff person #4, with a documented start date of 8-11-20, had an initial health assessment dated 8-12-20.

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. 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.

Noncompliance Area: Staff person #1, with a documented start date of 8-11-20, had an initial TB test dated 7-3-18, which was expired at initial hire. Staff person #2, with a documented start date of 8-11-20, had an initial health assessment dated 6-9-19, which was expired at initial hire. Staff person #4, with a documented start date of 8-12-20, lacked a TB test.

Correction Required: An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

Noncompliance Area: Staff person #4 had a health assessment that did not include an examination for communicable diseases and the results of that examination.

Correction Required: An adult health assessment must include an examination for communicable diseases and the results of that examination.

Noncompliance Area: Staff person #4 had a health assessment that did not include the physician's or CRNP's assessment of the person's suitability to provide child care.

Correction Required: An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Noncompliance Area: Staff person #5 had a record that included only 1 written non-family reference.

Correction Required: A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person

Noncompliance Area: During the onsite inspection on 8-26-20, the agents of the Department were denied immediate access to the facility person's files. Four of the requested facility person's files were e-mailed to the Department representative on 8-31-20 and the fifth requested file was e-mailed to the Department representative on 9-4-20.

Correction Required: A staff person shall provide to agents of the Department immediate access to the facility, the children and the files and records

Noncompliance Area: The negative sanction letter sent to the operator was not posted in a conspicuous location at the facility.

Correction Required: The operator shall post a copy of each inspection summary issued by the Department in a conspicuous location used by parents. The inspection summary shall remain posted until an agent of the Department verifies that each regulatory noncompliance item cited on the inspection summary has been corrected.

Noncompliance Area: The facility's emergency plan lists the person in charge in an emergency as being a person who is reportedly no longer physically present at the facility.

Correction Required: The operator shall review the emergency plan at least annually and update the plan as needed. The operator shall document in writing each review and update of the emergency plan and kept on file at the facility.

Noncompliance Area: Facility person #1, with a documented start date of 8-11-20, lacked a signed disclosure statement and had a state police clearance dated 8-30-20 and documented proof that the state police clearance had not been applied for until 8-30-20. Staff person #2, with a documented start date of 8-11-20, lacked a signed disclosure statement and an NSOR verification. Staff person #2 had documented proof of not applying for the NSOR verification until 8-31-20. Staff person #3, with a documented start date of 8-12-20, lacked a signed disclosure statement. Staff person #4, with a documented start date of 8-11-20, lacked an FBI clearance. Staff person #4 was identified during the onsite inspection as the director of the facility and was designated as the assistant director on the staff data worksheets that were e-mailed to the department on 8-31-20.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 2 and #4 may not work in a child care position at the facility. 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.

Noncompliance Area: Staff person #2, classified as an assistant group supervisor, had only 2251 hours of childcare experience documented. Staff person #4, classified as assistant director, had no proof of education. Staff person #5, classified as group supervisor, had no proof of education.

Correction Required: A staff person or a substitute staff person shall meet one of the applicable staff qualifications for the position in which the person is performing.A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: During the onsite inspection on 8-26-20, Facility person #1 and Staff person #7 reported that Individual #6 was the director of the facility. Individual #6 was not present at the facility for the onsite inspection on 8-26-20. During a phone conversation with Individual #6 during the onsite inspection on 8-26-20, Individual #6 reported that she was in training to be the director of the facility but was currently not the director. After that phone conversation, Facility person #1 then reported that Staff person #4 was the director and Staff person #7 was the acting director. When questioned again about her position, Staff person #7 then reported that she was the acting director. Staff person #4 was not present at the facility for the onsite inspection. During a phone conversation with Staff person #4 during the onsite inspection, Staff person #4 claimed to be the director of the facility. On 8-31-20, Staff person #4 sent an e-mail to the certification representative that Staff person #4 is the assistant director and that Staff person #7 is the director of the facility. Given all of the conflicting information, the facility has not made a clear determination as to whom the director of the facility is.

Correction Required: A director shall be employed by a facility and be present at the facility site a minimum of 30 hours per week.

Noncompliance Area: At 11:28am it was observed that a young school age child left the infant room unaccompanied by a staff person, walked across the lobby area, and went into the bathroom in the lobby. It was observed that several minutes later, the young school age child exited the bathroom in the lobby, walked across the lobby and went back into the infant room. At no time was the child supervised or accompanied by a staff person.

