Echo Child Development/greenwood Ctr

Regulation: 3270.124(b)(6)

Description: Insurance coverage information

Noncompliance Area: The child file for Child #1 contained a current emergency contact information form that lacked the child's health insurance name and policy number.

Correction Required: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Regulation: 3270.131(a)/3270.182(1)

Description: Health information/Initial and subsequent health reports

Noncompliance Area: The child file for Child #1, was observed to lack an initial health report within 60 days of enrollment.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility. A child's record shall contain initial and subsequent health reports.

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

Description: Infant: updated health report every 6 months/Initial and subsequent health reports

Noncompliance Area: The child file for Child #2, who was an older toddler at the time, was observed to lack an updated health report every 6 months; the two most recent health report on file were dated 1/13/25 and 9/11/23.

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

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 child file for Child #2, who is a preschool age child, was observed to lack an updated health report; the most recent health report on file is dated 1/13/25.

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(e)(1)/3270.131(e)(3)

Description: Exemption documentation from parent/guardian/Dismissal policy

Noncompliance Area: The child file for Child #1, was observed to lack an immunization record within 60 days of enrollment.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP. 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). Child #1 must be dismissed from care by close of business 2/11/26 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Regulation: 3270.151(a)

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

Noncompliance Area: The staff file for Staff person #1, contained a current health assessment dated 4/14/25 which was conducted more than 24 months from the previously dated 2/16/23 health assessment on file.

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

Regulation: 3270.32(a)

Description: Comply with CPSL

Noncompliance Area: The staff file for Staff person #1 contained current mandated reporter training dated 8/11/25 which was not renewed within 60 months from the previously existing mandated reporter certificate dated 6/15/20.

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

Regulation: 3270.76

Description: Building Surfaces

Noncompliance Area: In the School Age Room and in the Preschool Room, four ceiling tiles were observed to not be kept clean as evidence by having water spots from a previous leak that has since been repaired.

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: 3270.102(a)

Description: Clean and good repair

Noncompliance Area: In the Older Toddler Room, a white plastic toy bin was observed to not be in good repair having two edges that had pieces broken off allowing for sharp corners.

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: 3270.131(a)

Description: Health information

Noncompliance Area: The child file for Child #2, contained an initial health report that is dated more than 60 days after initial enrollment.

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.

Regulation: 3270.131(b)(2)

Description: Toddler/preschool: updated health report every 12 months

Noncompliance Area: The child file for Child #1, who is a preschool age child, was observed to lack an updated health report; the most recent health report on file is dated 12/8/23. The child file for Child #2, who is an older toddler, was observed to lack an updated health report; the most recent health report on file is dated 1/30/24.

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.

Regulation: 3270.151(a)

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

Noncompliance Area: The staff file for Staff person #4, contained a current health assessment dated 10/10/23 which was conducted more than 24 months from the previously dated 9/7/21 health assessment on file. The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which was conducted more than 24 months from the previously dated 1/23/23 health assessment on file.

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

Regulation: 3270.151(c)(3)

Description: Exam communicable disease

Noncompliance Area: The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which lacked 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.

Regulation: 3270.151(c)(5)

Description: Physician/CRNP assessment

Noncompliance Area: The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which lacked the physician's or CRNP's assessment of the person's suitability to provide childcare.

Correction Required: An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Regulation: 3270.27(a)(6)

Description: Emergency plan

Noncompliance Area: An annual emergency drill was observed to be conducted on 8/7/24 which was more than 12 months after the previously documented emergency drill dated 3/3/23.

Correction Required: Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Regulation: 3270.27(e)

Description: Letter to parents

Noncompliance Area: The letter to the parents explaining the emergency procedures does not address lockdown procedure and annual emergency drills.

Correction Required: The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures. The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

Regulation: 3270.31(e)(4)(i)

Description: Age and Training

Noncompliance Area: Staff person #3 does not have current pediatric first-aid/CPR training. This is evidenced by the previously documented pediatric first-aid/CPR training expiration date of January 2025.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.

Regulation: 3270.31(f)

Description: Health and Safety Training

Noncompliance Area: Staff person #1 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid and CPR.

