World Of Wonders Day Care Center

Noncompliance Area: The handle on the faucet of the toy sink in the downstairs PS room was observed to be loose, causing a pinch point.

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

Noncompliance Area: The file for Child #1, birthdate 10/9/17, contained consecutive health reports dated 3/8/19 and 10/11/19.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler

Noncompliance Area: The file for Staff #5 contained consecutive health assessments dated more than 24 months apart.

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: An unlabeled bottle containing white liquid was observed by the sink in the Newborn Room.

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

Noncompliance Area: The files for Staff #1, #2, #3, #5, #6, #7, #9 and #10 contained documentation of consecutive mandated child abuse reporter trainings dated more than 60 months apart.

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 files for Staff #3, #4 and #7 contained consecutive state police and child abuse clearances dated more than 60 months apart. The files for Staff #6, #8 and #9 contained consecutive child abuse clearances dated more than 60 months apart.

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

Noncompliance Area: Sunscreen labeled Keep Out of Reach of Children was observed to be accessible to children in a child's bag in a low cubby in the OT room.

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

Noncompliance Area: The first-aid kit in the SA Room was observed to be accessible to children on a chair.

Correction Required: A first-aid kit must be inaccessible to children.

Noncompliance Area: Animal feces were observed on the grass of the outdoor playground. A metal pole was observed to protrude from the end of the railing at the stairs of the slides on the outdoor playground.

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 paint was observed on the interior of the white metal structure on the upper playground.

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 far bathroom in the OT Room was observed to lack a handwashing sign at the toilet.

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: The foam protective coating on two pogo sticks in the gym was observed to be torn, exposing sharp metal edges.

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

Noncompliance Area: The file for Staff #2 contained employee verification forms used as documentation to qualify as an AGS which lacked signatures of the previous employers.

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: The file for Staff #2 lacked documentation of an initial health assessment and initial tuberculin skin test.

Correction Required: A facility person's record shall include a written report of initial and subsequent health assessments, including the results of initial and subsequent tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

Noncompliance Area: The file for Staff #1 lacked documentation of an NSOR clearance.

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: Two electrical outlets in an extension cord were observed to be uncovered in the back left corner of the upstairs PS room.

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

Noncompliance Area: Toxic bleach was observed to be accessible to children in an unlocked closet in the downstairs PS room.

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

Noncompliance Area: The pole on the gate at the right side of the asphalt play area was observed to be rusted at the bottom, causing a sharp edge.

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: A brown toy bin in the SA Room was observed to be cracked, causing a pinch point. A plastic sink in the toy kitchen set of the PS Room was observed to be cracked, causing a pinch point.

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: Two embedded pieces of play equipment were observed on the playground, which lacked surface covering that meets the recommendations of the USCPSC.

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: An expired Auvi-Q was observed in the SA medicine box.

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

Noncompliance Area: A cold and mucous medication labeled for Child #1 lacked parental written consent for administration. A Tylenol labeled for Child #2 contained parental consent which had expired.

Correction Required: A parent shall provide written consent for administration of medication or a special diet.

Noncompliance Area: Two electrical outlets on the left wall and one behind the changing table in the Newborn room were observed to be uncovered. Two electrical outlets on the left wall of the Gym were observed to be uncovered.

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

Noncompliance Area: Weeds with thorns were observed at the bottom corner of the grassy play space and along the back fence of the asphalt play space.

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

Noncompliance Area: Upon assessment of supervision and ratio in the YT/OT Room on 3/4/2020 at 8:45 AM., Staff #1 named 5 OT and Staff #6 named 5 OT. There were 11 children present in the room at that time. Staff were asked again how many children they each were responsible for, which they both answered 5. When asked regarding the unnamed child. Staff #1looked through the unclaimed identification tags and found the unnamed child, whom was then assigned to Staff #1'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: A loose crib sheet was observed on a crib in which an infant was using in the Older Infant/Young Toddler Room, causing a suffocation hazard.

