Chatterbox Day Care Center

Noncompliance Area: On 3-10-20 at approximately 8 a.m., staff person #1 was observed transporting 6 children total between the facility and another facility without the emergency contact forms present in the vehicle.

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: According to observations and staff statements, on 3-10-20, staff person #1, the driver, transported three 3-year olds, child #2, child #3, and child #4 and an older toddler, child #1 between two facilities in the morning and in the afternoon/evening without having a second staff person in the vehicle. According to staff statements, children have been transported between the two facilities daily for approximately the last 3 months.

Correction Required: The driver may not be considered part of the staff-child ratio when infant, young or older toddler or preschool children are transported.

Noncompliance Area: According to observations and staff statements, on 3-10-20, staff person #1 transported five children ages 3 to 7 years old, including three 3-year olds, child #2, child #3, and child #4, and two young school-age children, child #5 and child #6, from the facility to a second facility in the morning at approximately 8 a.m. and transported child #1, a 2 year old child, back to the facility on the return trip without the children using car seats or booster seats as required for their age group. According to staff statements, the same process was repeated in the late afternoon/evening to return the children to each facility to be picked up by their parent, and transportation has been ongoing for approximately the last 3 months.

Correction Required: A child 7 years of age or younger shall be transported in accordance with the requirements for parents and guardians as stated in 75 Pa.C.S. 4581 (relating to restraint systems).

Noncompliance Area: Child #1 and child #2, who were observed on 3-10-20 being transported between the facility and another facility, lacked signed parental consent for transportation.

Correction Required: A child's record shall contain signed parental consent for transportation, walking excursions, swimming and wading.

Noncompliance Area: On 3-10-20 at approximately 8 a.m., staff person #1 was observed transporting children to another facility without a first-aid kit or bottle of water in the vehicle.

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).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: 2nd CITATION: The file for child #2, with a start date of 10-11-19, lacked an initial health assessment within 60 days of their start date and requires a current health assessment. PREVIOUSLY CITED ON 12-18-19.

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

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

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: 2nd CITATION: The file for child #2, with a start date of 10-11-19, lacked an immunization record within 60 days of their start date and requires a current immunization record. PREVIOUSLY CITED ON 12-18-19.

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: 2nd CITATION: The file for child #3, a 10 month old, had an immunization record that lacked documentation of the initial dose of the Influenza vaccination at age 6 months in accordance with the schedule recommended by the ACIP. PREVIOUSLY CITED ON 12-18-19.

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: In the young toddler room, there was a child sleeping in a pack 'n play that was not labeled 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: 2nd CITATION: In the young toddler 2 room, there was a child sleeping on a cot that had 2 feet of space on two sides and had a shelf and a table bordering on the other two sides. PREVIOUSLY CITED ON 4-18-19.

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: In the front room, the refrigerator that stores food for the children lacked 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.

Noncompliance Area: The daily activity schedule was not posted in the front room.

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

Noncompliance Area: In the infant room, staff person #4 transferred an infant from one crib to another crib and placed the child on their stomach.

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 #5 had an agreement that lacked the date on which the fee is to be paid.

Correction Required: An agreement shall specify the date on which the fee is to be paid.

Noncompliance Area: The file for child #5 had an agreement that lacked the child's admission date.

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

Noncompliance Area: The file for child #3 had an emergency contact form that lacked the address of the individual designated by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The emergency contact forms were not present in the front room or the young toddler 2 room downstairs for the children that receive care in each of those rooms.

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 file for child #1, with a start date of 6-3-19, and child #5, with a start date of 10-11-19, lacked an initial health assessment within 60 days of their start date and require a current 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 #1, with a start date of 6-3-19, and child #5, with a start date of 10-11-19, lacked an immunization record within 60 days of their start date and require a current immunization record.

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

Noncompliance Area: The file for child #2, a 10 month old, and child #4, a 7 month old, had an immunization record that lacked documentation of the initial dose of the Influenza vaccination at age 6 months in accordance with the schedule recommended by the ACIP. The file for child #2, a 10 month old, and child #4, a 7 month old, had an immunization record that lacked documentation of the 3rd dose of the DTAP vaccination by age 6 months and the 3rd dose of the Pneumococcal vaccination by age 6 months 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: In the front room, there was Children's Motrin that was not labeled with the name of the child for whom the medication was intended.

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: The file for staff person #2 and staff person #3 had a health assessment that exceeded 24 months between assessments.

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: In the lunch room/kitchen, the refrigerator had 2 bottles that were not labeled with the child's name.

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

Noncompliance Area: On 12-18-19, it was observed that there was not an operable fire detection system because the alarm did not sound when the pull station was activated. This condition at the facility poses a threat to the health or safety of 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 person #1, with a start date of 7-22-19, had emergency plan training dated 12-2-19 that was after their start date.

