Altagracia Mercedes

Regulation: 3290.32(a)/3290.192(4)

Description: Comply with CPSL/Required training

Noncompliance Area: Facility staff and HH member # 1,2, & 3 all have NSORS on file that expired on 3/11/25.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include records of training required by the Department. Facility staff # 1, and 2 may not operate the childcare facility until a new NSOR is completed and on file at the facility. HH member # 3 may not be at the facility during childcare hours when able to resume childcare until a NSOR is on file at the facility for HH member # 3.

Regulation: 3290.95(a)/3290.95(b)

Description: System in compliance/Operator or designated staff responsibility

Noncompliance Area: Facility fire alarms were not tested in over 30 days since 5/26/25.

Correction Required: Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c)). The operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

Regulation: 3290.31(f)

Description: Age and training

Noncompliance Area: Facility staff # 1 does not have 12 hours of annual childcare training.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training.

Regulation: 3290.123(a)(5)

Description: Designated release persons

Noncompliance Area: During the renewal inspection, the agreement on file for child #4 did not specify the persons designated by a parent to whom the child may be released.

Correction Required: An agreement shall specify the persons designated by a parent to whom the child may be released.

Regulation: 3290.123(a)(6)/3290.182(2)

Description: Admission date/Application, admission, withdrawal dates

Noncompliance Area: During the renewal inspection, the date of admission was not on the agreement for child #4.

Correction Required: An agreement shall specify the date of the child's admission. A child's record must contain the dates of application, admission and withdrawal of the child.

Regulation: 3290.124(b)(1)

Description: Child's name, birth date

Noncompliance Area: During the renewal inspection, the date of birth on the emergency contact was incorrect for child #4

Correction Required: Emergency contact information must include the name and birth date of the child.

Regulation: 3290.124(d)

Description: Written emergency plan posted

Noncompliance Area: During the renewal inspection, the operator did not have a written plan shall be conspicuously posted which identifies the means of transporting a child to emergency care and the facility staffing provisions in the event of an emergency.

Correction Required: A written plan shall be conspicuously posted which identifies the means of transporting a child to emergency care and the facility staffing provisions in the event of an emergency. The plan must accompany a staff person who leaves the facility on an excursion with children.

Regulation: 3290.131(d)(5)/3290.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: During the renewal inspection, child #3 did not have any immunizations on file.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings). Child #3 must be dismissed from care by close of business on 4/14/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Regulation: 3290.131(d)(7)

Description: Free from contagious/communicable disease

Noncompliance Area: During the renewal inspection, the health report on file for child #4 did not state that the child is able to participate in child care and appears to be free from contagious or communicable disease.

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.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: During the renewal inspection, the operator did not have a written policy identifying abusive head trauma and a policy which addresses the prevention and identification of child maltreatment.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. The provider's written policy must include, but is not limited to recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and address the prevention and identification of child maltreatment.

Regulation: 3290.24(a)(3)/3290.24(a)(4)

Description: Contact when arises/Contact when ended

Noncompliance Area: During the renewal inspection, the emergency plan did not include a method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises. The facility did not have a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

Correction Required: The facility shall have an emergency plan that provides for a method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises. The facility shall have an emergency plan that provides for a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

Regulation: 3290.24(a)(5)

Description: Emergency plan

Noncompliance Area: During the renewal inspection, the emergency plan did not include accommodations of infants and toddlers.

Correction Required: The facility shall have an emergency plan that provides for accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

Regulation: 3290.24(c)

Description: Training regarding plan

Noncompliance Area: During the renewal inspection, there was no documentation showing that staff person #2 is trained in the emergency plan annually.

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.

Regulation: 3290.101(a)/3290.111(c)

Description: Age appropriate/Promote development

Noncompliance Area: During an onsite inspection on 4/25/23, the children were located on the first floor and were not playing with toys or any developmentally appropriate activities. The certification representative asked where the children's toys were located and that's when toys were brought out of an ottoman in the dining room. The majority of children's toys and activities are upstairs on the 2nd floor in a playroom and inaccessible to children on the first floor.

