The Growing Patch Child Care Center LLC

Noncompliance Area: The most current and updated health assessment on file for child #1, who is a young toddler, was not completed within the past six months and was due prior to 3/6/2020 (regulatory suspensions.) Previously cited on 8/26/2020 under SIN -00174589.

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.A child's record shall contain initial and subsequent health reports.

Noncompliance Area: The file for child #1 lacks verification of ongoing vaccinations as in accordance with the schedule recommended by the ACIP. Previously cited on 8/26/2020 under SIN - 00174589.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Noncompliance Area: The file for staff #1 lacks an initial health assessment which was conducted 12 months on or before initial start date in a child care position. Previously cited on 8/26/2020 under SIN-00174589.

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 staff #1 lacks an initial TB screening by the Mantoux method. Previously cited on 8/26/2020 under SIN -00174589.

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.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: Based on a conversation with staff and review of the menu, the children had pancakes, sausage, applesauce and juice for lunch. A dairy product was not served at lunch. Based on the review of the two week menu, 9 of the 10 lunches posted did not contain a dairy product.

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: The last review of the fee agreement on file for child #2 was not completed within the past six months and is dated 4/10/2019. This were due prior to 3/6/2020 (regulatory suspensions.) Previously cited on 8/26/2020 under SIN -00174589.

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: In the Toddler Room, observed a toy plane and two toy trucks which were dirty.

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

Noncompliance Area: In the older children's outdoor play space, observed that the wooden mulch around the embedded swing set and embedded climbing apparatus with slide, was approximately 5-6 inches deep and not the 9 inches recommended by the CPSC.

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: In the Toddler Room, observed that all of the blue cots lacked a label with the child's name.

Correction Required: Individual, clean, age-appropriate rest equipment shall be provided for preschool, toddler and infant children as agreed between the child's parent and the operator. The rest equipment shall be labeled for the use of a specific child and used only by the specified child.

Noncompliance Area: The files for children #2, 4 and 5 lack verification of child service reports within the past six months and were due in the file prior to 3/6/2020 (regulatory suspensions.) There are no child service reports on file for children #2 and 4. The last child service report on file for child #5 is dated 7/31/19.

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: The parent did not receive the original fee agreements for children #1, 2, 3, 4 and 5 as the originals were observed in the files.

Correction Required: A parent shall receive the original agreement. The facility shall retain a copy of the agreement.A child's record shall 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 most current emergency contact information on file for child #1 lacks a health insurance name and policy number. The most current emergency contact information on file for children #3 and 4 lack the address of all release persons.

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. 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 last review of the emergency contact information and fee agreement on file for child #2 was not completed within the past six months and is dated 8/12/2019. This was due prior to 3/6/2020 (regulatory suspensions.) There was more than six months between reviews of the emergency contact information on file for child #4. Reviews were completed on 4/10/2019 and then 2/3/2020. The last review of the fee agreement on file for child #4 was not completed within the past six months and is dated 4/10/2019. These were due prior to 3/6/2020 (regulatory suspensions.)

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 most current and updated health assessments on file for children #2 and 5, who are young toddlers, were not completed within the past six months and were due prior to 3/6/2020 (regulatory suspensions.) The most current health assessment for child #5, who was a young toddler at the time the assessment was due, was not completed within the past six months and was due prior to 3/6/2020 (regulatory suspensions.)

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddlerA child's record shall contain initial and subsequent health reports.

Noncompliance Area: The files for children #1, 4 and 5 lack verification of ongoing vaccinations as in accordance with the schedule recommended by the ACIP.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Noncompliance Area: There was more than 24 months between the previous and most current and updated health assessment on file for staff #1, 4, 5 and 6. The file for staff #9 lacks an initial health assessment which was conducted 12 months on or before initial start date in a child care position.

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 staff #9 lacks an initial TB screening by the Mantoux method.

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.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 initial health assessment on file for staff #8 lacked an examination for communicable diseases and an assessment of the person's suitability to provide child care.

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: There was more than one year between documented reviews of the emergency plan. Emergency plan reviews were completed on 6/1/19 and then on 7/1/2020.

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: The file for staff ##5 lacks verification of emergency plan training within the past year. Last date of emergency plan was 8/14/19.

