Destini S Daycare Inc

Noncompliance Area: In the indoor playspace a red square mat was observed to be torn and the foam was exposed.

Correction Required: Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

Noncompliance Area: In multiple areas, including back corner by the yellow slide, there were many tiny beads that were loose the children could place in their mouth on the poured-in-place surface in the outdoor playspace.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Noncompliance Area: In the outdoor playspace a first-aid kit was observed in a backpack on the ground by bench accessible to the children.

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

Noncompliance Area: In the outdoor playspace, two holes were observed in the poured surface the larger hole near the climbing wall that is 8 inches across and two inches deep had an exposed metal spring that is a tripping hazard. The second hole is at the bottom of the first slide walking into the playspace it measures 5 inches across and 1 inch deep. At the edge of the poured surface under the second panel over from the door into the playspace there is a 6 inch across and 1 inch place where the poured surface is missing.

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

Noncompliance Area: In the outdoor playspace, two holes were observed in the poured surface the larger hole near the climbing wall that is 8 inches across and two inches deep had an exposed metal spring that is a tripping hazard. The second hole is at the bottom of the first slide walking into the playspace it measures 5 inches across and 1 inch deep. At the edge of the poured surface under the second panel over from the door into the playspace there is a 6 inch across and 1 inch place where the poured surface is missing.

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: At approximately 11:00am staff person #1 named 4 children in her group including 1 infant and 3 young toddlers. Staff person #2 named 7 children in her group including all older toddlers making her group over ratio by 1 child due to the youngest child in her group being an older toddler.

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 the outdoor playspace, two holes were observed in the poured surface the larger hole near the climbing wall that is 8 inches across and two inches deep had an exposed metal spring that is a tripping hazard. The second hole is at the bottom of the first slide walking into the playspace it measures 5 inches across and 1 inch deep. At the edge of the poured surface under the second panel over from the door into the playspace there is a 6 inch across and 1 inch place where the poured surface is missing.

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

Noncompliance Area: In the outdoor play space, on the second play structure, a large hole measuring 10 inches across and 5 inches wide was observed in the purple wall causing rough edges and sharp corners. The door to the outdoor play space was observed lying on the ground accessible to the children with a 5 inch by 5 inch piece missing from the door causing rough edges and sharp corners to be exposed. On the door of the storage shed a large hole measuring 10 inches by 10 inches was observed with rough edges and sharp corners exposed. The red spring riding toy that broke out of the poured surfacing was lying under the steps to the outdoor play space the spring has rough metal edges exposed accessible to the children while they are on the play space.

Correction Required: Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

Noncompliance Area: In the indoor play space the white fence that goes from the emergency exit door over was observed to be unstable. The fence has come unattached from the floor and a child could pull the fence down on top of the child causing injury.

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

Noncompliance Area: In the outdoor play space, by the stone wall under the stairs, small pieces of the wall with a diameter of less than 1 inch were observed to have crumbled off of the wall accessible to children still placing objects in their mouths.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Noncompliance Area: In the preschool room, Cerave body lotion and two medicated chapsticks were observed, the parent did not provide written consent for administration of medication.

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

Noncompliance Area: In the kitchen area, in the drawer under the stove top, there were two large knives and two small knives and a pizza cutter observed that were accessible to the children.

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

Noncompliance Area: In the kitchen area, under the sink in an unlocked cabinet accessible to the children, toxic materials were observed including Ajax, Quick Clean, and Jet Dry.

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: In the outdoor playspace, two holes were observed in the poured surface the larger hole near the climbing wall that is 8 inches across and two inches deep had an exposed metal spring that is a tripping hazard. The second hole is at the bottom of the first slide walking into the playspace it measures 5 inches across and 1 inch deep. At the edge of the poured surface under the second panel over from the door into the playspace there is a 6 inch across and 1 inch place where the poured surface is missing.

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

Noncompliance Area: In the indoor playspace the blue square mat under the triangle on the far right hand side of the playspace was observed to be torn with exposed foam. The red square mat was observed to have a large tear with exposed foam.

