Creative Minds Learning & Development Centers Llc

Noncompliance Area: SECOND CITATION- On 09/11/2020 at 7:10 am, classroom #1 did not have emergency contact information for child #1, while receiving care in the child care space. At 7:30 am, child #1 was moved to classroom #2 which also did not have emergency contact information in the child care space for child #1. Previously cited on 06/02/2020

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: On 09/11/2020, at approximately 7:30 am, observed staff person #1 take an infant from classroom #1 over to the infant classroom, which is down the hallway, through the entrance lobby and into the classroom on the other side of the lobby. Staff person #1 was unsupervised by a permanent employee during this time. The file for staff person #1, with an initial start date of 07/20/2020, lacked FBI clearance results or documentation of a request for a DHS FBI clearance. The file contained a request for a PDE FBI clearance dated 07/05/2020. The file did not have a signed disclosure statement. The file contained a copy of the request for the NSOR clearance dated 07/20/2020 with the results of the NSOR dated 07/23/2020, a PSP criminal history clearance dated 07/05/2020 and a child abuse clearance dated 07/07/2020. Staff person #1 who was working in a capacity of a provisional hire did not have proper provisional hire documents on file at the time of hire.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person #1 may not work in a child care position at the facility. PROVISIONAL HIRE UNSUPERVISED: A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

Noncompliance Area: On 09/11/2020, at approximately 7:30 am, observed staff person #1 (an aide) take an infant from classroom #1 over to the infant classroom, which is down the hallway, through the entrance lobby and into the classroom on the other side of the lobby. Staff person #1 was unsupervised by a staff person qualified at a minimum as an assistant group supervisor during this time.

Correction Required: An aide or a combination of aides shall be supervised at all times by a staff person qualified at minimum as an assistant group supervisor.

Noncompliance Area: The file for staff person #1, with a hire date of 01/27/2020, lacked an initial health assessment with the results of a tuberculosis screening at the time of initial employment. The health assessment and TB screening results on file were dated 02/01/2020.

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

Noncompliance Area: The file for staff person #1, with a hire date of 01/27/2020, lacked the NSOR verification certificate. The file contained documentation of a request for the NSOR verification dated 01/14/2020 and a second request dated 06/04/2020.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person #1 may not work in a child care position at the facility. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

Noncompliance Area: On 06/02/2020 at 7:35 am, classroom #2 lacked emergency contact information for children #1, #2, #3 and #4 while receiving care in the child care space. At 8:30 am, classroom #9 lacked emergency contact information for children #5 and #6 while receiving care in the child care space.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: Observed a bottle of bleach cleaner on top of the cubbies next to the opening leading into room 3 which was accessible to preschool and school-age 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: Several staff stated they witnessed child #1 having a temper tantrum in the classroom and threw a plastic toy bin, in response, staff person #1 picked up the bin and threw it back toward the child and the bin landed in front of the child.

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

Noncompliance Area: Staff interviewed verified that on various mornings in February and March between the hours of 6:30 - 8:30 am, there were classrooms at the facility that were over-ratio for a few minutes to up to a half hour or longer in the toddler, preschool and infant rooms.

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).

Noncompliance Area: In Room 3, an orange plastic toy bin and a purple plastic toy bin were observed to have cracks, exposing children to pinch points and 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: The refrigerator in the Left Side Room 2 was lacking an operating thermometer.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: The emergency contact form in the file for Child #5 lacked the health insurance coverage information and 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 files for Child #1, #2, #3, #5, #6, #8, and #9 contained emergency contact forms and agreements that had not been reviewed by the parents in the last 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.

Noncompliance Area: The files for Child #4 and Child #7 lacked initial health reported within the first 60 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.

Noncompliance Area: The file for Child #8, an infant, contained a most recent health report dated 03/01/2019; lacking an updated health report in 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 #1, an older toddler, contained an initial health assessment dated 09/11/2018, but lacked a health assessment in the last 12 months. The file for Child #2, a preschooler, contained health assessments dated 09/13/2018 and 10/9/2019; more than 12 months passed between health assessments.

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 files for Child #1 and Child #5 lacked documentation of up to date flu vaccinations in accordance with the schedule recommended by the ACIP. The file for Child #8 lacked documentation of up to date Rotavirus, DTAP, HIB, Pneumococcal, and Polio vaccinations 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: An expired ventolin inhaler was observed in the medication box, with an expiration date of October 2019; the medication log contained documentation that the medication had been administered after the expiration date.