Correction Required: Staff person(s) shall complete professional development in the topics of 3270.31(f)(1 -- 10) within 90 days of hire. Staff person #1 will have until 2/27/25 to complete the required training. Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children, by an AGS who has completed the required training related to this citation. If there are no staff available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility.

Regulation: 3270.32(a)/3270.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The staff file for Facility Person #2, who is a volunteer, was observed to lack a National Sex Offender Registry (NSOR) Check. The staff file for Staff person #4 contained a current Child Abuse clearance dated 6/27/24 and a current State Police clearance dated 6/17/24 both of which were not renewed within 60 months of the previously dated 6/18/19 Child Abuse clearance and 6/11/19 State Police clearance expiring.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Facility Person #2 may not work in a childcare position at the facility.

Regulation: 3270.34(a)(6)

Description: Staff evaluations

Noncompliance Area: The staff file for Staff person #5 contained current staff evaluation dated 2/3/25 which was not completed at least one every 12 months from the previous staff evaluation on file dated 1/23/24.

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

Regulation: 3270.95(a)/3270.95(b)

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

Noncompliance Area: Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 2/2/24 to 3/4/24 (31 days).

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: 3270.14/3270.21

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: The operator lacked a section addressing the prevention and identification of Child Maltreatment in their Shaken Baby syndrome, abusive head trauma and child maltreatment policy and procedure to maintain compliance with 45 CFR 98.41(a)(1)(vi) and in accordance with Announcement C-22-03.

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: 3270.192(5)

Description: Two written references

Noncompliance Area: Staff file #1 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person 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.

Regulation: 3270.27(e)

Description: Letter to parents

Noncompliance Area: The facility lacked a updated letter to the parents of enrolled children explaining the emergency plan, including any subsequent updates made to the emergency plan.

Correction Required: The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures. The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

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

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

Noncompliance Area: Child file #2 lacked written consent signed by a parent for emergency medical care on the emergency contact form.

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

Regulation: 3270.131(e)(1)

Description: Exemption documentation from parent/guardian

Noncompliance Area: Child file #1 lacked documentation of receipt of an influenza vaccination received according to the schedule recommended by the ACIP or an exemption from the parents.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Regulation: 3270.14/3270.21

Description: Pertinent Laws & Regulations/General Health and Safety

Noncompliance Area: Staff person #2 completed the Pennsylvania Health and Safety Update 2022on 2/3/23 which was after the required date of 12/30/22. Staff person #3 completed the Pennsylvania Health and Safety Update 2022on 1/2/23 which was after the required date of 12/30/22. Staff person #5 completed the Pennsylvania Health and Safety Update 2022on 2/7/23 which was after the required date of 12/30/22.

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: Staff file #6 contains valid health assessments dated 6/19/20 and 2/16/23 which exceeded the 24 months as required for health assessments.

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

Regulation: 3270.182(5)

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

Noncompliance Area: Child file #2 lacked written consent on the emergency contact form signed by a parent for minor first aid procedures administered by staff persons to the child while in care.

Correction Required: A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

Regulation: 3270.27(a)(6)

Description: Emergency plan

Noncompliance Area: The emergency drill log did not include the required information according to Announcement C-22-04 including special accommodations used for infants, toddlers, children with special needs.

Correction Required: Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Regulation: 3270.31(f)

Description: Health and Safety Training

Noncompliance Area: Staff person #4 has an acceptable Pediatric First-Aid/CPR training in an approved curriculum, however the trainer has not provided documentation that they are PQAS-certified in that training topic.

Correction Required: Staff persons shall complete professional development within 90 days of hire as listed in subsections (f)1-10. Staff person #4 must do one of the following; provide documentation that the trainer has become PQAS-certified or at least is on the waiting list, request that the instructor provide documentation, such as their Pediatric First Aid/CPR Instructor card from the PQAS-approved curriculum organization, that the instructor is approved to offer Pediatric First Aid/CPR training on behalf of their organization, or receive Pediatric First Aid/CPR training in an approved curriculum by a PQAS-certified trainer.