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

Noncompliance Area: SIN-100170089, an open Inspection Summary, with violations not yet verified as corrected, was not posted in a conspicuous location in the facility for 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: The file for Staff #1 lacked documentation 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. 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 contained a disclosure statement which lacked a signature, date or witness. The file for Staff #2 contained documentation of a DHS FBI clearance dated more than 60 months ago. The file for Staff #3 lacked a disclosure statement.

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

Noncompliance Area: The file for Staff #2 contained documentation of education in a foreign language, making it unable to be determined if the staff member met the qualifications for the position in which she was performing. The file for Staff #3 lacked documentation of prior education or experience, making it unable to be determined if she met the qualifications for the position in which she was performing.

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 facility person's record shall include acceptable verification of experience, education or training is a transcript or a diploma or a letter signed by a representative of the experiential, educational or training entity.

Noncompliance Area: **Per SIN-00161926, all staff were to attend an OCDEL-approved training regarding ratio of children presented by ELRC within 3 months from approval of OCDEL. Documentation of completed training was to be kept in staff files. Documentation observed of completed training lacked participation of three staff members - Staff #2, #4 and #5.

Correction Required: Remaining staff are to complete the previous OCDEL-approved training regarding ratio of children presented by ELRC within 3 months from approval of OCDEL. Documentation of completed training was to be kept in staff files.

Noncompliance Area: Two cribs in the Young Infant Room were observed to have less than 2 feet of space on three sides, while infants were sleeping in the cribs.

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

Noncompliance Area: During staff interviews conducted as part of a complaint investigation, staff report hearing a staff member swearing and yelling while on the phone and also at her own daughter in the facility, in the presence of other children.

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

Noncompliance Area: During staff and parent interviews conducted as part of a complaint investigation, it was reported Child #1 hit his head after falling from an adult chair in the YT/OT Room on 1/29/2020. A review of the child and facility files provided no documentation of an accident report being completed. The parent of the child also did not receive or sign an accident report regarding the incident.

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: Upon assessment of supervision and ratio in the downstairs PS Room on 2/12/2020 at 8:15 AM, Staff #1 was observed with 11 PS 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: During staff interviews as part of a complaint investigation, staff reported in the Older Infant/YT Room and the YT/OT Room have been over ratio on multiple occasions, specifically between 7:30 and 9:00 AM. On 2/5/2020 two staff were present with 18 YT and OT for one hour.

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: Peeling paint was observed to the right of the entrance door to the upstairs PS 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: Upon assessment of supervision and ratio in the Toddler Room at 7:35 AM on 1/23/2020, Staff #1 was observed with 10 PS and Staff #2 was observed with 5 YT. While still in the room, cert rep observed two more YT be accepted into the room by the staff members by 7:47 AM. Upon reentry of the Toddler Room at 7:56 AM on 1/23/2020, cert rep observed Staff #2 with 6 YT and 3 OT with no other staff present. At 8:30 AM on 1/23/2020, Staff #3 was observed leaving the Toddler Room with one OT to cross the hall to another child care room, leaving Staff #2 alone in the Toddler Room with 10 YT. Previously cited on SIN-00161926 on 9/11/19.

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: Upon assessment of supervision and ratio in the Toddler Room on 1/7/2020 at 5 PM, Staff #1 named 8 children -6 OT, 1 YT and 1 PS, and Staff #2 named 2 YT, including one YT from Staff #1's named group. The groups were then re-assigned, with the YT taken from Staff #1's group and named only in Staff #2's group. Upon assessment of supervision and ratio in the Toddler Room on 1/13/2020 at 3:30 PM, Staff #1 stated she was responsible for 5 OTs but did not know the names of which children she had. Staff #1 stated she was covering for staff who did not leave their tags. Staff #3 named 6 OT. Staff #2 then stated she could name her group but did not name two present children when naming. The children were then split into groups and Staff #1 and #3 named their groups.

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: During interviews conducted as part of a complaint investigation, staff reported 2 staff with 17 YT on 1/7/2020 in the Older Infant/YT Room after nap until almost 5 PM. Staff reported there were 10 YT to one staff and 12 OT to one staff in the Toddler Room between 2:30 and 3:30 PM on 1/7/2020. Staff reported one staff having up to 13 YT In the Toddler Room from anywhere between 10 minutes and 1 hour on multiple occasions.