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: At approximately 11:10 am, staff person #1 had identified her group to be 10 children, including 6 older toddlers, 3 younger toddlers, and 1 infant making her group over ratio by 6 children due to the youngest child in her group being an 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).

Noncompliance Area: The hot water temperature in the preschool classroom was observed to be 123 degrees F. The hot water temperature in the boys bathroom was observed to be 125 degrees F. The hot water temperature in the girls bathroom in the sink to the right was observed to be 130 degrees F and in the sink to the left was observed to be 127 degrees F.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: The hot water temperature in the preschool classroom was observed to be 117 degrees F and the hot water temperature in the boys bathroom was observed to be 115 degrees F.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: In the indoor playspace the blue mat on the floor to the right was torn along the outside edge.

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's negative sanction letter was not posted in a conspicuous location used by parents.

Correction Required: The facility's current certificate of compliance and a copy of the applicable regulations under which the facility is certified shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional day care office posted at the same location.

Noncompliance Area: At approximately 11:40a.m., in the school-age room, staff person #1 had identified her group to be 15 children, including young school agers making her group over ratio by three children due to the youngest child in her group being a young school ager.

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: On the indoor play gym the purple pole on the right side of the steps was observed to be loose causing a visible hazard.

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

Noncompliance Area: In the school-age room, staff person #1 identified and named 12 children in her group, including all young school age children, resulting in 12 out of 13 young school aged children in her group being identified and named.

Correction Required: 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: At approximately 11a.m., in the school-age room, staff person #1 had identified her group to be 13 children, including young school agers making her group over ratio by one child due to the youngest child in her group being a young school ager. Staff person #2 identified her group to be 13 children, including young school agers making her group over ratio by one child due to the youngest child in her group being a young school ager.

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: At approximately 8:09am staff person #1 came to answer the door leaving 5 children 1 young toddler, 1 older toddler, 2 preschool children, and 1 young school age child alone and unsupervised in the classroom for three minutes.

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: At approximately 8:09am staff person #1 came to answer the door leaving 5 children 1 young toddler, 1 older toddler, 2 preschool children, and 1 young school age child alone and unsupervised in the classroom for three minutes. At 8:47am another child entered the facility staff person #1 was observed to be caring for 1 young toddler, 2 young toddlers, 2 preschool age children, and 1 young school-age child equaling a total of 6 children causing staff person #1 to be out of ratio from 8:47am until 8:52am. At 8:52am another child entered the facility, she was an older school-age child, staff person #1 was caring for a total of 7 children from 8:52am until 8:53am when staff person #2 arrived at the facility.

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: At 8:09am staff person #1 was observed to be the only facility person present in the facility caring for 5 children.

Correction Required: At least two facility persons shall be present in the facility when two or more children are in care. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: In the lunch room observed an uninstalled broken dishwasher and three damaged floor tiles.

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

Noncompliance Area: In the indoor play space a torn mat was observed in front left corner. In the outdoor play space two holes in the poured surface were observed. One hole was by the foot of the slide and the other hole was by the edge of the fence second panel over from the left.

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: At approximately 11:10am child #1 left the school-age classroom unsupervised to go down the hall to the restroom. Staff person #1 was responsible for supervising child #1.

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: During the unannounced inspection on 6/21/18 emergency contact information for Child #2, #3, and #4 was observed to not be present in the child care space where the children were receiving care.

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 file for staff person #1 lacked a health assessment that included the date of the tuberculosis screening by the Mantoux method at initial employment.

Correction Required: An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

Noncompliance Area: The file for staff person #1 lacked two written, nonfamily reference from individuals attesting to the person's suitability to serve as a facility person. There was one reference in the 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 file for staff person #1 lacked initial emergency plan training that was completed within the first week after being hired. The file for staff person #2 lacked 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.

Noncompliance Area: The file for staff person #1, whom was hired provisionally as an aide at the facility lacked initial mandated reporter training. The file for staff person #2, whom was hired provisionally as an assistant group supervisor at the facility, lacked a signed disclosure statement and proof of fingerprinting prior to the hire date.

