Raffensbergers Kidz Korner

Noncompliance Area: Observed a loose knob on the wooden play stove. Observed visible dirt and mildew on the outdoor toys including a Little Tykes car and Little Tykes ship. Observed a doll chair with a broken arm.

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

Noncompliance Area: Observed a broken hinge on the cabinet door on the diaper changing table

Correction Required: Furniture must be durable, safe, easily cleaned and appropriate for the child's size, age and special needs.

Noncompliance Area: The agreement form for child #1 lacked the signature of the operator and the parent.

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

Noncompliance Area: The agreement forms for children #1, #2 and #3 lacked the arrival and departure times.

Correction Required: An agreement shall specify the child's arrival and departure times.

Noncompliance Area: The agreement forms for children #1, #2 and #3 lacked the names of the persons designated by a parent 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: The agreement forms for children #1 and #2 lacked the date of the child's admission.

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

Noncompliance Area: The emergency contact information for child #3 lacked the address of the child's physician or source of medical care.

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: The emergency contact information for child #3 lacked the work address and telephone number of the enrolling parent.

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

Noncompliance Area: The emergency contact information for child #3 lacked the 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: The emergency contact information for child #3 lacked the addresses 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 living room used as child care space lacked a posting of the written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency

Correction Required: A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency shall be displayed conspicuously in every child care space and shall accompany a staff person who leaves on an excursion with children.

Noncompliance Area: The initial health report for child #2 dated 10/16/2019 lacked a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

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: The initial health report for child #2, with an enrollment date of 10/11/2019, lacked an immunization record within 60 days of enrollment; the initial health report dated 10/16/2019 lacked 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.

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.

Noncompliance Area: The file for staff person #1 lacked a updated health assessment at least once every 24 months; the file contains a current health assessment dated 05/10/2019 with the previous health assessment dated 03/28/2017.

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

Noncompliance Area: The emergency contact information for child #2 lacked signed parental consent for emergency medical care prior to admission.

Correction Required: A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

Noncompliance Area: The emergency contact information for child #2 lacked signed parental consent for administration of minor first-aid procedures by facility staff prior to admission.

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: Observed a plug in air freshener labeled "Keep out of Reach of Children" in an outlet located on the wall in the kitchen next to the doorway leading into dining room which was 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.

Noncompliance Area: Observed peeling paint on the trim of the entry doorway leading into 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: 2nd CITATION: The file for facility person #1, a volunteer, lacked two-written, nonfamily references. PREVIOUSLY CITED ON 12/18/2018.

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

Noncompliance Area: 2nd CITATION: The file for facility person #1, a volunteer, lacked a copy of the request for a child abuse registry clearance; a completed child abuse clearance was not on file at the facility. PREVIOUSLY CITED ON 12/18/2018.

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 #1 may not work in a child care position at the facility.

Noncompliance Area: 2nd CITATION: At approximately 10:55 am observed staff person #2 walk out of the living room with 2 preschool age children to help them put their socks on in the dining room while facility person #1, a volunteer, was left alone with 4 preschool age children. Staff person #2 was unable to see, hear, direct and assess staff person #1 from the dining room. PREVIOUSLY CITED ON 12/18/2018.

Correction Required: A volunteer shall be supervised by a staff person.

Noncompliance Area: Observed an uncovered electrical outlet next to the main entry of the facility which is located on the front porch; the porch is used as outdoor play space.

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

Noncompliance Area: Observed an open bag of ice melt on the floor next to the main entry of the facility which is located on the front porch; the porch is used as outdoor play space.

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: Observed the trash can located in the sink room, where children wash their hands, it was full from the previous days trash as reported by staff #2. The lid was open due to the amount of trash in the can preventing the lid from closing properly and there was a strong odor of spoiled food in the trash can.

Correction Required: Trash shall be removed from the facility at least once per day.

Noncompliance Area: Observed a snow blower on the front porch; the porch is used as outdoor play space and as the main entry into the facility. Observed a mini-blind on the window located in the dining room with broken slats; the window sits low to the ground and the blind was accessible to the children in care.

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

Noncompliance Area: Observed a handle broken on the wooden play stove located in the playroom creating rough 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.

Noncompliance Area: The file for child #1 lacked the signature by the parent on the agreement form.

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

Noncompliance Area: The file for child #1 lacked the names of the persons designated by a parent to whom the child may be released on the agreement form.

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

Noncompliance Area: The file for child #1 lacked the health insurance policy number on the emergency contact form.

