Almost Home Day Care

Noncompliance Area: 2nd CITATION: The most recent child health report for Child #1, a preschooler, is dated more than 12 months ago. PREVIOUSLY CITED on 1/14/20.

Correction Required: The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

Noncompliance Area: 2nd CITATION: The health report for Child #1 continues to lack indication that the children had obtained current influenza vaccine or acceptable exemption documentation. An acceptable, complete new health report has not yet been obtained. PREVIOUSLY CITED ON 1/14/20.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP.

Noncompliance Area: The health report in the file in lieu of the department-provided child health report for Child #2, submitted as a correction, lacks a statement that the child is able to participate in child care and appears to be free from contagious or communicable diseases.

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: 2nd CITATION: The health report in the file in lieu of the department-provided child health report for Child #2 continues to lack indication that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health report. PREVIOUSLY CITED 1/14/20.

Correction Required: A health report shall include a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health report required by this section.

Noncompliance Area: The file for Child #1 continues to lack a current immunization record and a new one has not been obtained since the renewal inspection.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Noncompliance Area: In the back play area, one plastic strawberry toy was observed to be cracked. On the shelf behind the rest mats, one handle of a hard plastic storage tote was observed to be cracked on both sides. The hard plastic wastebasket in the restroom was observed to have a long crack down the side.

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: Upon entry into the facility, Staff #3 was observed to be sitting on a chair at the entrance to the facility and Staff #1 was observed to be serving breakfast to a group of children who were sitting at the kitchen counter area. In the back area, an infant who was stated to be 4 1/2 months old was observed to be crying and lying on a rest cot. When the Cert. Rep. asked staff to identify their supervision groups, Staff #3 walked over to the serving area. Staff #3 identified the infant as part of her supervision group. Therefore, because Staff #3 was sitting at the entrance and not physically present with the infant and Staff #2 was serving breakfast to the children with her back turned to the infant, the infant was not being supervised.

Correction Required: Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: Child Service Reports completed since February 2019 could not be located in the files for Child #1 (preschooler), 3 (preschooler) & 4, (older toddler).

Correction Required: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. The operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at 3280.124(f).

Noncompliance Area: Emergency contact information for Child #3 lacks the name, address and telephone number of the child's physician or source of medical care.

Correction Required: Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Noncompliance Area: Emergency contact information for Child #3 lacks the health insurance coverage and policy number, or a statement that the child does not have health insurance.

Correction Required: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Noncompliance Area: Emergency contact information for Child #2 lacks a complete address of one of the individuals designated by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The most recent child health report for Child #1, a preschooler, is dated more than 12 months ago. The last two child health reports for Child #2, a preschooler, were dated more than 12 months apart. The last health document submitted in lieu of a child health report for Child #3, a preschooler, is dated more than 12 months ago. The last two child health reports for Child #4 are dated more than 12 months apart.

Correction Required: The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

Noncompliance Area: The health document contained in the file in lieu of a child health report for Child #3 is not signed by a medical professional either electronically or physically.

Correction Required: A health report must be written and signed by a physician, physician's assistant or a CRNP. The signature must include the individual's professional title.

Noncompliance Area: The health document contained in the file in lieu of a child health report for Child #3 lacks a review of the child's health history.

Correction Required: A health report shall include a review of the child's health history.

Noncompliance Area: The health reports for Child #1, 3 & 4 lack indication that the children had obtained current influenza vaccines as well as exemption documentation, if applicable.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP.

Noncompliance Area: The health document contained in the file in lieu of a child health report for Child #3 lacked indication that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health report.

Correction Required: A health report shall include a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health report required by this section.

Noncompliance Area: Staff #3 was observed to lift the lid of the hand-free covered trash can with her hand twice during a diaper change.

Correction Required: If disposable diapers are provided by a parent or by a facility, a soiled diaper shall be discarded by immediately placing the diaper into a plastic-lined, hands-free covered can.

Noncompliance Area: On the date of inspection, it was observed that there was not an operable fire detection system at the facility due to one detector having a dead battery and another detector having an incorrectly installed battery. This condition at the facility posed a threat to the health and safety of children.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. Demonstration of Compliance with 34 Pa. Code 403.23 is required. The provider will demonstrate an operable interconnected smoke detection system to an agent of the department.

Noncompliance Area: The file for Staff #1 lacks evidence of that the required six hours of child care training has been obtained between the anniversary year of 9/3/19- 9/3/19 or since.

