Keiki O Ka Aina Infant Toddler Center-kailua

Please ensure that employment history information is collected for the following staff:

XXXXX for the period April 2023 to April 2026

XXXXX for the period November 2022 to November 2025

XXXXX for the period March 2023 to March 2026

XXXXX for the period March 2023 to March 2026

XXXXX for the period November 2022 to November 2025

XXXXX for the period March 2023 to March 2026

XXXXX for the period March 2023 to March 2026

Please provide the completed DHS 959 A Self-Certification of Employment form and any returned DHS 959 Employment History form.

Employment History Instructions:

All employees shall complete the form DHS 959A Self Certification of Employment and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 Employment History (EH) form and have the former and/or current employer complete and sign part II.

Please complete the following information on the form DHS 959A: the date EH mailed and the date EH returned.

Keep copies of all forms mailed out to former employers. If EH forms are not returned after the first try, mail out the again in a few weeks and log the date of the second mailing. If forms are not returned after the second try, we will accept the written self-certification that two mailed attempts were recorded on the DHS 959A.

Forms can be found on our website below:

https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/

Provider is maintaining electronic records. During the visit, worker randomly reviewed 4 electronic child records - some or all records have incomplete information.

Please ensure that all child records contain the following information:

1. Name, address, and phone numbers of person to assume responsibility when parents/guardians are not available.

2. Name, address, and phone numbers of person authorized to take child from facility.

3. Health information, including TB clearance, current immunization records, and other health information.

Inform worker XXXXX when the above information has been collected and XXXXX will return to review ALL of the enrolled children's records to ensure that this requirement is met.

Please amend the following forms and provide them to the department.

1. The "Authorized pick up list" form can only allow parents to designate an alternate person(s) to pick up their child. This person can pick the child up from the facility when parents are not able to pick up.

2. The "Emergency Contact Information" form allows parents to designate an alternate person(s) to assume responsibility of their child when parents/guardians are not available.

The program's enrollment/application packet does not have a form that collects infant daily routine information.

Please provide evidence that you have this form for parents to complete.

XXXXX has 0 hours of training recorded for the period ending May 2026.

Please ensure that all staff, including substitutes, complete this training requirement and provide the training certificates to PATCH for timely recording.

Once the training has been recorded by PATCH, this deficiency will be corrected.

During the visit, both toddler (1s and 2s) groups did not have a Caregiver qualified staff member.

Please provide an updated staff sequence form to show that you have adequate caregiver qualified coverage during all operating hours.

The worker will also conduct a follow-up visit to verify that staffing patterns are met.

When the Worker reviewed four electronic records, it was observed that not all health information has been collected or current.

Please ensure that all child records has the TB clearance and current immunization records according to the child's age.

Please inform Worker XXXXX when all health information has been collected and is in the child record.

The worker will conduct a follow-up visit to review the records.

Please provide the form that has parent/guardian grant written permission for emergency (medical) care, administer first aid and/or CPR, and to allow emergency technicians to administer medical treatment or life saving procedures.

Please provide form DHS 984 Medical Report for XXXXX.

Please provide evidence that XXXXX have been cleared for TB.

Worker verified that staff procedures covers: Absences from work due to illness; Appearance, Grooming, Smoking; food handling safety (skin conditions).

The policies shall also include the following:

Controls for the spread of communicable diseases (including COVID19);

Staff with altered mental state shall not be allowed to work;

Personal hygiene covering clean and neat hair and nails, and good oral hygiene; and

Staff shall take appropriate measures to manage stress by maintaining good mental health and physical health.

Once this information is added, please send us a copy.

Worker verified in the staff procedures that Appearance, Grooming, Smoking is covered.

Please add a sentence reminding staff to store nicotine products out of reach of children.

Please add to your staff health policies reminding staff that they shall not take medications that impair or limit the ability to care for children during operating hours.

Please amend the emergency plan to include how the program will provide for the needs of children with disabilities, special needs or chronic medical conditions during an emergency.

Please provide us your written procedures for staff to follow to minimize accidental injury to children in care during activities and in the facility.

Please provide the program's written procedures for infection control, to prevent transmission of blood-borne pathogens.

The following staff do not have safe sleep training or safe sleep training has expired:

XXXXX

Reminder: Safe sleep training is expiring soon for XXXXX.

Immediately provide training certificates to PATCH for recording.