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, with an initial enrollment date of 09/18/2018, lacked an initial health report within 60 days following the first day of attendance at the facility. The file for child #1 contained a summary report with an immunization record printed on 11/28/2018 from a visit on 08/30/2018.

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

Noncompliance Area: The file for child #1 lacked the signature of the physician, physician's assistant or a CRNP on the initial health report.

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

Noncompliance Area: The file for child #1 lacked a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease on the initial health report.

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: The file for facility person #1 lacked an initial health assessment including the results of an initial tuberculin skin test prior to volunteering at the facility. On 12/18/2018, observed facility person #1 prepare lunch for the children at the facility.

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.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.

Noncompliance Area: The file for facility person #1 lacked an initial health assessment including the results of an initial tuberculin skin test prior to volunteering at the facility.

Correction Required: 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.

Noncompliance Area: The file for facility person #1 lacked two-written, nonfamily references prior to volunteering at the facility.

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

Noncompliance Area: The file for facility person #1, a volunteer, lacked a copy of the request for the child abuse clearance and a signed volunteer disclosure statement prior to the first day volunteering at the facility. The file contained a signed employee disclosure statement dated 11/30/2018 and a state police clearance dated 12/01/2018. According to staff person #2, facility person #1 began volunteering approximately 2 weeks ago and helps watch the children at the facility on Tuesdays and Thursdays.

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: On 12/18/2018 at approximately 10:15 am, observed facility person #1, a volunteer, alone with a child at the facility for a minimum of 5 minutes while staff person #2 went next door to get something from her home.

Correction Required: A volunteer shall be supervised by a staff person.

Noncompliance Area: Observed a bolt protruding into the outdoor play space on the far right corner of the fence. Observed the top rail of detached from the right corner of the fence in the outdoor play space. Observed a cap missing from the gate leading out of the outdoor play space, the cap was lying on the ground next to the fence.

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

Noncompliance Area: Observed children #1, #2 and #3, older toddlers, coloring at the dining room table with broken crayons which were under one inch in diameter while staff person #1 was preparing lunch in the kitchen. Observed child #1, an older toddler, with a handful of the broken crayons, placing the crayons into their mouth.

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 3 older toddlers, and 1 preschool child in the dining room while Staff #1, who was the only staff person present at the facility was preparing lunch. Staff #1 was unable to see, hear, direct and assess the children while working in the kitchen. The children were placed at a table in the dining room which was blocked from view of staff person #1 by a wall. While staff person #1 was cooking at the stove, their back was to the children. While staff person #1 was preparing food at the counter next to the sink, their view of the dining room was blocked by the wall of the dining room.

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 at 3280.52(b). 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.

Noncompliance Area: Observed a razor in a drawer with a broken child safety latch located in the kitchen which is accessible to children in care.

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 grocery bags hanging in the sink room of the facility which 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: The file for child #2, lacked an updated child service report every 6 months; the file contained a child service report that was completed on 03/17/2017 and re-signed on 09/26/2017, a new child service report was not completed. The file for child #4, lacked an updated child service report at least once every 6 months; the most recent child service report on file was dated 07/03/2017.

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 3280.124(f).

Noncompliance Area: The file for child #4 lacked a review of the financial agreement at least once every 6 months; the financial agreement was last reviewed on 07/03/2017.

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 file for child #4, lacked an updated health report at least once every 12 months for a preschool child; the file contains a current health report dated 12/06/2017 with a previous health report dated 11/16/2016.

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

Noncompliance Area: The files for children #1 and #3, lacked a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease on the health report.

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: Observed iodine packets in the first-aid kit with an expiration date of 12/2005. Observed insect sting cream in the first-aid kit with an expiration date of 04/2004.

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

Noncompliance Area: Observed staff person #1 change a child's diaper and then sent the child to the table without washing their hands while staff person #1 cleaned up the diaper station. Staff person #1 then took the children to wash their hands before lunch.

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: Observed staff person #1 change a child's diaper without discarding it immediately into a plastic-lined, hands-free covered can. The hands-free covered can at the diaper station lacked a plastic liner. Staff person #1, discarded the diaper into a covered can located in the bathroom which was not hands-free.

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 a bottle on a shelf in the living room which lacked a label with the child's name for whom it is intended.

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

Noncompliance Area: The file for child #1 with an enrollment date in 02/2017, lacked a copy of the initial health report; the file contained a health report dated 07/12/2017 with no additional health reports on file.