Regulation: 3270.31(f)(10)

Description: Health and Safety Training - Pediatric First Aid and CPR

Noncompliance Area: Staff person #5 completed Pediatric First Aid/CPR on 2/7/23 which was more than 90 days after hire at the facility. (See LIS CODE SHEET)

Correction Required: Staff persons shall complete professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire.

Regulation: 3270.32(a)

Description: Comply with CPSL

Noncompliance Area: Staff person #4 completed Mandated reporter training on 2/19/22 which was more than more than 90 days after hire. (See LIS CODE SHEET)

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

Regulation: 3270.65

Description: Protective Outlet Covers 5 yrs. or less

Noncompliance Area: The electrical outlet next to the microwave lacked a protective outlet cover and was accessible to children 5 years of age or younger.

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

Regulation: 3270.103

Description: Small Toys and Objects

Noncompliance Area: In the Preschool Classroom there were foam toys and small plastic toys with less than an inch in diameter. The toys were accessible to children who are still placing objects in their mouths. In the bathroom there was an unlocked cabinet under the sink that contained plastic bags that were accessible to children still placing items 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(a)

Description: Supervised at all times

Noncompliance Area: At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

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: 3270.113(a)(1)

Description: Staff assigned to specific children

Noncompliance Area: At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

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.

Regulation: 3270.124(b)(7)

Description: Name/address/phone release person

Noncompliance Area: The Emergency Contact Form for Child #1 lacked the 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.

Regulation: 3270.124(c)

Description: Each child care space

Noncompliance Area: The Emergency Contact information was not present in the Infant Room for Child #2. The child was present and receiving care in the room.

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.

Regulation: 3270.131(e)(1)

Description: Exemption documentation from parent/guardian

Noncompliance Area: The Health Reports for the following children lacked verification of ongoing vaccines in accordance with the schedule recommended by the ACIP. The Report for Child #3 lacked an influenza vaccination.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Regulation: 3270.151(c)(2)

Description: Mantoux TB

Noncompliance Area: The file for Staff #3 did not contain the results of a tuberculin skin test, x-ray or other medical documentation necessary to confirm freedom from communicable tuberculosis.

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.

Regulation: 3270.151(c)(3)

Description: Exam communicable disease

Noncompliance Area: The file for Staff #3 contained a Health Assessment that did not include an examination for communicable diseases and the results of the examination.

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

Regulation: 3270.151(c)(5)

Description: Physician/CRNP assessment

Noncompliance Area: The Health Assessment for Staff #3 lacked the physician's assessment of the person's suitability to provide childcare.

Correction Required: An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Regulation: 3270.166(7)

Description: Meals for infants

Noncompliance Area: On the day of inspection, Cert Rep observed Staff heating human milk in the microwave.

Correction Required: Neither bottled formula nor human milk may be heated in a microwave.

Regulation: 3270.192(2)(ii)

Description: Exp, educ., training prior to facility

Noncompliance Area: Staff #3 was observed acting as an Aide in the Toddler Classroom. The file for Staff #3, lacked verification of childcare experience, education and training prior to service at the facility, to qualify as an Aide.

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

Regulation: 3270.192(2)(iv)

Description: Transcript, diploma and letters

Noncompliance Area: The file for Staff #3, lacked verification of experience and education or training. Staff was present on the day of inspection acting as an Aide.

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

Regulation: 3270.192(5)

Description: Two written references

Noncompliance Area: The file for Staff #3, lacked two written, nonfamily references from individuals attesting to the 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

Regulation: 3270.31(f)

Description: Health and Safety Training

Noncompliance Area: The file for Staff #2, employed for more than 90 days, lacked Health and Safety training.

Correction Required: Staff persons shall complete professional development in the following topics within 90 days of hire: (1) Prevention and control of infectious diseases (including immunization); (2) Prevention of Sudden Infant Death Syndrome and use of safe sleep practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Emergency preparedness and response planning for emergencies resulting from a natural disaster or a man-caused event (such as violence at a child care facility); (8) Handling and storage of hazardous materials and appropriate disposal of bio contaminants; (9) Precautions when transporting children.