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 person #2 and staff person #3 had fire safety training that exceeded a year between trainings.

Correction Required: Staff persons shall participate, at least annually, in firesafety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.

Noncompliance Area: The file for staff person #3 had a state police clearance dated 3-5-14 and lacked a current state police clearance within the last 60 months and had child abuse clearances dated 3-5-14 and 12-3-19 and FBI clearances dated 3-1-14 and 11-27-19 that exceeded 60 months between updated clearances.

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

Noncompliance Area: In the front room on a shelf in the kitchen, there was a package of Member's Mark Total Protection Premium Washcloths that were labeled "Keep out of reach of children" that were accessible to children.

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

Noncompliance Area: In the front room, the first-aid kit lacked scissors and adhesive bandages. In the infant 1 room, the first-aid kit lacked soap and tape. In the young toddler 2 room, the first-aid kit lacked tape.

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 front room, there was peeling paint in a couple areas to the right of the entrance near the fire alarm handle, a few areas on the wall across from the fire alarm under/near the bulletin board, on the corner area by the clock, and a few areas on the side of the half wall.

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 door between the office and the infant 1 room was blocked by a crib on the infant room side and equipment on the office side.

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: According to the fire drill log, a fire drill was not conducted every 60 days from 1-10-19 to 3-25-19.

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: At 1:45 p.m. during naptime in the nap room, there was a child sleeping in a pack 'n play with the wall, mat cart, and high chair bordering the mat on 3 sides and 2 feet on the remaining side. In the back toddler room, there was a child sleeping in a pack 'n play in the corner with 2 walls & a child on a mat on 3 sides, and 2 feet on the remaining side. In the infant room, there were 2 children in cribs in both corners with walls on 2 sides & infant swings on the 3rd and 2 feet on the remaining side.

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: According to interviews w/ staff, the parent of child #1 said not to refrigerate the child's milk, & the milk was not refrigerated in the bottle and sat out all day for as long as 6-7 hours w/out refrigeration. The parent brought 3 bottles cold, and they would sit out unrefrigerated because the parent wanted them at room temperature.

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

Noncompliance Area: In the young toddler room, there were mats for naptime stacked near the changing area with 3 purple mats that had tears that exposed the stuffing inside the mat.

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: On the outdoor preschool play space, the embedded playground equipment under the green slide lacked at least 9 inches of mulch to meet the recommendations of the United States Consumer Product Safety Commission.

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: The file for child #3 lacked a current child service report updated within the last 6 months. The file for child #1 and child #5 had a child service report that exceeded 6 months between reports.

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 #1 had an emergency contact form that lacked the address and telephone number of the child's physician. The file for child #3 had an emergency contact form that lacked telephone 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 #2 and child #4 had an emergency contact form that lacked the addresses of the individuals designated by the parent to whom the child may be released.

Correction Required: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released.

Noncompliance Area: The file for child #4 had an initial health assessment dated 8-15-18 that was over 60 days after the child's start date of 3-12-18.

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

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

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: In the preschool room, there was a bottle of Hyland's 4 Kids Cold 'n Cough medicine that was not labeled with the name of the child for whom the medication was intended.

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: In the preschool room, there was an inhaler for child #6 that lacked written parental consent for administration of the medication.

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

Noncompliance Area: The file for staff person #4 had an initial health assessment that was completed after her start date.

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

Noncompliance Area: The file for staff person #4 had an initial health assessment with a tuberculosis screening by the Mantoux method that was completed after her start date.

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

Noncompliance Area: Written notification of safe pick-up and drop-off points was not posted at a conspicuous location in the child care facility.

Correction Required: Written notification of safe routes shall be posted by the operator at a conspicuous location in the child care facility.

Noncompliance Area: The file for child #1 had an emergency contact form that lacked signed parental consent for administration of minor first-aid procedures by facility staff.

Correction Required: 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: The file for staff person #3 and staff person #4 had initial emergency plan training that was completed after their start date.

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 person #1 lacked current fire safety training completed within the last year. The file for staff person #2 had fire safety training that exceeded 1 year between trainings.

Correction Required: Staff persons shall participate, at least annually, in firesafety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.

Noncompliance Area: The file for staff person #4, with a start date of 7-23-18, had mandated reporter training that was completed over 90 days after her start date with a completion date of 11-29-18.

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: In the bathroom on the main floor, there was an unlocked drawer in a cabinet near the sink with a bottle of Sure Scents Air Freshener and in an unlocked storage cabinet next to the toilet there were a container of Clorox Disinfectant wipes and a bottle of Glade Air Freshener labeled "Keep out of reach of children" that were accessible to children.

