Creative Kids Club

Noncompliance Area: As of 12/2/2020, Staff #2 did not have a health assessment on file conducted within 12 months prior to beginning employment at the facility on 11/5/2020. Staff #2 also did not have a tuberculosis screening by the Mantoux method at initial employment on file that was within the previous 12 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. 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: As of 12/2/2020, Staff #1 only had written, nonfamily reference on file. Staff #1 began employment on 11/3/2020.

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: During the Monthly Monitoring Inspection on 8/27/2020, a wooden board was observed on the ground outside in the gated area that separates the main playground from a smaller play area. The wooden board had a crack in it causing sharp edges to be exposed and the risk of splinters to be present.

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: During a file review for the Monthly Monitoring Inspection on 8/27/2020, Staff #1 did not have any written nonfamily references on file.

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: During the Monthly Monitoring Inspection on 8/27/2020, an extension cord was observed on a shelf accessible to children in the program area that is closest to the door to the outdoor playground.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. 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: During a Complaint Inspection on 7/30/2020, Staff #1 admitted that she did say that an 18 month-old child "Looked like a little monkey in a cage" when the child was put in a crib to nap. Staff #1 stated that she didn't mean anything negative. It just came out wrong. This incident was reported to have occurred at the facility on 7/23/2020.

Correction Required: A facility person may not use harsh, demeaning or abusive language in the presence of children.

Noncompliance Area: The file for Staff #1 was received electronically on 7/29/2020. It was discovered that the the request for the NSOR-National Sex Offender Registry clearance for Staff #1 was requested after Staff #1 starting working at the facility in June 2020.

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. As per the CPSL hiring waiver, the requests for all staff clearances must be on file prior to any staff person working with children at the facility as a provisional hire.

Noncompliance Area: During a Complaint Inspection on 6/30/2020 at this facility, Staff #1 reported that prior to getting a buzzer put on the side door, that Staff #2 had previously re-entered the building through the main front door after returning from a walk with the young toddlers due to the nearby side door being locked from the outside. Staff #2 would then come out through the side door to get the young toddlers. Staff #1 stated that Staff #2 could see the young toddlers the whole time through the window while she quickly circled around to get them through the side door. After review, it was determined that the young toddlers were outside alone in the buggy stroller for at least a few seconds while Staff #2 went inside through the front door and circled around through the side door to bring the young toddlers inside.

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. Children must be supervised at all times. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: During a Complaint Inspection on 6/30/2020 at this facility, Staff #1 showed Rep. how the food that is frozen solid in the freezer is taken out of the freezer when they close at 6:00 PM each night and left out to thaw overnight. Staff #1 stated that it is then put in the oven at 210 degrees when the first person comes in at 6:00 AM the next morning. Staff #1 showed Rep. a frozen pan of macaroni and cheese from the freezer on 6/30/2020 as an example.

Correction Required: Potentially hazardous food brought from the child's home or provided by the facility shall be refrigerated.

Noncompliance Area: Staff #2 started working at the facility on 3/23/2020, but did not have a completed health assessment on file on 4/15/2020.

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: During a review of staff files on 4/15/2020, it was discovered that Staff #1 was fingerprinted through the Department of Human Services (DHS) process after she started working at the facility on 3/24/2020. The child abuse clearance for Staff #1 was also requested after 3/24/2020. The FBI clearance on file for Staff #2 was completed through the Department of Education.

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. As of 9/24/2018, DHS can no longer accept FBI clearances that are completed through the Department of Education.

Noncompliance Area: On 2/27/2020, a power strip with 2 uncovered electrical outlets was observed in the preschool area of the facility.

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

Noncompliance Area: On 2/27/2020, there was a hole in the back of a shelf that was about the size of a quarter in the preschool area of the facility.

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: During a review of child files on 1/21/2020, Child #1 an infant and Child #3, an older toddler did not have an initial report or any health report on file. Child #3 also did not have written verification on file that the child was administered immunizations in accordance with the recommendations of the ACIP. Both children have attended the facility 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 facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.

Noncompliance Area: During a review of child files on 1/21/2020, the most recent health report on file for Child #2, a young toddler was dated 7/12/2019. The most recent health report on file for Child #4, a preschool child was dated 10/23/2018.

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. 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: During a file review on 8/16/2019, it was observed that Staff #1 did not have an initial health assessment on file. In addition, the tuberculosis screening on file for Staff #1 was dated 2/15/2018, which is not within 12 months of providing initial service in a child care setting. Staff #7, employed since 6/17/2019 did not have an initial health assessment or tuberculosis screening on file.