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. A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: There was more than six months between fire safety trainings for staff #1, 2, 3, 5, 6, and 7. Fire safety training dates are as follows; Staff #1 - 6/17/2019 and 7/1/2020, Staff #2 - 6/17/2019 and 7/9/2020, Staff #3 - 6/17/2019 and 7/17/2020, Staff #5 -6/17/2019 and 7/9/2020, Staff #6 - 6/17/2019 and 7/9/2020, Staff #7 - 6/17/2019 and 7/15/2020. The file for staff #4 lacks verification of fire safety training within the past year. Most current fire safety training on file for staff #4 was completed on 6/17/2019.

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.A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: There was more than 60 months between the previous and most current mandated reporter training on file for staff #4. Dates are as follows; 8/20/14 and 8/20/20. The file for staff #8, with start date of 2/17/20, lacked mandated reporter training within 90 days of hire. There is now mandated reporter training on file and dated 6/27/20.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: The file for staff #4 lacks an FBI clearance within the past 60 months. Most current FBI clearance on file is dated 1/28/2015 and was due in file prior to 3/6/2020 (HB 360). There was more than 60 months between the previous State Police, Child Abuse and FBI clearances on file for staff #5. Clearance dates are as follows; State Police - 8/19/14 and 2/11/20, Child Abuse 10/6/14 and 2/28/20, and FBI, 9/17/14 and 2/17/20 (FBI due prior to 3/6/2020 - HB 360.) The file for staff #8, with start date of 2/17/2020, lacks an FBI clearance and was was due prior to 3/6/2020 (HB 360) and lacked a Child Abuse clearance on or before initial date in a child care position. Child Abuse clearance is now on file and dated 8/10/2020. There is no FBI clearance on file. The file for staff #9, with provisional hire date of 5/20/2020, lacks applications for clearances on or before initial date in a child care position. There is no application for Child Abuse clearance on file. Child Abuse clearance is on file and dated 6/29/2020. There is no application or State Police clearance on file. There is no State Police clearance on file. The National Sex Offender Registry certificate application date was after start date and dated 6/29/20. NSOR is now on file and dated 7/1/20.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). Facility Person #4, 8 and 9 -- 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: The file for staff #5 lacks a written staff evaluation by the director within the past year. Last staff evaluation was completed on 8/2/2019.

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: In the Toddler Room, observed a wooden box, utilized to cover exposed pipes, and located to the right of the entrance door. In the Preschool Room, observed a wooden box, utilized to cover exposed pipes, and located beside the entrance to the Toddler Room. Both boxes were approximately 2 feet high and had one sharp point on the edge of each box.

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: In the Toddler Room, observed that the exit door which leads to the front of the building, was blocked by a child's play crib and child's activity table.

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: On 7/29/2020, at approximately 7:10 AM, observed staff #1 alone in the toddler room and providing care to one infant, one young toddler, one older toddler, and one preschool age child. Staff #1 was named the young and older toddler and stated that she did not know the names of the infant and preschool age child. This left two children not named in any supervisory group.

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: The facility provides a morning snack, lunch, and afternoon snack. Observed that morning and afternoon snacks were not on the posted menu. Based on staff interviews, the lunch provided by the facility on 7/28/2020 consisted of meat ravioli, carrots, applesauce, and milk. The posted menu indicated that the lunch provided by the facility on 7/28/2020 was to consist of ham sandwiches, pickled cucumbers, bananas and milk. The change to the menu was not conveyed to parents ahead of time.

Correction Required: An operator shall conspicuously post the menu at least 1 week in advance or provide a menu to each family.

Noncompliance Area: On 7/29/2020, it was observed that there was not an operable fire detection system because the smoke detector in the infant room did not sound when activated.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. Conditions at the facility may not pose a threat to the health or safety of the children. Demonstration of Compliance with 34 Pa. Code 403.23 is required. If the provider is not able to demonstrate or document an operable fire detection system a complaint will not be filed until it is determined that the fire detection system is inoperable. If determined inoperable the agent of the Department will file a complaint with the appropriate municipal office to request an additional fire safety inspection by the appropriate agency to verify compliance with 34 Pa. Code 403.23 and per Chapter 20.35(c). The provider will demonstrate an operable fire detection system to an agent of the department.