Correction Required: Play equipment and materials appropriate to the developmental needs, individual interests and ages of the children shall be provided in sufficient amount and variety to preclude long waits for use. 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.

Regulation: 3290.11(h)(2)(ii)/3290.32(a)

Description: Clearances for individuals residing in home/Comply with CPSL

Noncompliance Area: Household member #1 moved into the home in November 2022. Household person #1 is also used as a staff person (see code sheet for date of hire). Staff person #1 does not have a signed disclosure statement or a completed NSOR certificate on file.

Correction Required: The individual moved into the child care facility following the date of the previous application for a certificate of compliance. The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Household member #1 who is also a staff person may not be present in the home while children are in care.

Regulation: 3290.11(h)(2)(ii)/3290.32(a)

Description: Clearances for individuals residing in home/Comply with CPSL

Noncompliance Area: Household member #1 moved into the home in November 2022. Household person #1 is also used as a staff person (see code sheet for date of hire). Staff person #1 does not have a signed disclosure statement or a completed NSOR certificate on file.

Correction Required: The individual moved into the child care facility following the date of the previous application for a certificate of compliance. The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Regulation: 3290.112

Description: Infant/Toddler Stimulation

Noncompliance Area: During an onsite inspection on 4/25/23, child #1 was observed to be strapped into and sitting in a car seat drinking a bottle at 9:15am. Staff person #2 stated the child was dropped off at 9:00am. There was no observed interaction with this child until staff #1 was told the child could not remain in the car seat, and then removed the child approximately 5 minutes later.

Correction Required: Infants and toddlers shall be provided stimulation by being held, rocked, talked to, played with and carried.

Regulation: 3290.113(a)

Description: Supervised at all times

Noncompliance Area: During an onsite visit on 4/25/23, household member #4 admitted that during an inspection from an outside agency on 4/17/23, staff person #1 walked up the stairs to the second floor to get household member #4 for translation. She took one child with her and left the remaining four children on the first 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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in §§ 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio). Children must be supervised at all times.

Regulation: 3290.113(a)

Description: Supervised at all times

Noncompliance Area: During an onsite visit on 4/25/23, household member #4 admitted that during an inspection from an outside agency on 4/17/23, staff person #1 walked up the stairs to the second floor to get household member #4 for translation. She took one child with her and left the remaining four children on the first 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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in §§ 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio). Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of PQAS approved training titled "Supervising Children in Family Child Care" provided by Better Kid Care.

Regulation: 3290.113(e)

Description: Restraints prohibited

Noncompliance Area: During an onsite inspection on 4/25/23, child #1 was observed to be strapped into and sitting in a car seat drinking a bottle at 9:15am. Staff person #2 stated the child was dropped off at 9:00am. There was no observed interaction with this child until staff #1 was told the child could not remain in the car seat, and then removed the child approximately 5 minutes later.

Correction Required: A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

Regulation: 3290.131(d)(5)/3290.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: During the inspection, child #1 did not have the following immunizations according to the recommendations of the ACIP: DTAP #2, DTAP #3, HIB #2, IPV #2, Pneumococcal #2, Pneumococcal #3 and Rotavirus #2.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings). Child #1 must be dismissed from care by close of business 4/25/23 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: During the inspection, staff person #2 admitted that staff person #1 was caring for children unsupervised on 4/17/23 during a visit from an outside agency. Staff person #1 has not completed the following pre-service training required prior to caring for children unsupervised: Health and Safety training requirements.

Correction Required: A facility shall be operated in conformity with applicable Federal and State laws and regulations. State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children. Until such time as the required pre-service trainings are completed, staff person #1 must be supervised, when interacting with children, by a family child care home staff person who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility.