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: During a file review on 8/16/2019, Staff #2, Staff #4 and Staff #6 did not have proof of previous child experience prior to working at the facility on file. Staff #4 also did not have proof of education on file.

Correction Required: A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: During a file review on 8/16/2019, Staff #5 and Staff #7 did not have two written, nonfamily references on file.

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: During a file review on 8/16/2019, it was observed that Staff #2, Staff #3 and Staff #6 did not have documentation of training regarding the emergency plan at initial employment. Each had been employed at the facility for more than seven days. In addition, Staff #1 had documentation that emergency plan training was completed on 6/3/2019. Staff #1 began employment on 5/2/2019.

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 5/16/2019, it was observed in large open area of the facility where the young toddler, older toddler and preschool groups are that the written plan of daily activities was not posted in this group space.

Correction Required: The written plan of daily activities shall be posted in the group space.

Noncompliance Area: On 5/16/2016, Staff #1, Staff #2 and Staff #3 admitted that "leashes" were used for Child #1 and Child #2 in the outdoor play area and on walks outside for safety. On 5/31/2019, Staff #4 stated that they had used the "leashes" to keep Child #1 and Child #2 safe.

Correction Required: A facility person may not use any form of physical punishment, including spanking a child. 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.

Noncompliance Area: It was verified through staff interviews and an accident/injury report on file at the facility that Child #1, age 2 was injured at the facility on 4/9/2019, Staff #1 documented that Child #1 was hit with an unknown object that was thrown by another child. On 5/10/2019, Staff #1 admitted that she did not see what Child #1 was hit with on 4/9/2019.

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. Children must be supervised at all times.

Noncompliance Area: It was verified through staff interviews and written statements that on or around 3/6/2019, Staff #1 held a child, age 2 down on the floor by putting her foot on the child while the child was laying down. The report was made on 3/20/2019 alleging that this happened two weeks prior.

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.

Noncompliance Area: An email chain showed that on 3/7/2019, the director replied to an email from an outside agency. This reply contained confidential information about a child that was unrelated to inspections and investigations by the Department. The email chain showed that the director's reply also went to several other child care facilities.

Correction Required: A facility person may not disclose information concerning a child or family, except in the course of inspections and investigations by agents of the Department.

Noncompliance Area: It was verified through verbal and written statements from staff that on the afternoon of 3/4/2019, Child #1, age 3 ran out of the building and was outside alone on the sidewalk in front of the building for at least 1 minute. A parent brought the child back into the facility. The facility was on a Settlement Agreement at the time of this incident for previous non-compliance with supervision.

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. Children must be supervised at all times. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: On the afternoon of 12/6/2018, the director reported that the heater in the facility was not working on 12/5/2018 and on the morning of 12/6/2018, until the heater was fixed earlier that afternoon on 12/6/2018. Director reported that the indoor temperature ranged from 54 F to 63 F during this time period. The director reported that portable space heaters were used during this time period.

Correction Required: The indoor temperature shall be at least 65 F. Portable space heaters are not permitted.

Noncompliance Area: On the morning of 11/29/2018, Child #1, an infant was observed sleeping in his crib with 2 stuffed animals sitting on his chest.

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

Noncompliance Area: Through staff interviews, it was verified that an infant child was given formula/food that belonged to another infant child on 11/8/2018.

Correction Required: New foods shall be introduced to an infant only after consultation with the child's parent.

Noncompliance Area: Staff files were reviewed on 11/29/2018. Staff #5 started employment on 9/18/2018. The child abuse clearance on file for Staff #5 was a volunteer clearance. Staff #7 started employment on 7/17/2018. The file proved that Staff #7 was fingerprinted on 7/16/2018. However, Staff #7 did not have the completed FBI clearance 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. Staff #5 and Staff #7 may not work in a child care position at the facility until all required clearances are on file.

Noncompliance Area: On 11/29/2018, Staff #6 and Staff #8 did not have proof of previous experience working in child care on file to show that they were qualified for the assistant group supervisor positions which they were observed performing.

Correction Required: A staff person or a substitute staff person shall meet one of the applicable staff qualifications for the position in which the person is performing. A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: On 11/20/2018, Staff #2 admitted that on 10/31/2018, she left the Infant room for approximately 5 minutes, which left the other staff alone for 5 minutes with 5 Infants and 2 Toddlers. On 11/29/2018 at 8:19AM, Staff #3 and Staff #4 were observed working with 9 Younger Toddlers and 1 Infant.