Regulation: 3270.32(a)/3270.192(2)(iii)

Description: Comply with CPSL/Exp, educ., training at facility

Noncompliance Area: The file for Staff #2, employed for more than 90 days, lacked Mandated Reporter training.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Regulation: 3270.51

Description: Similar Age Level

Noncompliance Area: At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

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. IF USING TIERED LIS: The required staff:child ratios must be maintained at all times. The legal entity must submit documentation in a format approved by DHS proving that the facility is maintaining the required staff:child ratios at all times. The legal entity will confirm continuing compliance by sending copies of the documentation to the -------- Region Office on a weekly basis for a period of three months after DHS approves the documentation format.

Regulation: 3270.52

Description: Mixed Age Level

Noncompliance Area: At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

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: 3270.75(c)

Description: Has all items

Noncompliance Area: The first aid kit located in the Infant Room lacked soap.

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

Regulation: 3270.31(e)(4)(i)/3270.31(h)

Description: Age and Training/Health and Safety Training

Noncompliance Area: SECOND CITATION: The file for Staff #1, Date of Hire 10/26/20, lacked training by a professional in the field of pediatric first-aid and pediatric cardiopulmonary resuscitation (CPR). Previously cited on 9/28/21.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification.All staff persons shall complete the professional development under subsection (f).

Noncompliance Area: The Emergency Contact Form for Child #1 and Child #3, lacked the enrolling parents work address and telephone number. The Emergency Contact Form for Child #4, lacked the enrolling parents work telephone number.

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

Noncompliance Area: The Emergency Contact Forms in the file for Child #2, lacked written consent signed by a parent for emergency medical care.

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

Noncompliance Area: The file for Child # 3, a preschool aged child, lacked a Updated Health Report within the last year. (12/11/18).

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.

Noncompliance Area: The file for Staff #2 contained a health assessment that was not conducted within 24 months of the previous assessment. (6/18/18 and 9/12/20).

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 Emergency Contact Form in the file for Child #2, lacked written consent signed by a parent for administration of minor first-aid procedures.

Correction Required: A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

Noncompliance Area: Two fire extinguishers located in the Preschool Room and the Older Twos Room were last Recharged in December 2018. They both were due to be inspected December 2019.

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

Noncompliance Area: The file for Staff #3 contained a NSOR Certificate (7/27/20) which was obtained after the first day caring for children (7/22/20). The requests for this clearance was not in the file making this an incorrect provisional hire.

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

Noncompliance Area: In the Older Twos Room, there was peeling paint next to the front door.

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

Noncompliance Area: The bookshelf near the door in the Older Two's room was observed to have an unstable shelf separator with exposed bolts, creating the potential for pinch points and crush hazards.

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 files for Child #1, start date 09/15/2018, and Child #2, start date 11/28/2018, lacked initial health assessments.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.

Noncompliance Area: The file for Child #2, a young toddler, did not contain any 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 toddler

Noncompliance Area: The file for Child #1, a preschooler, did not contain any health assessments.

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

Noncompliance Area: The file for Facility Person #1 lacked two written, non-family references.

Correction Required: A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person

Noncompliance Area: Sharp cutlery knives were observed in an unlocked drawer of the food preparation area in the Pre-K/School Age room, accessible to children.

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

Noncompliance Area: The file for Facility Person #1, start date 09/13/2019, contained documentation of initial emergency plan training on 09/24/2019, lacking documentation of emergency plan training at the time of initial employment. The file for Facility Person #3 contained documentation of emergency plan training on 03/08/2018 and 07/23/2019; more than one year went by between trainings.

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

Noncompliance Area: The file for Facility Person #4 lacked documentation of six clock hours of child care training in the last 12 months.

Correction Required: A staff person shall obtain an annual minimum of 6 clock hours of child care training.

Noncompliance Area: The file for Facility Person #3 contained documentation of fire safety training on 03/08/2018 and 07/23/2019; more than one year went by between trainings.

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

Noncompliance Area: The file for Facility Person #2, start date 03/12/2019, lacked documentation of completed mandated reporter training.

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

Noncompliance Area: The file for Facility Person #3, start date 03/05/2018, and Facility Person #4, start date 07/02/2018, contained documentation of initial staff evaluations on 09/03/2019; both lacking documentation of any staff evaluations in the 12 months prior.