Provider reported in December 2025 that they believed Castle Hospital has addressed the building permit violations cited in December 2023. A written request for a follow up inspection was sent to the City Department of Planning and Permitting in December 2025.

The City Department of Planning and Permitting provided a report dated May 13, 2026 indicating that the facility does not meet code requirements. Please follow up with Castle Hospital to address this and provide the department with an update.

Created in error.

Please have the following 2 staff complete the initial health & safety assessment: XXXXX.

This training shall be recorded by PATCH.

The Health & Safety assessment is attached.

On the DHS 954 Staff Listing form it includes one staff person XXXXX who does not have background checks.

Please schedule their fingerprinting immediately so that the department can conduct background checks. Once all

background checks are cleared, this requirement shall be met.

If she is no longer at the site, please submit a DHS 974 Notification of Change Form.

At the time of the visit, Worker reminded director to report staff changes timely since it was observed that there was a staff member at the site not listed on the DHS 954 Child Care Center Staff and Volunteer Listing form.

Also, the form shows two staff members unknown to the department and two other staff members are not listed.

On the DHS 954 Child Care Center Staff and Volunteer Listing form received on May 6, 2025, these are the staff members listed:

XXXXX.

Please document any staff changes on a DHS 974A Notification of Change(s) Form.

Note: Substitutes who will regularly be subbing at the Kailua site shall be included on the DHS 954 staff list. All substitutes who provide direct care to children for 10 or more hours a week are required to meet the requirements of regular staff which includes a physical exam and TB clearance within 12 months of their hire date, employment history clearances of 3 years prior to their hire date, health and safety training and safe sleep training.

Please address flooding in the Keiki O Ka Aina Emergency Preparedness Plan Kailua Infant/Toddler Center.

A sample flooding statement was emailed to Chief Early Education Officer Melodie Vega on May 29, 2025.

On that same email, we recommended to remove the statement, "KOKA does not enroll keiki that need one-to-one care and supervision," on page 3 as it may conflict with the requirements of the Americans with Disabilities Act (ADA), where providers cannot discriminate against persons with disabilities. Blanket exclusions based on a child's need for individualized support can be considered discriminatory.

Below is a sample ADA statement, which is required to be in the parent handbook:

KOKA complies with the Americans with Disabilities Act (ADA) and does not discriminate against individuals with disabilities. Reasonable accommodations will be considered on a case-by-case basis, taking into account the needs of the child and the program's resources and limitations.

Please make the necessary edits in the Keiki O Ka Aina Emergency Preparedness Plan Kailua Infant/Toddler Center as well as the Parent Handbook. Once completed, please send us a copy of both documents.

We received a building report from the City and County of Honolulu's Department of Planning and Permitting (DPP) on December 18, 2023, stating that the building located at the above address does not meet code requirements for child care. The report also states that a notice of violation was issued for alteration work without permit.

We sent an inspection request to the City and County of Honolulu's Department of Planning and Permitting (DPP), for them to conduct a building inspection on November 14, 2025. We are awaiting the results of that inspection report.

There are no record of safe sleep training for the following staff:

XXXXX

Annual safe sleep training has been expired since 2021 or the following staff:

XXXXX

Please have staff complete their required safe sleep training and submit the certificates to PATCH to be recorded.

Once we see that it has been recorded in the system, this deficiency will be corrected.

Note: Safe sleep training is imperative to be completed. Without it, the staff who are not current with their safe sleep training could be excluded from caring for children until the training is completed.

There is only one staff member XXXXX at the center from 6:00a-6:30am. There shall always be a minimum of two staff in the center when children are in care. Since it shows on the updated staff sequence received on May 28, 2025 that there was 1 toddler in the T2 group aa the center at 6:00am, you will need to assign a second staff member to be at center during that time.

During the visit, it was observed that there was 31 children enrolled and 28 children were signed in.

Staff child sequence is not met.

Updated Staff Sequence form was received on 5/28/25 via email from Chief Early Education Officer XXXXX:

Infants: 7 children with XXXXX, one caregiver and one aide qualified.

Toddler 1s: 10 children with XXXXX, one caregiver and two aide qualified.

Toddler 2s: 10 children with XXXXX, one caregiver qualified staff and 2 aide qualified.