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 in 3270.51 (relating to similar age level). The required staff:child ratios must be maintained at all times.

Noncompliance Area: On 11/8/2018 at 8:30AM, Staff #1 was observed to be working alone with 6 young toddlers. Staff #2 and Staff #3 were then observed to be working with 13 older toddlers.

Correction Required: When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30. The required staff:child ratios must be maintained at all times.

Noncompliance Area: During the inspection on 6/27/2018, the rest cots in the Toddler 1 area were 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: During the inspection on 7/10/2018, the emergency contact information for Child #2 did not have the health insurance coverage or policy number. The health insurance policy number was not listed for Child #3.

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: During the inspection on 7/10/2018, the following was observed: The most recent health report on file for Child #1, an infant dated 12/6/2017, the most recent health report on file for Child #2, a young toddler dated 10/31/2017, the most recent health report on file for Child #3, a young toddler dated 12/20/2017, Child #4 has attended since 5/1/2018, but does not have any immunization record on file.

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. The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.

Noncompliance Area: During the inspection on 6/27/2018, the diaper changing pad in the Infant classroom was ripped with foam exposed; thus it could be sanitized properly.

Correction Required: Diaper changing surfaces shall be cleaned after each use by wiping the surface with a sanitizing solution or by changing a pad or other surface covering.

Noncompliance Area: During the inspection on 6/27/2018, three expired yogurts with expiration dates of 5/23/2018(2) and 5/26/2018(1) were seen in the refrigerator in the Infant classroom.

Correction Required: Food stored, prepared or served shall be clean, wholesome, free from spoilage, free from adulteration and safe for human consumption.

Noncompliance Area: The financial agreement for Child #5 has not been updated since 9/12/2017. The emergency contact information and financial agreement for Child #6 have not been updated since 8/28/2017.

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: During the inspection on 6/27/2018, Staff #1 and Staff #5 only had one written nonfamily reference on file. Staff #2 and Staff #3 did not have any written nonfamily references on file. On 7/10/2018, Staff #4 did not have any written nonfamily references on file.

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: During the inspection on 6/27/2018, peeling paint was seen on one of the cribs in the Infant classroom and on the wall in the Toddler 2 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: A complaint visit was conducted. Through staff interviews on 3/22/2018 and 3/28/2018, it was verified that the older toddler group and a mixed group of infants and young toddlers were both out of ratio for at least 20 minutes on the morning of March 9, 2018 during the time frame of 7:45AM to 8:15AM. Staff #1 was with 10 older toddlers. Staff #2 and Staff #3 were with at least 12 infants and young toddlers. It was also admitted through a discussion with the legal entity on 3/28/2018 that the facility was out of ratio for 20 minutes on the morning of March 9, 2018 during the time frame of 7:45AM to 8:15AM.

Correction Required: When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30. The required staff:child ratios must be maintained at all times. 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 in 3270.51 (relating to similar age level). The required staff:child ratios must be maintained at all times. The facility will develop a written plan on how to proceed when staff call out sick. All facility staff will review and sign the plan.

Noncompliance Area: In the Young Toddler classroom, a purse with medication in it was observed in an unlocked cabinet accessible to children in the classroom. An expired bottle of children's ibuprofen was seen in the cabinet above the Young Toddler diapering area. Three expired tubes of diaper cream were also seen during the facility walk through.

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: The diaper changing pad in the Young Toddler diapering area was ripped with foam exposed; thus it could not be sanitized properly.

Correction Required: Diaper changing surfaces shall be cleaned after each use by wiping the surface with a sanitizing solution or by changing a pad or other surface covering.

Noncompliance Area: Staff #3 has been employed since 12/4/2017, but does not have any written, nonfamily references on file.

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 child abuse clearances that were on file for Staff #1 and Staff #2 on 1/10/2018 were volunteer clearances.

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

Noncompliance Area: On the date of this inspection (7/24/17), STAFF # 2 was viewed diapering children. STAFF # 2 failed to wash their hands as well as the chil's hands. Staff # 2 also did not wash the changing pad after diapering the child.

Correction Required: A staff person shall ensure that a child`s hands are washed before meals and snacks, after toileting and after being diapered.Diaper changing surfaces shall be cleaned after each use by wiping the surface with a sanitizing solution or by changing a pad or other surface covering.

