Billie Orts Laugh-N-Learn Day Care Ctr - Etters PA Child Care Center

Noncompliance Area: The emergency contact form on file for child #1 had not been updated within the past 6 months at the time of inspection.

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 information

Noncompliance Area: The most updated tuberculosis screening results for facility person #1 were not included in the facility person's record at the time of inspection.

Correction Required: A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

Noncompliance Area: Dolls in the infant/young toddler area were observed to be covered in a substance that appeared to be food, and a jumper in the same room was observed to be dirty, both of which were corrected on site. A tear was observed in the changing pad in the older toddler area, exposing the foam inside.

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: A plastic bag was observed to be accessible to young toddlers at the time of inspection A bag of M&M candy and other small, hard candy was observed to be accessible to older toddlers. Both were corrected on site.

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: Toys were observed to be placed over a crib while an infant was asleep in the crib, and the toys were hanging down into the crib, which was corrected on site.

Correction Required: Toys, bumper pads, or pillows may not be present in a crib while an infant is sleeping in the crib.

Noncompliance Area: The agreement for child #2 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.

Noncompliance Area: The emergency contact form for child #3 did not include a complete address for the child's 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: The file of child #1, 6 months old at the time of inspection, included documentation of only one hepatitis B vaccine. It did not include documentation of subsequent hepatitis B vaccinations, DTAP, HIB, Pneumococcal, or polio vaccinations. The file of child #2, 16 months old at the time of inspection, did not include documentation of any hepatitis B vaccinations or a hepatitis A vaccination.

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: The file of facility person #2, hired 11/1/18, contained results of tuberculosis screening dated 6/17/16, which is more than 12 months prior to the person's employment date. The file of facility person #3, hired 11/1/18, contained a health assessment dated 10/19/17 and a health assessment dated 2/18/19, therefore a health assessment dated within 12 months prior to hire was not on file at the time of hire. Also, the file contained results of tuberculosis screening dated 10/19/17, which therefore were more than 12 months prior to the person's employment date.

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. 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: The health assessments on file for facility persons #2 and #4 did not contain documentation of an examination for communicable disease or an assessment of the persons' suitability to provide child care.

Correction Required: An adult health assessment must include an examination for communicable diseases and the results of that examination. An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Noncompliance Area: Bottles for the use of an infant were observed not the be labeled with the child's name.

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

Noncompliance Area: The last documented date of update on the emergency contact form and financial agreement for child #3 was 1/24/18. The emergency contact forms in the child care space for children #4 and #5 were older than 6 months at the time of inspection.

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. If emergency information is updated in a master file, it shall be updated accordingly in other facility records.

Noncompliance Area: The file of child #2 contained only initials from the parent to indicate consent for emergency medical care and administration of minor first-aid procedures, but did not contain a full signature.

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

Noncompliance Area: The files of facility persons #2 and #3, both hired 11/1/18, contained documentation of emergency plan training at the time of inspection, however it was dated 6/6/19, and therefore there was not documentation of emergency plan training at the time of hire.

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: The file of facility person #1 contained current documentation of fire safety training at the time of inspection, however it was dated 8/14/19 and the previous documented training was 5/16/18, therefore fire safety training was not completed annually.

Correction Required: Staff persons shall participate, at least annually, in firesafety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.