Blessed Assurance Home Base Child Care

Regulation: 3280.123(a)(3)

Description: Services proceeded

Noncompliance Area: The files for child #1 and child #3, both of whom have been enrolled for more than 6 months (see LIS code sheet) did not include child service reports to provide information to the family about the child's growth and development in the context of services being provided.

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).

Regulation: 3280.131(b)(1)

Description: Infant: updated health report every 6 months

Noncompliance Area: Child #3, a young toddler, has a current health assessment dated 11/12/24, which is more than 6 months ago.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler.

Regulation: 3280.131(b)(2)

Description: Toddler/preschool: updated health report every 12 months

Noncompliance Area: The current health assessment for child #2, an older toddler, is dated 9/7/24, which is more than 12 months 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.

Regulation: 3280.131(e)(2)(i)

Description: Exemption documentation from parent/guardian

Noncompliance Area: The file for child #1, who has been enrolled for more than 60 days (see LIS code sheet) does not include a written, signed, and dated statement from the child's parent or guardian exempting them from immunizations based on religious belief or strong personal objection equated to a religious belief.

Correction Required: Exemption from immunization for religious belief or strong personal objection equated to a religious belief shall be documented by a written, signed and dated statement from the child's parent or guardian. The statement shall be kept in the child's record.

Regulation: 3280.14/3280.20

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: Staff person #1 has completed the health and safety course titled Getting Started with Center-Based Care (6-hr) and Getting Started with Center-Based Care (10-hr) but has not completed the required health and safety update course titled Pennsylvania Health and Safety Update 2022 (1 hour) training.

Correction Required: On 9/23/25 a renewal inspection was conducted at the facility. Staff person #1 had completed the health and safety course titled Getting Started with Center-Based Care (6-hour and 10-hour) but had not completed the required health and safety update course titled Pennsylvania Health and Safety Update 2022 (1 hour) training. The facility's acceptable plan of correction indicated staff person #1 would complete (PA Required Health and Safety for Centers-Group Child Care Parts 1 and 2/ PA Required Health and Safety for Family Child Care Parts 1 and 2) by 9/28/25. Conditions at the facility may not pose a threat to the health or safety of the children.

Regulation: 3280.14/3280.20

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: Continuity of operations was not observed within the emergency plan at the time of renewal inspection.

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.

Regulation: 3280.151(a)

Description: 12 months prior to service and every 24 months thereafter

Noncompliance Area: Staff person #1 has a current health assessment dated 9/1/23, which is more than 24 months ago.

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.

Regulation: 3280.26(a)(6)

Description: Emergency plan

Noncompliance Area: Documentation of an emergency drill conducted annually was not observed at the time of renewal inspection.

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

Regulation: 3280.32(a)

Description: Comply with CPSL

Noncompliance Area: Staff person #1 has not completed mandated reporter training within the last 60 months. This is evidenced by the previously documented mandated reporter training on file being dated 7/31/20.

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

Regulation: 3280.95(a)/3280.95(b)

Description: FIRE DETECTION/Staff responsibility

Noncompliance Area: Documentation of testing of interconnected fire-detection system exceeded 30 days on the following dates: 1/9/25-2/20/25; 3/19/25-4/22/25; 5/15/25-6/25/25; 7/17/25-8/21/25; 8/21/25-9/23/25.

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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met

Regulation: 3280.123(a)(3)

Description: Services proceeded

Noncompliance Area: The agreement for Child #1 did not specify the services to be provided to the family and the child. Child #1, #2, #4, and #5 have been enrolled longer than six months (see LIS code sheet) and did 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 § 3280.124(f).

Regulation: 3280.124(b)(3)

Description: Parent home/work address, phone

Noncompliance Area: The emergency contact information for child #2 did not include the work address or 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.

Regulation: 3280.131(a)

Description: Health Information

Noncompliance Area: The initial health assessment for child #3 is dated 9/6/24, which is more than 60 days after the child's date of admission. (See LIS code sheet). Child #4 did not have an initial or updated health assessment on file. (See LIS code sheet for date of enrollment)

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.