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

Noncompliance Area: At approximately 11:10am child #1 left the school-age classroom unsupervised to go down the hall to the restroom. Staff person #1 was responsible for supervising child #1.

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.

Noncompliance Area: A trash can was observed in the indoor play space that had tissues that were contaminated by human secretions in a non-lidded trash can.

Correction Required: Trash that has been contaminated by human secretions or excrement shall be contained in closed, plastic-lined receptacles.

Noncompliance Area: Observed in the indoor gym, a pink and purple Radio Flyer tricycle with damaged and cracked parts near the handle bars.

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: Observed an outdated certificate of compliance posted at the entrance to the facility, rather than the current certificate.

Correction Required: The facility's current certificate of compliance and a copy of the applicable regulations under which the facility is certified shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional day care office posted at the same location.

Noncompliance Area: Observed in the multi-purpose room, a wooden chair with 1 exposed screw and 1 missing screw, causing the chair to be unstable and a hazard to children when in use. Observed in the infant space a Fisher Price infant kitchen that was cracked at the base of the purple frame. Observed in the toddler space, a frog rider toy that was ripped at the top of neck with exposed foam. Also observed a cracked red barn door, and a Fisher Price plastic playhouse with a purple roof that was cracked along the side at the bottom hinge. Observed in the school-age room a blue plastic jar had cracked lid, a play dough bin was cracked at the bottom, the wooden cart with gaming floor mats had a crack in the corner of the plastic bin, the wooden shelf to the left of the gaming table had a vertical board between the cardboard blocks' and wooden blocks' sections that was damaged with missing and splintering wood, a damaged yellow cardboard building block with missing parts, a pink bin next to the dollhouse with dolls was damaged on the left side with exposed frame down, the dollhouse had 1 missing screw to attach the roof and 1 exposed screw on the left side near the bottom, a Sterlite brand bin in the kitchen play area had a cracked front drawer, the double painting easel had screws on both sides protruding from the frame creating a very sharp hazard. Observed in the preschool room a Spiderman sleeping bag with a 6 inch tear and exposed material, a brown and orange plastic pirate ship with a cracked and damaged top, a plastic airport with damaged and cracked top, a white laundry basket located in the corner of the room where the cots are stacked had a cracked and damaged handle, the cart in the dress up area was very unstable causing a crush hazard. Observed in the gym a Step 2 brown and tan climbing equipment was damaged, cracked, and unstable on the section near the green steps. Observed in the outdoor playground, Little Tikes school house with netting not attached strangulation hazard.

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: Observed in the toddler space a grey plastic grocery bag lying on the lid of the white garbage can, accessible to children in care.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Noncompliance Area: The files of children #1, #2, #3, #4, #5, #6, #7, #8, #9, and #10 lacked agreements with services to be provided to the family and the child.

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 of child #1 lacked an agreement with the child's arrival and departure times.

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

Noncompliance Area: The file of child #1 lacked an agreement with the persons designated by a parent to whom the child may be released.

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

Noncompliance Area: The file of child #1 lacked an agreement with the services which are to be considered as extra.

Correction Required: An agreement shall specify the services which are to be considered as extra.

Noncompliance Area: The files of children #5 and #6 lacked emergency contact forms with the work address of the parent.

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

Noncompliance Area: The gym lacked a posting of the emergency transportation plan.

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 of child #2, with an enrollment date of 6-9-09, lacked an initial health assessment. The file of child #9, with a enrollment date of 11-7-12 lacked an initial health assessment on file.

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 of child #1, enrolled as an infant, lacked updated health report at least every 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 of child #2, with an enrollment date of 6-9-09 lacked an updated health report at least every 12 months for an older toddler or preschool child. The health assessment on file for child #2 was dated 1-9-14. The file of child #4, with an enrollment date of 3-25-14 lacked an updated health report at least every 12 months for an older toddler or preschool child. The health assessments on file for child #4 were dated: 7-25-17 and 5-2-14. The file of child #5, with an enrollment date of 11-18-13 lacked an updated health report at least every 12 months for an older toddler or preschool child. The health assessments on file were dated: 7-24-17, 7-19-16, 10-11-16, 12-4-14, 1-10-14. Therefore, no health assessment present for 2015. The file of child #6, with an enrollment of 4-15-15 lacked an updated health report at least every 12 months for an older toddler or preschool child. The health assessments on file for child #6 were dated: 3-28-17, 6-18-15. Therefore, no health assessment was present for 2016. The file of child #9, with an enrollment date of 7-21-16 lacked an updated health report at least every 12 months for an older toddler or preschool child. The health assessments on file for child #9 were dated: 6-22-17 and 3-24-14.