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: Upon entry to facility on 1/13/2020 at 3:30 PM,, Staff #1 was observed leaving the office and walking into the Infant/Young Toddler Room. Upon assessment of supervision and ratio in the Infant/Young Toddler Room, Staff #1 named 5 YT, Staff #2 named 5 YT, Staff #3 named 2 YT and Staff #4 named 1 Inf and 2 YT. During the time Staff #1 was in the office, the Older Infant/Young Toddler Room was over ratio by 1 child. During staff interviews conducted as part of a complaint investigation, staff reported in the mornings between 7 AM and 9:30 AM, and after naptime, in the Toddler Room, one staff member has been in ratio with 7 -8 children, a mix of YT and OT.

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

Noncompliance Area: Rep observed mouse droppings around the cot areas in the Toddler Room. During interviews conducted as part of a complaint investigation unrelated to this violation, staff reported observing mouse droppings in the Older Infant/Young Toddler Room, the Toddler Room and the SA Rooms, as well as observing live mice running in the Toddler Room. Staff report children in the Toddler Room have observed the live mice.

Correction Required: Evidence of infestation of insects or rodents in the facility is not permitted.

Noncompliance Area: Upon assessment of supervision and ratio in the Older Infant/Young Toddler Room, Staff #2 named 5 YT, Staff #3 named 2 YT, Staff #4 named 4 YT and Staff #5 stated she had no children assigned to her, for a total of 11 children. There were 13 children in the room at this time. When the cert rep asked the staff to repeat their groups, they did so with the same result. When asked whom was responsible for the two unnamed infants, Staff #5 told Staff #3 that she was responsible.

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: Upon assessment of supervision and ratio in the Toddler Room at 7:20 AM on 12/16/19, Staff #1 was present with 11 children - 3 YT, 3 OT and 5 PS. Staff #1 reported she had been out of ratio for approximately 30 minutes. During staff interviews conducted as part of a complaint investigation, staff reported the toddler room being out of ratio on multiple occasions in the mornings before 7:30 AM and, at times, during the entire day.

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: Upon assessment of supervision and ratio in the Older Infant/Young Toddler Room on 10/9/19 at 8:05 AM, Staff #2 stated she had 5 YT but was unsure of which children they were. Staff #3 named 5 YT. Staff #2 stated she did not hear who Staff #3 listed so she could not name her own group. Staff #2 stated another staff left on an emergency and they were not yet organized as to whom had which children in their supervisory groups. Upon assessment of supervision and ratio in the downstairs PS room on 10/9/19 at 8:10 AM, Staff #4, whom was present in the front portion of the room, named 9 PS. Staff #5, whom was present in the back portion of the room, named 10 PS children. There were 11 children present in that area of the room at that time. When asked to name the children again, Staff #5 named 10 PS. When asked whom was responsible for the unnamed child, Staff #5 then named the child. The child was moved to Staff #4's 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: Upon assessment of supervision and ratio in the Young Toddler Room on 10/9/19 at 8:00 AM, 13 YT were present with two staff members. At 8:25 AM in the YT room, 15 YT were present with two staff members. At 8:45 AM in the YT Room, 16 YT were present with three staff members. At 8:50 AM another staff member entered the room to correct the ratio. Previously cited on SIN-00159625 on 7/24/19.

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: Upon assessment of supervision and ratio in the Older Infant/Young Toddler Room on 10/9/19 at 8:05 AM, Staff #1 was responsible for the supervision of 6 children, 4 INF and 2 YT. At 8:22 AM, Staff #1 had 7 children, 5 INF and 2 YT. At 8:25 AM, another staff member entered the room to correct ratio.

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

Noncompliance Area: The file for Staff #2 lacked documentation of two written, nonfamily 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 #1 contained a disclosure statement which lacked the signature of the staff person.

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: ****Upon assessment of supervision and ratio on 9/11/19 at 7:56 AM, there were 13 YT present in the Toddler Room. Two staff were present in the child care space with the children and one staff was observed in the kitchen area off the child care space, which is not a part of the licensed child care space. Staff #1 named 4 YT, Staff #2 named 4 YT and Staff #3, from the kitchen area, named 5 YT.

