Dreamers & Achievers Early Learning Academy

Regulation: 3270.151(a)/3270.192(3)

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

Noncompliance Area: The file for Staff #1 contained a health assessment dated 08.14.2024. In addition, the health assessment provided was not documented on the required DHS Staff Health Assessment form. As a result, the file does not contain the information required by DHS regulations. (See LIS Code Sheet)

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

Regulation: 3270.32(a)/3270.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The file(s) for Staff Person(s) #2 contained PA State Police Clearances that were dated more than 60 months apart.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: At approximately 09:34 a.m. in the MAIN childcare room, Staff #3 named seven (7) OLDER TODDLERS. Because the maximum ratio for a group with OLDER TODDLERS is 1:6, ratio was exceeded by 1 child.

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). IF

Regulation: 3270.94(a)(1)

Description: Every 60 days

Noncompliance Area: Fire drills were not conducted every 60 days (06.06.2025 - 08.25.2025 79 Days) held more than 60 days apart.

Correction Required: The Director or designated staff person who is responsible for compliance with this chapter ensure fire drills are conducted at least once every 60 days.

Regulation: 3270.102(a)

Description: Clean and good repair

Noncompliance Area: In the back right corner in front of the office a black, 12 shelfing unit was wobbly and poses a topping hazard. Wooden blocks, under the clock on the right wall were chipped and pose a cutting or splinter 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.

Regulation: 3270.151(a)

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

Noncompliance Area: The two most recent Health Assessments for Staff #1 and Staff #2 were dated more than 24-months apart. (See IS CODE SHEET)

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem.

Regulation: 3270.102(a)

Description: Clean and good repair

Noncompliance Area: The gate going into the infant/young toddler area was detached from the cabinet exposing protruding screws accessible to young children.

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

Regulation: 3270.103

Description: Small Toys and Objects

Noncompliance Area: Two screws were on the floor of the infant/young toddler area 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.

Regulation: 3270.113(e)

Description: Restraints prohibited

Noncompliance Area: Second citation previously cited on 5/21/24. At approximately 10:15am on 6/17/24 it was observed 2 young toddlers and 1 older toddler in highchairs without trays and 1 older toddler strapped into an infant bumbo seat while the staff member #1 sat on the floor and read a story during community time. When the staff member #1 was asked why the children were in highchairs and a bumbo seat she stated that she put them in there so that she could get her things ready for community time and the children could not get into everything. Staff #2 admitted to confining Child #1 on 5/3/24 to a highchair for the purpose of time out for 30 minutes. The plan of correction date for this citation given by the operator was 7/1/24. On 7/10/24 it was observed that there were 2 staff persons that still had not completed the required training.

Correction Required: The legal entity will arrange for all staff to complete 2-hours of training on developmentally appropriate behavior guidance and alternatives to time-out through the PA Keys. Training will be submitted to the DHS Certification Representative for approval prior to scheduling. Proof of training will be submitted upon completion.

Regulation: 3270.25(b)

Description: Post the inspection summary

Noncompliance Area: No inspection summary was posted in a conspicuous location used by parents.

Correction Required: The operator shall post a copy of each inspection summary issued by the Department in a conspicuous location used by parents. The inspection summary shall remain posted until an agent of the Department verifies that each regulatory noncompliance item cited on the inspection summary has been corrected.

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: *At approximately 10:20am on 7/10/24 in the infant/young toddler area, staff #3 was alone. Staff #3 stated she was in charge of 5 children. She named and identified the ages of all children in her care: 1 infant, 2 young toddlers, and 2 older toddlers. She was out of ratio.

Correction Required: *When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in § 3270.51 (relating to similar age level).

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: **At approximately 10:20am on 7/10/24 in the infant/young toddler area, staff #3 was alone. Staff #3 stated she was in charge of 5 children. She named and identified the ages of all children in her care: 1 infant, 2 young toddlers, and 2 older toddlers. She was out of ratio.