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

Noncompliance Area: At 1:30 p.m. in the nap room on the main floor, staff person #1 named 7 children in her group including 2 infants, 2 older toddlers, 1 preschooler, and 2 young school-age children, resulting in staff person #1 being out of ratio. The older toddlers, preschooler, and one of the school-age children were laying down on mats for naptime, the other school-age child was sitting in a chair, and the 2 infants were sitting in high chairs.

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: At 1:30 p.m. in the nap room on the main floor with a capacity for 5 children, there were 7 children in the nap room including 2 infants, 2 older toddlers, 1 preschooler, and 2 young school-age children. The older toddlers, preschooler, and one of the school-age children were laying down on mats for naptime, the other school-age child was sitting in a chair, and the 2 infants were sitting in high chairs.

Correction Required: The capacity established for an indoor space may not be exceeded.

Noncompliance Area: At 1:25 p.m. during naptime in the preschool room, 23 children were observed sleeping on their mats without 2 feet of space on 3 sides. Most of the mats were next to each other, and the mats were touching or overlapping. The mats in the middle of the room were all right next to each other without leaving space to walk through the middle of the room and around the corner to the right side of the room.

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: At 1:25 p.m. during naptime in the preschool room, staff person #1 was observed sitting down on the far left side of the room facing towards the wall and away from the children and was watching something on her tablet. Staff person #1 was unaware that the certification representative had entered the room. The staff person was unable to see the 23 children in the room, including a few children that were sleeping around the corner in the room.

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.

Noncompliance Area: * * * At 1:25 p.m. during naptime in the preschool room, staff person #1 named 10 preschoolers in her group, resulting in 13 out of 23 preschoolers being unnamed in a group.

Correction Required: The legal entity will create a supervision and ratio monitoring form for the director to check supervision and ratio for all staff a minimum of once daily for a period of 3 months. The times of the supervision check should vary to ensure all staff are monitored regularly and are in compliance with supervision and ratio. The legal entity must receive DHS approval for the monitoring form before implementation.

Noncompliance Area: At 1:25 p.m. during naptime in the preschool room, there were 23 preschoolers with staff person #1, resulting in staff person #1 being out of ratio.

Correction Required: The staff:child ratio while toddlers and preschoolers are napping is one staff person to 10 young toddlers, one staff person to 12 older toddlers, one staff person to 20 preschool children

Noncompliance Area: At 1:25 p.m. during naptime in the preschool room, 23 children were observed sleeping on their mats without 2 feet of space on 3 sides. Most of the mats were next to each other, and the mats were touching or overlapping. The mats in the middle of the room were all right next to each other without leaving space to walk through the middle of the room and around the corner to the right side of the room. Having 23 children on mats in the room did not allow for 2 feet of space on 3 sides of each mat. The room has a capacity of 13.

Correction Required: The capacity established for an indoor space may be exceeded at naptime, when toddler or preschool children are resting on rest equipment. The capacity of the space is determined by the requirement for placement of rest equipment described at 3270.106(f).

Noncompliance Area: On the outdoor preschool/school-age play space, there was a basketball net that was torn and coming apart.

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 young toddler room, there were 2 cribs and 3 rest mats along the outside wall that had 2 feet of space on one side and lacked 2 feet of space on three sides. In the upstairs preschool room, there was a child sleeping on a mat with 3 shelves on three sides and one side with 2 feet of space. In the infant room, there were infants in 2 cribs that were in a corner and had one other side with a swing next to them resulting in one side having 2 feet of space.

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: In the infant room, there was an infant sleeping in a crib with a pacifier that had a strap attached to the child's shirt.

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

Noncompliance Area: In the older toddler room, the small refrigerator lacked 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.

Noncompliance Area: A daily activity schedule was not posted in the young toddler room.

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

Noncompliance Area: At 3:10 p.m., staff person #6 walked around the corner in the kitchen, adjacent to the school-age room, while a school-age child was in the front school-age room alone and unsupervised at a table by the closet out of vision of the staff person. The child was out of view from the staff person for a minute.

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.

Noncompliance Area: In the young toddler room with a total of 9 children, staff person #1 named 5 older toddlers in her group, and staff person #3 named 2 older toddlers in her group and incorrectly named another child. There was 1 child that was not named in a 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, child #2, and child #3 lacked a current child service report completed within the last 6 months.

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 #3 had an agreement that lacked the child's admission date.

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

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

Correction Required: A health report shall include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Noncompliance Area: In the office, there was cold and cough medicine for child #4 that lacked written parental consent for administration of the medication. In the infant room, there was infant Ibuprofen for child #5 that lacked written parental consent for administration of the medication.

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

Noncompliance Area: The infant room had a trash can with a rotating spin lid for diapering next to the changing table and lacked a hands-free covered can to immediately discard a soiled diaper.