Correction Required: Medication shall be stored in accordance with the manufacturer's or health professional's instructions on the original label.

Noncompliance Area: The file for Facility Person #8 contained health assessments dated 10/15/2017 and 11/20/2019; more than 24 months passed between health assessments.

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 Facility Person #3 lacked documentation of verified child care experience or education prior to service at the facility. The file for Facility Person #4 lacked documentation of education prior to service at the facility.

Correction Required: A facility person's record shall include verification of child care experience, education and training prior to service at the facility. A facility person's record shall include acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

Noncompliance Area: The file for Facility Person #7 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 files for Facility Person(s) #1, #3, #4, #6, and #7 lacked documentation of emergency plan training at the time of initial employment.

Correction Required: The operator shall assure that each facility person receives training regarding the emergency plan at the time of initial employment, on an annual basis and at the time of each plan update. The operator shall document the date of each training and the names of all facility persons who received the training and kept on file at the facility.

Noncompliance Area: The file for Facility Person #2, start date 10/07/2019, lacked a completed National Sex Offender Registry clearance. The file for Facility Person #3, start date 05/10/2019, contained a disclosure statement signed 06/03/2019 and mandated reporter training dated 10/06/2019. The file for Facility Person #4, start date 05/10/2019, lacked documentation of completed mandated reporter training. The file for Facility Person #7, start date 10/01/2019, lacked a completed request for the National Sex Offender Registry clearance.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. 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 and Facility Person #7 may not work in a child care position at the facility.

Noncompliance Area: A power strip in Room 3 was observed to be lacking a protective receptacle cover and was accessible to children. An electrical outlet in Room 2 was observed to be lacking a protective receptacle cover and was accessible to children.

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

Noncompliance Area: The first aid kit in the outdoor bag for the preschoolers lacked soap. The first aid kits in the outdoor bags for the young toddlers lacked scissors and soap. The first aid kit in the outdoor bag for the older toddlers lacked soap.

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: The door leading from Room 2 to the hallway next to the office was obstructed by a Step 2 play kitchen. The door leading from the Left Side Room 2 into the Left Side Room was obstructed by a high chair.

Correction Required: Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

Noncompliance Area: 2nd CITATION: The file for child #3 lacked documentation of a completed child service report. PREVIOUSLY CITED ON 11/27/2018.

Correction Required: 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 in 3270.124(f) (relating to emergency contact information).

Noncompliance Area: 2nd CITATION: The infant classroom lacked a copy of the emergency contact information for child #4 (enrollment date 01/14/2019) while receiving care in the child care space. PREVIOUSLY CITED ON 11/27/2018.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: The files for children #1 and #2 lacked the withdrawal date on the agreement form.

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

Noncompliance Area: 2nd CITATION: The file for staff person #1 lacked documentation of education to qualify as an aide. PREVIOUSLY CITED ON 11/27/2018.

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: 2nd CITATION: The file for staff person #2 lacked two written nonfamily references; only one written nonfamily reference attesting to the person's suitability to serve as a facility person was in the staff file. PREVIOUSLY CITED ON 11/27/2018.

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: 2nd CITATION: At approximately 1:05 pm staff person #1 was observed working alone in the preschool classroom with 14 preschoolers during naptime. PREVIOUSLY CITED ON 11/27/2018.

Correction Required: An aide or a combination of aides shall be supervised at all times by a staff person qualified at minimum as an assistant group supervisor.

Noncompliance Area: On 01/15/2018 at approximately 1:05 pm, observed a staff member signing out for a break and leave the facility during naptime. At that time there were 9 staff members remaining with no additional staff in the facility. The following staff to child ratios were observed during naptime in the large classroom located in the area next to the main office: 2 staff with 10 older toddlers (older toddler classroom #1), 1 staff with 8 younger toddlers (young toddler classroom #1), 1 staff with 14 preschoolers. There was 1 staff with 6 older toddlers in classroom next to the storage room (older toddler classroom #2). The infant classroom had 3 staff with 10 infants and the younger toddler classroom #2 had 1 staff to 5 young toddlers.

Correction Required: Staff persons who are on duty but are not providing child care during naptime shall remain in the child care portion of the facility premises.

