The Acorn Academy

Noncompliance Area: During the virtual portion of the inspection on 12/9/20, the written plan for emergency transportation for medical care was not posted in the sunroom.

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: Rep observed plastic bags in the cabinet under the changing table in the infant/young toddler room. The cabinet is not locked and accessible to children.

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: Rep observed an uncovered accessible electrical outlet in the sunroom next to the outside door.

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

Noncompliance Area: Rep observed an open window without a screen in the sunroom.

Correction Required: Windows or doors used for ventilation shall be screened when open.

Noncompliance Area: Rep observed 2 small areas of peeling paint on the wall in the outside play space.

Correction Required: Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility. If any peeling paint is found it will be covered with duct tape immediately, then sanded off smooth when playground is not in use

Noncompliance Area: Data from the last renewal inspection in April 2019 indicated that the director's clearances were dated as follows: PSP 5/11/15, Child Abuse 5/15/15 and FBI 4/17/15. On 6/16/20, Rep requested the director's updated clearances be sent electronically as part of the blended monthly unannounced monitoring. On 6/19/20, Rep received a PSP clearance dated 6/16/20, a PDE FBI clearances dated 4/17/15 and an NSOR certification dated 11/12/19 for the director, Facility person #1. A child abuse clearance dated 6/23/20 and a DHS FBI clearance dated 6/19/20 were received by the Rep on 6/26/20. Facility has open since early May and director spoke with Rep on the phone while at the center on 5/14/20. Facility person #1 reported on 6/19/20 that she would be removed from care until complete clearances were received.

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. The legal entity must submit to the NE Regional Office, for approval, a written policy for maintaining compliance with the CPSL for approval. The policy must include information on CPSL compliance in regards to new hires as well as existing staff and must outline specific procedures in place.

Noncompliance Area: During the physical site inspection on 7/2/20, Rep observed the outdoor carpet covering the outdoor play space has many holes and tears in it.

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: During a renewal inspection on 4/15/19, the operator was cited for a CPSL violation. This violation was not corrected and the operator was cited for CPSL violations on subsequent unannounced monitoring visits on 9/16/19 and 10/24/19, which have also not been corrected. During an unannounced monitoring on 1/21/2020, Facility person #1 was observed providing child care in the infant room with another staff. Staff and director report that it is her first day of work. Facility person #1 has a signed disclosure dated 1/21/2020, a PSP clearance dated 10/14/16, a child abuse clearance dated 10/14/16 and an FBI clearance dated 10/24/16. She has a request for NSOR dated 1/13/2020. The operator reports that she has not at this time applied for a provisional hiring waiver, which would permit the facility to hire a staff person provisionally. Rep assisted operator in submitting a waiver request before leaving the facility.

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: On 1/21/2020, a power strip with uncovered electrical outlets was observed on top of the portable sink in the sunroom where toddlers normally receive care.

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

Noncompliance Area: On 1/21/2020, an area of peeling paint was observed in the lunch area on the wall near the pantry closet.

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

Noncompliance Area: On 10/29/19, when Rep arrived at facility Rep observed facility person #1 outside smoking. Facility person #1 entered the building with the Rep. At that time 12 children were present with Facility person #2. Facility person #2 identified 10 preschool children as being in her supervision group. Facility person #1 identified 2 older toddlers as being in her supervision group. On 10/24/19 between 5 -6pm, between 1-5 children were in care during staff CPR/first aid training in a room apart from staff and were not being supervised by staff as all staff were present in training. .

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.

Noncompliance Area: On 10/29/19, Rep observed facility person #3 in the infant room supervising 5 children. Facility person #3 identified one of the children as an infant. Facility person #1 came to the infant room following the Rep but facility person #1 had been outside and then in the preschool room when Rep initially arrived at the facility. While Rep was in the rear of the facility, another child arrived. When Rep entered the sunroom, Facility person #1 was now in there with a group of 6 children. Facility person #1 identified one of the children in the group as a young toddler who had previously been in the infant room. Facility person #2 was supervising a group of 10 preschool children at this time. Another child arrived at 9:16am and Rep directed staff to have parent wait with child until another staff arrived. Facility person #4 arrived at 9:30am.

