MY LITTLE WORLD 2

Noncompliance Area: While in the preschool room during inspection, Rep observed a preschool child leave the room and go around the corner into the bathroom. Staff did not follow child and could not properly supervise child while she was in the bathroom. Rep checked on child and then asked facility person #5, who had child's supervision card, if all of the children in her group were currently in the classroom and she replied yes. Rep again went to the bathroom to check on child and timed the incident. The child was gone from the classroom for 3 minutes. Rep then both staff, facility persons #4 and #5, if either of them were aware that the child had gone to the bathroom by herself. Neither was aware and reported that children are not supposed to go the bathroom without asking a teacher.

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. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises. Facility person #4 and #5 and the director will view the DHS vodcast regarding supervision of children in the presence of the legal entity.

Noncompliance Area: Child #1 does not have an agreement on file at facility.

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

Noncompliance Area: Child #1, age 2 years 6 months, does not have any Hep B or Hep A vaccines on record. Child #1 does not have a medical or personal exemption on file.

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: Facility person #3 has health assessments dated 10/17/16 and 8/4/19. The period between health assessments exceeds 24 months.

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

Noncompliance Area: Child #2 has a fee agreement that was last updated 8/26/16.

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: Facility person#1 did not have 6 hours of annual training during the training year 8/2018- 8/2019. Facility person #3 did not have 6 hours of training during the training year 10/2018- 10/2019.

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

Noncompliance Area: Facility person #2 has mandated reporter of abuse training dated 2/17/15 which is more than 5 years old and is considered expired.

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

Noncompliance Area: Rep observed a a spray bottle with liquid in it in the older toddler room that is not labeled. Staff report that is contains disinfectant Steramine.

Correction Required: Cleaning materials and other toxic materials shall be stored in an original labeled container or in a container that specifies the content. Toxics shall be stored away from food, food preparation areas and child care spaces.

Noncompliance Area: Rep observed the backpack containing the first aid kit in the school age/pre K room in a bucket on the floor making it accessible to children. The first aid kit that is taken outdoors does not contain water.

Correction Required: A first-aid kit must be inaccessible to children. One first-aid kit per child care group must accompany children and facility persons on excursions from the facility. Each first aid kit taken on an excursion must contain a bottle of water in addition to the items specified at 3270.75(c).

Noncompliance Area: a pack & play was partially obstructing the rear exit door in the infant room. This door is shown on evacuation route as an emergency 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: Facility person #1 held a child's arm behind his back and grabbed a phone out of his hand. Facility person #1 pushed the child up against a wall and held him there with her hand on his neck/collarbone area.

Correction Required: A facility person may not use any form of physical punishment, including spanking a child. A facility person may not restrain a child by using bonds, ties or straps to restrict a child's movement or by enclosing the child in a confined space, closet or locked room. The prohibition against restraining a child does not apply to the use of adaptive equipment prescribed for a child with special needs. The legal entity must arrange for Facility Person #1 to receive a minimum of 2 hours of PQAS approved training in Behavior Management. It does not matter if the PQAS approved training is through the ELRC. Content of training shall be approved by the Northeast Regional Office prior to the training.

Noncompliance Area: Rep observed a rip in the covering of the blue couch cushion in the preschool 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: Children #1, #2 & #3 do not have documentation of receiving the influenza vaccine. All three were over 6 months of age during the vaccination period. None have exemption letters on file. This vaccine in no longer being administered.

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: Rep observed expired diaper cream in an unlocked accessible drawer in the infant room. drawer

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

Noncompliance Area: The first aid kit in the van is missing soap and tweezers. The first aid kit in the PK/SA room was in a bucket on the floor which is accessible.

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.A first-aid kit, including the contents as specified in 3270.75 (relating to first-aid kit) shall be in the vehicle when children are being transported.

Noncompliance Area: Rep observed torn and peeling contact paper on the support posts on the PK/SA room in the basement.