Correction Required: When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30.

Noncompliance Area: There was an unlabeled spray bottle reported by Staff person #7 to contain a cleaning solution that was accessible to children in a crib in the back infant room.

Correction Required: Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

Noncompliance Area: There was an unlabeled spray bottle reported by Staff person #7 to contain a cleaning solution that was accessible to children in a crib in the back infant room.

Correction Required: 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 stored away from food, food preparation areas and child care spaces.

Noncompliance Area: There were two cracks on the blue wall in the indoor play area causing the paint to be damaged. There was damaged paint on the wall behind the rocking chair in the infant room. There was damaged plaster on the wall behind the door in the cafeteria room.

Correction Required: Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

Noncompliance Area: Staff person #1 reported that Child #1 had an accident on the floor in the bathroom near the indoor play space and that feces needed to be cleaned up from the floor. Staff person #2 and Staff person #3 claimed to be assigned responsibility for Child #1 and stated that they were unaware that the child had an accident on floor.

Correction Required: Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

Noncompliance Area: It was observed that the only soap dispenser in the bathroom adjacent to the indoor gross motor room was filled with water and not soap.

Correction Required: Liquid or powdered soap shall be used for handwashing.

Noncompliance Area: 3rd Citation - Previously cited on 5/31/2019 and 7/24/2019. In the Land of the 2's classroom the knob on the drawer of the small white stand was observed to be loose, exposing the children in the classroom to pinch and crush points.

Correction Required: 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.

Noncompliance Area: In the preschool room the red kidney shaped table was observed to not be durable and safe for the children in care. This is evidenced by one leg being stabilized by being placed on top of a child's chair and another leg being stabilized by a child's block.

Correction Required: Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

Noncompliance Area: The fire extinguisher stored at the child care facility on the window sill in the dining room located outside of the kitchen was observed to be empty. This is evidenced by the gauge pointing to empty at the time of inspection. Also, in the preschool room the red kidney shaped table was observed to not be durable and safe for the children in care. This is evidenced by one leg being stabilized by being placed on top of a child's chair and another leg being stabilized by a child's block.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children.

Noncompliance Area: The facility's current certificate of compliance, notice of negative sanction, copy of the applicable regulations under which the facility is certified and instructions for contacting the appropriate regional day care office were observed not to be posted in a conspicuous location used by parents. This is evidenced by these items being posted behind the operator's desk in the front lobby in an area not easily accessible by parents.

Correction Required: The facility's current certificate of compliance and a copy of the applicable regulations under which the facility is certified shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional day care office posted at the same location.

Noncompliance Area: The facility's emergency plan was observed not to have been reviewed within the last year. This is evidenced by the most recent documented date of review being 7/2018. Additionally, staff person's listed as being in charge in the event of an emergency are no longer employed at the child care facility.

Correction Required: The operator shall review the emergency plan at least annually and update the plan as needed. The operator shall document in writing each review and update of the emergency plan and kept on file at the facility.

Noncompliance Area: Damaged plaster was observed in the facility's gym on the left wall if you are looking at the toddler room, to the right of the outlet located in the middle of the wall.

Correction Required: Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

Noncompliance Area: The entrance of the facility's gym was observed not to be lighted. This is evidenced by the lights not being on at the time of inspection while children were being cared for in the facility's gym.

Correction Required: Rooms, hallways, stairways, outside steps, porches and ramps shall be lighted by artificial or natural light.

Noncompliance Area: 2nd Citation - Previously Cited on 7/24/2019. The glass door at the entrance of the child care facility was observed not to have any type of visual identification in place.

Correction Required: A visual strip or other visual identification shall be placed on glass located in a traffic area, a child care space or a play space.

Noncompliance Area: 2nd Citation - Previously cited on 5/31/2019. In the Land of the 2's classroom the knob on the drawer of the small white stand was observed to be loose, exposing the children in the classroom to pinch and crush points.

Correction Required: 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.

Noncompliance Area: 2nd Citation - Previously cited on 5/31/2019. Bookshelves standing approximately 5 feet 6 inches located in the toddler classroom, infant classroom, school aged class room, preschool classroom outside of the elevator shaft and to the right as you enter the upstairs from the steps were observed not to be secured to the wall creating a falling hazard to the children in care. Also, located across from the shelves in the preschool classroom outside of the elevator shaft was a stack of milk crates standing at the highest approximately 6 feet. The milk crates were not attached to the wall as well making them a falling hazard to the children in care.