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: On 10/24/19, Facility person #2, who began working in child care on 10/15/19, did not have 2 written, non-family references on file 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: On 4/15/19, Facility person #1,who began working in child care on 4/4/19, has a PSP clearance and request dated 4/1/19 and an FBI request & clearance dated 4/2/19. There is a request for child abuse clearance on file dated 3/29/19 but there is no child abuse clearance certification on file. Rep observed facility person #1 working alone in the infant room. Other than when another staff entered the room to change other children Facility person #1 was unsupervised until Rep checked the staff files and alerted the director. Rep returned on 9/16/19 to verify corrections and facility person #1 did not have a child abuse clearance on file. Director was unable to locate a child abuse clearance for facility person #1, who then left facility and returned with a current child abuse clearance before the Rep left facility. When Rep arrived at facility on 10/24/19 for an unannounced monitoring per a previous plan of correction, facility person #2 who began working in child care on 10/15/19, had a signed disclosure statement dated 10/15/19, a PSP clearance dated 2/7/18, a child abuse clearance dated 4/1/19, and an FBI clearance dated 2/17/18. Facility person #2 did not have a request for the NSOR on file. Director reported that it had not been requested because she couldn't print the application because her printer wasn't working. Facility person #3 has a PSP clearance dated 5/18/14, which is more than 60 months old. Child abuse and FBI clearances for Facility person #3 are dated 7/14/15 and 6/26/19, respectively. The director said it must have been overlooked. The director requested and obtained a current PSP clearance through e-patch during monitoring visit.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person # 2 may not work in a child care position at the facility. 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 9/16/19, Rep observed an infant sleeping in a crib with toys. The staff person present identified the child as an 11 month old infant. The toys were removed from the crib immediately.

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

Noncompliance Area: On 9/16/19, Cert Rep arrived at facility at approximately 1:55pm and observed an infant sleeping in a swing. The staff person present reported that the child is an infant and had been asleep in the swing for about 30 minutes. The child was removed from the swing.

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: On 4/15/19, Child #1, age 11 months, has only 1 dose documented of the following vaccines: Rotavirus, DTaP, HIB, Pneumococcal, & polio. Child #1 also does not have the influenza vaccination documented. Child #2, a 3 year old, has only 1 dose of HepB, 3 doses of DTaP and Pneumococcal and has no influenza or HepA documented. Child #3, a 4 year old, has only 3 doses of pneumococcal and no current influenza vaccines documented. On 9/16/19, child #1 still has no flu vaccine or an exemption documented for the 2018-19 flu season. Child #2 has only 1 dose of HepB, 3 doses of DTaP and Pneumococcal and has no influenza or HepA documented.

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: On 4/15/19, Child #3 has fee agreement dated 8/3/18. It has not been updated in the previous 6 months. Rep returned to verify correction on 9/16/19 and child #3 has no fee agreement in file. While the Rep was present a staff person wrote an updated fee agreement but it is not signed by the parent.

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: On 4/15/19, Facility person #1,who began working in child care on 4/4/19, has a PSP clearance and request dated 4/1/19 and an FBI request & clearance dated 4/2/19. There is a request for child abuse clearance on file dated 3/29/19 but there is no child abuse clearance certification on file. Rep observed facility person #1 working alone in the infant room. Other than when another staff entered the room to change other children Facility person #1 was unsupervised until Rep checked the staff files and alerted the director. Rep returned on 9/16/19 to verify corrections and facility person #1 did not have a child abuse clearance on file. Director was unable to locate a child abuse clearance for facility person #1, who then left facility and returned with a current child abuse clearance before the Rep left facility.

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. The legal entity will submit to 2 unannounced visits conducted on 2 consecutive months at which time staff files will be reviewed.

