M & M Kids

Noncompliance Area: *FOURTH CITATION: At 2:12pm it was observed that a preschool child opened the half door between the dining room and the kitchen, walked through the kitchen to the play room in the rear of the facility unsupervised, and returned to the living room with a toy. It was observed that Staff person #1 and Staff person #2 had their backs to the child while they were talking to a parent who was standing in the front doorway of the facility and did not know that the child left the room until the child returned. PREVIOUSLY CITED 3-16-20, 6-15-20 and 7-16-20

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).

Noncompliance Area: The sliding glass door that served as an exit to the play room in the rear of the facility was obstructed with toys on the floor that were placed directly in front of the door.

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: At 11:15 AM when additional children arrived at the home, the operator went outside to meet them, leaving a child alone and unsupervised in the family room. It was noticed at 11:30 AM that a one year old child had gone upstairs alone and was unsupervised.

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). TIERED LIS: Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training. The legal entity must submit documentation in a format approved by DHS proving that the facility procedure for counting children is followed at all times e.g., a checklist. The legal entity will confirm continuing compliance by sending copies of the documentation to the Regional Office of Child Development and Early Learning on a weekly basis for a period of three months after DHS approves the documentation format.

Noncompliance Area: Upon arrival at 12:00 PM on Monday, June 15, 2020, there were 10 children outside playing in the fenced in front yard with no adult visible. The children ranged in ages from 1 year old up to 9 years old.

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). TIERED LIS: Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training. The legal entity must submit documentation in a format approved by DHS proving that the facility procedure for counting children is followed at all times e.g., a checklist. The legal entity will confirm continuing compliance by sending copies of the documentation to the Regional Office of Child Development and Early Learning on a weekly basis for a period of three months after DHS approves the documentation format.

Noncompliance Area: In the sunroom there was a interactive toddler standing toy that had visible dirt. In the family room, there was a child's wooden chair that had a broken support bar running between two of the chair's legs.

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

Noncompliance Area: In the kitchen, there was a bag full of plastic bags hanging from the door handle making it accessible to children who are still placing objects in their mouths. In the outside play area, there was foam that was flaking from the Treehouse play structure and a bike seat that had exposed foam, both items were accessible to children who are still placing objects in their mouths. In the outside play area, there were small plastic pieces from broken toys and soda lids located throughout the grass area that were accessible to children who are still placing objects in their mouths.

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

Noncompliance Area: Children in care on Monday, March 16, 2020 were not supervised by a staff person at all times. A young toddler was taken upstairs by a household member who was not being supervised.

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). TIERED LIS: Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training. The legal entity must submit documentation in a format approved by DHS proving that the facility procedure for counting children is followed at all times e.g., a checklist. The legal entity will confirm continuing compliance by sending copies of the documentation to the Regional Office of Child Development and Early Learning on a weekly basis for a period of three months after DHS approves the documentation format.

Noncompliance Area: The file for child # 1, # 2, and #3 lacked an agreement that was signed by the parent.

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

Noncompliance Area: The file for child # 5 lacked an updated child service report, (3/1/18 and 3/15/19).

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 file for child # 4 contained an agreement that did not specify the date of the child's admission.

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

Noncompliance Area: The file for child # 4 contained a emergency contact form that did not reference who shall be contacted in an emergency.

Correction Required: Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.

Noncompliance Area: The file for child # 1, # 2, and #3 contained a emergency contact form that did not include written consent signed by a parent for emergency care.

Correction Required: Emergency contact information must include the written consent signed by a parent for emergency medical care.

Noncompliance Area: The file for child # 1, # 2, and #3 contained a emergency contact form that did not include information on health insurance coverage or policy numbers.

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 file for child #1, #2, #3, and #4 contained a emergency contact form that did not include the address of the individuals 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 file for child #4 contained a emergency contact form that was updated at a interval greater than 6 months (2/27/18 and 3/15/19) and still requires an update. The file for child #5 contained an emergency contact form that was updated in a interval greater that 6 months (3/1/18 and 3/15/19) and still requires an update.

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

Noncompliance Area: The health report for child #5 lacked verification of the influenza vaccine in accordance with the schedule recommended by the ACIP.

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.

