Erica R Winstead Family Child Care

Regulation: 3290.151(a)(2)/3290.192(2)

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

Noncompliance Area: 2ND CITATION: The staff file for Staff person #2 was observed to lack a current health assessment; the health assessment on file is dated 4/10/24 which was conducted more than 24 months. The staff file for Staff person #3 was observed to lack a current health assessment; the health assessment on file is dated 8/1/23 which was conducted more than 24 months. PREVIOUSLY CITED ON 6/16/26

Correction Required: 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: 3290.31(f)(4)(i)

Description: Age and training

Noncompliance Area: On 6/16/26 a renewal inspection was conducted at the facility. Staff person #2 and Staff person #3 had not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This was evidenced by the previously documented Pediatric first aid and CPR training on file expiring 2/25/26. The facility's acceptable plan of correction indicated the correction would be implemented by 7/26/26. Staff person #2 and Staff person #3 still does not have documentation of current Pediatric first aid and CPR training.

Correction Required: Staff persons shall complete professional development in the topics of 3270.31(f)(10), 3280.31(f) (10), or 3290.31(g) (10) within 90 days of hire. Staff person #2 and #3 must receive pediatric first aid/CPR training in an approved curriculum by a PQAS-certified trainer. Until such time as the correction is implemented, staff person #2, and Staff person #3 must be supervised, when interacting with children, by a family childcare home staff person who has completed the required training related to this citation. If there are no staff available to supervise staff person #2, and staff person #3, staff person #2, and staff person #3 may not work in a child-care position at the facility.

Regulation: 3290.31(f)/3290.192(4)

Description: Age and training/Required training

Noncompliance Area: 2nd CITATION: The staff file for Staff person #3 was observed to lack 12 clock hours of annual childcare training for required from 12/2024 - 12/2025. PREVIOUSLY CITED ON 6/16/26.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training. A facility person's record shall include records of training required by the Department.

Regulation: 3290.32(a)

Description: Comply with CPSL

Noncompliance Area: 2nd CITATION: The staff file for Staff person #3 lacked valid mandated reporter training; the current mandated reporter training certificates on file were completed on 9/22/20 and is more than 60 months old. PREVIOUSLY CITED ON 6/16/26.

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

Regulation: 3290.151(a)(2)/3290.192(2)

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

Noncompliance Area: The staff file for Staff person #2 was observed to lack a current health assessment; the health assessment on file is dated 4/10/24 which was conducted more than 24 months. The staff file for Staff person #3 was observed to lack a current health assessment; the health assessment on file is dated 8/1/23 which was conducted more than 24 months.

Correction Required: 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: 3290.18

Description: General Health and Safety

Noncompliance Area: Staff person #1 and Staff person #2 were observed to be caring for children unsupervised. Staff person #1 and Staff person #2 do not have a valid pediatric first aid/CPR training. This is evidenced by the previously documented pediatric first aid/CPR training expiration date of 2/25/26 and the training taken on 2/3/26 was not with a valid PQAS instructor.

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. Until such time as the required trainings are completed, staff person #1 and staff person #2-- must be supervised, when interacting with children, by a family childcare home staff person who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person #1 and staff person #2, staff person #1 and staff person #2 may not work in a childcare position at the facility.

Regulation: 3290.181(c)

Description: Emergency info/agreement updated 6 mos

Noncompliance Area: The child file for Child #1, Child #2, and Child #3 contained an emergency contact information form that was not reviewed and signed by the parent at least once in 6-months; the last documented review was signed and dated 5/17/24.

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: 3290.31(f)(4)(i)

Description: Age and training

Noncompliance Area: Staff person #1 and Staff person #2 do not have a valid pediatric first aid/CPR training. This is evidenced by the previously documented pediatric first aid/CPR training expiration date of 2/25/26 and the training taken on 2/3/26 was not with a valid PQAS instructor.