Noncompliance Area: Rep observed facility person #2, date of hire 7/1/19, working alone with infants when the first arrived at the facility. Facility person #2 has a high school diploma and 2180 hours of experience with children and is qualified as an aide. When facility person #2 was approved for employment by the NE Regional Office the Legal entity was instructed that this facility person was qualified as an aide.

Correction Required: An aide or a combination of aides shall be supervised at all times by a staff person qualified at minimum as an assistant group supervisor.

Noncompliance Area: Rep observed nap mats in the toddler room that have ripped plastic covers 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: No thermometer was present in the infant room refrigerator.

Correction Required: A facility shall have an operable, clean refrigerator used to store potentially hazardous foods. The refrigerator shall be capable of maintaining food at 45 F or below. An operating thermometer shall be placed in the refrigerator.

Noncompliance Area: A plan of daily activities was not posted in the preschool room.

Correction Required: The written plan of daily activities shall be posted in the group space.

Noncompliance Area: Child #2 does not have a current child service report on file.

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 #1, DOB 5/22/18, has an initial health assessment dated 6/25/18. Child #1 is an infant and does not have an updated health assessment on file. Infant health assessments must be updated every 6 months.

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, age 11 months, has only 1 dose documented of the following vaccines: Rotavirus, DTaP, HIB, Pneumococcal, & polio. Child #1 also does not have the influenza vaccination documented. Child #2, a 3 year old, has only 1 dose of HepB, 3 doses of DTaP and Pneumococcal and has no influenza or HepA documented. Child #3, a 4 year old, has only 3 doses of pneumococcal and no current influenza vaccines documented.

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 a tube of buttpaste in the infant room that was not labeled with a child's name.

Correction Required: The label of a medication container shall identify the name of the medication and the name of the child for whom the medication is intended. Medication shall be administered to only the child whose name appears on the container.

Noncompliance Area: Rep observed a staff person change a child's diaper and then place him on the floor without washing his hands while she looked for clean clothing for the child. During that time he handled toys used by infants. The staff person dressed the child and then washed his hands.

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: Rep observed a staff person change a child's diaper without sanitizing the surface after the previous child's diaper was changed.

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: Children #1 & #3 have fee agreements that are dated 7/2/18 and 8/3/18 respectively. Neither has been updated in the previous 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: Facility person #1, DOH 4/4/19, does not have proof of education or experience on file. Facility person #1 does not have 2 written, non-family references 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.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 emergency plan was last updated 2/9/18, over 1 year ago.

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 & #3 had emergency plan training on 3/6/18 and have not had emergency plan training since. Facility person #1, DOH 4/1/19 has not had initial emergency plan 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 and kept on file at the facility.

Noncompliance Area: The last fire safety training for staff was held 3/9/18, over 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: Facility person #1, began working in child care on 4/4/19. She has a PSP clearance and request dated 4/1/19 and an FBI request & clearance dated 4/2/19. There is a request for child abuse clearance on file dated 3/29/19 but there is no child abuse clearance certification on file. Rep observed facility person #1 working alone in the infant room. Other than when another staff entered the room to change other children Facility person #1 was unsupervised until Rep checked the staff files and alerted the director

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee.

Noncompliance Area: The capacity of the sunroom is 9. Rep observed 10 children receiving care in the sunroom throughout the morning. Over capacity is not designated on the daily schedule.

Correction Required: The capacity established for an indoor space may be exceeded for no more than two separate 1/2 hour time periods daily when older toddler, preschool or school-age children are participating in a program activity

Noncompliance Area: Rep observed pine sol and glass cleaner on a counter in the kitchenette area that is accessible to 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 peeling paint on both door trims in the infant 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 fire drill log indicates that a fire drill was conducted on 5/28/18 and not again until 8/14/18, a period which exceeds 60 days.