Correction Required: **The legal entity will conduct mandatory staff meetings at least once per month for a period of 3 months following the approval of this plan of correction. At each staff meeting, time will be set aside to review and discuss the facility's previous regulatory non-compliance items documented on inspection summaries issued in the last year, as well as, the Department of Human Services' regulations related to staff:child ratios, supervision of children and appropriate methods of child discipline/behavior management in lieu of restraining children in high chairs. An agenda will be prepared for each staff meeting and a log identifying the date, time and persons attending each meeting will be maintained. The staff meeting agendas and logs will be made available to OCDEL-DHS representatives upon request.

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: ***At approximately 10:20am on 7/10/24 in the infant/young toddler area, staff #3 was alone. Staff #3 stated she was in charge of 5 children. She named and identified the ages of all children in her care: 1 infant, 2 young toddlers, and 2 older toddlers. She was out of ratio.

Correction Required: ***The correct staff to child ratios for all age groups will be posted conspicuously in each childcare space.

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: ****At approximately 10:20am on 7/10/24 in the infant/young toddler area, staff #3 was alone. Staff #3 stated she was in charge of 5 children. She named and identified the ages of all children in her care: 1 infant, 2 young toddlers, and 2 older toddlers. She was out of ratio.

Correction Required: ****The legal entity will implement system wherein each staff person will be given a color coded card for each child for whom they are responsible to keep on their person at all times. The cards will be color coded by age and will contain at a minimum the name of the child and the age of the child.

Regulation: 3270.111(c)

Description: Promote development

Noncompliance Area: At approximately 10:15am on 6/17/24 it was observed 2 young toddlers and 1 older toddler in highchairs without trays and 1 older toddler strapped into an infant bumbo seat while the staff member #1 sat on the floor and read a story during community time. When the staff member #1 was asked why the children were in highchairs and a bumbo seat she stated that she put them in there so that she could get her things ready for community time and the children could not get into everything. Staff #2 admitted to confining Child #1 on 5/3/24 to a highchair for the purpose of time out for 30 minutes.

Correction Required: Daily activities shall promote the development of skills, social competence and self-esteem. Daily experiences shall recognize the child as an individual and give some choice of activities that respect personal privacy, lifestyle and cultural background.

Regulation: 3270.113(e)

Description: Restraints prohibited

Noncompliance Area: Second Citation previously cited on 5/21/24. At approximately 10:15am on 6/17/24 it was observed 2 young toddlers and 1 older toddler in highchairs without trays and 1 older toddler strapped into an infant bumbo seat while the staff member #1 sat on the floor and read a story during community time. When the staff member #1 was asked why the children were in highchairs and a bumbo seat she stated that she put them in there so that she could get her things ready for community time and the children could not get into everything. Staff #2 admitted to confining Child #1 on 5/3/24 to a highchair for the purpose of time out for 30 minutes.

Correction Required: The legal entity will arrange for all staff to complete 2-hours of training on developmentally appropriate behavior guidance and alternatives to time-out through the PA Keys. Training will be submitted to the DHS Certification Representative for approval prior to scheduling. Proof of training will be submitted upon completion.

Regulation: 3270.113(e)

Description: Restraints prohibited

Noncompliance Area: Second Citation previously cited on 5/21/24. At approximately 10:15am on 6/17/24 it was observed 2 young toddlers and 1 older toddler in highchairs without trays and 1 older toddler strapped into an infant bumbo seat while the staff member #1 sat on the floor and read a story during community time. When the staff member #1 was asked why the children were in highchairs and a bumbo seat she stated that she put them in there so that she could get her things ready for community time and the children could not get into everything. Staff #2 admitted to confining Child #1 on 5/3/24 to a highchair for the purpose of time out for 30 minutes.

Correction Required: A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

Regulation: 3270.102(a)

Description: Clean and good repair

Noncompliance Area: Foam blocks with teeth marks were observed in the Middle 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.

Regulation: 3270.113(e)

Description: Restraints prohibited

Noncompliance Area: In a group of 9 toddlers at approximately 10:50 AM, 3 toddlers were observed confined in highchairs during circle time with Staff #2 and Staff #6.

Correction Required: A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs.