Correction Required: Staff persons shall complete professional development in the topics of 3270.31(f)(10), 3280.31(f) (10), or 3290.31(g) (10) within 90 days of hire. Staff person #1, staff person #2, and staff person #3 must receive pediatric first aid/CPR training in an approved curriculum by a PQAS-certified trainer. Until such time as the correction is implemented, staff person #1, staff person #2, and Staff person #3 must be supervised, when interacting with children, by a family childcare home staff person who has completed the required training related to this citation. If there are no staff available to supervise staff person #1, staff person #2, and staff person #3, staff person #1, staff person #2, and staff person #3 may not work in a child-care position at the facility.

Regulation: 3290.31(f)/3290.192(4)

Description: Age and training/Required training

Noncompliance Area: The staff file for Staff person #3 was observed to lack 12 clock hours of annual childcare training for required from 12/2024 - 12/2025.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training. A facility person's record shall include records of training required by the Department.

Regulation: 3290.32(a)

Description: Comply with CPSL

Noncompliance Area: The staff file for Staff person #1 and Staff person #3 lacked valid mandated reporter training; the current mandated reporter training certificates on file were completed on 9/22/20 and is more than 60 months old.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). The operator shall comply with the CPSL and with Chapter 3490 (relating to Child Protective Services). Until such time as the required training has been completed, staff person# 1 and staff person #3 must be supervised, when interacting with children, by a family childcare home staff person who has completed the required training related to this citation. If there are no staff person(s) available to supervise staff person# 1 and staff person #3, staff person# 1 and staff person #3 may not work in a child-care position at the facility.

Regulation: 3290.32(a)/3290.192(3)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The staff file for Staff person #3 lacked a valid National Sex Offender Registry (NSOR) clearance; the NSOR clearance on file is dated 1/28/20 which is more than 60 months old.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Staff Person #3 may not work in a childcare position at the facility.

Regulation: 3290.32(d)

Description: Age and training

Noncompliance Area: Staff person #1 and Staff person #2 were observed to be caring for children and neither Staff person #1 nor Staff person #2 have valid pediatric first aid/CPR training. This is evidenced by the previously documented pediatric first aid/CPR training expiration date of 2/25/26 and the training taken on 2/3/26 was not with a valid PQAS instructor.

Correction Required: One or more facility persons competent in pediatric first-aid and pediatric cardiopulmonary resuscitation techniques shall be at the facility when one or more children are in care.

Regulation: 3290.64(a)

Description: Locked or inaccessible - in original container

Noncompliance Area: A gallon of Sani Clean Plus sanitizer labeled 'Keep Out of Reach of Children' was observed stored on an orange three-tier utility cart accessible to the children in care.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Regulation: 3290.74(a)

Description: Requirements

Noncompliance Area: A metal post from the chain link metal fence that surrounds the front yard, where the children play outside, was observed to have become detached laying on the ground near a child's playhouse posing a tripping hazard.

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

Regulation: 3290.102(a)

Description: Clean and good repair

Noncompliance Area: The back of the bench in the outdoor play area was broken exposing sharp edges.

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

Regulation: 3290.123(a)(3)

Description: Services provided

Noncompliance Area: The files for Child #2 and Child #3 lacked documentation on the Department's approved form to provide the family information about the child's growth and development.

Correction Required: An agreement shall specify 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 at § 3290.124(e).

Regulation: 3290.131(a)/3290.182(1)

Description: Within 60 days/Initial and subsequent health assessments

Noncompliance Area: The file for Child #1, a school age child, contained a health report dated 5/17/24 which was obtained more than 60 days following the first day of attendance at the facility. The file for Child #2, a preschool age child, contained a health report dated 9/13/24 which was obtained more than 60 days following the first day of attendance at the facility.

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

Regulation: 3290.131(b)(1)

Description: Updated infant health report: every 6 months

Noncompliance Area: The most recent health report on file for Child #3 dated 5/16/24 was obtained more than 6 months ago.

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.

Regulation: 3290.131(e)/3290.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: The files for Child #1 and Child #2 lacked verification of immunizations within 60 days following the first day of attendance at the facility. The file for Child #3 lacked verification the child was administered immunizations in accordance with the recommendations of the ACIP.

Correction Required: 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. 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 #3 will be dismissed from care by close of business 6/20/25 until either the immunization record is updated or a parent provides a written, signed exemption letter.