Correction Required: Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

Noncompliance Area: The small refrigerator located on the table in the corner of the dining area was observed not to have a thermometer in it to verify that the refrigerator is operable and capable of maintaining food at 45 degrees Fahrenheit or below.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: On 7/24/2019, from approximately 1057 to 1105, a preschool aged child was observed to be placed in time out by staff person #2. During this time the child was left without an activity.

Correction Required: Daily activities shall promote the development of skills, social competence and self-esteem. Daily experiences shall recognize the child as an individual and give some choice of activities that respect personal privacy, lifestyle and cultural background.

Noncompliance Area: On 7/24/2019 at approximately 1035, staff person #2 was observed grasping a preschool aged child by the top of his shoulder near the collar bone with his (staff person #2) thumb in the front of the child and fore finger on the back. This was done after staff person #2 redirected the child to slide his chair up to the table. When grasped the child was observed to whine in discomfort.

Correction Required: A facility person may not use any form of physical punishment, including spanking a child.

Noncompliance Area: It was observed that there was no emergency contact information present for child #1 while receiving care in the preschool classroom.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: In the toddler, while the toddler aged children were upstairs eating lunch, a "sippy" cup of milk was observed in the back corner of the classroom. Milk a potentially hazardous food shall be refrigerated.

Correction Required: Potentially hazardous food brought from the child's home or provided by the facility shall be refrigerated.

Noncompliance Area: It was observed that the facility did not have a written statement giving the formula and feeding schedule for infant aged children in care obtained from the child's parent.

Correction Required: A written statement giving the formula and feeding schedule for an infant shall be obtained from the parent.

Noncompliance Area: The file for staff person #1 who was identified as an Aide was observed not to contain documentation of education obtained prior to the onset of employment at the child care facility to qualify her to work in this capacity.

Correction Required: A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: The file for staff person #1 whose date of hire was 6/22/2019 was observed not to contain documentation of education to qualify her to work in the capacity of Aide which is what she was designated as on the operator's Child Care Staff Data Sheet.

Correction Required: An aide shall have attained one of the qualification levels specified in 3270.37(b)(1)-(3).

Noncompliance Area: In the infant room (First Floor First Room on Left), one electrical outlet accessible to the children in care near the diaper changing table was observed to be lacking one protective receptacle cover.

Correction Required: Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.

Noncompliance Area: 2nd Citation - Previously Cited on 5/31/2019 - The door leading to the kitchen on the second floor was observed to not be locked at the time of inspection. Stored in the closet of the kitchen was multiple cleaning materials labeled keep out of reach of children, also the HVAC room with toxic materials is also located in the kitchen. With the door to the kitchen not being locked these closets containing cleaning materials and toxic's are accessible to the children in care.

Correction Required: Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

Noncompliance Area: The door to the kitchen was observed not to be locked at the time of inspection. This leaves the toaster oven that was in operation at the time of inspection accessible to the children in care.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: 2nd Citation - Previously cited on 5/31/2019. In the preschool room the wood rail at the top of the half wall where the nap cots were being stored was observed to be splintering.

Correction Required: Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

Noncompliance Area: Damaged plaster was observed in Land of the 2's classroom on the pillar to the left of the train table. In the preschool class room peeling paint was observed on the purple wall to the left of the computer table and on the green pillar to the right of the computer table. A hole in the wall exposing damaged plaster was observed in the dining area behind the door where the door knob strikes the wall. Peeling paint was observed in the toddler room to the left of the fridge. A hole in the wall exposing damaged plaster was observed in the gym across from the middle pillar.

Correction Required: Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

Noncompliance Area: The glass doors located at the entrance of the facility were observed not to contain a visual strip of other visual identification placed at the eye level of the children.

Correction Required: A visual strip or other visual identification shall be placed on glass located in a traffic area, a child care space or a play space.

Noncompliance Area: 2nd Citation - Previously cited on 5/31/2019. In the upstairs restroom the bolts at the base of the toilet located all the way to the right were observed to not be covered.

Correction Required: Toilet areas and fixtures shall be cleaned daily and be in good repair.