Noncompliance Area: The file for staff person # 1 lacked a current health assessment. The health assessment on file was dated 3/5/18.

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: In the upstairs bathroom that the children in care use, there was water in the bathtub posing a threat to the health and safety of the children. Based on a statement from the owner there are hazards in the basement. The door to the basement was unlocked and accessible to the children in care. In the dining room, there were window clings less than 1 inch in diameter on the floor posing a choking hazard to the children in care.

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

Noncompliance Area: The file for child #4 contained a emergency contact form that was updated in a interval greater than 6 months (2/27/18 and 3/15/19) and still requires an update. The agreement was updated 3/26/19 and still requires an update. The file for child #5 contained an emergency contact form and agreement that was updated in a interval greater that 6 months (3/1/18 and 3/15/19) and both still require an update.

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.

Noncompliance Area: The file for child # 1, # 2, and #3 contained a emergency contact form that did not include written consent signed by a parent for administration of minor first aid.

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

Noncompliance Area: A file for staff # 2, which was previously observed, was lacking a file during the inspection.

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

Noncompliance Area: The facility did not have a emergency plan.

Correction Required: The facility shall have an emergency plan.

Noncompliance Area: The files for staff #1 and #2 did not have a documentation of current emergency plan training and still require annual training.

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

Noncompliance Area: Household member #2 (DOB 6/27/02) was acting as a volunteer, did not have a file, and was not directly supervised at all times.

Correction Required: A volunteer shall be 16 years of age or older and shall be directly supervised at all times.

Noncompliance Area: In the sunroom, laundry room, and family room there were electrical outlets that lacked protective receptacle covers. In the sunroom, on the outside wall there were two electrical outlets missing protective receptacle covers. In the laundry room, there was one electrical outlets missing from the wall adjourning the sunroom. In the family room, underneath the two end tables, there were two power strips missing protective outlets covers. The outlets were accessible to children 5 years of age and younger.

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

Noncompliance Area: In the family room, there was a albuterol inhaler and fish food that were located on the mantel on top of the fire place and accessible to the children in care. In the dining room, there was a Airwick plug in located in the one outlet and accessible to the children in care. Airwick plug ins are labeled with the warning keep out of reach of children. In the upstairs bathroom closet, there was a basket of items on a lower shelf that contained blue toilet bowl cleaner disks that were accessible to the children in care. On the front porch, which is used as an entrance for the children and families, there was Miracle Grow top soil labeled keep out of 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: In the laundry room, there was splintering wood located next to the washing machine. There was a nail sticking out of the baseboard in the corner across from the shelves. In the family room, there was a nail sticking out of the banister. Throughout the house in various common areas there were cobwebs in doorways and windows that did not allow for the house to remain in good repair and free from visible hazards. In the outside play space, there were three rose bushes that were accessible to children posing a visible hazard. The chain link fence running around the play space, had multiple areas where the bottom anchors were sticking out and posing a tripping hazard and sharp edges. There were multiple holes in the grass area of the play space posing a tripping hazard to the children in care. The metal siding on the side of the house by the side entrance was sticking out posing a sharp 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.

Noncompliance Area: In the sunroom there was peeling paint located on the wall adjoining the laundry room. The outside front railing and the concrete front porch floor had peeling paint on the entrance that the children use to enter the facility.

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

Noncompliance Area: In the sunroom, there was a couch obstructing the sliding glass doorway that serves as an exit. In the dining room, there was a table obstructing the sliding glass doorway that serves as an exit.

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: Child #1, child #2 and child #3 lacked current child service reports.

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: Child #4, child #5 and child #6 lacked emergency contact forms.

Correction Required: Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.

Noncompliance Area: Child #2 had a most recent health assessment dated 3-27-18.

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: Child #1 and child #3 had immunization records that lacked the recommended influenza immunizations as recommended by the ACIP. Child #2 had an immunization record that lacked the recommended DTAP, MMR, influenza and Varicella immunizations according to the ACIP.

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.

Noncompliance Area: Child #1, child #2, and child #3 had emergency contact forms and agreements that had not been updated in a 6 month time period.

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.

Noncompliance Area: Child #4, child #5, and child #6 lacked agreements.

Correction Required: 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.