Regulation: 3290.31(f)(4)(i)

Description: Age and training

Noncompliance Area: The file for Staff Person #2 (See LIS Code Sheet) contained a current pediatric first aid and CPR training dated 2/25/24; the prior pediatric first aid and CPR training was dated 9/11/21 which expired in September 2023.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and 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: 3290.32(a)/3290.192(3)

Description: Comply with CPSL/CPSL information

Noncompliance Area: The file for Staff Person #1 (See LIS Code Sheet) contained a State Police clearance dated 6/28/23 and a PA Child Abuse clearance dated 7/3/23 which were obtained after the date of hire. The file for Staff Person #2 (See LIS Code Sheet) contained a State Police clearance dated 5/28/24 which was obtained more than 60 months from the previous State Police clearance dated 4/22/19; a PA Child Abuse clearance dated 6/3/24 which was obtained more than 60 months from the previous PA Child Abuse clearance dated 5/14/19; an FBI clearance dated 6/3/24 which was obtained more than 60 months from the previous FBI clearance dated 4/23/19. The file for Staff Person #2 contained an NSOR certificate dated 1/28/20 which was obtained more than 60 months ago.

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

Regulation: 3290.32(a)/3290.192(4)

Description: Comply with CPSL/Required training

Noncompliance Area: The file for Staff Person #1 (See LIS Code Sheet) contained a Mandated Reporter training dated 5/1/24 which was obtained more than 90 days after date of 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 records of training required by the Department.

Regulation: 3290.74(a)

Description: Requirements

Noncompliance Area: In the outdoor play area, to the left of the porch was a piece of siding with sharp edges next to the fence. There were sticks and debris in the play house.

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

Regulation: 3290.75(a)

Description: No peeling paint or plaster

Noncompliance Area: There were two white wooden chairs in the outdoor play area with peeling paint.

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

Regulation: 3290.123(a)

Description: Signed

Noncompliance Area: The agreement form in the files for Child #2 and Child #5 lack the operator's signature.

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

Regulation: 3290.123(a)(3)

Description: Services provided

Noncompliance Area: The files for Child #1, Child #3, Child #4, and Child #5 lacked a child service report including information about the child's growth and development.

Correction Required: An agreement shall specify 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 at § 3290.124(e).

Regulation: 3290.123(b)/3290.182(8)

Description: Parent receives original/Copy of initial and subsequent agreements. Parent receives original.

Noncompliance Area: The files for Child #1, Child #2, Child #3, Child #4, and Child #5 all contained the original agreement form.

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

Regulation: 3290.124(b)(2)

Description: Physician name, address, phone

Noncompliance Area: The emergency contact form in the file for Child #5 lacked contact information including the name, address, and phone number of the child's physician.

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

Regulation: 3290.124(b)(3)

Description: Parent home/work address, phone

Noncompliance Area: The emergency contact form in the file for Child #4 lacked the parent's work address and phone number.

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

Regulation: 3290.124(b)(6)

Description: Insurance coverage information

Noncompliance Area: The emergency contact form in the files for Child #2 and Child #4 lacked the health insurance policy number. The emergency contact form in the file for Child #5 lacked the health insurance coverage 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: 3290.124(d)

Description: Written emergency plan posted

Noncompliance Area: Per staff statements, the emergency transportation plan has not accompanied the staff transporting the children to and from school.

Correction Required: A written plan shall be conspicuously posted which identifies the means of transporting a child to emergency care and the facility staffing provisions in the event of an emergency. The plan must accompany a staff person who leaves the facility on an excursion with children.

Regulation: 3290.131(a)/3290.131(e)

Description: Within 60 days/Immunization record

Noncompliance Area: The file for Child #5, a toddler, lacked a health report and an immunization record. Child #5 has been enrolled more than 60 days.

Correction Required: The operator shall require the parent of an enrolled child 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: 3290.131(e)(3)

Description: Dismissal policy

Noncompliance Area: Child #5, a toddler enrolled for more than 60 days, lacks an immunization record.

Correction Required: 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 #5 must be dismissed from care by close of business 8/23/24 and may only return to care when the immunization record is obtained.