Regulation: 3270.123(a)(3)

Description: Services proceeded

Noncompliance Area: The files for Child #1, #2, #3, and #4 contained Child Service Reports that are not an acceptable developmental tool.

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).

Regulation: 3270.124(b)(3)

Description: Parent home/work address, phone

Noncompliance Area: The Emergency contact form for Child #1 lacked the enrolling parent's work address and phone number. The Emergency Contact form for Child #3 lacked the enrolling parent's home address.

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

Regulation: 3270.124(b)(6)

Description: Insurance coverage information

Noncompliance Area: The Emergency Contact form for Child #3 lacked the Health Insurance/MA 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.

Regulation: 3270.124(b)(7)

Description: Name/address/phone release person

Noncompliance Area: The Emergency Contact forms for Child #1, Child #2, and Child #3 lack complete addresses for all listed release persons.

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.

Regulation: 3270.124(f)/3270.181(c)

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

Noncompliance Area: The most recent 6 month review signature for the emergency contact form on file for Child #1 (7/7/23 & 4/16/24) and Child #3 (8/15/23) is dated more than 6 months after the previous 6 month review signature.

Correction Required: The parent shall update in writing emergency contact information once in a 6-month period or as soon as there is a change in the information. A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

Regulation: 3270.131(a)/3270.131(e)

Description: Health information/ACIP recommended immunization record

Noncompliance Area: The Initial Child Health Report for Child #3, enrolled for more than 60 days, was lacking from the child file. Child #3 must be dismissed from care by close of business on 5/21/24 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility. The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.

Regulation: 3270.131(b)(2)/3270.182(1)

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

Noncompliance Area: The most recent health report on file for Child #2 (OT) is dated 4/19/23, more than 12 months prior.

Correction Required: The operator shall require the parent to provide an updated health report at least every 12 months for an older toddler or preschool child. A child's record shall contain initial and subsequent health reports.

Regulation: 3270.131(d)(5)/3270.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: The immunization record for Child #2 (OT) lacked the following vaccines: 1 dose of DTAP, 2 doses of HiB, 1 dose of Pneumococcal, 1 dose of MMR, 1 dose of Varicella, and 2 doses of Hepatitis A with no letter of exemption in the file. Child #2 must be dismissed from care by close of business on 5/21/24 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings).

Regulation: 3270.151(a)/3270.192(3)

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

Noncompliance Area: The two most recent health assessments on file for Staff #1 are dated 11/4/21 and 1/4/24, more than 24 months apart. The initial health assessment and tuberculosis test on file for Staff #2 are dated 11/15/23, which is beyond date of hire. (SEE LIS CODE SHEET).

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

Regulation: 3270.18(a)

Description: On file at facility

Noncompliance Area: The liability insurance observed on site during the inspection listed the effective dates of the policy as 1/13/23 through 1/13/24, making it invalid.

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

Regulation: 3270.181(c)

Description: Emergency info/agreement updated 6 mos

Noncompliance Area: The most recent 6-month review signature for the financial agreement form on file for Child #1 (7/7/23), #2 (5/18/23), and Child #3 (8/15/23) is dated more than 6 months prior.

Correction Required: A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

Regulation: 3270.21

Description: General Health and Safety

Noncompliance Area: Standing water was observed in a container connected to a small playhouse on the outdoor toddler playground. The fire extinguishers in the Lobby and Kitchen were serviced in November of 2022. The directions on the tag of the extinguisher read to 'void 1 year from date punched on tag', meaning the fire extinguisher inspection was not current and was out of date.

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

Regulation: 3270.27(c)

Description: Training regarding plan

Noncompliance Area: The Emergency Plan training on file for Staff #2, Staff #5, and Staff #6 is dated 5/13/24, more than 90 days beyond Staff #2, Staff #5, and Staff #6's date of hire. (SEE LIS CODE SHEET).

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.