Regulation: 3280.131(b)(1)

Description: Infant: updated health report every 6 months

Noncompliance Area: The most recent health assessment for child #1, a young toddler, is dated 4/12/23, indicating an updated health report was not provided every 6 months. The initial and updated health assessments for child #2, a young toddler, are dated more than six months apart. The initial health assessment is dated 3/23/23 and the updated health assessment is dated 9/7/24.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler.

Regulation: 3280.95(a)/3280.95(b)

Description: FIRE DETECTION/Staff responsibility

Noncompliance Area: Fire-detection testing documentation showed that time between testing exceeded 30 days on the following dates: 1/12/24-2/16/24, 4/12/24-5/17/24, 5/17/24-6/21/24, and 7/19/24-8/23/24.

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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met.

Regulation: 3280.52(c)

Description: Mixed age levels

Noncompliance Area: During the supervision/ratio inspection, on 9.22.23, seven (7) children, unrelated to the operator, were observed with one (1) primary staff person, Staff #1. There were two (2) infants, two (2) young toddlers, and three (3) preschoolers.

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 at §3280.52(b).

Regulation: 3280.124(f)/3280.181(c)

Description: Updated every 6 months/Emergency info/agreement updated 6 mos

Noncompliance Area: The files for Child #1, Child #2, Child #3, Child #4, and Child #5 did not contain documentation of parent review/updates, of the Emergency Plan and Financial Agreement, at least every 6 months.

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. 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.

Regulation: 3280.131(b)(2)/3280.182(1)

Description: Toddler/preschool: updated health report every 12 months/Initial and subsequent health assessments

Noncompliance Area: The Health Assessment, in the file for Child #5, was dated 8.27.20, and no other Health Assessments were available.

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. A child's record must contain initial and subsequent health reports.

Regulation: 3280.131(d)(5)/3280.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: The Immunization Records, in the files for Child #2 and Child #3, did not contain documentation of the influenza vaccination. The file for Child #5 did not contain any immunization records.

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 #2, Child #3, and Child #5 must be dismissed from care by close of business on 9.22.23, and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Regulation: 3280.14/3280.20

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: The file for Staff #1 did not contain the Health & Safety Training - 1-Hour Update, which was due by 12.30.22. The Emergency Plan did not contain documentation regarding Continuity of Operations.

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.

Regulation: 3280.151(a)/3280.192(3)

Description: 12 months prior to service and every 24 months thereafter/Health assessment, TB test

Noncompliance Area: The Health Assessments, in the file for Staff #1, were dated 4.19.19 and 10.11.21, which exceeded the 24-month renewal requirement.

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. 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.

Regulation: 3280.26(a)(6)

Description: Emergency plan

Noncompliance Area: Based on a conversation with the operator, and lack of documentation, the annual emergency drill had not been conducted.

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

Regulation: 3280.95(a)/3280.95(b)

Description: FIRE DETECTION/Staff responsibility

Noncompliance Area: Documentation of Fire System testing contained dates of 2.3.23, 3.10.23, 4.17.23, 6.8.23 and 7.6.23, 8.8.23, and 9.13.23, which exceeded the 30-day requirement.

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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met.

Regulation: 3280.131(e)(1)

Description: Exemption documentation from parent/guardian

Noncompliance Area: The file for Child #1 was lacking the annual influenza vaccine. The file for Child #2 was lacking one dose of Hepatitis B, two doses of DTAP, the annual influenza vaccine, and one dose of Hepatitis A.

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.

Regulation: 3280.14/3280.20

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: The facility was lacking a policy on shaken baby syndrome, head trauma, and child maltreatment.

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.

Regulation: 3280.26(a)(6)

Description: Emergency plan

Noncompliance Area: The facility did not conduct and document an annual emergency drill in 2021.