Noncompliance Area: The door located at the back of the Land of the 2's classroom was observed not to have a door knob or handle in place allowing the door to be opened from the inside. This makes this means of egress from the classroom inaccessible.

Correction Required: Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

Noncompliance Area: Review of the facility's fire drill log showed the last documented fire drill being conducted on 12/28/2018. This is a period greater than 60 days.

Correction Required: A fire drill shall be held at least every 60 days. Facility persons and children in attendance shall participate in the fire drill. Facility persons and children shall exit the building, weather permitting.

Noncompliance Area: When asked to review the emergency contact form for child #1, facility staff in the preschool classroom and older toddler classroom were not able to locate the emergency contact form in either classroom the child was observed to be in.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: The file of facility person #1, with a start date of 6/24/2019, did not contain a completed disclosure as it did not contain the date, and documentation of fingerprinting for their FBI clearance. The file of facility person #2, with a start date of 6/2019 did not contain documentation of fingerprinting for their FBI clearance.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person # 1 and 2 may not work in a child care position at the facility. 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. Facility Person #--- may not work in a child care position at the facility.

Noncompliance Area: In the preschool classroom, a yellow bin on the shelf next to the train table was broken and the middle support was not attached to the leg of the train table which made it wobble.

Correction Required: 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.

Noncompliance Area: In the preschool room, the kidney shaped table with the yellow edging did not have even table legs making it tilt. One leg was shorter than the other 2 legs.

Correction Required: Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

Noncompliance Area: The Land of the Two's classroom did not have a written plan of daily activities posted in the group space.

Correction Required: The written plan of daily activities shall be posted in the group space.

Noncompliance Area: At approximately 12:23 pm, an infant was observed to be sleeping in a swing. Facility person #3 walked over to the child twice and did not remove them from the swing. At approximately 12:30 pm, I pointed out the child was sleeping in the swing and asked them to place her in a crib on her back to sleep.

Correction Required: Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

Noncompliance Area: In the toddler room off of the indoor play space, Cough and Mucus Syrup and Tylenol Pain Reliever, ," were accessible to children on the top edge of a 9 cube shelf. In the indoor play space, a black backpack containing Pain and Fever medication and prescription Ibuprofen, both labeled "keep out of the reach of children," on a low hook accessible to the children. Also in the indoor play space, a reusable bag containing Cough and Mucus Syrup, Multivitamin with Iron and Benadryl, all labeled "keep out of the reach of children," was sitting on the floor accessible to children.

Correction Required: Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

Noncompliance Area: The downstairs restroom off the indoor play space did not contain soap for the children to wash their hands.

Correction Required: Liquid or powdered soap shall be used for handwashing.

Noncompliance Area: At approximately 11:10 am, facility person #1 identified 4 children, with the youngest being an infant, and facility person #2 identified 4 children, with the youngest being an infant, in the infant classroom. When facility person #3 was asked which child they were responsible for, facility person #3 stated all of them and named a child which was already identified by facility person #1. When facility person #3 was asked again, they stated all of the children. There were 9 children in the classroom, 8 were infants and 1 was a young toddler.

Correction Required: When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in 3270.51 (relating to similar age level). Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

Noncompliance Area: In the small room off the school-age room upstairs, Super Hair Bond labeled "keep out of the reach of children" was accessible on a desk. In the indoor play space, the door next to the restroom was unlocked and Clorax Bleach and Pine Sol labled "keep out of the reach of children" were accessible to children in an unlocked cabinet accessible to children. The door by the arcade games in the indoor play space was unlocked making 3 small Glidon paint cans and 2 large drums of Glidon paint accessible to the children.

Correction Required: Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

Noncompliance Area: On the shelf in the preschool room, a spray bottle filled with disinfectant was not labeled with it's contents.

Correction Required: 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 stored away from food, food preparation areas and child care spaces.

Noncompliance Area: In the toddler room off of the indoor play space, a round piece of plastic was attached to the wall to prevent the door knob from damaging the plaster. The plastic was cracked. The door to the Land of the Two's classroom was splitting on the side and the area where the door knob was removed was also broken leaving splintering wood exposed and accessible to the children.

Correction Required: Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

Noncompliance Area: The upstairs restroom contained 1 toilet which was missing a bolt cover and another toilet that was missing 2 bolt covers. The downstairs restroom contained 1 toilet which was missing one bolt cover and another toilet which was missing 2 bolt covers.