Regulation: 3270.31(f)

Description: Health and Safety Training

Noncompliance Area: Staff person #5 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid/Pediatric CPR. The file for Staff #6 lacked the following trainings within 90 days of their date of hire: Pediatric First Aid/CPR (5/30/23) & Get Started with Center-Based Care: Building Blocks for Quality -- Revised 2022 (11/9/23). The file for Staff #7 lacked Pediatric First Aid and CPR training within 90 days of hire. The training for Staff #7 was completed on 5/30/23. (SEE LIS CODE SHEET)

Correction Required: Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10.

Regulation: 3270.32(a)/3270.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The file for Staff #2 was lacked documentation of application of District of Columbia state Criminal History, Child Abuse, and Sex Offender clearances prior to date of hire (See IS CODE SHEET) required for provisional hiring under the CPSL. The Child Abuse (11/14/23) and FBI Clearances (11/15/23) on file for Staff #2 are dated after Staff #2's date of hire (SEE LIS CODE SHEET). The PA Criminal History (6/22/23), Child Abuse (6/28/23), and FBI Clearances (6/22/23) on file for Staff #3 are dated after Staff #3's date of hire (SEE LIS CODE SHEET). The Child Abuse Clearance on file for Staff #5 is dated 3/15/24, which is after their date of hire (SEE LIS CODE SHEET). The file for Staff #2 (1/25/24), Staff #5 (3/19/24), and Staff #6 (6/5/23) lacked a valid NSOR certificate within 45 days of hire (SEE LIS CODE SHEET). The file for Staff #4 lacked documentation of application of an NSOR certificate prior to date of hire (5/7/24) required for provisional hiring under the CPSL. (SEE LIS CODE SHEET).

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 2 and #5 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 #2 and #5 may not work in a child care position at the facility.

Regulation: 3270.65

Description: Protective Outlet Covers 5 yrs. or less

Noncompliance Area: In the Infant Space protective receptacle covers were missing in an outlet under thermostat and in a power strip.

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

Regulation: 3270.66(b)

Description: Original container

Noncompliance Area: A spray bottle containing toxics in the Infant Space was observed unlabeled.

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.

Regulation: 3270.76

Description: Building Surfaces

Noncompliance Area: Broken pieces of brick were observed with sharp edges in the Outdoor Play Space, which could be hazardous to children.

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.

Regulation: 3270.77(a)

Description: No peeling paint or plaster

Noncompliance Area: Peeling plaster was observed under the television in the Front Preschool Space.

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

Regulation: 3270.82(h)

Description: Handwashing signs

Noncompliance Area: In the bathroom, a sink lacked a handwashing sign.

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.

Regulation: 3270.91(a)

Description: Stairs, exits, etc. unobstructed

Noncompliance Area: In the Infant space, a crib was observed blocking the exit gate of the space.

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

Regulation: 3270.94(a)(1)

Description: Every 60 days

Noncompliance Area: On the fire drill log, the fire drill dated 5/17/24 lacked the evacuation length of the drill conducted.

Correction Required: The Director or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that fire drills are conducted at least once every 60 days.

Regulation: 3270.95(a)/3270.95(b)

Description: Devices must be compliant/Director or designated staff person ensure compliance

Noncompliance Area: The fire alarm 30-day test log includes test dates 1/1/24-2/2/24 and 3/1/24-4/1/24, more than 30 days apart.

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

Regulation: 3270.113(a)

Description: Supervised at all times

Noncompliance Area: At approximately 1:30 pm, upon entering the facility, the following was observed: Staff person #2 was sitting at a desk in the front of the only room in the facility, facing the entrance. Staff person #1 was in the infant area of the room, which is partly partitioned off in the front left hand corner of the room. Staff person #3 was observed standing in the kitchen doorway at the back of the room, then disappeared into the kitchen. Staff person #4 was observed not to be in the room and the operator stated that staff person #4 was in the kitchen at the time. Behind staff person #2 and in front of the gated off area, 14 children were on their rest equipment, a combined group of 6 preschoolers, 3 older toddlers and 5 young toddlers. Staff person #2 stated that they were responsible for all 14 children since staff #3 and #4 were in the kitchen at the time, placing staff person #2 out of ratio. Next in the infant area, staff person #1 identified the 4 children in the area. When staff person #3 and #4 came out of the kitchen and joined staff person #2 at the front of the room, all 3 staff identified their groups, placing them back in ratio. At this time, staff person #2 identified a young toddler in their group that was sleeping on the other side of the diaper table in the infant area, which this certification rep was not aware of. None of the 4 staff could see, hear direct or assess the child. Staff person #3 identified a preschooler in their group that was lying on rest equipment in the quiet area, which is located in the far back right hand corner of the large room, which this certification rep was not aware of. None of the 4 staff could see, hear, direct or assess the child.