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

Regulation: 3280.95(a)/3280.95(b)

Description: FIRE DETECTION/Staff responsibility

Noncompliance Area: The facility lacked an interconnected fire detection system in accordance with 62 P.S. 1016(c)(3).

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 primary staff person or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in subsection (a) are met.

Regulation: 3280.131(a)

Description: Health Information

Noncompliance Area: The file for child #2, with a start date of 3-22-21, had an initial health assessment dated 8-13-21 that was over 90 days after their start date. (The suspended regulation requires the parent to provide an initial health assessment no later than 90 days following the first day of attendance 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.

Regulation: 3280.131(e)(1)

Description: Exemption documentation from parent/guardian

Noncompliance Area: The file for child #3, a 3 year old, had an immunization record that lacked verification of the Influenza vaccination being administered within the last calendar year in accordance with the schedule recommended by the ACIP and lacked exemption documentation. The file for child #1, a 21 month old, had an immunization record that lacked documentation of the 4th dose of the DTAP vaccination by age 18 months and the 4th dose of the Pneumococcal vaccination by age 15 months in accordance with the schedule recommended by the ACIP and lacked exemption documentation.

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.

Regulation: 3280.151(a)

Description: 12 months prior to service and every 24 months thereafter

Noncompliance Area: The files for staff person #1 and #2 lacked a current health assessment within the last 24 months.

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.

Regulation: 3280.23(f)

Description: Primary staff person ID

Noncompliance Area: Primary staff person #1, who is responsible for compliance with the regulations, had a Pennsylvania Driver's License that was expired.

Correction Required: A valid photo identification of the primary staff person or designated staff person who is responsible for compliance with this chapter shall be provided to the agent of the Department at the time of inspection.

Regulation: 3280.26(a)(1)

Description: Emergency plan

Noncompliance Area: The facility's emergency plan lacked a plan that provides for shelter of children during a lock-down.

Correction Required: The facility shall have an emergency plan that provides 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.

Regulation: 3280.26(a)(5)

Description: Emergency plan

Noncompliance Area: The facility's emergency plan lacked a plan that provides for accommodations for infants and toddlers.

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

Regulation: 3280.31(e)(4)(i)/3280.31(h)

Description: Age and training/Completion of professional development

Noncompliance Area: The files for staff person #1 and #2 had pediatric first-aid and CPR training that expired in March 2021 and lacked current training.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and CPR. All staff persons shall renew their certification in pediatric first-aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. All staff persons shall complete the professional development under subsection (f): Pediatric First Aid and Pediatric CPR.

Regulation: 3280.31(h)

Description: Completion of professional development

Noncompliance Area: The file for staff person #2 lacked current health and safety training completed by 6-17-21 covering topics #1-9 as required in regulation 3270.31(f) for staff persons with a start date prior to 12-19-20.

Correction Required: All staff persons shall complete the professional development under subsection(f): (1) Prevention and control of infectious diseases (including immunization); (2) Prevention of Sudden Infant Death Syndrome and use of safe sleep practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Emergency preparedness and response planning for emergencies resulting from a natural disaster or a man-caused event (such as violence at a child care facility); (8) Handling and storage of hazardous materials and appropriate disposal of bio contaminants; (9) Precautions when transporting children.

Regulation: 3280.32(a)/3280.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The file for staff person #2, with a state police clearance dated 9-22-16 and an FBI clearance dated 8-9-16, lacked current state police and FBI clearances updated within the last 60 months.

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. Staff Person #2 may not work in a child care position at the facility.

Regulation: 3280.33(c)

Description: Age and training

Noncompliance Area: On 10-4-21, children were observed in care with both staff persons at the facility that lacked current pediatric first-aid and CPR training.

Correction Required: One or more facility persons competent in pediatric first aid and pediatric cardiopulmonary resuscitation techniques shall be at the facility when one or more children are in care.

Regulation: 3280.95(a)/3280.95(b)

Description: FIRE DETECTION/Staff responsibility

Noncompliance Area: The operator lacked written documentation of manually testing the smoke detectors in the facility at least every 30 days prior to 8-10-21.