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: Observed in the toddler space Desitin diaper cream labeled extra' rather than for a specific child.

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 in the school-age room, in the Reading area 2 electrical outlets lacking protective receptacle covers.

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

Noncompliance Area: The gym lacked a first-aid kit.

Correction Required: A first-aid kit shall be in a child care space.

Noncompliance Area: Observed the first-aid kits for the infant and toddler space and in the preschool room lacked sterile gauze due to the fact that the gauze present was not in its original packaging.

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: Fire drill log conducted 62 days rather than 60 days (9-12-17 and 11-13-17). However, the following fire drills conducted were within 60 days.

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: Observed in the indoor gym, the pink and purple railing located at the entrance to ball pit of the large climbing structure not bolted securely to the floor. Observed in the school age room a plastic yellow house with an orange roof was cracked on the side from top to bottom, the whiteboard had a blue shelf cracked and not attached securely, a turquoise chair at the tables was cracked at top back, a green bin housing blankets located where the mats are stacked was damaged and had exposed parts in the frame. Observed in the infant room the crib labeled for children #1 and #2 had a hole in the mesh on the right side, the crib labeled child #3 had a hole in the mesh on the right side, the grey and red shelf labeled 'large blocks' had loose red trim at the bottom.

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: Observed in the dining room at the far corner, a high chair lacked the horizontal part of the T-shaped safety strap.

Correction Required: High chairs shall have a wide base and a T-shaped safety strap.

Noncompliance Area: During the unannounced visit, the staff present did not have access to the files and records.

Correction Required: A staff person shall provide to agents of the Department immediate access to the facility, the children and the files and records

Noncompliance Area: Observed at the gate to the indoor gym damaged and cracked flooring. Observed at the entrance to multi-purpose room, 2 tiles of damaged and cracked flooring. Observed in front of kitchen counter and under high chairs damaged and cracked flooring. Observed between closets in the multi-purpose room, 7 tiles of the flooring damaged with the subfloor exposed. Observed in the boys' restroom, in the area from the wall to the sinks, 4 tiles damaged with subfloor raising up.

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: Observed in the preschool room, peeling paint an damaged plaster on the wall where the soap dispenser is mounted.

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

Noncompliance Area: Based on interviews and a review of documents, it was determined that staff #1 was alone at the facility with the following children from 4:45 a.m. to 8:00 a.m. 1 older toddler and 1 pre-school age child arrived at 4:45 a.m., 1 school age child arrived at 5:00 a.m., 1 school age child arrived at 5:05 a.m. and left at 6:55 a.m., and 1 older toddler, 1 pre-school age child, and 1 school age child arrived at 5:50 a.m.

Correction Required: At least two facility persons shall be present in the facility when two or more children are in care. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: After interviewing staff, it was determined that cups of milk that were previously served to children in care are placed in the refrigerator and served again to the children rather than discarded.

Correction Required: Food that has been previously served to a person or returned from a table shall be discarded.

Noncompliance Area: In the indoor play space, two slides were observed to be lacking a protective surface under the ladder area where children access the climbing structure and the slide area where children exit the climbing structure.

Correction Required: Indoor play equipment for climbing shall be installed or used over a protective surface covering which does not interfere with the stability of the equipment.

Noncompliance Area: Young and Older Toddlers were observed being cared for in the pre-school classroom. Two toys, Dominos and a Benny the Bull figurine, that had a diameter of less than one inch were observed to be accessible to the toddlers present. The Dominoes were observed to be mouthed by one of the toddlers present.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Noncompliance Area: Child #1, a seven month old, was being cared for in the pre-school room. There was not sleep equipment present in the pre-school classroom that would allow for Child #1 to be placed in a supine position for sleeping. Based on staff statements and observations, the identified rest equipment for child #1 was an infant rocker seat.