Correction Required: Toilet areas and fixtures shall be cleaned daily and be in good repair.

Noncompliance Area: A handwashing sign was not posted at the sink in the Land of the Two's classroom.

Correction Required: A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

Noncompliance Area: The school-age child care space contained a table that had uneven legs (one bowed inward) and had two metal hinges which came out from the underneath of the table.

Correction Required: 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.

Noncompliance Area: In the preschool area, an unlocked Rubbermaid drawer contained plastic bags accessible to children still placing objects in their mouths.

Correction Required: 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.

Noncompliance Area: The indoor play space contained a backpack hanging on a low hook which contained Pain & Fever Reliever, labeled keep out of the reach of children and prescription ibuprofen accessible to children.

Correction Required: Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

Noncompliance Area: An open bag of Ice Melt, labeled keep out of the reach of children, was in on the floor in the corner of the hallway leading to the indoor play space. Gorilla Glue, labeled store away from children, was accessible to children in a backpack hanging in the indoor gross motor room.

Correction Required: Cleaning materials and other toxic materials shall be kept in an area or container that is locked or made inaccessible to children.

Noncompliance Area: The back child care space in Classroom 3, contained a linoleum floor which was torn causing a tripping hazard. The indoor play space contained a hole in the plaster above the baseboard by the video game. The adjacent wall in the indoor play space below the "Do Not Run" sign, the plaster was damaged.

Correction Required: Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 and 2/27/2019- The middle refrigerator in the kitchen did not contain a thermometer.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: 3rd citation previously cited on 1/29/2019 and 3/6/2019- The file of child #2, 3, 5, 6 and 8 contained an emergency contact forms which did not contain the work address or work telephone number of the enrolling parent. The file of child #4 contained an emergency contact form which did not contain the work telephone number of the enrolling parent.

Correction Required: Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

Noncompliance Area: 3rd citation previously cited on 1/29/2019 and 3/7/2019 - The file of child #1, with a start date of 6/15/2018, contained a health assessment dated 12/13/2018, which exceeds the requirement of providing an initial health assessment no later than 60 days following their starting at the facility. The file of child #6, with a start date of 8/7/2018, does not contain documentation of an initial health report. The file of child #7, with a start date of 6/15/2018, contained a health assessment dated 12/13/2018, which exceeds the requirement of providing an initial health assessment no later than 60 days following their starting at the facility.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.

Noncompliance Area: 2nd citation previously cited on 2/14/2019 - The file of facility person #1, with a start date of 9/27/2017, contained a PA State Police clearance which shows convictions involving a crime of child abuse, child neglect, physical violence or moral corruptness. Facility person #1 was to be removed from the facility in 12/2017 due to pending charges.

Correction Required: The operator may not allow an individual to enter the facility if the operator knows that the individual has been convicted or is awaiting trial on charges involving a crime of child abuse, child neglect, physical violence or moral corruptness.

Noncompliance Area: 3rd citation previously cited on 1/29/2019 and 3/6/2019- The file of facility person #8, with a start date of 11/13/2017, and the file of facility person #10, with a start date of 1/30/2017, did not contain documentation of a written evaluation completed by the director.

Correction Required: A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

Noncompliance Area: 3rd citation previously cited on 1/29/2019 and 2/27/2019- The infant classroom contained a spray bottle of disinfectant which was not labeled with its contents. The upstairs 2 year old classroom contained a spray bottle of cleaner which was not labeled with its contents.

Correction Required: 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 stored away from food, food preparation areas and child care spaces.

Noncompliance Area: On 3/6/2019 at approximately 12:05 pm, we arrived at the facility and were let in the door. When facility person #5 was asked if facility person #6 was available, we were told they were not and asked if we could come back another day. At approximately 12:15 pm, when asked to interview facility persons alone in private, facility person #5 stated staff needed to stay with the children. Facility person #5 made multiple telephone calls to facility person #6. At approximately 12:34 pm, we were given access to speak with the facility staff privately when facility person #6 arrived at the center. There were 2 facility persons that were not in ratio at the time of the investigation.