Since there are no caregiver qualified staff members present, the staff sequence is not met in the afternoon when the T1 and T2 groups combine from 4:00pm-5:30p.

Please send us an updated staff-sequence form showing that there is a caregiver qualified staff member at that time of the day. We also need the ages of the children in the two toddler groups so we can determine if the staff sequence and group size is met.

There are no caregiver qualified staff members present in the afternoon when the T1 and T2 groups combine from 4:00pm-5:30p.

This requirement shall be met when current staff meets caregiver qualification or new caregiver qualified staff is hired.

The facility shall maintain, and make available to the department current records and information including: (7) Log of emergency preparedness drills practiced in accordance with section 17-895.1-71.

*Section 17-895.1-71 Disaster plan for emergencies. (c) The facility shall complete practice drills for the various emergency situations at regular intervals, or whenever a new procedure has been added.

*Provide the program's emergency drills that has been conducted for this school year that shows it is being completed at regular intervals.*

The facility shall have written policies, which have been developed with the assistance of the facility's health consultant and that minimally require:

*Please add the following to your employee/staff handbook:*

*5. Personal nicotine products shall be stored out of the reach of children.*

*6. Medication that impairs or limits your staff member's ability to provide care shall not be consumed prior to or during the hours of child care*

*Once completed, please provide a copy of your employee/staff handbook that shows these were added.*

Please provide a written attestation that all cleaning materials are clearly labeled and stored (name the area) in a secure area that is away from food preparation areas.

1. Provide photographic evidence (wide angle photographs, to confirm the location of the items) of where the area will be for infants and toddlers who become ill after arrival at the facility.

2. Provide written attestation that your site has an operating telephone (including telephone number) in case of an emergency that is accessible to all staff

3. Provide the department with your plan for accessing a telephone when child care is provided somewhere other than in the usual location where care is regularly provided

Provide photographic evidence (wide angle photographs to confirm the location) of a list of food items that are provided by the caregiver, posted in a prominent place for review by parents.

If the menu is shared with parents electronically, it is still requirement to be posted in a prominent place.

Please provide a copy of your current parent handbook with the required additions/edits that are required of the Hawaii Administrative Rules (HAR) Title 17, Chapter 895.1

During the October 30, 2024 visit, the Director reported that there were some staff changes that were made. Please provide us with written notification of any changes in staff within 5 working days after the change.

During the visit, Worker reviewed this rule with the Director and provided the DHS 974A Change report form.

*The DHS 974A Notification of Change(s) Form that was provided on November 18, 2024 via email did not reflect the staff changes that the site director noted during the October 30, 2024 visit. To clarify the staff that are at the site, we have attached a Service Summary Report for your record. This is what the department has on file on the employees/substitutes/volunteers that are at this site . Please look it over and report any changes via the DHS 974A.*

(c) Each caregiver, substitute, and volunteer within forty-five days of hire, shall complete initial training that is approved by the department in health and safety standards.

Please have staff members XXXXX complete the initial Health and Safety assessment by December 31, 2024. Failure to do so will result in the individuals being excluded from providing child care until the training requirement is met.

This requirement will be met once the assessment is recorded in the system by PATCH.

All employees are required to complete training in safe sleep practices within forty-five days of hire and on an annual basis. The child care facility shall maintain a record of policy reviews and trainings completed.

Safe Sleep training for new employees XXXXX are required to be completed. Please have XXXXX complete the required annual safe sleep training by January 15, 2025. Failure to do so will result in the individuals having to be excluded from providing child care until the training requirement is met.

Note: Annual Safe Sleep training for XXXXX will be expiring soon. Please have them complete their training in a timely manner.

This requirement will be met once the training is recorded in the system by PATCH.

§17-895.1-96 Program requirements

(b) All employees... caring for children less than one year of age shall... complete training in safe sleep practices that is approved by the department, upon hire and on an annual basis.

This requirement is not met for XXXXX.

Annual training shall expire in August for XXXXX.

The above staff shall conduct this training.

Annual background checks has expired (more than 90 days) for XXXXX.

Annual background checks will be expiring (within 30 days in August) for XXXXX

The above staff shall provide completed clearance forms to initiate annual background checks.