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

Noncompliance Area: The file for child #1 had an emergency contact form that lacked the fee amount to be charged per day or per week.

Correction Required: An agreement shall specify the amount of the fee to be charged per day or per week.

Noncompliance Area: The file for child #1 had an emergency contact form that lacked the date on which the fee is to be paid.

Correction Required: An agreement shall specify the date on which the fee is to be paid.

Noncompliance Area: The file for child #1 had a health assessment that lacked 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.

Noncompliance Area: The file for child #1 had a health assessment that lacked a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health assessment.

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: 2ND CITATION: The file for child #2, a 21 month old, and child #4, a 19 month old, had an immunization record that lacked verification of the Influenza vaccination being administered within the last year in accordance with the schedule recommended by the ACIP. The file for child #1, a 4 year old, had an immunization record that lacked documentation of the 1st and 2nd doses of the Hepatitis A vaccination by age 23 months in accordance with the schedule recommended by the ACIP. The file for child #3, a 13 month old, had an immunization record that lacked documentation of the 3rd dose of the DTAP vaccination by age 6 months and 3rd dose of the Pneumococcal vaccination by age 6 months in accordance with the schedule recommended by the ACIP. The file for child #4, a 19 month old, had an immunization record that lacked documentation of the 4th dose of the DTAP vaccination by age 18 months, the 3rd dose of the HIB vaccination by age 15 months, the 4th dose of the Pneumococcal vaccination by age 15 months, and the 1st doses of the MMR and Varicella vaccinations by age 15 months in accordance with the schedule recommended by the ACIP. PREVIOUSLY CITED ON 7-29-20.

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: 2ND CITATION: There were three operable smoke detectors, one on each of the three floors, and four battery operated smoke detectors located in each of the 4 bedrooms on the top floor that were not functioning. These conditions at the facility pose a threat to the health or safety of children. PREVIOUSLY CITED ON 7-29-20.

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

Noncompliance Area: The phone number for contacting the DHS regional day care office was not posted in a conspicuous location used 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 file for household member #1 lacked a disclosure statement, an FBI clearance, and the NSOR verification certificate. Household member #1 became a household member on 8-15-20.

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: In the back room, there was a power strip on the shelf near the television that had 3 outlets that lacked outlet covers that were accessible to children 5 years of age and younger. In the main child care room, there was a power strip near the television that had an outlet that lacked an outlet cover and was accessible to children 5 years of age and younger.

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

Noncompliance Area: * * At approximately 3:17 p.m., staff person #1 was observed upstairs in the living room with 2 children in their group, including an infant and a young toddler. Staff person #1 was unable to name the two children in their group.

Correction Required: The legal entity is required to post in all child care spaces the room name, room capacity, and the staff to child ratios for all age levels as listed in regulation 3280.52.

Noncompliance Area: At approximately 3:17 p.m., staff person #1 was observed upstairs in the living room with 2 children in their group, in space that was not measured for child care.

Correction Required: Indoor child care space is measured within permanent stationary partitions or walls. The allowable number of children in a space is determined by dividing the total square feet in a space by 40.

Noncompliance Area: In the main child care room, there were broken drawers on the cabinet below the printer with drawer covers that were pulling away from the connectors resulting in potential pinch 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: On the backyard outdoor play space, there were several small pebbles on the sidewalk and the immediate grassy area after the sidewalk that were less than 1 inch in diameter and were accessible to infants and toddlers.

Correction Required: Pea gravel and other materials with a diameter of less than 1 inch may not be used in spaces where infants or toddlers receive care.

Noncompliance Area: The file for child #1 and child #3 lacked a current child service report updated within the last 6 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: The file for child #5 had an emergency contact form that lacked the name of the health insurance and the 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 file for child #1 had an emergency contact form that lacked the address 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: The file for child #5, a young toddler, lacked a current health assessment updated within the last 6 months.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler

Noncompliance Area: The file for child #3, a preschooler, lacked a current health assessment updated within the last 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: The file for child #2 had a health assessment that lacked 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 file for child #2 had a health assessment that lacked 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.