Correction Required: The facility or agency shall provide to authorized agents of the Department full access to the facility or agency and its records during both announced and unannounced inspections. The facility or agency shall provide the opportunity for authorized agents of the Department to privately interview staff and clients.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The middle refrigerator in the kitchen did not contain a thermometer.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: 3rd citation previously cited on 12/3/2018 and 1/29/2019 - The infant classroom contained a daily schedule which noted a defined breakfast, lunch and nap time which did not accommodate the needs of the individual children and the dynamics of the group.

Correction Required: A written plan of daily activities and routines, including a time for free play shall be established for each group. The plan shall be flexible to accommodate the needs of individual children and the dynamics of the group.

Noncompliance Area: At approximately 7:35 pm on 2/27/2019, 2 infants were in bouncy seats in front of facility person #2, who was sitting in a rocking chair. The infant to the left of facility person #2 was sleeping in the bouncy seat.

Correction Required: Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The file of child #2, 3, 5, 6 and 8 contained an emergency contact forms which did not contain the work address or work telephone number of the enrolling parent. The file of child #4 contained an emergency contact form which did not contain the work telephone number of the enrolling parent.

Correction Required: Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The file of child #1, with a start date of 6/15/2018, contained a health assessment dated 12/13/2018, which exceeds the requirement of providing an initial health assessment no later than 60 days following their starting at the facility. The file of child #6, with a start date of 8/7/2018, does not contain documentation of an initial health report. The file of child #7, with a start date of 6/15/2018, contained a health assessment dated 12/13/2018, which exceeds the requirement of providing an initial health assessment no later than 60 days following their starting at the facility.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.

Noncompliance Area: On 3/6/2019 at approximately 12:08 pm, facility person #3 was sitting in the doorway of 2 classrooms supervising 16 napping children alone. About 12:09 pm, facility person #4 returned back to the classroom with 8 two-year old children on their cots. Facility person #3 did not have a complete PA State Police or Child Abuse clearance on file.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). PROVISIONAL HIRE UNSUPERVISED: A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The file of facility person #7, with a start date of 1/28/2019 did not contain documentation of FBI fingerprinting or a completed FBI clearance. The file of facility person #9, with a start date of 10/2018, did not contain a completed disclosure statement and requests for, or completed Child Abuse or FBI clearances. The file of facility person #2, 5 and 6 contained mandated reporter training completed after 90 days from their start dates of working with children.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person # 7 and 9 may not work in a child care position at the facility. 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.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The file of facility person #8, with a start date of 11/13/2017, and the file of facility person #10, with a start date of 1/30/2017, did not contain documentation of a written evaluation completed by the director.

Correction Required: A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

Noncompliance Area: 3rd citation previously cited on 12/12/2018 and 1/29/19 - The file of facility person #1, identified as an assistant group supervisor, did not contain documentation of their education to qualify them for the position

Correction Required: An assistant group supervisor shall have a high school diploma or a general educational development certificate and 30 credit hours from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field.A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 -The file of facility person #3 and 4, both identified as aides, did not contain documentation of their education to qualify them for their positions.

Correction Required: An aide shall have attained one of the qualification levels specified in 3270.37(b)(1)-(3).A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: At approximately 7:40 pm on 2/27/2019, facility person #1 was alone in the indoor play space. Facility person #1 identified 15 children they were responsible for in their group with the youngest children being 2 years of age and the oldest was 9 years of age.

Correction Required: When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in 3270.51 (relating to similar age level). Children must be supervised at all times.

Noncompliance Area: On 3/6/2019 at approximately 12:08 pm, facility person #3 was sitting between 2 classrooms upstairs supervising 8 preschool children in one room and 8 older toddlers in the other. All of the children were on their cots. At approximately 12:09 pm, facility person #4 returned to the classroom with the older toddlers putting them in compliance.

Correction Required: The staff:child ratio while toddlers and preschoolers are napping is one staff person to 10 young toddlers, one staff person to 12 older toddlers, one staff person to 20 preschool children. Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The infant classroom contained a spray bottle of disinfectant which was not labeled with its contents. The upstairs 2 year old classroom contained a spray bottle of cleaner which was not labeled with its contents.

Correction Required: 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 stored away from food, food preparation areas and child care spaces.

Noncompliance Area: 2nd citation previously cited on 1/29/2019 - The restroom off of the indoor play space did not contain a handwashing sign at one sink. The upstairs restroom did not contain a handwashing sign at one sink and one toilet.

Correction Required: A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.