Billie Orts Laugh-N-Learn Day Care Ctr

Noncompliance Area: The emergency contact form on file for child #1 had not been updated within the past 6 months at the time of inspection.

Correction Required: The parent shall update in writing emergency contact information once in a 6-month period or as soon as there is a change in the information

Noncompliance Area: The most updated tuberculosis screening results for facility person #1 were not included in the facility person's record at the time of inspection.

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: Dolls in the infant/young toddler area were observed to be covered in a substance that appeared to be food, and a jumper in the same room was observed to be dirty, both of which were corrected on site. A tear was observed in the changing pad in the older toddler area, exposing the foam inside.

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 plastic bag was observed to be accessible to young toddlers at the time of inspection A bag of M&M candy and other small, hard candy was observed to be accessible to older toddlers. Both were corrected on site.

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: Toys were observed to be placed over a crib while an infant was asleep in the crib, and the toys were hanging down into the crib, which was corrected on site.

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

Noncompliance Area: The agreement for child #2 did not specify the persons designated by a parent to whom the child may be released.

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

Noncompliance Area: The emergency contact form for child #3 did not include a complete address for the child's source of medical care.

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 of child #1, 6 months old at the time of inspection, included documentation of only one hepatitis B vaccine. It did not include documentation of subsequent hepatitis B vaccinations, DTAP, HIB, Pneumococcal, or polio vaccinations. The file of child #2, 16 months old at the time of inspection, did not include documentation of any hepatitis B vaccinations or a hepatitis A vaccination.

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

Noncompliance Area: The file of facility person #2, hired 11/1/18, contained results of tuberculosis screening dated 6/17/16, which is more than 12 months prior to the person's employment date. The file of facility person #3, hired 11/1/18, contained a health assessment dated 10/19/17 and a health assessment dated 2/18/19, therefore a health assessment dated within 12 months prior to hire was not on file at the time of hire. Also, the file contained results of tuberculosis screening dated 10/19/17, which therefore were more than 12 months prior to the person's employment 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. 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 health assessments on file for facility persons #2 and #4 did not contain documentation of an examination for communicable disease or an assessment of the persons' 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: Bottles for the use of an infant were observed not the be labeled with the child's name.

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

Noncompliance Area: The last documented date of update on the emergency contact form and financial agreement for child #3 was 1/24/18. The emergency contact forms in the child care space for children #4 and #5 were older than 6 months at the time of inspection.

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. If emergency information is updated in a master file, it shall be updated accordingly in other facility records.

Noncompliance Area: The file of child #2 contained only initials from the parent to indicate consent for emergency medical care and administration of minor first-aid procedures, but did not contain a full signature.

Correction Required: A child's record shall contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission. A child's record shall contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission.

Noncompliance Area: The files of facility persons #2 and #3, both hired 11/1/18, contained documentation of emergency plan training at the time of inspection, however it was dated 6/6/19, and therefore there was not documentation of emergency plan training at the time of hire.

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 of facility person #1 contained current documentation of fire safety training at the time of inspection, however it was dated 8/14/19 and the previous documented training was 5/16/18, therefore fire safety training was not completed annually.

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 of facility person #2, hired 11/1/18, did not sign a new disclosure statement at the time of hire. There was a disclosure statement dated 8/28/17, however there was not one signed at the time of employment.

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

Noncompliance Area: It was observed that facility person #1, responsible for one infant and two young toddlers, had asked facility person #2 to supervise the children in facility person #1's care while facility person #1 stepped out of the room on two occasions, one lasting about a minute and the second lasting a few minutes. Facility person #2 was also responsible for six older toddlers at the time. During this time, facility person #2 was alone with six older toddlers, two young toddlers, and one infant. Ratios were corrected at the time of inspection, with facility person #1 returning to the room.

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: Hand sanitizer, bleach wipes, and aquaphor were observed to be accessible to children in the upstairs classroom, which was corrected on site.

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 van, used to transport children, was observed not to have tweezers, gloves, or soap, which was corrected on site.

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. 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: Apples were observed to have fallen from a tree onto the preschool/school-age outdoor play space, which had attracted bees at the time of inspection. There were children playing on the adjacent playground at the time in which the bees were observed. A board in the ground was observed to be exposed from under the mulch, creating a trip hazard. The lattice of the fence on the toddler outdoor play area was observed to be broken. Foam was observed to be exposed on a support beam, which was accessible to toddlers. The waste receptacle in the infant/toddler area was observed to have feces on it, which was corrected on site.