Correction Required: A child's record must contain initial and subsequent health reports.

Noncompliance Area: Observed an open bag of ice melt next to the door used by children to enter and exit the facility. Observed a bottle of starter fluid in a bucket on top of the picnic table on the front porch which is also a designated outdoor play space, the bucket also contained toys.

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 file for child #2 lacked the complete address of the individuals designated by the parent to whom the child may be released on the 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: The file for child #1 lacked a review of the agreement form at least once every 6 months. The most recent review of the agreement form was dated 03/21/2017 with no previous reviews documented; a review of the agreement form due in September 2017 was not completed.

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. 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, with an enrollment date of 02/26/2014, lacked copies of the initial and subsequent health reports; a current health report is not on file, the file contained a recent immunization record dated 02/20/2017 without a complete health report.

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

Noncompliance Area: The file for child #1 lacked a complete health report written and signed by a physician, physician's assistant or a CRNP with a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Correction Required: A health report must be written and signed by a physician, physician's assistant or a CRNP. The signature must include the individual's professional title.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: Observed non-prescription medication for children #3 and #4 which lacked a medication log with written consent for administration of medication by a parent.

Correction Required: A parent shall provide written consent for administration of medication or a special diet. An operator is responsible to establish and maintain a medication log if prescription or nonprescription medication is administered.

Noncompliance Area: The file for staff person #1 lacked first-aid training by a professional in the field of first-aid; a certificate of online first-aid training dated 01/13/2016 was on file.

Correction Required: Competence in first-aid is demonstrated by the completion of training by a professional in the field of first-aid. First-aid training shall be renewed on or before expiration of certification or every 3 years, as applicable.

Noncompliance Area: Observed electrical outlets in the kitchen which lacked protective receptacle covers, the kitchen is accessible to children 5 years of age or younger.

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

Noncompliance Area: Observed a Pack 'N Play and a pile of blankets used for naptime which lacked a label for use by a specific child and used only by the specified child.

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 less than 2 feet of space on three sides of the cots and Pack 'N Plays in the living room during naptime. During naptime, 5 cots were placed side by side across the living room floor with less than 2 feet between each cot. 2 Pack 'N Plays and one additional cot were on the sides of the room with less than 2 feet of space on 3 sides.

Correction Required: At least 2 feet of space is required on three sides of a bed, cot, crib or other rest equipment while the equipment is in use.

Noncompliance Area: The file for child #6 lacked the signature of the parent on the agreement form.

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

Noncompliance Area: The file for child #8 lacked completed child service reports every 6 months. The file for child #8 (start date 05/02/2016) contained one undated child service report with no additional child service reports on file.

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 3280.124(f).

Noncompliance Area: The file for child #2 lacked the complete address of the child's physician or source of medical care on the emergency contact 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: The file for child #1 lacked the work address and telephone number of the enrolling parent on the emergency contact form. The file for child #2 lacked the complete work address of the enrolling parent on the emergency contact form.

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

Noncompliance Area: The files for children #1, #2, #5, #6 and #7 lacked the complete address of the individuals designated by the parent to whom the child may be released on the 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: The file for child #6, with an admission date of 11/19/2015 has an original emergency contact form dated 11/18/2015 with no additional records of review until 11/18/2017. The file for child #2, has an original emergency contact form dated 12/20/2017 with a review of the emergency contact form dated 07/05/2017. The file for child #4, has documentation of a recent review of the emergency contact dated 02/21/2017 with a previous review dated 01/29/2016 and a recent review of the agreement form dated 03/21/2017 with no previous reviews documented. The file for child #5, with an admission date of 01/03/2013 has documentation of a recent review of the emergency contact form dated 03/18/2017 and documentation of a recent review of the agreement form dated 01/14/2017 with no additional records of review on file. The file for child #6, with an admission date of 11/19/2016 has an original emergency contact form dated 11/18/2015 with no additional records of review until 11/18/2017.

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. 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 #2, with an enrollment date of 12/12/2016, lacked an initial health report no later than 60 days following the first day of attendance at the facility, a current health report on file is dated 02/24/2017. The file for child #4, with an enrollment date of 02/26/2014, lacked copies of the initial and subsequent health reports; a current health report is not on file, the file contained a recent immunization record dated 02/20/2017.

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

Noncompliance Area: The file for child #5 lacked an updated health report at least every 12 months for a preschool child. The current health report on file is dated 04/03/2017 with the previous health report on file dated 11/24/2015. The current health report dated 04/03/2017 lacked a copy of the immunization records.

