Buttons And Bows Child Care And Learning Cntr Inc

Regulation: 3270.123(a)

Description: Signed

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #1's file did not include an agreement signed by the operator and the parent.

Correction Required: An agreement shall be signed by the operator and the parent.

Regulation: 3270.123(a)(4)/3270.123(a)(5)

Description: Arrival/departure times/Designated release persons

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #2's agreement did not specify the child's arrival and departure times. Observed child #2 and #3's agreement did not specify the persons designated by a parent to whom the child may be released. Corrected on-site 5/6/2026.

Correction Required: An agreement shall specify the child's arrival and departure times. An agreement shall specify the persons designated by a parent to whom the child may be released.

Regulation: 3270.123(a)(6)/3270.182(2)

Description: Admission date/Application, admission, withdrawal dates

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #2's agreement did not specify the date of the child's admission. Corrected on-site 5/6/2026.

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

Regulation: 3270.124(b)(4)/3270.182(3)

Description: Written consent/Consent for emergency medical care required prior to admission

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #2, #3, and #4's emergency contact information did not include the written consent signed by a parent for emergency medical care.

Correction Required: Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

Regulation: 3270.124(b)(6)/3270.124(b)(7)

Description: Insurance coverage information/Name/address/phone release person

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #3 and #4's emergency contact information did not include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits. Also observed child #3's emergency contact information did not include the address of the individual designated by the parent to whom the child may be released.

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. 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: 3270.182(5)

Description: Consent for administration of minor first-aid required prior to admission

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed child #2, #3, and #4's record did not contain signed parental consent for administration of minor first-aid procedures by facility staff.

Correction Required: 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.

Regulation: 3270.66(a)

Description: Locked or inaccessible

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed diaper rash cream child accessible in room #1. Corrected on-site 5/6/2026.

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

Regulation: 3270.72(b)/3270.72(c)

Description: Screened/Good repair

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed the windows used for ventilation in room #1, #4, and #5 had damaged screens.

Correction Required: Windows or doors used for ventilation shall be screened when open. Screens shall be in good repair.

Regulation: 3270.72(d)

Description: Above ground window opening restricted to 6"

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed the windows located in room #4 open to 2'5".

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.

Regulation: 3270.76

Description: Building Surfaces

Noncompliance Area: During the initial inspection conducted on 5/6/2026 observed a window in room #5 had broken glass that was taped together.

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: On 6/25/20, Rep observed large planters in the outside play space that are broken and have sharp edges. They are accessible to children.

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 facility parent handbook/written policies does not contain the facility supervision policy.

Correction Required: 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.

Noncompliance Area: Child #1, age 19 months, has received only 3 doses of DTaP, Hib and Pneumococcal vaccines. Child #1 also does not have any influenza, MMR, Varicella or HepA vaccines documented. Child #2, age 2 yrs 5 months, has only 1 dose of Hep A vaccine documented and does not have an influenza vaccine documented. Child #3, age 4 years, does not have a current influenza vaccine documented. All of these vaccinations are recommended by the ACIP for children of these ages.

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: Facility person #1, DOH 2/1/19, has a TB screening dated 7/18/16. This is more than 1 year prior to start date. Her health assessment is current.

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 current copy of the general liability insurance policy was not at the facility and could not be assessed during the inspection.

Correction Required: The legal entity shall have comprehensive general liability insurance to cover the persons who are on the premises. A current copy of the insurance policy shall be on file at the facility.

Noncompliance Area: Facility person #2, DOH 9//19/18, has mandated reporter training dated 3/12/19. Facility person #3, DOH 9/18/18, has mandated reporter training dated 3/5/19. Both of these trainings were completed past the 90 day provisional period.

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

Noncompliance Area: Currently none of the staff have documentation of valid CPR/First aid training. Director reports that they just took new training and are waiting for new cards. Previous CPR/First aid expired 2/28/19.

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

Noncompliance Area: Rep observed a bottle of sunscreen in the outside bag which was located on a low shelf in the hallway and is accessible to children.

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

Noncompliance Area: The thermostat in the infant room displayed a current temp of 63 degrees F. A note near the thermometer indicates that thermostat should not be turned up past 62 degrees F. Children are present in the infant room.

Correction Required: The indoor temperature shall be at least 65 F.

Noncompliance Area: The first aid kit in the infant room did not contain soap. The first aid kit in the School age room did not contain scissors. All other required items were present.