Noncompliance Area: A fire drill has not been conducted within the past 60 days. Fire drill log was observed and the last day that a fire drill was conducted was 12/05/2019.

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: In the toddler/infant outside play space, observed a large play house which has a blue room and white and pink walls, 4 toy trucks in the play house, a yellow shopping cart in the play house, and a purple teeter totter. These toys were very dirty. In the preschool age room, observed a large light teal colored bean bag which was dirty. In the school age room, observed a checker set in the grey cabinet. The plastic bin used for the checker set was cracked.

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 #4, with enrollment date of 8/6/2019, lacked an emergency contact form and fee agreement.

Correction Required: Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.A child's record shall 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 emergency contact information on file for child #1 lacked the names and addresses of all release persons and the name of the health insurance coverage.

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. 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: Emergency contact information was not present in the toddler room for children #5, 6, an 7 who were receiving care in that space. Emergency contact information was not present in the school age room for child #8 who was receiving care in that space.

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.

Noncompliance Area: The most current immunization record on file for child #1 and 2 lack verification of a flu shot within the past year.

Correction Required: The facility shall require the parent to provide updated written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of ongoing vaccines administered to an infant, toddler or preschool child in accordance with the schedule recommended by the ACIP.

Noncompliance Area: The file for staff #6 lacked an initial health assessment on or before initial date in a child care position. There is a current health assessment on file. The files for staff #2 and 3, lack a health assessment which was conducted within the past 24 months. There was more than 24 months between the previous health assessment and the most current and updated health assessments for staff #1 and #4.

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: There was more than six months in between the review of the fee agreement and emergency contact information on file for child #2. Review of the fee agreement and emergency contact information on 7-18-2018 and then on 7-30-2019.

Correction Required: A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

Noncompliance Area: The file for child #1 lacked signed parental consent for emergency medical care and for administration of minor first-aid procedures by facility staff.

Correction Required: A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.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: In the school age room, observed an air conditioner in the window. The cord to the air conditioner was hanging at child level posing a threat to the health and safety of the children.

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

Noncompliance Area: The file for staff #1 lacked 1 hour of child care training for the current year. The file for staff #2 lacked 2 hours of child care training for the current year. The file for staff #4 lacked 3 hours of child care training for the current year.

Correction Required: A staff person shall obtain an annual minimum of 6 clock hours of child care training.A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: The file for staff #5, with hire date of 5-30-2019, lacks a disclosure statement at initial hire.

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: There was more than 12 months between the previous staff evaluation and the most current staff evaluation for staff #2 and 4. Staff #2's staff evaluations were conducted on 11-16-17 and then on 12-6-18. Staff #4's staff evaluations were conducted on 1-1-2018 and then on 2-6-2019.

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: In the preschool room, there is a box which sits near the toddler room which is carpeted. Some of the carpeting is starting to come off. In the preschool room, observed that the carpet near circle time was starting to frey and the wall heater near circle time was starting to come loose. In the preschool boys bathroom, observed that the wall heater near the toilet was rusty. In the school age room, observed that the wood panel beside the green chair was starting to come loose.

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: After multiple attempts, observed that the preschool room girls' toilet would not flush. Based on a conversation with staff, the toilet will only flush some of the time and needs to be plunged often.

Correction Required: Toilet areas and fixtures shall be cleaned daily and be in good repair.

Noncompliance Area: On 2/08/2019, at approximately 10:30 AM, staff #1 was observed alone in the infant room supervising 5 infants. Previously cited under SIN-00149810.

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.

Noncompliance Area: Based on interviews, a 10 month old child was scratched on the lower right cheek by an older toddler. The child files and facility files lacked an incident report.

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: On 2/08/2019, at approximately 10:30 AM, staff #1 was observed alone in the infant room supervising 5 infants.

Correction Required: **The Legal Entity will arrange for all staff to attend a minimum of 3 hours of training on ratio conducted by the ELRC along with ELRC providing TA for the director in training of staff. The training will be submitted to the regional office for approval prior to attendance. Proof of training will be submitted upon completion.

Noncompliance Area: In the School Age 1 room, observed a large foosball table. On the left side of the top of the table, the covering of the outer layer of the table was coming loose and was ripping. In the entrance to the daycare, there is a large adult size desk. Two of the edges are at child level and have sharp corners.