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

Noncompliance Area: The file for child #2 lacked a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease on the health report.

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: Observed a bottle of non-prescription medication in a diaper bag which was on the dining room table which 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.

Noncompliance Area: Observed toothbrushes on the bathroom counter which lacked labels with the names of the children for whom they are intended.

Correction Required: A child shall have a labeled toothbrush if brushing teeth is a program activity.

Noncompliance Area: The file for staff person #2 lacked the signature of the physician, physician's assistant or CRNP with the individual's professional title on the health assessment form.

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: The file for staff person #2 lacked the physician or CRNP's assessment of the persons suitability to provide child care along with the results of an examination for communicable diseases and the results of that examination on the health assessment form.

Correction Required: An adult health assessment must include an examination for communicable diseases and the results of that examination. An adult health assessment must include the physician's or CRNP's assessment of the person's suitability to provide child care.

Noncompliance Area: Observed a variety of food items in the refrigerator past the expiration or use by dates which included: gourmet mayonnaise- 11/20/2016, grape jelly- 02/21/2014, sour cream- 01/20/2017, mustard 07/14/2016.

Correction Required: Food stored, prepared or served shall be clean, wholesome, free from spoilage, free from adulteration and safe for human consumption.

Noncompliance Area: Observed bottles and sippy cups which lacked the label with the child's name for whom the bottle or cup was intended.

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

Noncompliance Area: The files for children #2, #3, #4 and #5 lacked copies of the initial and subsequent written agreements between the parent and the operator.

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: The facility lacked a posting with instructions for contacting the appropriate regional day care office in a conspicuous location used by parents.

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: The file for staff person #1 lacked first-aid training by a professional in the field of first-aid; a certificate of online first-aid training date 01/13/2016 was on file.

Correction Required: Competence in first-aid is demonstrated by the completion of training by a professional in the field of first-aid. First-aid training shall be renewed on or before expiration of certification or every 3 years, as applicable.

Noncompliance Area: At approximately 1:45 pm, staff person #1 was observed working in the kitchen with 1 school-age child in the dining room adjacent to the kitchen. Staff person #2 was observed supervising 2 infants, 1 young toddler, 1 older toddler, 7 preschoolers and 1 school-age child in the living room. The room was over ratio for a mixed age group and over capacity. The maximum capacity of the living room is 8 children. At approximately 3:15 pm, 1 young toddler, 1 older toddler 5 preschoolers and 1 school-age child were observed in the living room with staff person #1 while staff person #2 was in the dining room with 2 infants. The room was over ratio for a mixed age group.

Correction Required: When children are grouped in mixed age levels, the age of the youngest child in the group determines the staff:child ratio and maximum group size in accordance with the requirements at 3280.52(b). The required staff:child ratios must be maintained at all times. The capacity established for an indoor space may not be exceeded.

Noncompliance Area: At approximately 3:10 pm, 2 infants, 1 young toddler, 1 older toddler 5 preschoolers and 1 school-age child were in the living room with staff person #1 and #2. The room was over ratio for a mixed age group and over capacity. The maximum capacity of the living room is 8 children.

Correction Required: The capacity established for an indoor space may not be exceeded except when older toddler, preschool or school-age children are participating in a program activity. When the number of older toddler, preschool or school-age children participating in a program activity exceeds the capacity of the child care space the space may not be occupied by children of the infant or young toddler age levels.

Noncompliance Area: Observed electrical outlets in the kitchen which lacked protective receptacle covers, the kitchen in accessible to children 5 years of age or younger.

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

Noncompliance Area: Observed hairspray, mousse, Lysol spray, and disinfectant wipes in an unlocked cabinet above the toilet which were accessible to children in care. Observed diaper cream in an unlocked drawer of the changing table which was accessible to children in care. Observed a can of paint located on the corner of the front porch which is used as outdoor play space and was accessible to 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.