Correction Required: The legal entity shall conduct monthly staff meetings for a minimum of 3 months following the acceptance of this plan. An agenda must be provided including the discussion of all ratio violations which have been cited in the past year. All staff shall document presence at meetings with a signature. The legal entity shall provide documentation of the agenda and sign-in sheets to the Regional Office upon completion of each meeting.

Noncompliance Area: Broken pieces of a toy were observed in the play hut on the back blacktop play space, containing sharp edges.

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

Noncompliance Area: An unlabeled Benadryl was observed in the SA medicine box.

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: An expired Advil, labeled for Child #2, was observed in the downstairs PS Room. An expired Pain and fever medication labeled for Child #4, was observed in the Older Infant Room.

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

Noncompliance Area: Written parental consent was not available for an Ibuprofen labeled for Child #1 in the SA Room. The consent form for Child #3 Pain and Fever medication in the Older Infant Room lacked a parental signature.

Correction Required: A parent shall provide written consent for administration of medication or a special diet.

Noncompliance Area: The file for Staff #1 lacked two written, nonfamily 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 #3, with a start date of 6/5/19, lacked documentation 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 file for Staff #1 contained a disclosure statement which lacked a date and witness signature. The file for Staff #2 contained a disclosure statement which lacked a date. The file for Staff #4 lacked a disclosure statement.

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

Noncompliance Area: Upon assessment of ratio and supervision in the upstairs Front Pre-School Room, Staff # 5 was present with 12 Pre-School children. An employee of a dance company was observed alone with 3 PS children in the downstairs PS Room. The facility did not have a file for this employee and parents had not signed a release for this dance employee.

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: Broken strips of wooden lattice were observed by the stairs in the back blacktop play area, containing sharp edges. Weeds with thorns were observed along the fence of the upper playground.

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 files for Child #5, #6 and #9 were observed to contain documentation of immunization history which lacked current influenza vaccinations. Previously cited on 4/9/19 on SIN-00153521.

Correction Required: The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.

Noncompliance Area: A broken bin containing foam puzzle pieces was observed in the back of the downstairs PS room. A broken bin containing wooden doll pieces was observed in the front of the downstairs PS room. Broken toy shovels were observed in the middle sandbox in the upper playground. A ripped karate mat was observed in the indoor gym. A loose toy sink faucet was observed in the back of the YT/OT room, causing a pinch point.

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: A ripped karate mat in the indoor play gym was observed to expose foam, and was accessible to young children who may still be placing objects in their mouths.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Noncompliance Area: A crib being used for a sleeping infant in the Older Infant/Young Toddler Room was observed to lack a label for the infant. The rest mats in the upstairs PS room were observed to lack labels for the children for whom they were intended.

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: An infant was observed to be sleeping in a swing for a period of time between 10 and 15 minutes while staff were available to remove the infant and place her in an appropriate sleeping position.

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

Noncompliance Area: The file for Child #8 contained an agreement which lacked the operator's signature.

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

Noncompliance Area: The file for Child #9 lacked documentation of a current 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: The file for Child #7 contained an agreement which lacked release persons.

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

Noncompliance Area: The file for Child #5 contained an agreement which lacked the child's enrollment date.

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

Noncompliance Area: The files for Child #2 and #8 contained emergency contact forms which lacked the work telephone numbers of the enrolling parents.

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

Noncompliance Area: The file for Child #1 contained an emergency contact form which lacked addresses for release persons.

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: A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not posted in the indoor gym play space.

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

Noncompliance Area: The file for Child #9 contained a current health report yet lacked a previous health reported completed 12 months prior.

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

Noncompliance Area: The files for Child #5, #6, #8 and #9 were observed to contain documentation of immunization history which lacked current influenza vaccinations.

Correction Required: The facility may not accept or retain an infant 2 months of age or older, a toddler or a preschool child at the facility for more than 60 days following the first day of attendance at the facility unless the parent provides written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP.

Noncompliance Area: A cream labeled for Child #10 was observed to be in a container that was not original.

Correction Required: A prescription or nonprescription medication may be accepted only in an original container. The medication shall remain in the container in which it was received.