Regulation: 3290.133(4)

Description: Locked

Noncompliance Area: Medication stored under the diaper changing station in an unlocked cabinet was accessible to children.

Correction Required: Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: The Emergency Plan did not address Continuity of Operations as required by Announcement C-22-04 which states to maintain full compliance with 45 CFR § 98.41(a)(1)(vii), child care facilities must have requirements for volunteer emergency preparedness training, practice drills and continuity of operations included in their emergency plan.

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

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: Adult scissors were on the table accessible to children. Cords and wires for video game systems located on the bottom shelf of the stand were accessible to children. The vehicle used to transport the children is out of inspection as of June 2024.

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

Regulation: 3290.22(a)

Description: Availability of certificate of compliance and applicable regulations

Noncompliance Area: The facility's current certificate of compliance was not posted in a conspicuous location used by parents.

Correction Required: The facility's current certificate of compliance shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional child care office posted at the same location.

Regulation: 3290.24(b)

Description: Emergency plan

Noncompliance Area: There was a current emergency plan dated, 12/12/23, on file at the facility. The facility lacked documentation of previous emergency plan annual reviews and previous updates.

Correction Required: The operator shall review the emergency plan at least annually and update the plan as needed. Each review and update of the emergency plan shall be documented in writing and kept on file at the facility.

Regulation: 3290.24(c)

Description: Training regarding plan

Noncompliance Area: The files for Staff #1, Staff #2, and Staff #3 lacked current Emergency Plan training. The most recent Emergency Plan training documentation for Staff #1 and Staff #2 was dated 3/20/23.

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.

Regulation: 3290.31(f)(4)(i)

Description: Age and training

Noncompliance Area: The file for Staff #2 contains current first-aid and CPR training dated 2/25/24, more than 24 months from previous first-aid and CPR training dated 9/11/21.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and 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: 3290.31(f)/3290.192(4)

Description: Age and training/Required training

Noncompliance Area: Staff #1 lacked 6 of the 12 annual child care training hours required between December 2022 and December 2023.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training. A facility person's record shall include records of training required by the Department.

Regulation: 3290.63

Description: Protective Outlet Covers 5 yrs. or less

Noncompliance Area: The power strip on the couch accessible to children ages 5 and younger lacked covers over the outlets.

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

Regulation: 3290.64(a)

Description: Locked or inaccessible - in original container

Noncompliance Area: Cleaning agents marked "keep out of reach of children" were observed on the kitchen counter near food preparation areas as well as on the floor accessible to children.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Regulation: 3290.75(a)

Description: No peeling paint or plaster

Noncompliance Area: There is peeling paint on the wall to the right of the front door, when exiting.

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

Regulation: 3290.91(a)

Description: Stairs, exits, etc. unobstructed

Noncompliance Area: There is a large table leaning against the wall in the hallway obstructing the exit.

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

Regulation: 3290.94(a)(1)

Description: Every 60 days

Noncompliance Area: The fire drill log on file included fire drills conducted more than 60 days apart: 2/22/24 and 4/29/24.

Correction Required: The operator 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: 3290.102(a)

Description: Clean and good repair

Noncompliance Area: Observed in the outdoor play space: a broken toy wheelbarrow and play house. Observed leaves and debris in the ball bin.

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: 3290.103

Description: Small Toys and Objects

Noncompliance Area: Observed small beads less than one inch in diameter, which were accessible to children, in the main child care space. This presents a potential choking hazard to children who may still be 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: 3290.123(a)(1)

Description: Amount of fee

Noncompliance Area: The fee agreement in the file for Child #1 lacked the fee amount.

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

Regulation: 3290.151(a)/3290.192(2)

Description: Within 3 months, then 12 months/Health assessment, TB test

Noncompliance Area: The file for Staff Person #1 did not included an updated health assessment conducted within the past 24 months. The previous health assessment in the file for Staff Person #2 had been purged.

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 on file at the facility. 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: 3290.176

Description: Transportation First Aid Kit

Noncompliance Area: The vehicle first aid kit lacked soap.