Regulation: 3290.31(g)

Description: Age and training

Noncompliance Area: During the inspection, staff person #2 has not completed the following required pre-service training: Health and safety training topics.

Correction Required: Staff person(s) shall complete professional development in the topics of 3290.31(g) (1-9) within 90 days of hire. Staff person #2 will have until 5/16/23 to complete the required training. Until such time as the required training has been completed, staff person #2 must be supervised, when interacting with children, by a family child care home staff person who has completed the required training related to this citation. If there are no staff available to supervise staff person #2, staff person #2 may not work in a child-care position at the facility.

Regulation: 3290.31(g)

Description: Age and training

Noncompliance Area: During the inspection, staff person #3 did not complete the required one-hour 2022 update to the health and safety training by 12/30/2022.

Correction Required: Staff person #3 shall complete the required one-hour 2022 update to the health and safety training by 5/16/23.

Regulation: 3290.94(a)(1)

Description: Every 60 days

Noncompliance Area: During the inspection, the last documented fire drill being conducted was on 2/1/23 and not within the required 60-day timeframe.

Correction Required: The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that fire drills are conducted at least once every 60 days.

Regulation: 3290.94(a)(5)

Description: Evacuation routes posted

Noncompliance Area: During the inspection, evacuation maps were not posted on the second or third floors.

Correction Required: The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that evacuation routes are posted in a conspicuous location on each floor of the facility.

Regulation: 3290.95(a)/3290.95(b)

Description: System in compliance/Operator or designated staff responsibility

Noncompliance Area: During the inspection, the lasty documented manual monthly monitoring of the fire detection system was recorded as conducted on 2/1/23 and not within the required 30-day timeframe. The operator was not in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c).

Correction Required: Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c)). The operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

Regulation: 3290.118

Description: Infant sleep position

Noncompliance Area: During the renewal inspection, the certification representative observed the operator place child #4, an infant, on her stomach to sleep and not the sleeping position recommended by the American Academy of Pediatrics. There was no medical documentation on file stating that the child should be sleeping on her stomach.

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.

Regulation: 3290.121(a)/3290.121(b)

Description: Review policies and procedures/Given parents in writing

Noncompliance Area: During the renewal inspection, the operator was unable to provide documentation that they provide each parent in writing the facility's general daily schedule, hours for which care is provided, fees, responsibilities for meals, clothing, health policies, supervision policies, night care policies, dismissal policies, transportation and pick-up arrangements.

Correction Required: The operator shall review with the parent, at the time of application, the facility's general daily schedule, hours for which care is provided, fees, responsibilities for meals, clothing, health policies, supervision policies, night care policies, dismissal policies, transportation and pick-up arrangements. At the time of enrollment, a parent shall receive in writing the facility's general daily schedule, hours for which care is provided, fees, responsibilities for meals, clothing, health policies, supervision policies, night care policies, dismissal policies, transportation and pick-up arrangements.

Regulation: 3290.124(b)(7)

Description: Name/address/phone release person

Noncompliance Area: During a renewal inspection, on the emergency contact form for child #3, the address of the individual designated by the parent to whom the child may be released was missing.

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.

Regulation: 3290.131(d)(7)

Description: Free from contagious/communicable disease

Noncompliance Area: During the renewal inspection, the health reports on file for child #1 and child #2 did not include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

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.

Regulation: 3290.134(a)

Description: Child's hands washed

Noncompliance Area: During the renewal inspection, the operator did not wash the hands of child #4 after diapering. The child was immediately placed back in the child's rest equipment.

Correction Required: A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

Regulation: 3290.14(a)/3290.18

Description: Building codes/General Health and Safety

Noncompliance Area: During the renewal inspection, the operator did not have requirements for volunteer emergency preparedness training, practice drills and continuity of operations included in their emergency plan.