Noncompliance Area: An unlabeled Ibuprofen was observed in the YT/OT room. An unlabeled diaper cream was observed in the Newborn room.

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: A diaper cream labeled for Child #11 was observed to be expired.

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

Noncompliance Area: Diaper creams labeled for Child #11 and Child #12 in the Older Infant room and Child #13 in the upstairs PS room were observed to lack written parental consent for administration. Calmoseptines labeled for Child #3 in the young toddler side of the Older Infant/YT room, Child #14 and Child #15 in the YT/OT room were observed to lack written parental consent for administration. A Clotrimazole cream labeled for Child #16 in the YT/OT room was observed to lack written parental consent for administration.

Correction Required: A parent shall provide written consent for administration of medication or a special diet.

Noncompliance Area: Bottles were observed being hand washed in the older infant room.

Correction Required: Disposable nursers shall be used for infants unless bottles are provided by the parent or unless a commercial dishwasher is used by the facility.

Noncompliance Area: Bottles lacking a label for the child for whom they were intended were observed in the Older Infant Room.

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

Noncompliance Area: The first-aid kit for the Chevrolet Omni-bus was observed to lack soap, scissors and tweezers.

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

Noncompliance Area: The file for Child #8 contained an agreement with consecutive updates dated more than 6 months apart.

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. Following review, a parent shall attest to the accuracy of information in the emergency contact information and the financial agreement at each review by affixing a dated signature to the record.

Noncompliance Area: Adult scissors were observed to be accessible to children on a cabinet in the SA room, which is used to care for PS 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 contained a state police clearance dated after the first day of employment in a child care position. The file for Staff #1 contained an FBI clearance which lacked dispositions for charges listed. The file for Staff #2 contained a state police clearance which was listed as under review.

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: Twenty PS children were observed to be in care in the indoor gym play space between 11:10 AM and 11:25 AM on 4/10/19. The indoor gym play space has a capacity of 10 PS children.

Correction Required: Outdoor or indoor play space shall be measured at 65 square feet per child

Noncompliance Area: The excursion first-aid kit in the front of the downstairs PS room was observed to lack scissors. The excursion first-aid kit in the YT/OT room was observed to lack tweezers.

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 3270.75(c).

Noncompliance Area: A sharp wire was protruding from the fence in the outdoor back playground near the drain pipe, causing a sharp hazard. A drain grate was observed to be ajar from its position on the ground in the outdoor back playground, causing a tripping hazard. A pipe with a rough metal edge protruding was observed in the back of the outdoor back playground near the stage area, causing a rough edge. A broken cup and aluminum can were observed in the back corner of the back playground, causing rough edges and pinch points. A pole with an exposed rusted metal end was observed in the first sand box in the upper playground. Rough cement was observed at the base of poles in the upper playground, causing a tripping hazard. An electrical outlet was pulling away from the wall in the back of the downstairs PS room, exposing a hole in the plaster and wires.

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: A handwashing sign was not posted in the last stall of the boys' bathroom in the SA room.

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: The diapering area being used in the back area of the YT/OT Room lacked a source of running water to wash the children and staff hands after diapering.

Correction Required: A source of running water for handwashing shall be present in infant and toddler diapering areas. If the running water does not flow directly into a drain that is connected to a sewage system, a receptacle shall be provided to contain the water used for washing. The receptacle shall be emptied into an approved sewage system at least once a day.

Noncompliance Area: Upon assessment of ratio and supervision during a complaint investigation at 8:40 AM on 3/13/19 in the downstairs Pre-School Room, Staff #1 named 10 PS and Staff #2 named 9 PS children. There were 20 children present in the room at this time. When asked regarding the unnamed child, Staff #2 found the child's tag in her id tags and added the child to her 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 files for Child #! and #2 contained most recent health records dated more than 12 months ago.