Noncompliance Area: Staff person #1 lacked documentation of mandated reporter training.

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

Noncompliance Area: The telephone number of poison control was not posted by the telephone in the facility.

Correction Required: The telephone number of the nearest hospital, police department, fire department, ambulance and poison control center shall be posted by each telephone in the facility.

Noncompliance Area: The first aid kit 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.

Noncompliance Area: There was a small bolt that came off of a fidget spinner toy that measured less than one inch in diameter and was accessible to children who were still placing objects in their mouths.

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

Noncompliance Area: Child #1 and child #2 had agreements that lacked the operator and the parent signatures.

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

Noncompliance Area: Child #5 lacked a current child service report.

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: Child #1 and child #2 had agreements that lacked the persons designated by the parents to whom the child may be released.

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

Noncompliance Area: Child #3 and child #4 lacked emergency contact forms.

Correction Required: Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.

Noncompliance Area: Child #2 had an emergency contact form that lacked the child's health insurance 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.

Noncompliance Area: It was observed that the children began eating a meal and had not washed their hands first.

Correction Required: A staff person shall ensure that a child's hands are washed before meals and snacks, after toileting and after being diapered.

Noncompliance Area: Staff person #2's record did not contain an updated health assessment. Staff person #1 lacked a health assessment.

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.

Noncompliance Area: Staff person #1 lacked a TB test.

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: Child #5 had an agreement and emergency contact form that were not updated within the past 6 months,

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.

Noncompliance Area: Child #3 and child #4 lacked agreements.

Correction Required: 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.

Noncompliance Area: Staff person #1 lacked an FBI clearance.

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

Noncompliance Area: There was an uncovered outlet on the wall accessible to children in the room outside of the playroom on the first floor.

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

Noncompliance Area: There was chipping and damaged paint on the mail box and mail box post on the outside play area.

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

Noncompliance Area: There was a crack on a toy plastic stove in the play room.

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: It was observed that there was a child sleeping on the couch instead of on the child's rest mat.

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.

Noncompliance Area: The gate leading to the area of the yard in which there was an above ground swimming pool was unlocked allowing the swimming pool to be accessible to the children from the outside play area.

Correction Required: An aboveground swimming pool which is not in use must be made inaccessible to children in accordance with the swimming pool barrier guidelines of the United States Consumer Product Safety Commission.

Noncompliance Area: Individual #1 was observed to be providing care to an enrolled child by holding and feeding the child a bottle. Individual #1 lacked a health asssessment and a TB test.

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.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: There was a baby bottle being used by a child and the bottle was not labeled with the child's name.

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

Noncompliance Area: Individual #1 was observed to be providing care to an enrolled child by holding and feeding the child a bottle. Individual #1 lacked a state police clearance, a child abuse clearance, and an FBI clearance.

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

Noncompliance Area: There was an uncovered outlet on the wall in the dining room and on a power strip in the living room.

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

Noncompliance Area: There was a cigarette butt on the ground in the outdoor play area.

Correction Required: Ashes and cigarette or cigar butts are prohibited in a child care space, a play space or a food preparation area.

Noncompliance Area: It was observed that the ceiling in the kitchen was missing causing wooden beams, wires, and pipes to be exposed. The operator reported that there was a water leak and the kitchen ceiling collapsed. There was a rusty metal barrel on the side porch accessible to children in the outdoor play area. There was a telelvison set sitting on a chair on the front porch and the television was not secured to the chair making it a hazard. There were multiple piles of dog feces on the ground in the children's outdoor play area.

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 peeling and damaged paint on the wall in several areas in the play 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: Child #1 and child #2 lacked child service reports.

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: Child #3 had an emergency contact form that lacked the information about the child's health insurance 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.

Noncompliance Area: Child #1, child #2 and child #3 had health assessments that had not been updated at least every 12 months.

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: Staff person #1 had a most recent health assessment dated 6-23-14.

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: Child #1, child #2 and child #3 had emergency contact forms and agreements that were not updated within a 6 month time period.

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.

Noncompliance Area: Staff person #1 lacked the required number of childcare training hours.

Correction Required: A staff person shall obtain an biennial minimum of 12 clock hours of child care training.