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

Noncompliance Area: On 2/25/19 during nap time, Rep observed facility person #1 in the older toddler room near the table with 4 older toddlers napping. Rep moved into the young toddler room and observed 5 young toddlers napping without an adult in the room. When asked who was supervising the young toddlers, facility person #1 reported that she was supervising both groups by standing in the doorway.

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. Children must be supervised at all times. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: On 1/23/19, Rep observed school age children and preschool children receiving care in rooms where their emergency contact information was not present. Child #1 has an emergency contact form in the master file dated 12/24/18 but has an emergency form in the classroom dated in 2017. When Rep returned to verify corrections on 2/25/19, Child #1 had an updated emergency form on file in the classroom but Rep preschool child in the Pre K room in the basement and their emergency forms were not present.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.If emergency information is updated in a master file, it shall be updated accordingly in other facility records.

Noncompliance Area: Child #3 does not have an agreement on file.

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

Noncompliance Area: Child #1 does not have address and phone number of physician on the emergency information form.

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

Noncompliance Area: Child #1 does not have address of release person on emergency contact form.

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: Observed school age children and preschool children receiving care in rooms where their emergency contact information was not present. Child #1 has an emergency contact form in the master file dated 12/24/18 but has an emergency form dated in 2017.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.If emergency information is updated in a master file, it shall be updated accordingly in other facility records.

Noncompliance Area: Child #4, date of admission 9/4/18, has an initial health assessment dated 1/7/19 which is more than 60 days from the first day of attendance.

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

Noncompliance Area: Child #2 has a current health assessment on a DHS form and the box stating that the child is able to participate in child care and appears to be free from communicable disease has not been checked by the physician.

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: Rep observed a small rip in the changing pad cover in the infant room.

Correction Required: Diaper changing surfaces shall be cleaned after each use by wiping the surface with a sanitizing solution or by changing a pad or other surface covering.

Noncompliance Area: Rep observed that lunch did not contain a dairy group. Preschool children had peanut butter and jelly on bread, pasta noodles with tomato sauce, meatball and a banana. They were served water to drink.

Correction Required: A lunch or dinner prepared at the facility for children of toddler age or older shall include at least one dairy product.

Noncompliance Area: Child #5 has an emergency contact form that is dated 1/18/17.

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 does not have signed parental consent for administration of minor first aid.

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

Noncompliance Area: Facility persons #1 and #2 have evaluations on file dated 6/1/17 and 8/8/17 respectively. These are more than 1 year old.

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

Noncompliance Area: Rep observed an operable stove in the kitchen area. The kitchen area is not separated from measured child care space by a permanent stationary wall. Children do not have access to the stove as entry is blocked by cubbies and a gate.

Correction Required: Measured indoor space excludes space occupied by halls, bathrooms, offices, kitchens and locker rooms.

Noncompliance Area: Rep observed white out in an accessible unlocked drawer in the Pre K/School age room. It is labeled "Keep away from children".

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

Noncompliance Area: Rep observed a child, whom staff reported is an infant, sleeping in in an infant seat in an inclined position. Director does not report that a physician's note is on file for sleeping position.

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. The legal entity shall arrange for all staff to receive a minimum of 2 hours of PQAS approved training regarding safe sleep for infants that is conducted in person. . It does not matter if the PQAS approved training is done through the Regional Key. The legal entity must receive DHS approval of the training content prior to scheduling the training

Noncompliance Area: Rep observed one staff with a group of 10 preschool children and 1 school age child in the preschool room. The school age child was present for approximately 5 minutes before returning to the school age room. Rep also observed 2 staff person with 23 school age children in the room in the basement. 1 staff was assigned a group of 10 children including preschool and school age children. the other staff was assigned a group of 13 school age children. This staff is the director and acknowledged that some of the children were young school age.

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

Noncompliance Area: Rep arrived at facility at approximately 12:30pm on 12/11/18 to conduct an unannounced verification of corrections. At that time, no one present in the facility was able to provide access to the children's or staff's files. Rep contacted director who was not present and was told that she could not come to the center until 6pm to provide access to the files.