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.

Regulation: 3270.55(a)

Description: Toddler and preschool children

Noncompliance Area: *At approximately 1:30 pm, upon entering the facility, the following was observed: Staff person #2 was sitting at a desk in the front of the only room in the facility, facing the entrance. Staff person #1 was in the infant area of the room, which is partly partitioned off in the front left hand corner of the room. Staff person #3 was observed standing in the kitchen doorway at the back of the room, then disappeared into the kitchen. Staff person #4 was observed not to be in the room and the operator stated that staff person #4 was in the kitchen at the time. Behind staff person #2 and in front of the gated off area, 14 children were on their rest equipment, a combined group of 6 preschoolers, 3 older toddlers and 5 young toddlers. Staff person #2 stated that they were responsible for all 14 children since staff #3 and #4 were in the kitchen at the time, placing staff person #2 out of ratio. Next in the infant area, staff person #1 identified the 4 children in the area. When staff person #3 and #4 came out of the kitchen and joined staff person #2 at the front of the room, all 3 staff identified their groups, placing them back in ratio. At this time, staff person #2 identified a young toddler in their group that was sleeping on the other side of the diaper table in the infant area, which this certification rep was not aware of. None of the 4 staff could see, hear direct or assess the child. Staff person #3 identified a preschooler in their group that was lying on rest equipment in the quiet area, which is located in the far back right hand corner of the large room, which this certification rep was not aware of. None of the 4 staff could see, hear, direct or assess the child.

Correction Required: *The legal entity will conduct mandatory staff meetings at least once per month for a period of 4 months following the approval of this plan of correction. At each staff meeting, time will be set aside to review and discuss the facility's previous regulatory non-compliance items documented on inspection summaries issued in the last year, as well as, the Department of Human Services' regulations related to staff:child ratios and supervision of children. An agenda will be prepared for each staff meeting and a log identifying the date, time and persons attending each meeting will be maintained. The staff meeting agendas and logs will be made available to OCDEL-DHS representatives upon request.

Regulation: 3270.55(a)

Description: Toddler and preschool children

Noncompliance Area: At approximately 1:30 pm, upon entering the facility, the following was observed: Staff person #2 was sitting at a desk in the front of the only room in the facility, facing the entrance. Staff person #1 was in the infant area of the room, which is partly partitioned off in the front left hand corner of the room. Staff person #3 was observed standing in the kitchen doorway at the back of the room, then disappeared into the kitchen. Staff person #4 was observed not to be in the room and the operator stated that staff person #4 was in the kitchen at the time. Behind staff person #2 and in front of the gated off area, 14 children were on their rest equipment, a combined group of 6 preschoolers, 3 older toddlers and 5 young toddlers. Staff person #2 stated that they were responsible for all 14 children since staff #3 and #4 were in the kitchen at the time, placing staff person #2 out of ratio. Next in the infant area, staff person #1 identified the 4 children in the area. When staff person #3 and #4 came out of the kitchen and joined staff person #2 at the front of the room, all 3 staff identified their groups, placing them back in ratio. At this time, staff person #2 identified a young toddler in their group that was sleeping on the other side of the diaper table in the infant area, which this certification rep was not aware of. None of the 4 staff could see, hear direct or assess the child. Staff person #3 identified a preschooler in their group that was lying on rest equipment in the quiet area, which is located in the far back right hand corner of the large room, which this certification rep was not aware of. None of the 4 staff could see, hear, direct or assess the child.

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.