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

Noncompliance Area: In the infant/toddler outdoor play space, observed two red Cozy Coupe riding toys which had paper stickers that were starting to come off.

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: On 08-24-2018, at approximately 10:00 AM, supervision and ratio was conducted in the Preschool/School Age Room. There were 15 school age and preschool children present. Staff #2 named 8 children in her group. Staff #3 named 5 children in her group. This left 2 children that were not named in any group.

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: The emergency contact information on file for child #2 lacked the address of all release persons and a health insurance policy number. The emergency contact information on file for child #4 lacked the address of all release persons and the name of the health insurer and policy number.

Correction Required: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable. 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: There was more than six months in between the most current reviews of the emergency contact and fee agreements for children #1 and #3.

Correction Required: A parent is required to review and update the emergency contact information and the financial agreement at least once in a 6-month period or as soon as there is a change in the information.

Noncompliance Area: The file for staff #4 contains 5 of the 6 required annual clock hours of child care training for the current year.

Correction Required: A staff person shall obtain an annual minimum of 6 clock hours of child care training.A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: The file for staff #1, with hire date of 09-15-2017, lacked mandated reporter training within 90 days of hire. There is current mandated reporter training on file and dated 07-28-2018.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: The file for staff #4, with hire date of 01-12-2015, lacked a Child Abuse and FBI Clearance on or before initial date in a child care position. There is a current Child Abuse Clearance on file and dated 02-23-2015 and FBI Clearance on file and dated 01-28-2015.

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 05-18-2018, at approximately 10:30 AM, observed staff #1 alone in the preschool room and providing care to 13 preschool age children.

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.

Noncompliance Area: In the Toddler Room, the refrigerator's thermometer was 50 Degrees Fahrenheit.

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: At approximately 10:30 AM, in the outside play area where two staff and twelve children were present, staff #3 identified five of the six children in her group leaving one child who was not identified in any group. Staff #5 , who was to be supervising six children, identified seven children. The seventh child was identified by both staff and was a part of staff #3's group.

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: The file for child #1 lacked the address of the child's physician. The file for child #2 lacked the telephone number and addresss of the child's physician.

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 on file for child #1 and #2 lacked the policy number of the health insurance.

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 staff #2 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

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 file lacked verification that the emergency plan was reviewed/updated within the past year.

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: The file for staff #2 and #4 lacked verification of the training regarding the emergency plan at the time of initial employment. Staff #2's hire date was 05-23-2017 and emergency plan was reviewed 06-23-2017. Staff #4's hire date was 05-08-2017 and emergency plan was reviewed on 06-07-2017.

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. A facility person`s record shall include verification of child care experience, education and training following the outset of service at the facility.

Noncompliance Area: The file for staff #2, with hire date of 05-23-2017, lacked verification that a disclosure statement was signed on or before first day in a child care position. There is a current disclosure statement on file and dated 08-08-2017. The file for staff #3 with hire date of 06-15-2017, lacked verification that a disclosure statement was signed on or before the first day in a child care position. There is a current disclosure statement on file for staff #3 and dated 08/08/2017. The file for staff #4, with hire date of 05-08-2017, lacked verification that a disclosure statement was signed on or before first day in a child care position. There is a current disclosure statement on file and dated 05-09-2017.

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: The file for staff #1 lacked a current written staff evaluation from the director within the past 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 staff file for staff person #3 lacked a disclosure statement as well as a valid State Police clearance; the clearance on file was requested as a volunteer. The staff file for staff person #4, lacked mandated reporter training.

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

Noncompliance Area: At approximately 11:20am staff person #1 was observed in a vehicle outside in the facility parking lot. Upon entering the facility staff person #1 went to the toddler room and reported to the representative that she was a part of ratio. Prior to staff person #1 returning to the toddler room staff person #2 was alone with 10 toddlers.

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. IF USING TIERED LIS: The required staff:child ratios must be maintained at all times. The legal entity must submit documentation in a format approved by DHS proving that the facility is maintaining the required staff:child ratios at all times. The legal entity will confirm continuing compliance by sending copies of the documentation to the -------- Region Office on a weekly basis for a period of three months after DHS approves the documentation format.

Noncompliance Area: In the Preschool Room a bottle of hand sanitizer was observed on the front desk 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.