Noncompliance Area: According to video footage taken on 12/13/2018 and viewed during the investigation on 12/27/2018, child #2 walked up to child #1 and shoved them to the floor. Child #2 then shoved child #1 back down a second time while they were attempting to stand back up again. After child #1 was back on their feet, child #2 came toward child #1 and shoved them again. Child #2 then grabbed and scratched the face of child #1. Child #2 then hit child #1 on the head with their hand. From additional video footage viewed, staff person #1 was observed helping 3 children put books on a shelf along the wall between the young toddler and the preschool classrooms and had her back to the young toddlers in the classroom while putting the books on the shelf and handing a bin over the wall to one of the preschool children. Staff person #1 was unable to see what happened between child #1 and child #2 during the incident between the two 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.

Noncompliance Area: On 12/11/2018, child #3 was injured at the facility and taken to the emergency room by the parent after being picked up from the facility. The operator did not notify the regional office within 24 hours of the incident.

Correction Required: The operator shall immediately notify a child's parent and shall telephone notice to the appropriate regional office within 24 hours if a child in care at the facility is hospitalized or receives emergency room treatment.

Noncompliance Area: On 12/11/2018, child #3 was injured at the facility and taken to the emergency room by the parent after being picked up from the facility. The operator did not send a written report to regional office within 72 hours of the incident.

Correction Required: The operator shall mail or deliver a written report to the appropriate regional office within 72 hours after hospitalization of a child in care, emergency room treatment of a child in care, death of a child in care, a facility fire requiring the services of a fire department

Noncompliance Area: On 12/13/2018, child #1 was scratched by child #2. The incident report completed by staff person #1 was signed and dated on 12/20/2018. According to the incident report the incident occurred on 12/20/2018 at 7:46 am. According to the Smart Care notification sent to the parent on 12/13/2018 at 7:46 am, the incident occurred just prior to the notification sent to the parent.

Correction Required: A report of injury, death or fire shall include a description of the incident, including the date, time and location of the incident and the equipment involved.

Noncompliance Area: On 12/11/2018, child #3 was injured at the facility and taken to the emergency room by the parent after being picked up from the facility. The incident report on file lacked documentation of the nature of the treatment.

Correction Required: A report of injury, death or fire shall include the nature of the treatment.

Noncompliance Area: On 12/11/2018, child #3 was injured at the facility and taken to the emergency room by the parent after being picked up from the facility. The incident report on file lacked the name and address of the emergency room where treatment was received.

Correction Required: A report of injury, death or fire shall include the name and address of the place where the treatment was received.

Noncompliance Area: On 11/27/2018, observed an infant sleeping in a Fisher Price Rock 'N Play Infant Sleeper which had been recalled by the CPSC in 2013 due to the risk of exposure to mold.

Correction Required: Children's toys and equipment, including furniture and rest equipment, described as hazardous by the United States Consumer Product Safety Commission may not be used by children at the facility and may not be on the premises at the facility. At the time of inspection, the operator shall submit to the Department written affirmation on a form provided by the Department stating that the facility is in compliance with this requirement.

Noncompliance Area: On 11/27/2018 at approximately 8:10 am, observed staff person #11 place child #9 into a Pack 'N Play which was not labeled for use for child #9; the Pack 'N Play was not labeled for use by any specific child. At approximately 1:40 pm, observed 18 preschool and school-age children resting on mats in the preschool/school-age classroom; the mats were labeled with a numbering system, the coordinating chart was incomplete with names missing from the chart.

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 older toddler classroom located next to the storage room in the child care area to the right of the office lacked a written plan of daily activities and routines posted in a conspicuous location.

Correction Required: A written plan of daily activities and routines, including a time for free play shall be established for each group. The plan shall be flexible to accommodate the needs of individual children and the dynamics of the group. The written plan of daily activities shall be posted in the group space.

Noncompliance Area: On 11/27/2018 at approximately 7:55 am, observed staff persons #7 and #10 working in the toddler classroom with a group of 15 young and older toddlers. Staff person #10 identified 5 children they were responsible for and staff person #7 stated they were responsible for all of the children together. On 11/27/2018 at approximately 8:05 am, observed staff persons #14 and #15 sitting on the floor preparing plates of food for the young toddlers in the large classroom divided by a plastic gate system ; 9 young toddlers were seated at the table and 2 young toddlers were seated in high chairs across the room. Staff persons #14 and #15 were seated with their backs to the children while preparing the food and were unable to see, hear, direct and assess the children sitting at the table.

