Tiny Toes Llc

Noncompliance Area: The first aid kit in the facility was lacking tape, soap, sterile gauze, gloves, tweezers and scissors.

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 toy bin with crayons on it was torn and fraying on all 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 kitchen, where the door was open, there were empty garbage bags under the sink that were accessible, and there were empty plastic bags next to the refrigerator.

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 #1 contained a Child Service report that was completed more than 6 months ago.

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 #1 contained an emergency contact form that was lacking the phone number 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 file for Child #1 contained an emergency contact form that was lacking the addresses of the people 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 files for Child #1, #3 and #4 who were all enrolled more than 60 days, were all lacking an initial health assessment.

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 #2, a young toddler age child, contained a health assessment that was more than 6 months old.

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 Child#2 contained an immunization record that was lacking a dose of DTAP/DTP/TD, 2 doses of HIB and the influenza vaccine.

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 files for Staff #1, #2, and #3 all contained Health Assessments that were 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.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 #3 was lacking annual 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.

Noncompliance Area: The file for Staff #1, #2, and #3 were all lacking verification of First-Aid training.

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.A record shall include a copy of records of training required by the Department

Noncompliance Area: The file for Staff #2 was lacking verification of 6 annual hours of child care training.

Correction Required: A staff person shall obtain an annual minimum of 6 clock hours of child care training.A record shall include a copy of records of training required by the Department

Noncompliance Area: When cert. rep. entered the facility at approximately 9 A.M. on June 13, 2019 Staff #2 was by herself with 2-School-age children, 1-preschool child, 2-older Toddler age children, 1-young Toddler child, and 1 infant. Staff #1 entered the facility at 9:11A.M.

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 12; Young toddlers 1:5 with a maximum group size of 12; Older toddlers 1:6 with a maximum group size of 12; Preschool children 1:10 with a maximum group size of 12; Young school-age children 1:12 with a maximum group size of 12; Older school-age children 1:15 with a maximum group size of 15.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).

Noncompliance Area: The kitchen door was open, making the stove accessible to the children.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: The first aid kit in the facility was lacking gloves.

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 carpet was coming up on one of the steps on the way up to the restroom causing 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: The refrigerator contained containers of breast milk that were lacking the name of the child to whom they belonged.

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

Noncompliance Area: Plug covers were missing thru the front door and to the right and to the left, and straight back in the back room.

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

Noncompliance Area: The first aid kit was lacking gloves.

Correction Required: A first-aid kit must contain the following: soap, an assortment of adhesive bandages, sterile gauze pads, tweezers, tape, scissors and disposable, nonporous gloves.

Noncompliance Area: There were empty garbage bags being stored in an unlocked cabinet under the since in the kitchen making them 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: Pack in play in the middle room was not labeled for individual use by a 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: The toy box in the front room was observed to have fraying edges.

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

Noncompliance Area: The files for Child #1, 2, 3 and 4 all contained emergency contact forms that were lacking the address 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 files for Child #3 and 4 contained emergency contact forms that were lacking their policy number for their 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.

Noncompliance Area: The file for Child #1 and 2 contained Health Assessments that were obtained more than 60 days after the children's enrollment date. The files for Child #3 and 4 are lacking Health Assessments and both children have been enrolled for more than 60 days.

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: In the kitchen cupboard there were two boxes of shake-n-bake that had expired in February and April of 2014.

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

Noncompliance Area: The file for Staff #1 contained 1 hour of child care training. The file for Staff #2 contained zero hours of child care training.

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

Noncompliance Area: The file for Staff #1 contained a state police and child abuse clearance that were both more than 60 months old.

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

Noncompliance Area: Bleach, hand soap, and floor cleaner were all kept in an unlocked cabinet under the sink making them accessible to children. Lysol, and cholorox wipes were kept in an unlocked cabinet in the kitchen making them accessible to children. There were also Chlorox wipes, handsoap being kept on and under the table in the kitchen making them 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: The knobs on the stove are accessible to children and do not have any protective coverings on them.

Correction Required: Hot water pipes and other sources of heat exceeding 110 F that are accessible to children shall be equipped with protective guards or shall be insulated to prevent direct contact.

Noncompliance Area: Emergency numbers were not posted by the phone in the facility.

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

Noncompliance Area: In the outside play space there were edges to the siding on the building that were rough and sticking out. There were also a big piece of rock sticking up with sharp edges.

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: Peeling yellow paint was observed next to the window in the middle 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 file for staff #1, serving as a primary staff person, contained a high school diploma determined to be invalid.

Correction Required: A staff person or a substitute staff person shall meet one of the applicable staff qualifications for the position in which the person is performing.A primary staff person shall have attained a high school diploma or a general educational development certificate and 2 years of experience with children

Noncompliance Area: An infant activity seat in the main child care space was observed to be physically 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: The files for child #2, #4, and #5 contained financial agreements lacking the date of the child's admission.

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

Noncompliance Area: The file for child #4 was lacking the health insurance policy number.

Correction Required: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

Noncompliance Area: A group of 6 children and 1 staff were observed returning from a walking excursion and did not have emergency contact information for the children with them.