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

Noncompliance Area: Upon assessment of supervision and ratio in the Upstairs Pre-School Room on 2/12/19 at 8:10 AM, Staff #1 named 6 PS children and Staff #2 named 8 PS children, for a total of 14 children. There were 15 children in the room at this time. When asked regarding the unnamed child, Staff #2 found the child's identification tag and added the child to her group. Upon assessment of supervision and ratio in the Older Toddler area on 2/12/19 at 10:45 AM, Staff #3 named 1 OT, Staff #4 named 6 OT and Staff #5 named 5 OT, for a total of 12 children. There were 13 children in the room at this time. When asked regarding the unnamed child, Staff #5 determined which child was unnamed and added that to child to her 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: Upon assessment of supervision and ratio in the downstairs Pre-School Room on 1/15/19 at 8:05 AM, Staff #1 named one PS child and Staff #2 named 10 PS children. There were 13 children in the room at that time. Upon review of the identification cards that were on a table, Staff #1 added the two remaining children to her 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: One of the exits from the upstairs PS/Older Toddler Room was observed to be obstructed by cots and crates.

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: Upon assessment of supervision and ratio in the downstairs PS Room at 8:10 AM on 10/9/18, Staff #1 was present with 14 PS children and at 8:40 AM on !0/9/18, Staff #1 was present with 16 PS children. Upon assessment of supervision in the upstairs PS Room at 8:15 AM on 10/9/18, Staff #2 was present with 11 PS children and at 8:51 AM on 10/9/18, Staff #2 was present with 14 PS children. According to staff interviews conducted during a complaint investigation, the facility is out of ratio between 7 AM and 8:30 AM in multiple rooms.

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: Upon assessment of supervision and ratio in the SA Room at 8:05 AM on 10/9/18, Staff # 3 was present with 13 YSA and OSA children, Staff #4 was present with 12 children - 10 YSA and 2 PS. According to staff interviews conducted during a complaint investigation, the facility is out of ratio between 7 AM and 8:30 AM in multiple rooms.

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: *Upon assessment of supervision and ratio in the Older Infant/Young Toddler Room during naptime on 9/25/18 at 1:30 PM, Staff #1 named 9 YT. There were 10 YT in the room at this time. Staff #1 stated that she did not know the name of the tenth child and did not have the child's ID card as she was covering a break. Another staff member found the ID card, told Staff #1 the name of the child and gave the ID card to Staff #1, whom was then able to name the child. Upon assessment of supervision and ratio in the SA Room on 10/9/18 at 8:05 AM, Staff #2 named 2 PS and 9 YSA children. There were 12 children in her group at that time. When asked regarding the child unnamed, Staff #2 stated she did not know his name and she did not have a tag for that child. The tag was found and the child was assigned to another staff person at that time.

Correction Required: The operator will develop a system to meet compliance with supervision and ratios at all times. It will include consistently counting the children and scheduling enough staff for the specific number of children in care. The legal entity must maintain documentation at the facility that shows the facility's system for counting children and that enough staff have been scheduled at all times, e.g. checklist. The legal entity will confirm continuing compliance by maintaining a record of the documentation at the facility for a period of three months. The checklist shall include employee names, child care room, date and number of children scheduled for that day. The checklist shall be updated weekly and prepared before the next day of care. The checklist will be pre-approved before use by DHS and then made available to DHS. Verification of compliance will be established with more than one onsite visit.

Noncompliance Area: Upon the assessment of supervision and ratio during a correction visit at 1:50 PM on 8/28/18 in the Toddler Room at naptime, Staff #1 was unable to see and properly supervise two of the children in her care from her seated position in a chair on the other side of the room with her back to the children, whom were lying on mats behind toy shelves.

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. TIERED LIS: Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training. The legal entity must submit documentation in a format approved by DHS proving that the facility procedure for counting children is followed at all times e.g., a checklist. The legal entity will confirm continuing compliance by sending copies of the documentation to the Regional Office of Child Development and Early Learning on a weekly basis for a period of three months after DHS approves the documentation format.

Noncompliance Area: A broken batman toy was observed in the sand box in the rear asphalt play space, causing a sharp edge. A sink in the toy kitchen and toy food were observed to be cracked in the 3s Room.

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

Noncompliance Area: Small pieces of the cement covering were observed on the toddler playground, causing small pieces less than 1" in diameter.

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 downstairs Pre-K Room refrigerator was observed to lack a thermometer.

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.