Correction Required: A certificate of compliance will not be granted by the Department until the legal entity provides a certificate of occupancy as proof of compliance with the applicable requirements in 34 Pa. Code § 403.23 (relating to child day care facilities) and under section 1016(c) of the act (62 P.S. § 1016(c)).Conditions at the facility may not pose a threat to the health or safety of the children. To maintain full compliance with 45 CFR § 98.41(a)(1)(vii), child care facilities must have requirements for volunteer emergency preparedness training, practice drills and continuity of operations included in their emergency plan.

Regulation: 3290.22(b)

Description: Availability of certificate of compliance and applicable regulations

Noncompliance Area: During the renewal inspection, the operator did not have verification of providing the parent of each child enrolled in the facility the information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office

Correction Required: The operator shall provide the parent of each child enrolled in the facility with information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office.

Regulation: 3290.24(a)(1)/3290.24(a)(5)

Description: Emergency plan/Emergency plan

Noncompliance Area: During the renewal inspection, the emergency plan did not provide lock down procedures. The emergency plan did not include accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

Correction Required: The facility shall have an emergency plan that provides for accommodations for shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises. The facility shall have an emergency plan that provides for accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

Regulation: 3290.24(a)(3)/3290.24(a)(4)

Description: Contact when arises/Contact when ended

Noncompliance Area: During the renewal inspection, the emergency plan did not include a method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises. It also did not include a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

Correction Required: The facility shall have an emergency plan that provides for a method for facility persons to contact parents as soon as reasonably possible when an emergency situation arises. The facility shall have an emergency plan that provides for a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

Regulation: 3290.24(d)

Description: Emergency plan

Noncompliance Area: During the renewal inspection, the provider did not have documentation of conducting emergency drills annually.

Correction Required: Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Regulation: 3290.64(a)

Description: Locked or inaccessible - in original container

Noncompliance Area: During the renewal inspection, in the upstairs bathroom, there was a bottle of Lysol that was accessible to children.

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.

Regulation: 3290.73(c)

Description: Has all items

Noncompliance Area: During the renewal inspection, on the second floor, soap was missing from the first aid kit.

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.

Regulation: 3290.94(a)(5)

Description: Evacuation routes posted

Noncompliance Area: During the renewal inspection, the evacuation map was missing from the third floor.

Correction Required: The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that evacuation routes are posted in a conspicuous location on each floor of the facility.

Noncompliance Area: There is an unlabeled infant bottle in the kitchen sink.

Correction Required: Disposable nursers and bottles shall be labeled with the child's name.

Noncompliance Area: Only 3 fire drills were conducted in 2018.

Correction Required: Fire evacuation drills shall be conducted at least four times a year.

Noncompliance Area: None of the cots are labeled for the use of a specific child.

Correction Required: Individual, clean, age-appropriate rest equipment shall be provided for preschool, toddler and infant children as agreed between the child's parent and the operator. The rest equipment shall be labeled for the use of a specific child and used only by the specified child.

Noncompliance Area: Fee agreements for children 1, 9 and 10 do not specify the amount of the fee to be charged per day or per week and the date on which the fee is to be paid. .

Correction Required: An agreement shall specify the amount of the fee to be charged per day or per week. An agreement shall specify the date on which the fee is to be paid.

Noncompliance Area: Children 1, 3 and 8 have been enrolled for more than 6 months and do not have child service reports on file.

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 3290.124(e).

Noncompliance Area: Fee agreement for children 8. 9 and 10 does not specify the persons designated by a parent to whom the child may be released.

Correction Required: An agreement shall specify the persons designated by a parent to whom the child may be released.

Noncompliance Area: Fee agreement for children 9 and 10 does not specify the date of the child's admission.

Correction Required: An agreement shall specify the date of the child's admission.

Noncompliance Area: Emergency contact information for children 5, 6 and 7 does not include the telephone number of the child's physician or source of medical care.Emergency contact information for children 9 and 10 does not include 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 children 9 and 10 does not include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits.