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.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 11/27/2018 at approximately 8:05 am, observed child #8 asleep in a Rock 'N Play Infant Sleeper; observed child #8 wake-up in the Rock 'N Play Infant Sleeper at approximately 8:15 am. Staff person #11 stated child #8 "wasn't asleep very long". Staff person #11 checked the log and noted child #8 fell asleep at 8:03 am.

Correction Required: Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

Noncompliance Area: The file for child #5 lacked the amount of the fee to be charged on the agreement form.

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

Noncompliance Area: The files for children #3 and #6 lacked the services to be provided to the family and the child on the agreement form. The file for child #1, with an enrollment date of 08/29/2016, lacked child service reports completed at least once every 6 months; the most recent child service report on file was dated 08/10/2018 with no additional child service reports on file. The file for child #3, with an enrollment date of 03/26/2018, lacked a timely child service report at least once every 6 months, the most recent child service report on file was dated 11/19/2018 with no additional child service reports on file. The files for child #5 (enrollment date: 08/14/2017) & child #7 (enrollment date: 10/16/2017), lacked documentation of any completed child service reports. The file for child # 6 with an enrollment date of 04/09/2018, lacked a timely child service report at least once every 6 months, the most recent child service report on file was dated 11/19/2018 with no additional child service reports on file.

Correction Required: 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 in 3270.124(f) (relating to emergency contact information).

Noncompliance Area: The file for child #5 lacked the child's arrival and departure times on the agreement form.

Correction Required: An agreement shall specify the child's arrival and departure times.

Noncompliance Area: The files for children #3 and #6 lacked the names of the persons designated by a parent to whom the child may be released on the agreement form.

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

Noncompliance Area: The file for child #2 lacked the date of the child's admission on the agreement form.

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

Noncompliance Area: The file for child #5 lacked the address of the child's physician or source of medical care on the emergency contact form.

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 #1 lacked the complete work address of the enrolling parent on the emergency contact form. The file for child #7 lacked the complete home and work address of the enrolling parent on the emergency contact form.

Correction Required: Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent.

Noncompliance Area: The files for children #5 and #7 lacked written parental consent for emergency medical care prior to admission.

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.

Noncompliance Area: The file for child #1 lacked the health insurance policy number on the emergency contact form.

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 lacked the complete addresses of the individuals designated by the parent to whom the child may be released on the emergency contact 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: On 11/27/2018, the infant classroom located in the large room divided by a plastic gate system lacked a copy of the emergency contact information for children #8, #9 and #10. The young toddler classroom located in the large room divided by a plastic gate system lacked a copy of the emergency contact information for child #12 while receiving care in the space. The young toddler classroom located to the left of the office lacked a copy of the emergency contact information for children #13, #14, #15, #16 and #17 while receiving care in the space. The older toddler classroom located to the right of the office lacked a copy of the emergency contact information for children #3, #19, #20, #21, #22 and #23. The older toddler classroom located in the large room with half walls lacked a copy of the emergency contact information for children #18 and #25 while receiving care in the child care space. The preschool/school-age classroom lacked emergency contact information for child #24 while receiving care in the child care space.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: The young toddler classroom located to the left of the office and the older toddler classroom located to the right of the office lacked a posting of the means of transporting a child to emergency care and staffing provisions in the event of an emergency in a conspicuous location in the classroom.

Correction Required: A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency shall be displayed conspicuously in every child care space and shall accompany a staff person who leaves on an excursion with children.

Noncompliance Area: The file for child #1 (enrollment date: 08/29/2016) lacked a timely review of the emergency contact form and agreement form at least once every 6 months; the most recent review was dated 08/14/2018 with the previous review dated 01/27/2017. The file for child #3 (enrollment date 03/23/2018 lacked a timely review of the emergency contact form and agreement form within a 6-month period following initial enrollment. The file for child #5 (enrollment date 08/14/2017) lacked a timely review of the emergency contact and agreement form at least once every 6 months; the most recent review was dated 10/08/2018 with no previous reviews documented. The file for child #6 (enrollment date 04/09/2018) lacked a timely review of the emergency contact and agreement form at least once every 6 months, the most recent review was dated 11/26/2018 with no additional reviews documented. The file for child #7 (enrollment date 10/16/2017) lacked a timely review of the emergency contact and agreement form at least once every 6 months, the most recent review was dated 04/09/2018 with no additional reviews documented.