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: At approximately 9:45, staff #1 was observed caring for one infant, one young toddler, one older toddler and 3 preschool aged children with no other staff person present at the facility.

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: At approximately 9:45, staff #1 was observed caring for one infant, one young toddler, one older toddler and 3 preschool aged children with no other staff person present at the facility.

Correction Required: At least two facility persons shall be present in the facility when two or more children are in care. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: In the pre school room, observed a dress up shelf not secure or stable, a mini market in the kitchen area had a red post that was cracked and broken, a red bin labeled "little cars and trucks" had a crack in the base, 13 soft building blocks had chucks of material missing. In the school-age room, observed a rainbow colored couch had a large section of exposed foam, 2 benches in the reading center had cushions with exposed foam, a phone jack on the wall in the reading center had splintering wood, a foos ball table had 3 broken legs and exposed splintering wood around the top, a bookshelf in the reading center was broken across the top, the dry erase board had 2 broken and cracked blue trays, a cracked plastic bin within a Joni Craft brand stand and 1 exposed bolt 1/2 was down the leg of the stand. In the toddler room, observed the white and grey shelf with yellow trim that houses cars and trucks had a hole in the back of shelving unit, and a plastic microphone was cracked in 3 places. In the indoor play space, observed a Cars brand trike with exposed foam on the seat, a grey and orange colored football with chunks of foam missing, a Radio Flyer brand trike with a broken seat on the left side, a damaged blue floor mat with exposed foam located under the jungle gym structure near at the "emergency exit" door, the jungle gym structure had a hole in the netting located on the top level, far right section and the purple and pink railing located in the middle of the structure had 1 side not bolted to the floor with 4 missing bolts. Observed in the play space labeled "infant corner" a plastic blue ball was cracked. In the outdoor play space, observed in the outdoor play space, the multi-colored plastic climber (brand unknown) had a cracked purple window in the back of the structure, a Step 2 brand brown and orange gazebo was missing part of the white frame that holds the fabric and there were broken pieces of the frame.

Correction Required: Toys, play equipment and other indoor and outdoor equipment used by the children shall be clean, in good repair and free from rough edges, sharp corners, pinch and crush points, splinters and exposed bolts.

Noncompliance Area: In the indoor play space, observed a Little Tikes brand multi-colored climber in the middle of the room had 1 slide without a protective surface under the slide.

Correction Required: Indoor play equipment for climbing shall be installed or used over a protective surface covering which does not interfere with the stability of the equipment.

Noncompliance Area: In the multi-purpose room used to serve lunch, observed 1 Fisher Price brand high chair without a T-shaped safety strap.

Correction Required: High chairs shall have a wide base and a T-shaped safety strap.

Noncompliance Area: The file of child #1, with an enrollment date of 6-6-14, did not have previous, timely child service reports. The most recent child service report was the only report in the file of child #1. The file of child #3 did not have the most recent child service report, which was due June 2017. The file of child #6 did not have previous, timely child service reports. The only one on file was dated March 19, 2014. The file of child #9 had a service report present that did not contain a date, therefore timeliness could not be established.

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 files of children #1, #2, #3, #4, #5, #6, and #7 lacked financial agreements with the child's arrival and departure times.

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

Noncompliance Area: The files of children #1, #2, #3, #4, #5, #6, #7, #8, #9, and #10 lacked financial agreements with the persons designated by a parent to whom the child may be released.

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

Noncompliance Area: The file of child #7 lacked a financial agreement with the date of the child's admission.

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

Noncompliance Area: The files of children #1 and #2 lacked emergency contact forms with the full physical address of the child's physician or source of medical care. The file of child #4 lacked an emergency contact form with the name, address and telephone number of the child's physician or source of medical care.

Correction Required: Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Noncompliance Area: The file of child #2 lacked an emergency contact form with the full physical work address of the enrolling parent.