Correction Required: A staff person shall provide to agents of the Department immediate access to the facility, the children and the files and records

Noncompliance Area: When Rep arrived at facility on 12/11/18, the expired certificate of compliance was posted near the entrance but the current provisional certificate of compliance was not posted in the facility.

Correction Required: The facility's current certificate of compliance and a copy of the applicable regulations under which the facility is certified shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional day care office posted at the same location.

Noncompliance Area: When Rep arrived at facility on 12/11/18, the current inspection summary was not posted in the facility. The Department has not yet verified that all items of noncompliance have been corrected.

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

Noncompliance Area: Observed climbing mats in the Toddler 1 room that have holes in the vinyl covering.

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

Noncompliance Area: Observed plastic bags on the bottom open shelves of the changing table and the small rattan table next to the changing table in the infant room. Also observed plastic shopping bags containing children's belongings on a low accessible shelf along the wall in the infant room.

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: Observed a mat in the infant room that staff reported is used for napping at times that has a rip in the covering exposing the inner foam.

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: Observed an infant sleeping (Child #3 DOB 8/22/17) in a pack & play that has a toy fastened to the side. The toy was hanging inside the pack & play while the infant was sleeping.

Correction Required: Toys, bumper pads, or pillows may not be present in a crib while an infant is sleeping in the crib.

Noncompliance Area: At 10:20am, the smoke alarm in the building sounded. Rep was present with the school age and Pre K groups in the basement room at this time. After evacuation, while at the drill meeting area, Rep conducted a supervision group check with school age staff. The two staff identified their groups indicating a combine group of 16 children. Rep counted the children present in the group and counted 18 children at that time. When questioned by Rep, a staff checked group and named 2 children that were present but had not been assigned to a supervision group and assigned them to the other staff person. The children were then permitted back into the facility and when inside the Rep conducted a supervision check with the Pre K staff person. She identified 9 children as being in her assigned group. The Rep then conducted a head count of all children in the basement room (school age and Pre K) and counted a total of 28 children present but the supervision groups only accounted for 27 children. During this time no new children had arrived to the groups. Rep questioned staff and had staff count children and compare assigned groups to the attendance. At 10:42, the correct child who had not been assigned was identified and assigned to a staff for supervision.

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. Children must be supervised at all times. 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. Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: Children #1 has a child service report dated 6/24/16, child #2 has a child service report dated 3/27/17 and child #4 has a child service report dated 3/28/17. All of these have not been updated in the last 6 months. Child #3, date of admission 10/30/17, does not have any child service reports on file and has been enrolled for more than 6 months.

Correction Required: The services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. The operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information in 3270.124(f) (relating to emergency contact information).

Noncompliance Area: Child #4 does not have an address for the release person who is not her parent.

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: Observed OTC medications in an unlocked desk drawer in the infant room. The drawer in approximately 18 inches off the floor and is 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.

Noncompliance Area: The foot pedal on the trash can in the diapering area of the infant room is broken and does not work. Observed diapers disposed of in non hands free lidded can.

Correction Required: If disposable diapers are provided by a parent or by a facility, a soiled diaper shall be discarded by immediately placing the diaper into a plastic-lined, hands-free covered can.

Noncompliance Area: Observed small tears in the vinyl covering of the changing pad in the infant room, making it unable to be properly sanitized.

Correction Required: Diaper changing surfaces shall be cleaned after each use by wiping the surface with a sanitizing solution or by changing a pad or other surface covering.

Noncompliance Area: Facility person #1 has an initial health assessment dated 4/15/18, that is not signed by the physician.

Correction Required: A health assessment shall be conducted and a report shall be written and signed by a physician, physician's assistant or CRNP. The signature must include the individual's professional title.

Noncompliance Area: Facility person #2, DOH 6/27/18, has an unofficial college transcript showing completion of 36 credits in human services on file but it does not indicate graduation. Facility person #2 does not have a high school diploma on file.