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.

Noncompliance Area: The file for child #5 (enrollment date 08/14/2017) lacked an initial health report within 60 days following the first day of attendance at the facility; the file contains an initial health report dated 05/14/2018. The file for child #7 (enrollment date 10/16/2017) lacked an initial health report within 60 days following the first day of attendance at the facility; the file contains an initial health report dated 03/22/2018.

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.

Noncompliance Area: The file for child #5 (enrollment date 08/14/2017) lacked an updated health report at least once every 6 months for a young toddler; the most recent health report on file is dated 05/14/2018 with no additional health reports on file. The file for child #7 (enrollment date 10/16/2017) lacked an updated health report at least once every 6 months for a young toddler, the most recent health report on file is dated 03/22/2018 with no additional health reports 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

Noncompliance Area: The file for child #3 (enrollment date 03/26/2018) lacked a statement that the child is able to participate in child care and appears to be free from contagious or communicable diseases on the initial health report dated 02/14/2018.

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 diaper changing area located in the young toddler classroom located to the left of the office lacked a hands-free covered can for the disposal of soiled diapers; observed a trash can with a flip lid in the diaper changing area.

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 #9 (Hire date 10/09/2018) lacked an initial health assessment prior to providing initial service in a child care setting; the health assessment on file is dated 11/15/2018. The file for staff person #11 (Hire date 11/18/2017) lacked an initial health assessment w/TB screening results prior to providing initial service in a child care setting; the health assessment on file is dated 11/24/2017 and a TB screening dated 12/17/2017. The file for staff person #12 lacked an updated health assessment at least once every 24 months; the most recent health assessment on file is dated 10/24/2016 with no additional health assessment 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.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: The file for staff person #5 (Hire date 02/24/2018) lacked documentation of TB screening results prior to providing initial service in a child care setting; the file contains a health assessment dated 07/07/2017 with no information of the TB screening results on the health assessment form.

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 files for staff person #2 and staff person #8 lacked a statement by the physician or CRNP that the person is free from communicable diseases and is suited to provide child care on the health assessment form

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: On 11/27/2018 at approximately 8:05 am, observed staff persons #14 and #15 sitting on the floor preparing plates of food for the young toddlers in the large classroom divided by a plastic gate system ; the plates were on the floor while food was being served onto the plates.

Correction Required: Food handling practices shall conform to the requirements of the Department of Health or the Department of Environmental Resources or its delegate agency where the child care facility is located.

Noncompliance Area: The infant classroom lacked a written statement from the parent giving the formula and feeding schedule for children #6 and #11; according to staff in the room they were "not sure where the feeding schedule was".

Correction Required: A written statement giving the formula and feeding schedule for an infant shall be obtained from the parent.

Noncompliance Area: The bottles for child #8 lacked a label with the child's name.

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

Noncompliance Area: The operator did not notify the local traffic safety authorities annually in writing of the location of the facility and the program's use of pedestrian and vehicular routes around the day care facility.

Correction Required: An operator shall notify local traffic safety authorities annually in writing of the location of the facility and the program's use of pedestrian and vehicular routes around the day care facility.

Noncompliance Area: The form in the files for children #1, #3, #5, #6 and #7 utilized by the facility for the periodic review process lacked a space to receive a dated signature by the parent to attest to the accuracy of the information on the emergency contact form and agreement form

Correction Required: Following review, a parent shall attest to the accuracy of information in the emergency contact information and the financial agreement at each review by affixing a dated signature to the record.

Noncompliance Area: The file for child #1 (enrollment date 08/29/2016) lacked copies of the initial and subsequent health reports; the most recent health report on file is dated 08/24/2018 with no additional health reports on file.

Correction Required: A child's record shall contain initial and subsequent health reports.

Noncompliance Area: The files for children #5 and #7 lacked written parental consent for administration of minor first-aid procedures by facility staff prior to admission.

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.

Noncompliance Area: The file for staff person #3 & #9 lacked documentation of education prior to service at the facility to qualify as an aide.

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: The file for staff persons #1 and #11 lacked two written nonfamily references; only one written nonfamily reference attesting to the person's suitability to serve as a facility person was in the staff file. The file for staff persons #3 and #9 lacked two written nonfamily references attesting to the person's suitability to serve as a facility person.