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

Noncompliance Area: The files of children #2, #4, and #5 lacked emergency contact forms with the health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

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 of children #1, #2, #4, #8, and #10 lacked emergency contact forms with the full physical address of the individual designated by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The files of children #5 and #8 lacked initial health reports no later than 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 files of children #2 and #5 lacked updated health reports at least every 6 months for an infant or young toddler. The files of children #2 and #5 had health assessments with more than 12 months between health assessments.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddlerThe operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child.

Noncompliance Area: The file of child #1 lacked a health assessment with a statement from a medical professional that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: In the infant room, observed 2 diaper creams not labeled for use of the intended child.

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: In the school age room, observed a purse belonging to staff person #9 was stored in a cubby accessible to children in care. Staff person #9 confirmed there were prescription medications in the purse.

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: In the infant room, observed 1 expired medication, Infant drops with an expiration date of 2016.

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

Noncompliance Area: The initial and current health assessment on file for staff #8 were not acceptable due to a discrepancy in the date observed on the copy in the 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.

Noncompliance Area: The current health assessment on file for staff #5 lacked a signature by a physician, physician's assistant or CRNP. The signature must include the individual's professional title.

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

Noncompliance Area: The current health assessment on file for staff #8 was not acceptable due to a discrepancy in the date observed on the copy in the file.

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 of staff #1, #5, and #8 had health assessments on file that did not include an examination for communicable diseases and the results of that examination.

Correction Required: An adult health assessment must include an examination for communicable diseases and the results of that examination.

Noncompliance Area: The file of child #10 lacked the initial agreement and subsequent written agreements between the parent and the operator. No financial agreement was on file for child #10.

Correction Required: A child's record shall contain a copy of the initial agreement and subsequent written agreements between the parent and the operator. The parent receives the original agreement.

Noncompliance Area: The files of staff #3 and #12 lacked two written, nonfamily references from individuals 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 file of staff #1 lacked documentation of completion 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 file of staff #2 had a PA State Police clearance that was obtained for the purpose of volunteering and not the required purpose of employment. The file for Staff #4 contained a state police clearance that was not complete due to lacking the attachments. The file of staff #8 had an invalid FBI report because it was generated through the Department of Aging.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 4 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. Facility Person #4 may not work in a child care position at the facility.

Noncompliance Area: The files of staff #7, #9, #10, and #11 lacked documentation of written staff evaluations completed by the director on a regular basis, a minimum of one evaluation every 12 months.

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: In the pre school room, observed 2 bottles with unidentified liquid; the bottles were not labeled.

Correction Required: Cleaning materials and other toxic materials shall be stored in an original labeled container or in a container that specifies the content. Toxics shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: In the closet in the multi-purpose room, observed 2 jugs of ProForce sanitizing cleaner stored on a shelf above canned and boxed foods.

Correction Required: Cleaning materials and other toxic materials shall be used in a way that does not contaminate play surfaces, food, food preparation areas and does not constitute a hazard to the children.

Noncompliance Area: In the men's restroom, observed a broken tile on the floor with exposed floorboard. In the multi-purpose room, observed 2 1/2 tiles broken with exposed floor board near the kitchen counter. In the hallway of the restrooms, observed a ceiling light fixture had the front left corner hanging down, not secured within its frame. In the outdoor play space, observed a hole in the unitary surface. The hole measured 3" deep with a 5" diameter and had exposed metal in the hole. Observed in the toddler restroom a cracked floor tile in front of the toilet.

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: Observed on the exterior wall of the building within the outdoor play space, 8 spots of peeling paint. Also in the outdoor play space, observed on the large red and green climbing structure, the arched ladder had chipping green paint on the left and right sides of the platform. On the same play structure in the back far corner, observed chipping green paint on the platform of the 4 step straight ladder.

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

Noncompliance Area: In the multi-purpose room, there was not a hand washing sign posted at the sink.

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: Observed in the men's restroom used by children in care, exposed bolts at the base of the toilet in the far right stall.

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: Observed on 4-24-17, a 6 month old infant being placed in a crib not labeled for that child for the purpose of sleeping.

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.