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 children 9 and 10 does not include the name, address and telephone number of the individual designated by the parent to whom the child may be released. Emergency contact information for children 6 and 7 does not include the address of the individual designated by the parent to whom the child may be released. Emergency contact information for child 5 does not include the address and telephone number of the individual 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: Children 2 through 8 have been enrolled for more than 6 months and have not updated the emergency contact information and the financial agreement at least once in a 6-month period. Child 1's emergency contact information was not updated within 6 months. Child 1 has an emergency contact form on file dated 1/29/18 and 8/2/18. Child 1 does not have an updated fee agreement on file. Child 1's fee agreement has a date of 1/29/18 on file.

Correction Required: The parent shall update in writing emergency contact information once in a 6-month period or as soon as there is a change in the informationA 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: Child 1 does not have a health assessment on file and has been enrolled for more than 60 days.

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.The initial health report for an infant must be dated no more than 3 months prior to the first day of attendance at the facility.

Noncompliance Area: Child 1 does not have immunizations on file.

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

Noncompliance Area: Provider was asked by inspector for all children's files. Provider did not provide files for children 11 and 12. Children 11 and 12 are subsidy children. Child 1's effective date with provider is 10/19/18 and child 2's effective date with provider is 10/18/18.

Correction Required: An operator shall establish and maintain an individual record for each child enrolled in the facility.

Noncompliance Area: Emergency contact forms for children 9 and 10 do not contain signed parental consent for emergency medical care for the child and signed parental consent for administration of minor first-aid procedures by facility staff. Written consent was not provided prior to admission.

Correction Required: A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

Noncompliance Area: Staff 1 does not have emergency plan training on file and admitted to inspector that she assists with child care.

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: Staff 1 does not have any child care training on file and admitted to inspector that she assists with child care.

Correction Required: A staff person shall obtain an biennial minimum of 12 clock hours of child care training.

Noncompliance Area: Staff 1 is a household member since 12/15/2005 as well as a staff person and does not have proof of request for the state police clearance nor does staff 1 have a completed state police clearance on file. Staff 1 does not have mandated reporter training on file. Staff 1 does not have a signed disclosure statement on file.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). 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: On the day of the renewal, inspector observed 7 unrelated children in care. Inspector asked provider and staff 1 several times if any of the children were related and they both stated none of the children in care at time of renewal are related to them.

Correction Required: The number of children in care may not exceed six children at any one time who are unrelated to the operator.

Noncompliance Area: Inspector observed a big gallon bottle of pine sol in the kitchen that is labeled "keep of children" on the floor by the counter and it is accessible to children.

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: Provider is unable to show inspector when requested at renewal inspection that the ammunition is contained in a locked area separate from weapons and firearms. Provider's son was only able to show inspector one locked safe that he believed was the gun safe. Provider does not have proof showing the operator notified the parents that weapons, firearms or ammunition are present at the facility.

Correction Required: If the facility is located in a residence, ammunition shall be contained in a locked area separate from weapons and firearms.If the facility is located in a residence, the operator shall notify the parent when weapons, firearms or ammunition are present at the facility.

Noncompliance Area: Four fire drills were not conducted in 2017. Provider has proof of three fire drills conducted 2/20/17, 6/30/17 and 12/15/17.

Correction Required: Fire evacuation drills shall be conducted at least four times a year.

Noncompliance Area: IN THE PLAYROOM UPSTAIRS, A SET OF PLASTIC DRAWERS CONTAINING TOYS FOR THE CHILDREN WAS OBSERVED TO HAVE MANY CRACKS IN THE PLASTIC, EXPOSING SHARP CORNERS AROUND THE EQUIPMENT.

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 #2, CHILD #4 AND CHILD #8 DO NOT CONTAIN COMPLETE INSURANCE POLICY INFORMATION.