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 files for staff persons #1, #2, #3, #4, #5, #6, #7, #8, #9, #12 and #13 lacked documentation of training regarding the emergency plan at the time of initial employment.

Correction Required: The operator shall assure that each facility person receives training regarding the emergency plan at the time of initial employment, on an annual basis and at the time of each plan update. The operator shall document the date of each training and the names of all facility persons who received the training and kept on file at the facility.

Noncompliance Area: The facility lacked a posting of the emergency plan at a conspicuous location; the emergency plan had been moved to a bulletin board in the director's office.

Correction Required: The operator shall post the emergency plan in the facility at a conspicuous location.

Noncompliance Area: The files for staff persons #10 & #11 lacked fire safety training annually. The most recent documentation of fire safety training for staff person #10 was dated 10/23/2017 with no additional training on file. The most recent documentation of fire safety training for staff person #11 was dated 09/28/2017 with no additional training on file.

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

Noncompliance Area: The file for staff person #3 (Hire date 10/26/2018) lacked a signed disclosure statement at the time of hire; a disclosure statement dated 11/15/2018 was observed in the file. The file for staff persons #8 (Hire date 07/17/2018) lacked a child abuse clearance for the purpose of employment, the file contained a volunteer child abuse clearance dated 06/30/2017. The file for staff person #9 (Hire date: 10/09/2018) lacked complete provisional hire documentation at the time of hire. The file for staff person #9 contained a signed disclosure statement dated 10/10/2018, a state police clearance dated 11/15/2018 with the same request date, a child abuse clearance dated 10/12/2018 with the same request date, a receipt for FBI fingerprinting completed on 11/19/2018. On 11/27/2018 at approximately 1:40 pm staff person #9 was observed working alone with children in the preschool/school-age classroom. The file for staff person #12 (Date of hire 09/01/2018) lacked a signed disclosure statement at the time of hire; a recent disclosure statement dated 11/26/2018 and a signed disclosure statement from a previous employer dated 06/09/2014 was observed in the file. The file for staff person #13 (Date of hire 09/01/2018) lacked a signed disclosure statement at the time of hire; a signed disclosure statement from a previous employer dated 06/08/2015 was observed in the file.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person # 3 & #9 may not work in a child care position at the facility. A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. 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 #3 & #9- may not work in a child care position at the facility.

Noncompliance Area: Observed staff person #11 working in the infant classroom as an Assistant Group Supervisor; the file for staff person #11 included documentation of a high school diploma and lacked verification of child care experience to qualify as an AGS.

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 following the outset of service at the facility.

Noncompliance Area: The files for staff persons #10 and #11 lacked a written evaluation at least once every 12 months. Written evaluations for staff persons are currently not completed on a regular basis by the director .

Correction Required: A director is responsible for written evaluation of staff persons on a regular basis, a minimum of one evaluation every 12 months.

Noncompliance Area: The file for staff person #5 lacked verified documentation of 1 year of experience working with children to qualify as a director.

Correction Required: A director shall have attained a bachelor's degree from an accredited college or university in early childhood education, child development, special education, elementary education or the human services field and 1 year of experience with children. A facility person's record shall include acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

Noncompliance Area: On 11/27/2018 at approximately 8:00 am, staff person #13, was observed working alone in the preschool/school-age classroom with 8 preschoolers and 3 school-age children. On 11/27/2018 at approximately 8:05 am, staff person #11 was observed working alone in the infant classroom with 5 infants. On 11/27/2018 at approximately 8:30 am, staff persons #9 and #13 were observed working together in the preschool/school-age room without supervision by a staff person qualified at minimum as an assistant group supervisor. On 11/27/2018 at approximately 1:40 pm staff person #9 was observed working alone in the preschool/school-age classroom with 15 preschoolers and 3 school age children.

Correction Required: An aide or a combination of aides shall be supervised at all times by a staff person qualified at minimum as an assistant group supervisor.

Noncompliance Area: On 11/27/2018 at approximately 8:05 am, observed staff persons #7 and #10 working in the young toddler classroom with 11 young toddlers; at approximately 8:20 am another young toddler entered the classroom. At approximately 8:05 am, observed staff person #11 working alone in the infant classroom with 5 infants; at approximately 8:15 am staff person #7 came into the classroom to help with the infants.