Noncompliance Area: The file for child #2 had a health assessment that lacked a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health assessment.

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, a 4 year old, child #2, a 4 year old, child #3, a 3 year old, and child #5, a 16 month old, had an immunization record that lacked verification of the Influenza vaccination being administered within the last year in accordance with the schedule recommended by the ACIP. The file for child #1, a 4 year old, and child #3, a 3 year old, had an immunization record that lacked documentation of the 2nd dose of the Hepatitis A vaccination by age 23 months in accordance with the schedule recommended by the ACIP. The file for child #4, a 10 month old, had an immunization record that lacked documentation of the 2nd dose of the Hepatitis B vaccination by age 2 months, the 2nd dose of the Rotavirus vaccination by age 4 months, the 2nd and 3rd doses of the DTAP vaccination by age 6 months, the 2nd dose of the HIB vaccination by age 4 months, the 2nd and 3rd doses of the Pneumococcal vaccination by age 6 months, and the 2nd dose of the Polio vaccination by age 6 months in accordance with the schedule recommended by the ACIP. The file for child #5, a 16 month old, had an immunization record that lacked documentation of the 3rd doses of the DTAP and Pneumococcal vaccinations by age 6 months and the 1st doses of the MMR and Varicella vaccinations by age 15 months in accordance with the schedule recommended by the ACIP.

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 for child #2 and child #3 had an emergency contact form and agreement that exceeded 6 months between updates.

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: There were three operable smoke detectors, one on each of the three floors, and four battery operated smoke detectors located in each of the 4 bedrooms on the top floor that were not functioning. These conditions at the facility pose a threat to the health or safety of children.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. Operable interconnected smoke detectors will be installed on each floor.

Noncompliance Area: The emergency plan for the facility had not been reviewed/updated within the last year.

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: The file for staff person #1 and #2 lacked current emergency plan training updated within the last year.

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 person #1 had mandated reporter training dated 6-11-15 and lacked current training within the last 5 years.

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

Noncompliance Area: * * At approximately 9:04 a.m., staff person #2 was observed supervising 5 children, including an infant, a young toddler, and three preschoolers, resulting in staff person #2 being out of ratio.

Correction Required: The legal entity must arrange for all facility staff to receive a minimum of two hours of online training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training.

Noncompliance Area: On the front porch, there was an extension cord with 2 electrical outlets that lacked outlet covers. In the main child care room under the television, there were two electrical outlets on the surge protector that lacked outlet covers.

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

Noncompliance Area: On the front porch, there were 2 bottles of cleaner/toxics labeled "Keep out of reach of children" that were accessible to children. Near the back entrance to the facility in the main child care room, there was a bottle of hand sanitizer on top of the piano that was accessible to children. In the main child care room, there was a can of Raid bug spray on the computer desk 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.

Noncompliance Area: On the front right side of the porch, there were a couple sections of loose stone on the wall of the house that were unstable and accessible to children. On the backyard outdoor play space there was a shovel on the deck outside the sliding doors, a hole in the wall of the fence adjacent to the house, and a black cracked bin in the yard that each had sharp edges.

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: In the main child care room in the corner near the rest mats, there was peeling paint in one area.

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

Noncompliance Area: According to the fire drill log, a fire drill was not conducted at least every 60 days from 5-7-19 to 7-19-19.

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

Noncompliance Area: The file for staff person #1 had a health assessment that lacked an examination for communicable diseases and the results of that examination and the physician's or CRNP's assessment of the person's 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: The file for staff person #1 lacked two written, nonfamily references.

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: The file for staff person #1, with a start date of 5-6-19, lacked initial emergency plan training at her start date and requires current emergency plan 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: The file for staff person #1, with a start date of 5-6-19, lacked a disclosure statement and state police clearance at her start date and requires a current disclosure statement and state police clearance.

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. Staff Person #1 may not work in a child care position at the facility.