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

Noncompliance Area: Fire safety training was held on 4/29/17 which is more than one year ago.

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

Noncompliance Area: Required emergency telephone numbers are not posted in the Toddler 1 room.

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: Rep arrived at facility at 10:30 am. At that time, observed one staff person on the playground with 7 older toddlers. Rep conducted a supervision and ratio check inside the facility and found that one staff was alone with a group of 3 young toddlers and 4 older toddlers. In the preschool room there were 2 staff present with 20 preschool children and in the infant room, there was one staff with 3 infants. At that time no other staff were present in the facility. The director reported that one staff person had had to leave and that children who were not scheduled to be in care were in care at this time. Rep remained at facility until other staff arrived and required staff:child ratios were in place.

Correction Required: When children are grouped in similar age levels, the following maximum child group sizes and ratios of staff persons apply: Infants 1:4 with a maximum group size of 8; Young toddlers 1:5 with a maximum group size of 10; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 20; Young school-age children 1:12 with a maximum group size of 24; Older school-age children 1:15 with a maximum group size of 30. The required staff:child ratios must be maintained at all times. When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements in 3270.51 (relating to similar age level).

Noncompliance Area: DURING A COMPLAINT INVESTIGATION ON 1/31/18, A STAFF PERSON IN THE TODDLER ROOM WAS UNABLE TO IDENTIFY THE CHILDREN ASSIGNED TO HER FOR SUPERVISION. SHE STATED THAT BOTH STAFF WERE WATCHING ALL OF THE CHILDREN. THERE WERE MORE THAN 6 OLDER TODDLERS PRESENT.

Correction Required: Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises.

Noncompliance Area: On 1/31/18, Rep was in office on ground floor and heard loud angry yelling of an adult coming from the preschool room in the basement. Staff person #1 was sitting with a child trying to write his name and had been yelling at him.

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

Noncompliance Area: On 1/31/18, during a complaint investigation, infant room staff and the director reported that infants are allowed to nap in infant swings.

Correction Required: Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility.

Noncompliance Area: The facility is not keeping a copy of accident/injury/illness reports in a center accident file. a copy is kept in the child's file and given to the parent.

Correction Required: A child's record shall contain reports of accidents, injuries and illnesses involving a child in care at the facility. The original report shall be given to the parent on the day of the incident. The second copy of the report shall be retained at the facility in an accident file. The third copy of the report shall be retained at the facility in the child's file.

Noncompliance Area: The embedded equipment in the preschool outside play space does not have the required amount of protective surface covering recommended by the United States Consumer Product Safety Commission.

Correction Required: Outdoor equipment that requires embedded mounting must be mounted over a loose-fill or unitary playground protective surface covering that meets the recommendations of the United States Consumer Product Safety Commission. The equipment must be anchored firmly and be in good repair.

Noncompliance Area: Facility person #2 was responsible for a group of 7 children. Facility person #2 did not know the whereabouts of Child #1. Child #1 was in the bathroom 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. Children must be supervised at all times.

Noncompliance Area: Facility persons #1 & 3 do not have an updated health assessment on file.

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

Noncompliance Area: Certification Rep observed a steak knife in a drawer in the infant room accessible to the children.

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

Noncompliance Area: The facility's emergency plan has not been reviewed and updated annually. July 7, 2015 is the last signature signifying a review was done.

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

Noncompliance Area: Facility person #2 does not have proof of annual fire safety training on file.

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

Noncompliance Area: The closet door in the school age room is unlocked and there are cleaning supplies (tilex, comet, multi purpose cleaner, disinfectant spray, and bleach) accessible to the children.

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

Noncompliance Area: The sink in the school age bathroom is broken and is not securely attached to the cabinet. The floor vent in the older toddler room has several areas of rust.

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

Noncompliance Area: There is peeling paint under the window near the shelf and light switch in the older toddler room. There is several areas of peeling paint near the window and outlet in the young toddler 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 preschool bathroom is missing a hand washing sign.

Correction Required: A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.