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 requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in 3270.51--3270.55.

Noncompliance Area: On 11/27/2018 at approximately 7:55 am, observed staff persons #7 and #10 working in the toddler classroom with a group of 15 young and older toddlers. At approximately 8:00 am, observed staff person #13 working alone in the preschool/school-age classroom with 8 preschool and 3 school-age children.

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 requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in 3270.51--3270.55.

Noncompliance Area: Observed the lock on the storage closet door next to the older toddler classroom was unlocked; the lower shelf (second shelf up from the floor) immediately across from the doorway contained starch, shaving cream, Elmer's Craft Bond, hair styling gel and hand sanitizer gel which were all labeled "Keep out of reach of 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: Observed the bag containing the first-aid kit resting on the half wall located in the preschool/school-age classroom during lunchtime which was accessible to the children in care.

Correction Required: A first-aid kit must be inaccessible to children.

Noncompliance Area: The first-aid kit located in the young toddler classroom located in the small classroom to the left of the office lacked soap, sterile gauze pads and nonporous gloves. The first aid kit located in the preschool/school-age classroom lacked soap and nonporous gloves. The first-aid kit located in the older toddler classroom located next to the storage room in the child care area to the right of the office lacked tweezers, soap, sterile gauze pads and nonporous gloves.

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: The sink and diapering area located in the younger toddler classroom located to the left of the office lacked handwashing signs

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: The younger toddler classroom located to the left of the office lacked a posting with the evacuation routes.

Correction Required: Evacuation routes shall be posted.

Noncompliance Area: Observed children putting toys in their mouths that were previously soiled by secretions from another child.

Correction Required: Toys soiled by secretion or excretion shall be cleaned with soap and water, rinsed and sanitized before being used by a child.

Noncompliance Area: Regulation first cited on 12/13/2016 and again on 2/6/2018 -A tube of First Aid Antibiotic Cream, labeled Keep Out of Reach of Children was located on a low shelf of the changing table in the restroom making it accessible to the children. A tube of cortisone cream labeled Keep Out of Reach of Children was located in a Princess backpack handing on a hook in a cubby and accessible to the children.

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.

Noncompliance Area: Staff Person #1 identified 10 children in her group with the youngest child being a young toddler. Staff Person #3 identified 12 children in her group with the youngest being of preschool age. Staff Person #4 identified 9 children in her group with the youngest being a young toddler. There were no other staff members in the building for the facility to maintain regulated ratio requirements.

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: During naptime Staff Person #1 identified 10 children in her group with the youngest child being a young toddler. Staff Person #3 identified 12 children in her group with the youngest being of preschool age. Staff Person #4 identified 9 children in her group with the youngest being a young toddler.

Correction Required: The staff:child ratio while toddlers and preschoolers are napping is one staff person to 10 young toddlers, one staff person to 12 older toddlers, one staff person to 20 preschool children

Noncompliance Area: Staff Person #6, who was on duty but not providing child care during naptime, left the facility premises.

Correction Required: Staff persons who are on duty but are not providing child care during naptime shall remain in the child care portion of the facility premises.

Noncompliance Area: Protective receptacle covers were missing in the infant area, the preschool area, the room next to the kitchen and the room across from the Art Closet.

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

Noncompliance Area: A can of Barbasol Shaving Cream labeled Keep Out of Reach of Children, was located on an accessible shelf in the unlocked Art Closet. The following toxics: Cascade Liquid Dishwasher Detergent, Clorox Fresh Meadow Bleach, Windex and Comet Multi Purpose cleaner, all labeled Keep Out of Reach of Children, were located in an unlocked cabinet under the sink in the kitchen area. Children use the sink to wash their hands and the area is accessible to the children at all times.

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: There was no thermometer in the refrigerator located in the infant section.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: The file for Child #1 - #4 lacked documentation of 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.

Correction Required: 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 in 3270.124(f) (relating to emergency contact information).

Noncompliance Area: The agreements for Child #1 and #3 did not specify the child's arrival and departure times.

Correction Required: An agreement shall specify the child's arrival and departure times.

Noncompliance Area: The emergency contact information for Child #4 lacked the address and phone number of the child's physician.

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 emergency contact information for Child #2 and #4 did not include the policy number for the child's health insurance coverage.

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.