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

Noncompliance Area: Facility person #1 has a signed disclosure statement dated 10/12/18, a PSP clearance dated 10/9/18, a child abuse clearance dated 10/10/18 and a request for FBI clearance showing a fingerprinting date of 12/29/18. When asked what day she began working in child care she responded that her first day was in October 2018 but wasn't sure of the exact date. The director and another staff acknowledged that facility person #1 worked in child care on a substitute basis from October 2018 and was hired on a full time basis in December 2018. Facility person #1 was hired provisionally.

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

Noncompliance Area: On 10/15/18, Rep observed children in drop in seats that were not buckled with T-strap. when Rep returned to facility on 11/7/18 to verify corrections, Rep observed toddlers in drop in seats and children were not buckled with T-straps.

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

Noncompliance Area: Rep arrived at facility on 11/7/18 at 11:40am and conducted a supervision check. 3 staff were present with children in the preschool area in the front of the facility. One staff identified 5 children in her group and stated that all were 2 years old. Another staff identified 5 children in her group and stated that they were all 2 years old. A third staff identified 9 children in her group as all preschool age. When Rep counted all of the children, 22 children were present, not 19 as had been identified. Rep asked staff about the discrepancy. Staff reviewed groups and children and reported that two other children had not been named and that they were 2 years old. Rep again counted the children and 22 children were present but 1 child still had not been identified as belonging to a primary supervision group. Staff and Rep compared list of children to children present and at 11:57pm all children were accounted for. Staff reported that another staff person had been present but had to leave and she had been responsible for those children. When asked about childrens' ages later it was reported that 2 of the children present were under 2 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. 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. Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of 4 hours of PQAS approved training regarding supervision of children. 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: On 10/15/18, Facility person #1, DOH 8/10/18, does not have two non-family written references on file. When Rep returned to verify corrections on 11/7/18, facility person #1 had only one non-family written reference on file.

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: When Rep arrived at facility on 11/7/18 to verify corrections from allocated unannounced monitoring dated 10/15/18, that inspection summary was not posted in a conspicuous area used by parents.

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: Rep arrived at facility on 11/7/18 at approximately 11:40am. At that time Rep observed 22 children in the preschool area near the front of the facility: 9 preschool, 11 older toddlers, 2 young toddlers. Three staff were present with these children. To meet required staff:child ratios, four staff are needed. When the Rep first arrived the staff supervising toddlers reported that all toddlers present were 2 years old. It was later reported by staff that 2 of the toddlers had not turned 2 years old yet. It was reported that another staff had been present but had to leave and another staff had been called. Another staff arrived at the facility at approximately 12:25pm. Rep stayed until all children had been assigned to a primary supervision group that met required staff:child ratios.

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: Observed children in drop in seats that were not buckled with T-strap.

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

Noncompliance Area: Facility person #1, DOH 8/10/18, does not have proof of experience 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: Facility person #1, DOH 8/10/18, does not have two non-family written references on file.

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: Facility person #1, date of hire 8/10/18, has a disclosure statement that is not dated, a PSP clearance dated 8/20/18 with a request date of 8/20/18 and an FBI clearance that is dated 8/11/18 without proof of request date. Facility person #1 does not have a child abuse clearance or an acceptable form of proof of request (a completed paper application for clearance is present but does not contain proof of payment or mailing). Facility person #1 was hired provisionally.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 Facility Person #1 may not work in a child care position at the facility. 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: Observed a floor mat in the infant room that has holes and tears in the plastic covering. Observed a climbing mat in the toddler play room that has a ripped 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 a napping mat in the 2-3 year old room that has a ripped cover and exposed 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 a prescription epinephrine auto inject pen that does not have written instructions from the prescriber or Rx label.

Correction Required: A staff person shall administer a prescription medication only if written instructions are provided from the individual who prescribed the medicine. Instructions for administration contained on a prescription label are acceptable.

Noncompliance Area: Observed and epinephrine auto inject pen that has an expiration date of 2/2018. The medication is expired.

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

Noncompliance Area: In the infant room, diapers are being disposed of in a can that is not hands free. the foot pedal of the hands free can is not working.