Correction Required: A staff person shall obtain an annual minimum of 6 clock hours of child care training.

Noncompliance Area: The PA State Police and PA Child abuse clearances for Staff #2 were renewed more than 60 months after the last clearance dates.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Noncompliance Area: One unlabeled bottle at the kitchen sink was stated by staff to contain bleach.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: The facility first aid kit lacked tape.

Correction Required: A first-aid kit must contain the following: soap, an assortment of adhesive bandages, sterile gauze pads, tweezers, tape, scissors and disposable, nonporous gloves.

Noncompliance Area: A clear plastic tub labeled "doctor" toys was observed to have a long crack down the side, creating a pinch point/ cutting hazard. The tub was placed into the child care area for the children to obtain the toys.

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: Foam was exposed on a changing pad that had been stored in a manner accessible to all children in the child care space, including young toddlers. The mat was identified as being used for one of the toddlers who was transitioning to potty training.

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: Two thermometers in the refrigerator measured 19 and 22 degrees respectively; however, none of the food appeared to be frozen. The DHS-issued thermometer was placed in the refrigerator and measured 34 degrees. Therefore, it was determined that both of the thermometers were not operating.

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: Staff #1 lacks four hours of annual training, due to the inclusion of four hours of training intended for operator orientation.

Correction Required: A legal entity or a representative of the legal entity shall participate in an orientation training provided by the Department within 12 months prior to commencing operation of the group child day care home. The orientation does not count toward the annual minimum of 6 hours of child care training required in 3280.31(e) (relating to age and training). A staff person shall obtain an annual minimum of 6 clock hours of child care training.

Noncompliance Area: The files for Child #1 & 3 lack Child Service Reports completed within the last six months.

Correction Required: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. The operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at 3280.124(f).

Noncompliance Area: On the Emergency Contact Form for Child #2, a full address is missing for one of the individuals named by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The most current health assessment in the file for Child #3, a preschooler, is dated more than one year ago.

Correction Required: The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

Noncompliance Area: One tube of diaper cream had an expiration date of April 2015.

Correction Required: Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.5.

Noncompliance Area: The Agreement for Child #2, a school ager, states that arrival is in the AM and that departure is in the PM. However, when the Cert. Rep. asked about hours of care for determining if a Child Service Report was needed, staff stated that the child no longer attends in the AM. Therefore, it is determined that the parent neglected to update the Agreement regarding times of care.

Correction Required: A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

Noncompliance Area: The Emergency Plan posted at the facility included names of staff members who no longer work for the facility. Therefore, it was determined that updates were not made to the plan when required.

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: Staff #1's signed Emergency Plan training verification was dated more than one year after the last documented training.

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.

Noncompliance Area: In a bucket of wooden blocks, one wooden triangular shape-block was observed to have a sharp edge at the wedge end, posing a scratching/ splintering hazard. In the back of the facility, one middle drawer in a white plastic storage unit was observed to be cracked in several places.

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: The Emergency Contact Forms for Child #1 & 3 lacked the addresses of the respective child's medical providers.

Correction Required: Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Noncompliance Area: The Emergency Contact Form for Child #1 lacked the health insurance policy number.

Correction Required: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Noncompliance Area: The Emergency Contact Form for Child #3 lacked the addresses/ phone numbers for two individuals designated by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The files for Child #1, enrolled for over a year, and Child #4, enrolled since 7/25/17, lack health assessments.

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: The previous health assessment for Child #2, a preschooler, lacked a date; therefore, it is unable to be determined if health assessments were obtained every 12 months.

Correction Required: The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

Noncompliance Area: In the medication container on top of the refrigerator, one plastic baggie contained unlabeled pills. The outside of the baggie was labeled with the names of two siblings.

Correction Required: A prescription or nonprescription medication may be accepted only in an original container. The medication shall remain in the container in which it was received. The label of a medication container shall identify the name of the medication and the name of the child for whom the medication is intended. Medication shall be administered to only the child whose name appears on the container.

Noncompliance Area: A health assessment for Staff #2 dated 11/18/16, lacked a statement from the medical provider assessing the staff member'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: The file for Staff #1, hired on 7/13/17, contained a signed disclosure statement published by OCDEL prior to 11/3/15.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Noncompliance Area: In the room farthest away from the entry across from a storage closet, one piece of corner trim was coming detached from the paneling and was observed to be split down the edge, posing a pinching/ splintering hazard.

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.