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 wall in the infant room behind a crib, and a chip of paint was also observed to be on the floor at the time of inspection. A small spot of peeling paint was observed on the pipe in the downstairs bathroom.

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

Noncompliance Area: At the time of inspection, it was observed that there was not 2 feet of space on three sides of a cot while a child was resting on the cot, which was corrected on site.

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: Rice was observed to be accessible to children in the older toddler classroom, which was corrected on site.

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: There was a current child service report on file for child #1 at the time of inspection, however there was not a previous child service report on file. There was not a current child service report on file for child #2 at the time of inspection, and the last child service report for child #2 was dated 2016. Child service reports are to be updated every 6 months as per the requirements of 3270.124(f).

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 emergency contact form for child #3 did not include the child's health insurance coverage or policy number.

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

Noncompliance Area: The emergency contact form for child #3 did not include a complete address for one of the release persons listed.

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 for children receiving care in the infant room and school-age children receiving care in the upstairs classroom were observed not to be present in the child care space at the time of inspection, which was corrected on site.

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: There were current, up to date health assessments on file for staff persons #1, 2, and 3 at the time of inspection, however they were dated more than 24 months from the previous health assessment dates.

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 emergency contact forms for children #1 - 3 were current and updated at the time of inspection, but had been updated more than 6 months from the dates of the previous updates. The financial agreements for children #1 and 2 were current and updated at the time of inspection, however they had been updated more than 6 months from the dates of the previous updates. The financial agreement for child #3 was dated more than 6 months old at the time of inspection.

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 state police clearance on file for staff person #4 did not include the staff person's AKA name.

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

Noncompliance Area: Bleach wipes were observed to be accessible to children on a shelf in the upstairs classroom and in the older toddler classroom, both of which were corrected on site. Cleaning spray was observed to be accessible to children in an outside container, along the walkway to the outside play space.

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 telephone number of the nearest hospital, police department, fire department, ambulance, and poison control center were observed not to be posted by the telephones in the facility.

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

Noncompliance Area: Dead insects and cobwebs were observed under a crib in the infant area, which was corrected on site. A sharp crack was observed in the downstairs bathroom sink faucet. The wall behind the toilet in the downstairs bathroom was observed to have rust.

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 behind the sink and toilet in the downstairs bathroom. Peeling paint was also observed in the upstairs classroom on the blue window frame, the blue molding next to the blue door, on the left green window frame, on the red window frame, and on the wall under the right green window.

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

Noncompliance Area: Plastic bags were observed to be accessible to children in the older toddler classroom. (CORRECTED ON SITE)

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: At the time of inspection, it was observed that during naptime, a preschool child was placed behind a kitchen toy, and the staff member supervising the child at nap time was unable to see the child around the barrier from the staff person's position relative to the child. (CORRECTED ON SITE)

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: Staff person #1 had results of tuberculosis screening on file at the time of inspection, however the results were dated 6 years prior to the staff person's start date. Staff person #1 must have updated tuberculosis screening results on file.

Correction Required: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department.

Noncompliance Area: There were no written, nonfamily references on file for staff person #1 at the time of inspection.

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: At the time of inspection, the current certificate of compliance was not posted in the facility. (CORRECTED ON SITE)

Correction Required: The facility's current certificate of compliance and a copy of the applicable regulations under which the facility is certified shall be posted in a conspicuous location used by parents, with instructions for contacting the appropriate regional day care office posted at the same location.

Noncompliance Area: Staff person #1 had a state police clearance on file at the time of inspection, but it was a volunteer clearance, not an employment clearance. Staff person #1 must obtain an employment state police clearance in order to work at the facility. Staff person #1 had mandated reporter on training, but was dated August 2010. Mandated reporter training is required to be updated every 60 months.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). LACKING REQUIRED HIRING DOCUMENTS: Facility Person # 1 may not work in a child care position at the facility.

Noncompliance Area: At the time of inspection, the file for staff person #1 did not include adequate documentation to verify that the staff person is qualified to be an assistant group supervisor. There was an associate's degree on file, but no transcript to verify how many hours were in the human services field and documentation of a CDA. Staff person #1 needs documentation of either an additional year of experience with children or documentation of additional 6 credit hours in the human services field in order to be assistant group supervisor qualified.