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: Facility person #1 has a health assessment dated 2/23/16. Facility person #4 has a health assessment dated 12/11/15. Facility person #6 has a health assessment dated 8/10/15. All of these are more than 24 months old.

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: Facility person #5, DOH 6/30/16, has a TB screening on file that is dated 9/14/14, which is more than 1 year old at the time of hire.

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

Noncompliance Area: Facility persons #2, #5 and #6 do not have annual evaluations on file in the last 12 months.

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: The first aid kit in the preschool room does not contain 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: The bathroom located next to the office does not contain 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.

Noncompliance Area: There are several areas in the toddler outdoor play space the mulch is accessible to the children. There are several plastic bags in the drawer in the kitchen accessible to the children.

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 is missing an updated child service report.

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: There are serveral medications in a drawer in the kitchen that are accessible to the 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: Child #2 has a prescription for Proair Inhaler, there is no medication log. Child #3 hasTylenol, there is no medication log. Child #4 has a prescription for Epinephrine, there is no medication log. Child #4 has Benadryl with no medication log. Child #5 has a prescription for an Epipen, there is no medication log.

Correction Required: An operator is responsible to establish and maintain a medication log if prescription or nonprescription medication is administered.

Noncompliance Area: The bottles in the infant room are not labeled for individual use.

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

Noncompliance Area: Certification Rep observed a young toddler drinking a bottle in a pack n play.

Correction Required: Neither an infant nor a toddler is permitted to sleep with a bottle in his mouth.

Noncompliance Area: The safety lock is broken on the drawer in the kitchen which has sharp knifes 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: There are several screens that are torn and falling off of the frames in the outdoor playspace.

Correction Required: Screens shall be in good repair.

Noncompliance Area: There is a hole in the plaster in the lunch room near the book shelf. The rug in the outdoor play space is torn and is a tripping hazard.

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: Child #5 does not have an updated child service report on file.

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 #1 is missing 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: Child #3, 4 & 5 are missing the child's date of admission.

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

Noncompliance Area: Child #1 is missing the physician's address. Child #2 is missing the physicians telephone number.

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 an initial health assessment or immunization record on file. Date of admission 10/1/16.

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 health report shall include a review of the child`s immunized status according to recommendations of the ACIP.

Noncompliance Area: Facility person #5 does not have an initial health assessment or TB screening on file. Date of hire 1/11/17.

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.An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

Noncompliance Area: Child #5 does not have an updated emergency contact or agreement on file.

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 #6 did not have an individual record at the facility at the time of the unannounced visit.

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

Noncompliance Area: Facility pesons #4 & 5 do not have proof of education 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: Facility persons #1 & 4 do not have two written non family references on file.

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 facility's certificate of compliance and a copy of the applicable regulations are not posted 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: Facility persons #1, 4 & 5 do not have proof of initial emergency plan 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 and kept on file at the facility.

Noncompliance Area: The facility's emergency plan is not posted in a conspicuous location used by the parents.

Correction Required: The operator shall post the emergency plan in the facility at a conspicuous location.

Noncompliance Area: Facility persons #2 & 3 do not have proof of 6 hours of annual child care training.

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

Noncompliance Area: Facility persons #2, 3 & 6 do not have proof of annual fire safety training.

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: Facility person #1 does not have a copy of requests for the criminal history, child abuse or FBI, date of hire 2/15/17. Facility person #4 does not have an FBI or child abuse clearance on file. Facility person #4 does not have mandated reporter training, date of hire 11/3/16. Facility person #5 does not have a signed disclosure or FBI clearance on file, date of hire 1/11/17.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Persons #1, 4 & 5 may not work in a child care position at the facility. PROVISIONAL HIRE UNSUPERVISED: A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. 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. CPSL law requires all new staff complete mandated child abuse training within 90 days of hire.

Noncompliance Area: Facility persons #2 & 3 do not have annual written evaluations on file.

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