Regulation: 3270.55(a)

Description: Toddler and preschool children

Noncompliance Area: **At approximately 1:30 pm, upon entering the facility, the following was observed: Staff person #2 was sitting at a desk in the front of the only room in the facility, facing the entrance. Staff person #1 was in the infant area of the room, which is partly partitioned off in the front left hand corner of the room. Staff person #3 was observed standing in the kitchen doorway at the back of the room, then disappeared into the kitchen. Staff person #4 was observed not to be in the room and the operator stated that staff person #4 was in the kitchen at the time. Behind staff person #2 and in front of the gated off area, 14 children were on their rest equipment, a combined group of 6 preschoolers, 3 older toddlers and 5 young toddlers. Staff person #2 stated that they were responsible for all 14 children since staff #3 and #4 were in the kitchen at the time, placing staff person #2 out of ratio. Next in the infant area, staff person #1 identified the 4 children in the area. When staff person #3 and #4 came out of the kitchen and joined staff person #2 at the front of the room, all 3 staff identified their groups, placing them back in ratio. At this time, staff person #2 identified a young toddler in their group that was sleeping on the other side of the diaper table in the infant area, which this certification rep was not aware of. None of the 4 staff could see, hear direct or assess the child. Staff person #3 identified a preschooler in their group that was lying on rest equipment in the quiet area, which is located in the far back right hand corner of the large room, which this certification rep was not aware of. None of the 4 staff could see, hear, direct or assess the child.

Correction Required: All staff persons at the facility will be required to attend an OCDEL-approved training regarding supervision of children presented by the ELRC within 4 months of the approval of this plan of correction and shall participate in TA regarding room set-up. The training may count towards the mandatory 12 training hours required by the Department. Following completion of the trainings and within 4 months of the approval of this plan of correction, the operator must develop a supervision policy for the facility, which will be discussed with staff and posted conspicuously in the all classrooms. The policy will be submitted to the certification representative for approval before being discussed with staff or posting in the facility.

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: Upon entering the facility at approximately 9:10 am, staff person #1 and #2 were observed in the enclosed area in the middle of the room with 16 children, a combination of 4 infants, 5 young toddlers, 3 older toddlers and 4 preschoolers. Staff person #1 identified the 4 infants and staff person #2 identified the other 12 children. Staff person #2 stated that they were out of ratio because staff person #3 was running late, but that the staff person was on their way. A few minutes later, staff person #2 stated that staff person #3 was at the Wilmerding location. At approximately 9:25, staff person #4 arrived at approximately the same time a 17th child arrived. Although the facility was still out of ratio with 3 staff, staff person #2 accepted the child into care. At approximately 9:30, staff #5 arrived, bringing the facility into ratio. Staff person #1 again identified the 4 infants. Staff person #2 identified 5 children, 1 older toddler and 4 preschoolers. Staff person #4 identified 5 young toddlers. Staff person #5 identified 3 children, 1 young toddler and 2 older toddlers.

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).

Regulation: 3270.113(b)

Description: No physical punishment

Noncompliance Area: Based on staff interviews, staff person #1 was attempting to de-escalate child #1 during a tantrum when they firmly clasped the child's head between their hands, leaving a red mark on the child's face.

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

Regulation: 3270.106(a)

Description: Clean, age appropriate

Noncompliance Area: At approximately 2:45 pm, child #1, an infant, was observed sleeping in a swing in the infant area. Based on conversation with staff, the child was asleep when they relieved staff person #4 for their break, which was approximately 10-15 minutes prior. At approximately the same time, a child was observed sleeping in an unlabeled pack n play in the infant area.

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.

Regulation: 3270.119

Description: Infant sleep position

Noncompliance Area: At approximately 2:45 pm, child #1, an infant, was observed sleeping in a swing in the infant area. Based on conversation with staff, the child was asleep when they relieved staff person #4 for their break, which was approximately 10-15 minutes prior.

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.

Regulation: 3270.123(a)

Description: Signed

Noncompliance Area: The agreement in the file for child #1 through #5, titled the "registration form," did not include the operator's signature.

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

Regulation: 3270.123(a)(1)

Description: Amount of fee

Noncompliance Area: The agreement in the file for child #1 through #5 did not specify the amount of the fee to be charged per day or per week.