Correction Required: A first-aid kit, including the contents as specified in §3290.73 (relating to first-aid kit) shall be in the vehicle when children are being transported.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: The facility's emergency plan did not include requirements for volunteer emergency preparedness training, practice drills and continuity of operations (backing up or retrieving health and other key records/files and managing financial issues such as paying employees and bills during the aftermath of the disaster) to maintain compliance with 45 CFR § 98.41(a)(1)(vii).

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

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: The files for Staff Person #1 and #2 did not include documentation of the one-hour Health and Safety Update. The prescribed timeframe was 12/30/22.

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

Regulation: 3290.32(a)/3290.192(3)

Description: Comply with CPSL/CPSL information

Noncompliance Area: Previous clearances had been purged from the file of Staff Person #1. The file for Facility Person #3, a Household Member over 18, did not include a State Police or Child Abuse clearance.

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 #3 may not work at the facility.

Regulation: 3290.74(a)

Description: Requirements

Noncompliance Area: Observed strip peeling away from ceiling, which had been repaired from water damage.

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

Regulation: 3290.118

Description: Infant sleep position

Noncompliance Area: It was observed that an infant was sleeping in a bouncy seat. When staff were asked about moving the child, staff stated that the parents stated that the infant sleeps better elevated.

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: 3290.124(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 work phone number.

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

Regulation: 3290.124(e)

Description: Updated every 6 months

Noncompliance Area: The emergency contact form for child #3, child #4 and child #5 were last reviewed/updated on 6/1/21, which is more than 6 months ago.

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

Regulation: 3290.131(d)(5)

Description: Immunization record

Noncompliance Area: The health report for child #2 and child #3 lacked immunizations in accordance to the recommendations of the ACIP.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP.

Regulation: 3290.151(a)(2)

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

Noncompliance Area: The file for staff person #1 had a health assessment completed on 5/7/19 and 9/20/21, which is more than 24 months apart.

Correction Required: 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: 3290.181(c)

Description: Emergency info/agreement updated 6 mos

Noncompliance Area: The emergency contact form and financial agreement for child #3, child #4 and child #5 were last reviewed/updated on 6/1/21, which is more than 6 months ago.

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: 3290.24(c)

Description: Training regarding plan

Noncompliance Area: The file for staff person #1 received emergency plan training on 8/29/20 and 9/29/21, which is not annually.

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.

Regulation: 3290.31(f)/3290.192(4)

Description: Age and training/Required training

Noncompliance Area: The file for staff person #1, see LIS for hire date, lacked 12 training hours from 12/19/20-12/19/21.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training.A facility person's record shall include records of training required by the Department.

Regulation: 3290.73(c)

Description: Has all items

Noncompliance Area: The first-aid kit lacked scissors.

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: 3290.69

Description: Heat Source

Noncompliance Area: Upon entering the facility at 8:55 am, the gate between the main room and the adjacent kitchen was ajar, making the stove accessible to child #1, a 6 year-old, observed in care in the main room at the time of the inspection.

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

Regulation: 3290.91(a)

Description: Stairs, exits, etc. unobstructed

Noncompliance Area: Upon entering the facility at approximately 8:55 am, the back door in the kitchen of the facility was observed to be obstructed by piles of items on the kitchen floor, including several dozen canned goods, some stacked approximately 2 feet high.

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

Regulation: 3290.113(a)/3290.113(f)

Description: Supervised at all times /Supervision of children

Noncompliance Area: At approximately 8:45 am, staff #1 answered the front door and upon entering the facility, no children were observed at the time. When staff person #1 was asked if there were any children in care as we walked from the hallway into the front room, they said "Yes." Child #1 and #2 were then observed in the middle room. The children were not being properly supervised as staff person #1 could not see, direct or assess the children from the front hallway.

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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in §§ 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio).When there is only one operator present in the family child care home and the operator is unable to be physically present with the children because the operator is preparing snacks or meals for children in care or the operator is using the restroom, the operator may comply with the supervision requirement in subsection (a) through the use of an electronic monitor, camera, mirror, or other device or method so the operator can see, hear, direct and assess the children in real time at all times.

Noncompliance Area: The last two health assessments in the file for staff person #1 were dated more than 24 months apart.