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

Noncompliance Area: At the time of inspection, an electrical outlet in the upstairs pre-school classroom was observed not to be covered with a protective receptacle cover. (CORRECTED ON SITE)

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

Noncompliance Area: At the time of inspection, peeling paint was observed on a window sill on the left wall in the upstairs classroom. (CORRECTED ON SITE)

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

Noncompliance Area: Plastic bags were observed to be in a plastic bag holder in the young toddler classroom, however the plastic bags were accessible to the children. Plastic bags were also observed to be in a plastic bag holder in the older toddler classroom, which was accessible to children. Plastic bags used to store children's clothing were observed in the older toddler classroom, and the bags were accessible to the children. In the older toddler classroom, a small plastic bead was found on the floor, which was less than 1 inch in diameter. A container of seeds and rabbit food, which were less than 1 inch in diameter, were also observed to be accessible to children in the older toddler classroom. (ALL CORRECTED ON SITE)

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 agreements for children #2 and 3 did not specify the arrival and departure times. (CORRECTED ON SITE)

Correction Required: An agreement shall specify the child`s arrival and departure times.

Noncompliance Area: The agreement for child #4 did not specify the child's date of admission. (CORRECTED ON SITE)

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

Noncompliance Area: The emergency contact forms and agreements on file for children #1 and 2 were updated, but had been updated more than 6 months from the prevous update.

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

Noncompliance Area: Child #3 had an updated health assessment on file, but it was dated over a year since the previous health assessment.

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 health assessment on file for child #4 did not include a signature from the medical professional who completed the examination.

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

Noncompliance Area: The current health assessment on file for child #3 did not include an updated immunization record.

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

Noncompliance Area: It was observed that after a diaper change, a staff person used a wipe to clean the child's hands, but did not wash the child's hands.

Correction Required: A staff person shall ensure that a child`s hands are washed before meals and snacks, after toileting and after being diapered.

Noncompliance Area: There was a health assessment on file for staff person #2, however the health assessment was not dated. Therefore, it is unclear if the health assessment was on file at the time of hire and if the health assessment is current.

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: Staff person #2 had a disclosure statement on file, but it was not dated (CORRECTED ON SITE). Staff persons #1, 3, 4 and 5 did not have disclosure statements on file.

Correction Required: 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: Staff person #1 had not had annual emergency plan training at the time of inspection, and it had been more than a year since the staff person's previous 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: Staff person #3 did not have documentation of completion of annual 6 hours training on file. Staff person #4 had documentation of 4 hours annual training, and still needs documentation of 2 more hours.

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

Noncompliance Area: For the staff members that had first aid, their certification had expired in January 2017, and at the time of inspection there was not proof of any staff members having certification. There was documentation that staff had signed up to attend first aid training prior to inspection, but the cerification documentation was not on file at the time of inspection. Currently, there is not documentation of a staff member having first aid training.

Correction Required: One or more facility persons competent in first-aid techniques shall be at the facility when one or more children are in care.

Noncompliance Area: In the upstairs classroom, it was observed that an outlet cover was missing, which was accessible to children. In the downstairs older toddler room, an outlet cover was observed to be missing. (CORRECTED ON SITE)

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

Noncompliance Area: A plug-in liquid air freshener was observed to be accessible to children in the upper entrance of the building. Disinfecting wipes were observed to be on a table accessible to children in the upstairs classroom. (CORRECTED ON SITE)

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: It was observed that telephone numbers the nearest hospital, police department, fire department, ambulance, and poison control center were not posted near the telephones in the facility. (CORRECTED ON SITE)

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

Noncompliance Area: It was observed that the first aid kid in the young toddler room did not contain sterile gauze pads, the first aid kit in the infant room did not contain band aids, and the first aid kit in the older toddler room did not contain soap. It was observed that the first aid kit on the playground was accessible to children. (CORRECTED ON SITE)

Correction Required: A first-aid kit must be inaccessible to children. 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: It was observed in the downstairs bathroom that the flooring was peeling. (CORRECTED ON SITE)

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 in the upstairs classroom under the window next to the stairs leading to the lower level classrooms and on the blue baseboards on the same wall in the upstairs classroom.

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

Noncompliance Area: At the time of inspection, it was observed that handwashing signs were not posted at the diapering areas in the facility (CORRECTED ON SITE).

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 trash can used for the upstairs bathroom was observed not to be lidded. (CORRECTED ON SITE)

Correction Required: A toilet area, training chair area, diapering area and sink area shall be equipped with a clean, lidded waste receptacle.

Noncompliance Area: The emergency contact forms and financial agreements for children #1-5 were not updated for more than six months prior to their leaving the facilitly.

Correction Required: The parent shall update in writing emergency contact information once in a 6-month period or as soon as there is a change in the information 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.