Correction Required: When children leave the facility on walking and riding excursions, emergency contact information specific to each child on the excursion shall accompany a staff person on the excursion.

Noncompliance Area: The files for child #1, child #2 and child #3 were lacking initial health reports and have been enrolled for more than 60 days.

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: Six older toddler, preschool and school aged children were observed eating snack and lunch without washing their hands first. Two preschool children were observed using the bathroom and not washing their hands afterwards.

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: Neither cloth nor paper towels were available for children to dry their hands after handwashing.

Correction Required: Cloth towels and washcloths shall be labeled with the child's name, used by only the named child and laundered weekly. The operator shall arrange a laundry schedule with the parent.Paper towels may be used as towels and washcloths. Paper towels shall be discarded after each use.

Noncompliance Area: In the bathroom it was observed that a diaper was disposed of in a trash can that was not working as 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: The operator was unable to provide verification that the vehicle used for transporting child care children was insured.

Correction Required: A vehicle shall be insured in accordance with the requirements of 75 Pa.C.S. 1701-1799.7 (relating to the Motor Vehicle Financial Responsibility Law).

Noncompliance Area: The file for child #2 contained current financial agreement and emergency contact forms that exceeded 6 months since their previous reveiw.

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 record for child #2 was lacking signed parental consent for emergency medical care and administration of minor first-aid.

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.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: The files for staff person #1 and #2 did not contain the person's address and phone number.

Correction Required: A facility person`s record shall include the name, address and telephone number of the facility person.

Noncompliance Area: The file for staff person #2 was lacking 2 written references.

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 staff person #3 was lacking verification of 6 hours of child care training during the previous 12 month period.

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 files for staff #1, #2 and #3 were lacking signed affirmation statements required under the CPSL.

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 files for staff person #2 and staff person #3, both employed as primary staff, were lacking verification of 2 years of experience.

Correction Required: A primary staff person shall have attained a high school diploma or a general educational development certificate and 2 years of experience with children. A facility person`s record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: Staff #4 was observed as the only facility person returning from a walking excursion with 6 older toddler, preschool and school aged children.

Correction Required: At least two facility persons shall accompany any number of children on an excursion away from a facility.

Noncompliance Area: Several cans of paint labeled 'keep out of the reach of children' were observed at the bottom of the basement stairs which were accessible to the children as they entered the back door of the facility.

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: A group of 6 children and 1 staff were observed returning from a walking excursion and did not have a first-aid kit.

Correction Required: One first-aid kit per child care group must accompany children and facility persons on excursions from the facility. Each first aid kit taken on an excursion must contain a bottle of water in addition to the items specified at 3280.75(c).

Noncompliance Area: The fence on the outdoor play space was leaning over and unstable. The door to the play space had been removed but the hinge brackets were still attached causing a 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: On the wall in the bathroom there was a hole and exposed plaster and drywall.

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

Noncompliance Area: **ORIGINALLY CITED ON 2/13/17 Staff person #1, the only staff person present at the facility, left the child care space to return items to the kitchen, leaving 6 older toddler and preschool aged children unsupervised for approximately 3 minutes. On 3/3/17 a toddler was observed using a portable potty chair in the small child care space and there were no staff in the room with her. On 4/4/17 at 12:40pm staff person #1 was observed running across the driveway toward the back of the child care facility. Staff #1 then opened the front door to allow certification rep entry. 9 children, including preschool, school age and one older toddler, were present with Staff #1 and Staff #2. There were no other staff present, therefore when Staff #1 was observed outside of the facility, Staff #2 was alone in the facility with the 9 children. The required staff child ratio when supervising an older toddler is 1:6 therefore 3 children were left unsupervised when Staff #2 was alone in the facility.

Correction Required: **The legal entity will post the definition of supervision and the required staff child ratios in each child care space.

Noncompliance Area: ORIGINALLY CITED 2/13/17 The first-aid kit was lacking soap, adhesive bandages, sterile gauze pads, tape, scissors and disposable gloves. 4/4/17 The first-aid kit was lacking 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: In the closet were mats and a pack and play not labeled for use by a specific 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: Staff person #1, the only staff person present at the facility, left the child care space to return items to the kitchen, leaving 6 older toddler and preschool aged children unsupervised for approximately 3 minutes. On 3/3/17 a toddler was observed using a portable potty chair in the small child care space and there were no staff in the room with her.

Correction Required: Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times.

Noncompliance Area: On 3/3/17 during a verification visit, 2 infants were observed sleeping in soft cradles which did not allow the infant to sleep flat on their back in the position recommended by the American Academy of Pediatrics.

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: There was no emergency contact information present in the child care space where children were being cared for.

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: In the small back child care room an electrical outlet was lacking a protective cover.

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

Noncompliance Area: In the bathroom, in a cabinet and drawers accessible to the children, were Kaboom cleaner, Lysol, suede cleaner, Listerine, medicated conditioner and all purpose cleaner, all labeled 'Keep out of the reach of children'.

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

Noncompliance Area: The first-aid kit was lacking soap, adhesive bandages, sterile gauze pads, tape, scissors and disposable gloves.

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.