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

Regulation: 3270.123(a)(2)

Description: Date fee to be paid

Noncompliance Area: The agreement in the file for child #1 through #5 did not specify the date on which the fee is to be paid.

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

Regulation: 3270.123(a)(3)

Description: Services proceeded

Noncompliance Area: The agreement in the file for child #1 through #5 did not specify the services to be provided to the family and 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).

Regulation: 3270.124(b)(3)

Description: Parent home/work address, phone

Noncompliance Area: The emergency contact information in the file for child #1 through #5 did not include any work information for the child's enrolling parent.

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

Regulation: 3270.14/3270.21

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: The one- hour health and safety update training in the file for staff person #2, hired on (SEE LIS CODE SHEET), was dated 1/12/23.

Correction Required: A facility shall be operated in conformity with applicable Federal and State laws and regulations.State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children.

Regulation: 3270.151(a)

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

Noncompliance Area: The initial health assessment in the file for staff person #3 who began working at this facility on (SEE LIS CODE SHEET), was dated 7/3/23, which is late, as this facility is under a different legal entity than the other facilities.

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem.

Regulation: 3270.165

Description: Menus

Noncompliance Area: The menu posted at the time of the inspection was for the current week.

Correction Required: An operator shall conspicuously post the menu at least 1 week in advance or provide a menu to each family.

Regulation: 3270.166(1)

Description: Written statement

Noncompliance Area: At the time of the inspection, there was not a formula and feeding schedule for child #1, an infant.

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

Regulation: 3270.166(6)

Description: Infant/toddler - no bottle in mouth to sleep

Noncompliance Area: At approximately 2:45 pm, a younger toddler was observed sleeping with a bottle still in their mouth in the infant area.

Correction Required: Neither an infant nor a toddler is permitted to sleep with a bottle in his mouth.

Regulation: 3270.183(a)

Description: Locked cabinet

Noncompliance Area: Upon entering the facility, the child files were obsereved on a bookshelf near the front desk.

Correction Required: Child records are confidential and shall be stored in a locked cabinet.

Regulation: 3270.193(a)

Description: Confidential; stored in locked cabinet

Noncompliance Area: Upon entering the facility, the staff files were obsereved on a bookshelf near the front desk.

Correction Required: Facility persons' records are confidential and shall be stored in a locked cabinet.

Regulation: 3270.32(a)/3270.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The file for staff person #1, hired provisionally on (SEE LIS CODE SHEET) and on their 46th day of working with children, included proof of request for the state police clearance, but not the actual clearance.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person #1 may not work in a child care position at the facility.

Regulation: 3270.66(a)

Description: Locked or inaccessible

Noncompliance Area: There was a tube of Desitin diaper cream and Lysol disinfectant spray in the unlocked cabinet underneath the diaper table in the area near the child-sized toilets, making them accessible to children. Both items included instructions to keep out of the reach of children. There was hand sanitizer and multiple cleaning products in an unlocked closet by the bathrooms.

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

Regulation: 3270.107

Description: Refrigerator

Noncompliance Area: The small refrigerator in the infant space in the main room did not contain a 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.

Regulation: 3270.14/3270.21

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: The facility's emergency plan did not include information regarding continuity of operations.

Correction Required: A facility shall be operated in conformity with applicable Federal and State laws and regulations.State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children.

Regulation: 3270.61(b)

Description: Care space not play space at same time

Noncompliance Area: There was a gated space in the middle of the main room that contained the following gross motor equipment: dome climbers, A plastic climber/slide, small basketball hoops and a small plastic see-saw.

Correction Required: Indoor child care space may not be used simultaneously as play space.

Regulation: 3270.63

Description: Unsafe Areas in Outdoor Space

Noncompliance Area: The facility's outdoor play space at the initial inspection observed to be located on a large grassy area with no barrier to the nearby hillside or the road that was several hundered feet away from the play space.

Correction Required: If unsafe areas or conditions are in or near an outdoor play space, fencing or natural barriers are required to restrict children from those unsafe areas or conditions.