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

Noncompliance Area: On 9/19/18, Rep observed rubber mulch in the play yard around the large climber. Children that director identified as toddlers were in the play yard in the area where that mulch is located and had access to the mulch. The Rep observed numerous pieces of mulch that are less that 1' in diameter.

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: On 9/19/18, Facility persons #1 & #2, both hired on 9/4/18, do not have initial health assessments or TB screenings on file. Facility person #1 has I non-family written reference on file and facility person #2 does not have any non-family written references on file.

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. 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: On 9/19/18, facility person #2, DOH 9/4/18, did not have emergency plan training documented in the file.

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: On 9/19/18, Facility person #1has signed the disclosure statement on 8/20/18 and has a PSP clearance dated 9/18/18, a child abuse clearance dated 7/20/18 and an FBI clearance dated 7/19/18. The PSP clearance was requested after facility person #1 had begun to work and the child abuse clearance was requested for volunteer purposes.. Facility person #2 has a PSP clearance dated 10/11/17, a child abuse clearance dated 10/11/18 and an FBI clearance dated 12/20/17. The PSP clearance was requested for volunteer purposes and is not acceptable for employment.

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. The legal entity must send the complete individual record (file) for all new hires to the NE Regional Office for a period of 3 months. During that period, new hires may not begin work in child care until the individual record has been approved by the NE Regional Office.

Noncompliance Area: Facility person #2 was observed working in the facility on 3/6/18 and had a supervision group assigned to her. Facility person #2 does not have any clearances or proof of any requests for clearances on file at the facility. Facility person #2 was working under supervision. On 5/22/18, rep reviewed file of facility person #2 to verify corrections and found that the PSP clearance dated 3/17/17 for facility person #2 was not a certification form and that the child abuse clearance dated 3/23/17for facility person #2 had been obtained for volunteer purposes. FBI clearance was dated 3/1/6/18.

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: Child #1 does not have release persons' addresses on the emergency information form.

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: Observed an epi-pen in the backpack of child #1. There are no written instruction from the prescriber at the facility. This is a rescue medication.

Correction Required: A staff person shall administer a prescription medication only if written instructions are provided from the individual who prescribed the medicine. Instructions for administration contained on a prescription label are acceptable.

Noncompliance Area: Observed an epi-pen in a child's backpack that was not labeled with the child's name.

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.

Noncompliance Area: Observed an epi-pen in a child's backpack that is hanging on the coat rack which is accessible to school age children. Also observed an expired tube of desitin in the infant room.

Correction Required: Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children. Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

Noncompliance Area: Observed an epi-pen in a child's backpack. There is no written parental consent to administer this medication. This is a rescue medication.

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

Noncompliance Area: Facility person #1, DOH 2/2001, has a health assessment that is dated 2/25/16. The assessment is more that 24 months old. Facility person #2 does not have a health assessment or TB screening on file at the facility.

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: Facility person #2 was observed working in the facility on 3/6/18 and had a supervision group assigned to her. Director reported that it was her first day of work. There is no individual record for facility person #2 at the facility.

Correction Required: An individual record is required for each facility person.

Noncompliance Area: Facility person #2 was observed working in the facility on 3/6/18 and had a supervision group assigned to her. Facility person #2 does not have any clearances of proofs of requests for clearances on file at facility. Facility person #2 was working under supervision.

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. Facility Person #2 may not work in a child care position at the facility. THE LEGAL ENTITY AND THE DIRECTOR MUST REGISTER FOR AND ATTEND THE EXISITING PROVIDER ORIENTATION ON MAY 16, 2018 AT THE NE REGIONAL OFFICE.

Noncompliance Area: Observed toddler and preschoolers being cared for in the first room on the right from the entrance throughout the renewal inspection. This room is not listed as measured space for capacity.

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: Child #1 is missing an updated health assessment. Date of last health assessment 4/21/16.

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 handle on the school age bathroom door is broken. There is a ceiling tile in the school age bathroom that is not securely attached.

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

Noncompliance Area: The health assessment on file for Child #1 is not signed by a physician, physician's assistant or a CRNP.

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

Noncompliance Area: Facility person #1 does not have an initial health assessement or TB screening on file. Date of hire 1/27/17.

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: Facility person #1 does not have a signed disclosure on file.

Correction Required: A facility person`s record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #--- may not work in a child care position at the facility.

Noncompliance Area: Facility person #1 does not have proof of initial 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 and kept on file at the facility.