Noncompliance Area: Observed a chair in the dining room with a cracked seat, creating a pinch hazard. Observed drawers to a hutch in the dining room that were loose, creating a gap when closed and were able to fall out when opened creating a pinch and fall hazard. Observed a cracked outlet wall plate on the wall next to the doorway in the living room creating sharp edges. Observed a broken child safety latch on a kitchen drawer containing sharp knives, allowing access to the children in care. Observed sharp knives in the kitchen sink which were accessible to children. Observed on the front porch: a cracked plastic storage tote creating a pinch hazard, a broken wooden baby doll cradle and a piece of the pirate house was broken off creating sharp edges. Observed in the outdoor play space: the door to the storage space under the porch is splintering; cracked siding at the corner of the house next to the base of the stairs; the plastic covering over the support beams of the outdoor play set was cracking creating sharp edges; loose mesh on the roof of the play loft; a splintering board at the base of the ladder on the side of the play set near the swings; a section of rusty chain link fencing along the yard; the corner of the fence had exposed bolts protruding into the play area creating sharp points; the far right corner of the fence had a top rail that was detached from the corner; loose boards were stored under the wooden play set; a cracked plastic shutter was lying on the ground under the wooden play set; loose connector wires were found hanging on the fence; broken Little Tykes toys and houses were lying on the ground on the playground; a section of the chain link fence on the left side of the playground was rusted; pieces of wooden shingles from the play equipment were on the ground on the playground; the white playhouse with green roof had a cracked window creating a pinch hazard. Observed a rusty screw laying on the steps leading to the outdoor play space. Observed a bolt laying in the mulch located in the outdoor play space.

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.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: Fire drills at the facility were not conducted at least once every 60 days. Fire drills were documented on 03/10/2017 and 05/26/2017.

Correction Required: A fire drill shall be held at least every 60 days. Staff persons, volunteers and children in attendance shall participate in the fire drill and shall exit the facility, weather permitting.

Noncompliance Area: The file for child #1 lacked an updated health report every 6 months for an infant; the most recent health report on file is dated 11/16/2016.

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 staff person #1 lacked an updated health assessment within 24 months; the most recent health report on file is dated 03/30/2015.

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.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.

Noncompliance Area: Observed cooked Macaroni and Cheese in a pot on top of the stove that was served the previous day which was not placed in the refrigerator overnight or discarded.

Correction Required: Potentially hazardous food brought from the child`s home or provided by the facility shall be refrigerated.

Noncompliance Area: Lunch prepared at the facility lacked at least one dairy item; the lunch that was served included Salisbury steak, French fries and peaches or applesauce.

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: On 05/23/2017 at approximately 10:10 am 7 children were observed at the facility with one staff person. The ages of the children were as follows: 1 infant, 2 older toddlers, 3 preschoolers and 1 Kindergartener. The room was over ratio for a mixed age group. At approximately 11:45 am 9 children were observed at the facility with one staff person. The ages of the children were as follows: 1 infant, 1 young toddler, 2 older toddlers, 3 preschoolers and 2 Kindergarteners. The room with a capacity of 8 children was over ratio and over capacity from 11:45 am - 12:30 pm when 3 children (1 infant, 1 preschooler and 1 Kindergartener) were picked up.

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 at 3280.52(b). The capacity established for an indoor space may not be exceeded.

Noncompliance Area: Observed board games with pieces with a diameter of less than 1 inch in the bottom cabinet of the hutch located in the dining room which were accessible to children who are still placing objects in their mouths. Observed plastic bags stored in the bottom of a storage closet next to the entrance of the facility; the closet lacks a door or barrier to prevent access.

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 high chair in the dining room which was missing the safety strap.

Correction Required: High chairs shall have a wide base and a T-shaped safety strap.

Noncompliance Area: Observed a Pack 'N Play and a pile of blankets used for naptime which lacked a label for the use by a specific child and used only by the specified child.

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 less than 2 feet of space between two cots while the equipment was in use during naptime.

Correction Required: At least 2 feet of space is required on three sides of a bed, cot, crib or other rest equipment while the equipment is in use.

Noncompliance Area: Observed Styrofoam compartment trays, bowls and plates in unlocked kitchen cabinets which were accessible to children.

Correction Required: Styrofoam cups and plates may not be used.

Noncompliance Area: On 02/22/2017 at approximately 1:45 pm 2 infants were observed sleeping in their car seats in the main room during naptime.

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 files for children #1, #3, #4 and #5 lacked a signature by the parent on the agreement form.

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

Noncompliance Area: The files for children #1, #3, #4 and #5 lacked the names of the persons designated by the parent to whom the child may be released on the agreement form.

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

Noncompliance Area: The files for children #3, #4 and #5 lacked the date of the child's admission on the agreement form.

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

Noncompliance Area: The parent is not provided the original agreement form; the facility retains the original copy in the child's file.

Correction Required: A parent shall receive the original agreement. The facility shall retain a copy of the agreement.