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 file for staff person #1 and staff person #4 had a health assessment that was dated after their start date. The file for staff person #2 had a health assessment that exceeded 24 months between assessments. The file for staff person #5 lacked a health assessment.

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

Noncompliance Area: The file for staff person #4 had a health assessment that lacked the physician, physician's assistant or CRNP's signature and professional title.

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

Noncompliance Area: The file for staff person #5 and staff person #6 lacked a tuberculosis screening by the Mantoux method at initial employment and require a current tuberculosis screening. The file for staff person #1 had a TB test read date that was after her start date.

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

Noncompliance Area: The file for staff person #3 and staff person #6 had a health assessment that lacked an examination for communicable diseases and the results of that examination and the physician's or CRNP's 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: In the infant room, there was an empty bottle on the refrigerator that previously had milk in it from a child drinking from it, that was not labeled with a child's name.

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

Noncompliance Area: The file for child #2 lacked an agreement updated within the last 6 months.

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

Noncompliance Area: The file for staff person #1, staff person #5, and staff person #6 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 person #1, staff person #3, and staff person #4 had emergency plan training that was dated after their start date. The file for staff person #2, staff person #5, and staff person #6 had emergency plan training that exceeded a year between trainings.

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 person #5 lacked current fire safety training completed within the last year. The file for staff person #2 had fire safety training that exceeded a year between trainings.

Correction Required: Staff persons shall participate, at least annually, in firesafety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.

Noncompliance Area: The file staff person #1 had a State Police and Child Abuse clearance that was dated after her start date and had an invalid FBI clearance. The file for staff person #3 had a volunteer Child Abuse clearance and requires a Child Abuse clearance for employment. The file for staff person #4 had an invalid State Police clearance and lacked an FBI clearance. The file for staff person #6 had a disclosure statement that was dated after her start date. The file for staff person #5 lacked mandated reporter training within 90 days of her start date and requires current 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.

Noncompliance Area: The file for staff person #1, staff person #4, and staff person #5, functioning as assistant group supervisors, lacked verification of education and experience to qualify as an assistant group supervisor.

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 verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: The file for staff person #2 and staff person #5 had staff evaluations that exceeded 12 months between evaluations.

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 file for staff person #3, functioning as an aide, lacked verification of education and experience to qualify as an aide.

Correction Required: An aide shall have a high school diploma or a general educational development certificate. A facility person's record shall include verification of child care experience, education and training prior to service at the facility.

Noncompliance Area: At 3:10 p.m., staff person #1 walked around the corner in the kitchen, adjacent to the school-age room, while a school-age child was in the front school-age room alone and unsupervised at a table by the closet out of vision of the staff person. The child was out of view from the staff person for a minute.

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: A staff person stated that there are usually not more than 5 infants in the infant room, and that will happen from 3-5:30 p.m. that the room will sometimes will be over capacity. The infant room has a capacity of 4 children.

Correction Required: The capacity established for an indoor space may not be exceeded.

Noncompliance Area: In the front school-age room, there was a bottle of Fabri-Tac Permanent Adhesive and Elmer's Rubber Cement labeled, 'Keep out of reach of children', on a shelf in an unlocked closet by the office that was accessible to children.

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

Noncompliance Area: In the middle room bathroom, the water temperature at the sink was 116 degrees.

Correction Required: Hot water temperature, in areas accessible to children, may not exceed 110 F.

Noncompliance Area: In the young toddler room, there was peeling blue paint in the bottom left and bottom right corners of the window on the left. In the older toddler room, there was an area of peeling paint to the left of the outside exit door.

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

Noncompliance Area: In the upstairs bathroom, the toilet lacked a handwashing sign.

Correction Required: A facility person and an able child shall wash his hands after toileting and before eating. A sign on which this requirement is written shall be posted at each toilet, training chair, diapering area and sink in the facility.

Noncompliance Area: There was a changing table in the young toddler room without a source of running water for handwashing in the room.

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: According to the fire drill log, a fire drill was not held every 60 days between 8-1-17 to 10-5-17 and 10-5-17 to 12-8-17.

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: The outdoor play equipment was not surrounded by 9" of mulch. ^ measurements were taken, and the measurement of the mulch was between 3 and 5 inches.

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: Toys and art items smaller than 1" in diameter were found in the middle room, the place where all children age 1 and up stay over night.

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: Two pack & plays located in the 1-2 year old room were not labeled with the child's name that uses the rest equipment

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 napping equipment was less than 2' apart while in use.

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

Noncompliance Area: The emergency contact form for child # 4 did not have his birthdate on the form

Correction Required: Emergency contact information must include the name and birth date of the child.

Noncompliance Area: The file for child #1 and #3 did not contain the phone numbers of their 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 #1 did not contain the health insurance carrier and policy numbers.

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: he files for child #4 did not contain the addresses of the release person(s)

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.