Please visit the following for the required forms:

http://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/

There following individuals are listed as substitutes on page 2 of the DHS 954 Child Care Staff and Volunteer Listing. They should also be listed on page 1 as well and will be required to fulfill the same requirements as regular staff. Please address the following requirements for each substitute:

XXXXX - TB and physical exam clearance, safe sleep training, employment history clearance

XXXXX - TB and physical exam clearance, safe sleep training, employment history clearance

-The following staff member is listed on the DHS 957 Staff Sequence form, but not on the DHS 954 Child Care Staff and Volunteer Listing:

XXXXX - TB and physical exam clearance, safe sleep training, employment history clearance

-The following staff member is not listed anywhere however, was there during our 10/30/24 site visit: XXXXX - initial background checks, TB/physical exam clearance, safe sleep training, employment history clearance

Please use the DHS 974 A Notification of Change(s) Form (attached) to report all substitutes. They should also be listed the DHS 954 Child Care Staff and Volunteer Listing.

The following policies shall be added and/or amended in your parent handbook:

1. Sick/Illness policy: please include written policies on how you shall mitigate the spread of communicable diseases.

2. Equal Opportunity/ADA statement: please remove "reasonable boundaries" and "undue hardship."

3. Management of EPI Pens (and other life saving medications).

4. Management of diapers and other infant supplies.

5. Fund raising statement: include the "non-exploitation of children and staff.".

6. Remove the following references to "state licensing regulations" in your handbook: Preschool toileting, page 2 and Enrollment forms, page 3.

7. TB clearance is required for all volunteers - please correct this statement, or remove entirely, in the handbook.

Written policy in the parent handbook: the sentence states they will not disclose information in an emergency.

Please correct this policy in the parent handbook as information shall be disclosed in the event of an emergency.

During the May 8, 2024 visit, the staffing patterns, staff-child ratio, and group size were not met for the 1s and 2s classrooms.

The following is what was observed:

1s: 12 present with XXXXX - staff-child ratio, staffing patterns not met

2s: 14 present with XXXXX - group size, staff-child ratio not met

1. Provide a written plan by June 30, 2024 as to how the facility will meet the required staff-child ratio, group size and staffing patterns for these two classes.

Note: Prior to providing a written plan, please discuss with your Child Care Licensing (CCL) Worker, XXXXX, to determine how this can be accomplished, with your current staff.

2. Please update the staffing sequence form (DHS 957 attached) to reflect current staffing and show how the facility will meet staff-child ratio, group size and staffing patterns.

Please provide written evidence of an agreement with a private physician, who is serving as your facility's health consultant.

The following staff will need to provide the following: XXXXX for TB clearance.

Please submit a completed DHS 984 Medical Report form, or a TB clearance form that the above named staff is cleared.

Please visit the following for the required forms:

http://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/

During the licensing visit on May 8, 2024, the Worker verified that the facility conducted drills only twice between January and early May. Per Director, Keiki O Ka Aina's policy are that monthly drills are done.

Please provide an updated fire drill in September to show that drills are practiced at regular monthly intervals in accordance with Keiki O Ka Aina's policy.

Please provide a current satisfactory Fire Inspection Report conducted by the Honolulu Fire Department.

If there were any findings, please address them and contact the fire department to do a reinspection of your site so that the inspection can be satisfactory.

*We received a building report from the City and County of Honolulu's Department of Planning and Permitting (DPP) on December 18, 2023, stating that the building located at the above address does not meet code requirements for child care. The report also states that a notice of violation was issued for alteration work without permit.*

We are aware that Keiki O Ka Aina is actively addressing this issue. In May 2024, it was reported by your Facilities Manager that plans are/have been submitted to the DPP.

Please update the department on the progress. We reached out to your Facilities Manager XXXXX on December 4 and again on December 11, 2024 and have not received any response.

Safe sleep training has expired or will be expiring soon for the following employees: XXXXX

All training certificates shall be forwarded to PATCH so that the training information can be updated in our system.

The following staff members will need to provide the following: XXXXX (physical exam) and XXXXX (TB).

These volunteers have not been cleared for physical exam and TB: XXXXX.

Please submit completed DHS 984 Medical Report forms (and TB clearance forms) that all the above named staff have been cleared.

Please visit the following for the required forms:

http://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/

The annual safe sleep training requirement has expired for XXXXX. Please have her complete her safe sleep training immediately.

Also, XXXXXhas no record of safe sleep training. Please have her complete her annual safe sleep training immediately.

The training certificates must be submitted to PATCH.