Noncompliance Area: At a renewal inspection on 6/28/17, toileting/diapering was viewed. Staff # 1 and Staff # 2 did not wash their hands after each individual diaper change of the children. AT AN UNANNOUNCED MONITORING VISIT ON 7/24/17, STAFF # 2 WAS AGAIN VIEWED DIAPERING CHILDREN. STAFF # 2 FAILED TO WASH THEIR HANDS AS WELL AS THE CHILD'S AND THE CHANGING PAD AREA AFTER DIAPERING THE CHILD.

Correction Required: A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

Noncompliance Area: On the date of this inspection (7/24/17), STAFF # 2 was viewed diapering children. STAFF # 2 failed to wash their hands as well as the chil's hands. Staff # 2 also did not wash the changing pad after diapering the child.

Correction Required: A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

Noncompliance Area: On the date of this inspection, child files were reviewed. Child # 1 had a date of enrollment of 2/6/17 and the file was missing an initial health assessment.

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.A child`s record shall contain initial and subsequent health reports.

Noncompliance Area: On the date of this inspection, toileting/diapering was viewed. Staff # 1 and Staff # 2 did not wash their hands after each individual diaper change of the children.

Correction Required: A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

Noncompliance Area: On the date of this inpection, while observing toileting/diapering, Staff # 2 was with a group of 5 toddlers. This group of 5 toddlers were acting out and trying to leave the group. As a form of punishment Staff # 2 stated the children would not receive dessert with lunch.

Correction Required: Food may not be withheld from a child for purposes of discipline.

Noncompliance Area: On the date of this inspection, staff files were viewed. Staff file 1 had a date of hire of 3/22/17 and the file did not contain proof of mandated reporter training.

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 #--- may not work in a child care position at the facility.

Noncompliance Area: On the date of this inspection, the facility's fire drill log was viewed. Fire drills that occured on 11/16/16 and 2/3/17 lapsed 60 days. A fire drill was conducted on 4/2/17 and the facility could not find documentation of a fire drill that occured within 60 days after this date at the time of the inspection.

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

Noncompliance Area: On the date of this inspection and through staff interviews, it was revealed that Staff # 2 was found by the director sleeping at nap time on a previous day. Staff # 2 was supposed to be supervising a group of napping toddlers.

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. Children must be supervised at all times. The legal entity will review and edit the current supervision policy to include spefic language that addresses supervision at nap time. The legal entity will seek DHS approval of the new policy and after DHS approval will review with all staff. The legal entity will obtain signatures from all staff to indicate their review of the revised policy.

Noncompliance Area: On the date of this inspection and through staff interviews, it was revealed that Staff # 1 had made comments such as "this kid is being a brat" and "these kids are driving me nuts". Staff # 2 pulled a child from the group and sent them to another group in the facility and yelled to the other staff to not send the child back because they could not deal with the child's behavior anymore. Staff # 1 and Staff # 2 were described during interviews as showing frustration when working with the children and were seen making comments that included curse words, sexuality jokes and a child's speech impairment.

Correction Required: A facility person may not single out the child for ridicule, threaten harm to the child or the child`s family and may not specifically aim to degrade the child or the child`s family. Staff # 1 and Staff # 2 shall be supervised by someone qualified as an assistant group supervisor or higher at all times until completion of appropriate training (required for 3270.113(d) violation).

Noncompliance Area: On the date of this inspection and through staff interviews, it was revealed that Staff # 1 had made comments such as "this kid is being a brat" and "these kids are driving me nuts". Staff # 2 pulled a child from the group and sent them to another group in the facility and yelled to the other staff to not send the child back because they could not deal with the child's behavior anymore. Staff # 1 and Staff # 2 were described during interviews as showing frustration when working with the children and were seen making comments that included curse words, sexuality jokes and a child's speech impairment.

Correction Required: A facility person may not use harsh, demeaning or abusive language in the presence of children. The legal entity will arrange for Staff # 1 and Staff # 2 to attend training regarding appropriate communication used around and with children. The legal entity will seek DHS approval of the content of the trainnig prior to scheduling the training. The legal entity will ensure training is PQAS approved.

Noncompliance Area: During this inspection, three dirty diapers were found in the sink next to the chaning area in the infant room.

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: Lunch served to the children on the day of this inspection only included a hot dog, puffs, pink lemonade or water and milk.

Correction Required: A lunch or dinner prepared at the facility for children of toddler age or older shall include at least one fruit and vegetable.