Correction Required: 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 last emergency plan training in the file for staff person #2 and #3 was more than 12 months ago.

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.

Noncompliance Area: Based on conversation with the operator, the emergency relocation site was recently changed and a copy of the updated plan was not yet sent to the County Emergency Management Agency.

Correction Required: The operator shall send a copy of the emergency plan and subsequent plan updates to the county emergency management agency.

Noncompliance Area: The last two Mandated Reporter training in the file for staff person #1, the operator, were dated more than 60 months apart. The Mandated Reporter training in the file for staff person #3, was dated beyond their first 90 days of employment.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include records of training required by the Department.

Noncompliance Area: The following items were observed as accessible to children in care, which included school-age children, and included instructions to keep out of the reach of children: A small space air freshener on the entrance-way cubby, Member's Mark Premium wipes on the floor in the living room and mounted hand sanitizers on the wall at the entrance, between the hall and living room, between the living room and dining room and between the dining room and kitchen.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: The following items, less than an inch in diameter, were observed in the middle room and accessible to toddlers in care.

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

Noncompliance Area: The file for child #10 did not include evidence of a child service report in the last 6 months.

Correction Required: An agreement shall specify 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 at 3290.124(e).

Noncompliance Area: The emergency contact form in the file for child #10 did not include a phone number for two of the individuals to whom the child may be released.

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

Noncompliance Area: The last update in writing by a parent on the emergency contact information and the agreement form in the file for child #10 was dated more than 6 months ago.

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

Noncompliance Area: The last two health reports in the file for child #1, who just turned two year-old, were dated 12 months apart.

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 #10 did not include evidence of a flu shot or a written statement of exemption from immunization from a parent or religious belief or strong personal objection

Correction Required: Exemption from immunization for religious belief or strong personal objection equated to a religious belief shall be documented by a written, signed and dated statement from the child's parent or guardian. The statement shall be kept in the child's record.

Noncompliance Area: At approximately 8:49 am, staff person #1, the operator, transported 8 children in their personal vehicle, a combined group of 4 preschoolers, 3 young school-ager and 1 older school-ager. There were no car seats or booster seats in the vehicle for the 6 children under 7 years of age. The 11 year-old sat in the single front passenger seat, 4 children sat in the middle row, which only seats 3 people, and 3 children sat in the back row, which only seats 2 people. Two sets of children were sharing seat belts.

Correction Required: A child 7 years of age or younger shall be transported in accordance with the requirements for parents and guardians as stated in 75 Pa.C.S. 4581 (relating to restraint systems).

Noncompliance Area: At approximately 8:49 am, staff person #1, the operator, transported 8 children in their personal vehicle, a combined group of 4 preschoolers, 3 young school-ager and 1 older school-ager. There was not a first aid kit in the vehicle.

Correction Required: A first-aid kit, including the contents as specified in 3290.73 (relating to first-aid kit) shall be in the vehicle when children are being transported.

Noncompliance Area: 2nd citation: On 6/21, the following toxics, all including instructions to keep out of the reach of children, were observed in the facility and were accessible to children: In the middle room, there was a travel size tube of Colgate toothpaste in a book bag in a chest of toys, 3 cans of adhesive spray, a small tube of super glue and a tube of green acrylic paint was in a low drawer in the arts and crafts cart, and a tube of Desonide, a bottle of baby oil and a packaged bath bomb was sitting on a table behind the television. TA--3 wax air fresheners On 6/4, the following toxics, all including instructions to keep out of the reach of children, were observed in the facility and were accessible to children, In an unlocked cabinet under the bathroom sink, there was Mister Plumber drain opener, Lysol toilet bowl cleaner, Comet cleanser, Crest mouthwash, Scrubbing Bubbles toilet bowl tablets and several other toxics. In an unlocked cabinet at the end of the second floor hallway, there were several toxics, including 2 containers of Chlorox wipes and Soft Scrub cleanser. There was an unlabeled bottle containing a pink solution on the bathroom sink. Previously cited on 4/9/19.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: There was a tube of green acrylic paint in a drawer in the arts and crafts cart in the middle room which was not non-toxic,, which included instructions to keep out of the reach of children.