Noncompliance Area: The file for child #1, child #2, child #4, and child #5 lacked a current child service report updated within the last 6 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: The file for child #2 had an emergency contact form that lacked the physician's telephone number.

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 for child #3 had an emergency contact form that lacked the addresses 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 file for child #4 and child #5, preschoolers, lacked a current health assessment updated within the last 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: The file for child #5 had a health assessment that lacked 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.

Noncompliance Area: At 11:22 a.m., staff person #1 changed an older toddler's diaper and did not wash the child's hands after diapering.

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

Noncompliance Area: At 11:22 a.m., staff person #1 changed an older toddler's diaper and threw away the diaper in a lidded trash can that was not hands-free.

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: The file for staff person #1 and staff person #2 lacked a current health assessment updated within the last 24 months. The file for staff person #3, with a start date of 3-19-19, lacked an initial health assessment and requires a current health assessment.

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: The file for staff person #3, with a start date of 3-19-19, lacked an initial health assessment with a tuberculosis screening by the Mantoux method at initial employment and requires a current tuberculosis screening by the Mantoux method .

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: The file for child #1 and child #2 lacked an agreement updated within the last 6 months. The file for child #4 and child #5 had an emergency contact form and agreement that exceeded 6 months between updates.

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 file for staff person #3 lacked two written, nonfamily references.

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: The file for staff person #2 lacked current emergency plan training completed within the last year.

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: The file for staff person #1 and staff person #2 lacked at least 6 clock hours of child care training completed within the last year.

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

Noncompliance Area: The file for staff person #1 had a state police clearance dated 3-6-14, a child abuse clearance dated 3-6-14, and an FBI clearance dated 3-4-14 and lacked current state police, child abuse, and FBI clearances that were updated within the last 60 months.

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. Staff Person #1 may not work in a child care position at the facility.

Noncompliance Area: The file for staff person #3, functioning as a secondary staff person, lacked verification of education to qualify as a secondary staff person.

Correction Required: A secondary staff person shall have obtained a high school diploma or a general educational development certificate

Noncompliance Area: At 9:45 a.m., staff person #1 was at the facility with 12 children in her group, including 3 young toddlers, 1 older toddler, and 8 preschoolers, resulting in staff person #1 being out of ratio. Staff person #1 was out of ratio until 1:00 p.m., when staff person #3 joined ratio and named the 4 toddlers in her group, resulting in staff person #1 and staff person #3 being in ratio.

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 at 3280.52(b).

Noncompliance Area: In the back room, there was an unlocked and open storage room with 2 bottles of Kingsford Charcoal Lighter Fluid, a container of Simple Grout, and UGG Water & Stain Repellent labeled "Keep out of reach of children" that were 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: In the backyard play space, the top step was loose along the walkway leading to the facility door causing the step to be unstable.

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: According to the fire drill log, a fire drill was not held at least every 60 days between 3-20-18 and 12-10-18.

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

Noncompliance Area: The file for Household Member #2 had a volunteer State Police clearance and lacked a State Police clearance for employment. The file for Household Member #2 lacked an FBI clearance. (Previously cited at renewal inspection on 3-20-18)

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: At 1:20 p.m. during naptime, staff person #1 was supervising 9 children in her group, including 2 young toddlers, 3 older toddlers, and 4 preschoolers, resulting in staff person #1 being out of ratio. (Previously cited at renewal inspection on 3-20-18)

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 at 3280.52(b).

Noncompliance Area: In the front room, there were 2 pack 'n plays that had tears in the netting on the side creating a hole. In the front room, there was a wooden play kitchen with a plastic sink bin that was cracked in a few places resulting in sharp edges.

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 front room, the desk in the corner had the bottom left drawer that was unlocked with a container of push pins and a container of thumb tacks that were accessible to children.

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: In the front room, there was a pack 'n play that was used by child #4 and was not labeled with the child's name.

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: The file for child #1, child #2, and child #3 lacked a current child service report updated within the last 6 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).