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: INFANTS' TYLENOL WAS OBSERVED FOR CHILD #1 IN AN UNLABELED BOX/CONTAINER, AND WAS OBSERVED IN A PAPER BAG ON A LOW SPEAKER, IN REACH OF THE CHILDREN PRESENT AT THE DAYCARE. DELSYM MEDICATION WAS OBSERVED IN THE MIDDLE OF THE DINING TABLE WHEN CERTIFICATION REPRESENTATIVE ARRIVED, IN REACH OF CHILDREN AT THE DAYCARE.

Correction Required: 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. 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: THERE WAS NO WRITTEN PERMISSION OR MEDICATION LOG ON FILE FOR THE INFANTS' TYLENOL OBSERVED FOR CHILD #1.

Correction Required: A parent shall provide written consent for administration of medication or a special diet.

Noncompliance Area: THE FEE AGREEMENTS FOR CHILD #2, CHILD #3, CHILD #4, CHILD #5 CHILD #6, AND CHILD #7 HAVE NOT BEEN UPDATED AT LEAST ONCE IN THE LAST 6 MONTHS. THE FEE AGREEMENTS FOR EACH CHILD HAVE NOT BEEN UPDATED SINCE AUGUST OR SEPTEMBER OF 2016. THE EMERGENCY CONTACT FORMS AND THE AGREEMENT FORMS FOR ALL CHILDREN ARE BEING UPDATED ONLY ONCE PER YEAR, INSTEAD OF EVERY 6 MONTHS.

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 CONTACT FORMS FOR CHILD #2, CHILD #3, CHILD #5, CHILD #6, AND CHILD #7 DO NOT CONTAIN SIGNED PARENTAL CONSENT FOR MINOR FIRST-AID PROCEDURES OR EMERGENCY MEDICAL CARE.

Correction Required: A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

Noncompliance Area: EMERGENCY PLAN FOR THE FACILITY HAS NOT BEEN UPDATED WITHIN THE LAST YEAR. THE DATE OF THE LAST DOCUMENTED UPDATE IS: 2/1/16.

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.

Noncompliance Area: MULTIPLE DRAWERS ON THE BUFFET CABINET IN THE DINING ROOM CONTAINED OBJECTS LESS THAN ONE INCH IN DIAMETER, AS WELL AS TOXIC MATERIALS. SOME OF THE OBJECTS OBSERVED WERE: SEWING PINS, AA AND AAA BATTERIES, MEN'S DEODORANT, AND SMALL CLIPS.

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.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: IN THE PLAYROOM UPSTAIRS, A WINDOW AIR CONDITIONER WAS OBSERVED IN THE WINDOW FARTHEST FROM THE DOOR, AND THE WINDOW WAS NOT MODIFIED TO LIMIT THE OPENING TO 6 OR FEWER INCHES.

Correction Required: Windows or doors above the ground floor that open directly to the outdoors and are accessible to children shall be constructed, modified or adapted to limit the opening to 6 or fewer inches.

Noncompliance Area: DURING THE INSPECTION, AMMUNITION FOR THE FIREARM ON THE PREMISES WAS OBSERVED TO BE SEPARATE FROM THE WEAPON, BUT NOT IN A LOCKED AREA.

Correction Required: If the facility is located in a residence, ammunition shall be contained in a locked area separate from weapons and firearms.

Noncompliance Area: THE OPERATOR STATED DURING THE INSPECTION THAT SHE HAS NOT NOTIFIED THE PARENTS THAT THERE ARE FIREARMS PRESENT AT THE FACILITY. THERE IS ALSO NO DOCUMENTATION ON FILE TO PROVE THAT THE OPERATOR NOTIFIED THE PARENTS AT ANY TIME.

Correction Required: If the facility is located in a residence, the operator shall notify the parent when weapons, firearms or ammunition are present at the facility.

Noncompliance Area: DURING THE LAST YEAR, ONLY ONE FIRE DRILL WAS CONDUCTED AND DOCUMENTED ON 3/30/2017.

Correction Required: Fire evacuation drills shall be conducted at least four times a year.