Correction Required: Arts and crafts materials shall be nontoxic.

Noncompliance Area: The bathroom medicine cabinet was detaching from the wall.

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

Noncompliance Area: There was an area of peeling paint above the toilet in the bathroom and a hairline crack of peeling paint on the wall behind the sofa in the living 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: The hallway leading from the front entrance to the middle room was obstructed by several items, including a large box and a large garbage bag. The kitchen door was blocked by a cart of canned goods.

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

Noncompliance Area: The file for staff person #1 and #2 did not include evidence of a health assessment.

Correction Required: A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem.

Noncompliance Area: The file for staff person #1 and #2 did not include evidence of a TB screening by the Mantoux method.

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

Noncompliance Area: The file for staff person #1 and #2 did not include evidence of training in 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.

Noncompliance Area: 2nd citation: The file for staff person #1, observed caring for 5 children alone at the facility for approximately 25 minutes, did not include a signed disclosure statement, none of the three required clearances or proof of request for those clearances. The file for staff person #2, who cares for children alone while the operator transports children before and after school, included a child abuse clearance dated after the staff person's start date and an FBI rap sheet with a missing disposition. Previously cited on 10/11/18.

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: The file for staff person #1, observed caring for 5 children alone at the facility for approximately 25 minutes, did not include evidence of first-aid training.

Correction Required: One or more persons competent in first-aid techniques shall be at the facility when day care children are in care.

Noncompliance Area: On the first floor, there was a box of Culturelle Probiotic packets on a table in the middle room, and a can of Great Value air freshener spray and Dove antiperspirant spray on the cubbies in the hallway entrance. On the second floor, there were gates leaning against the opening to both bedrooms and at the end of the hall, leaving the following toxics accessible to children: A bottle of Pink body lotion in the left bedroom and in the right bedroom, a can of Snuggle air freshener spray, a bottle of Neutrogena sunblock, a bottle of Fabuloso cleaner, a bottle of Imodium and Degree deodorant. At the end of the hallway, there was a bottle of Spic n Span, Salon Graphix mousse, two containers of Chlorox antibacterial wipes, a bottle of Fabuloso cleaner and a bottle of Shine and Finish hair spray. All items included instructions to keep out of the reach of children.

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 kept in a locked area or in an area inaccessible to children, and shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: The gate between the kitchen and the middle room, where children were observed in care, was ajar, making the stove accessible to the children in care.

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

Noncompliance Area: The hallway leading from the front entrance to the middle room, where children were observed in care, was blocked by a book case and had several large boxes stacked against the wall.

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

Noncompliance Area: Based on conversation with the operator, child #2, an infant, fell asleep in a car seat and remained sleeping in the seat for approximately 45 minutes.

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.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: There was not a file on site for individual #1, who was observed caring child #1, an enrolled child, alone at the facility for approximately 45 minutes. Based on conversation with the operator, individual #1 watches enrolled children in the morning while the operator takes her children to school and individual #2 and #3 watch enrolled children in the afternoon while the operator picks up her children from school. There was also no file on site for individual #2 and #3.

Correction Required: An individual record is required for each facility person.

Noncompliance Area: There were no clearances on site for individual #1, who was observed caring for child #1, an enrolled child, alone at the facility for approximately 45 minutes. Based on conversation with the operator, individual #1 watches enrolled children in the morning while the operator takes her children to school and individual #2 and #3 watch enrolled children in the afternoon while the operator picks up her children from school. There were no clearances on site for individual #2 and #3.

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: The emergency contact information in the file for child #1 did not include the policy number for the health insurance under which the child is covered.

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

Noncompliance Area: The emergency contact information in the file for child #1 did not include 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.

Noncompliance Area: The hallway exit from the middle room of the facility was obstructed

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

Noncompliance Area: There written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not displayed conspicuously in any child care spaces at the facility.

Correction Required: A written plan shall be conspicuously posted which identifies the means of transporting a child to emergency care and the facility staffing provisions in the event of an emergency. The plan must accompany a staff person who leaves the facility on an excursion with children.