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

Noncompliance Area: The hot water in the bathroom in the Infant/Toddler room measured at 115 F.

Correction Required: Hot water temperature, in areas accessible to children, may not exceed 110 F.

Noncompliance Area: The first-aid kit in the Infant/Toddler room lacked adhesive bandages.

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: Peeling paint and damaged plaster was observed on the wall near the desk in the Older Two's room.

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

Noncompliance Area: During staff interviews conducted as part of a complaint investigation, staff reported a staff member made fun of a child's gap between her teeth and told a child her dad was not her real dad when the child called her step-dad her dad.

Correction Required: A facility person may not single out the child for ridicule, threaten harm to the child or the child's family and may not specifically aim to degrade the child or the child's family.

Noncompliance Area: During staff interviews conducted as part of a complaint investigation, staff reported a staff member made fun of a child's gap between her teeth and told a child her dad was not her real dad when the child called her step-dad her dad.

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

Noncompliance Area: During interviews conducted as part of a complaint investigation, staff reported children are put in time out in pack and plays and required to stay in the pack and play for a designated amount of time.

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

Noncompliance Area: An infant was observed sleeping in a bouncy seat, which was placed on top of a table.

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: An expired Epi-Pen labeled for Child #1 was observed in the PS Room.

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

Noncompliance Area: A Tylenol labeled for Child #2, and a Cortisone Cream labeled for Child #3, in the PS Room were observed to lack written parental consent for administration.

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

Noncompliance Area: A written statement giving the formula and feeding schedule not available at the time of inspection for the infants in care.

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

Noncompliance Area: Bottles containing liquids were observed to lack labels for the children for whom they were intended in the Infant/Toddler Room.

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

Noncompliance Area: Loose crib sheets were observed on cribs used for sleeping infants, causing a suffocation hazard.

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

Noncompliance Area: Upon assessment of ratio and supervision in the Infant/Toddler Room at 10:45 AM on 7/30/19 during a complaint investigation, Infant/Toddler Room, Staff #1 named 5 children in her group, including 2 infants, 1 YT, 2 OT and 1 YSA. Staff #1 was asked again and re-named the same group.

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 picnic table located in the outdoor play space is cracked on two corners of the table and two corners of on of the benches posing a pinching and/or crushing hazard to the children.

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

Noncompliance Area: The file for Staff Person #1 lacked documentation the she received training regarding the emergency plan.

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 #2 lacked a Pennsylvania State Police Clearance, as required by the CPSL and Chapter 3490. The file for Staff Person #2, whose hire date was 3/5/2018 lacked documentation of proof of Mandated Reporter Training as required by the CPSL and Chapter 3490.

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

Noncompliance Area: In the outside playspace there is largre piece of plastic gross motor equipment with two slides attached. On the left edge of the longest slide, there is a sharp metal washer that was covered by a plastic cap at one time. The plastic cap is no longer over the sharp washer leaving a razor sharp edge exposed where children grab the slide when sitting down, posing a slicing hazard to the children.

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

Noncompliance Area: There were no written statements from the parents of the enrolled infants, giving the formula and feeding schedules for the infants.

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

Noncompliance Area: The file for Staff Person #1, who is working in the capacity of an assistant group supervisor, lacked a high school diploma or general educational development certificate.

Correction Required: An assistant group supervisor shall have a high school diploma or a general educational development certificate and 2 years experience with children.

Noncompliance Area: Observed in the entrance room, a pinch point on a wooden chair due to a missing screw needed to secure the seat.

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 a tube of sunscreen accessible to children on a desk in the entrance room. Observed orajel and acetamiinophen accessible to children in a diaper bag on a low hook by the entrance door.

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: Observed staff file #2 contained only one 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: Observed staff file #2 contained a volunteer child abuse clearance which is not valid for employment purposes.

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

Noncompliance Area: Observed staff file #1 did not contain documentation of 2 years experience with children.

Correction Required: An assistant group supervisor shall have a high school diploma or a general educational development certificate and 2 years experience with children.

Noncompliance Area: Observed the shed in the outdoor play area had a detached door tread plate sitting on the ground in front of the doorway.

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 peeling paint on the door frame on the shed in the outdoor play area.

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