Little Steps Academy

Noncompliance Area: On 06/24/2020, observed the embedded playground equipment had approximately 6-7" of wood mulch; the US Consumer Product Safety Commission recommends a minimum of 9" of wood mulch.

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: On 06/29/2020, the file for child #1, a 2 year old, included a record of the child's immunization status which lacked a 3rd dose of Hep B, a 4th dose of PCV13, and a 1st and 2nd dose of Hep A immunization.

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: On 06/29/2020, the file for child #1 lacked the date of withdrawal of the child on the agreement form.

Correction Required: A child's record shall contain the dates of application, admission and withdrawal of the child.

Noncompliance Area: On 06/24/2020, observed staff person #1, who was working alone in the toddler classroom, lacked acceptable verification of experience and education to work as an assistant group supervisor. The file for staff person #1 lacked proof of education and lacked documentation of 2 years of experience working with children. The file contained documentation of approximately 2300 hours of experience working with children.

Correction Required: 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: On 06/24/2020, observed staff person #1, a provisional hire with a start date of 06/23/2020, working alone with children in the toddler classroom. The file for staff person #1 contained a disclosure statement that lacked the date it was signed and witnessed. The file for staff person #1 contained the request for the NSOR clearance dated 06/22/2020, the clearance results were not yet on file.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). PROVISIONAL HIRE UNSUPERVISED: A provisional employee may not be permitted to work alone with children and must work within the vicinity of a permanent employee. A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL.

Noncompliance Area: On 06/24/2020, observed staff person #1 working alone in the toddler classroom as an assistant group supervisor. The operator lacked documentation of education and experience for staff person #1 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.

Noncompliance Area: On 06/29/2020, the director did not provide a written evaluation for staff person #2 on a regular basis. The file for staff person #2, with an initial hire date of 07/05/2017 did not contain any written 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: On 06/24/2020, observed the child safety lock on the cabinet under the kitchen sink was not tightly secured. The safety lock was able to easily be removed from the knobs on the cabinet, allowing children access to Borax and Oxyclean labeled "Keep out of Reach of 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: On 06/24/2020, observed Borax and Oxyclean stored next to sugar, salt and flour in the cabinet under the kitchen sink .

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

Noncompliance Area: On 06/24/2020, observed a bolt facing inside the fence with a missing cover on the far left corner of the fence located in the outdoor play space. Observed the front left corner of the fence was detached from the top rail and leaning outward.

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 file for staff person #1 lacked valid PA criminal history, child abuse and FBI clearances; the file contained an expired PA criminal history clearance dated 02/12/2015, an expired child abuse clearance dated 03/02/2015 and an expired FBI clearance dated 02/11/2015. Staff person #1 was working in a child care position at the facility after the clearances expired; hours were documented on their time sheet the week of 02/24 - 02/28/2020 and on 03/02. 03/03/2020 .

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: On 03/06/2020, it was observed that 2 children were documented as arriving for care at 5:30 am. According to staff time sheets, staff person #2 was the only staff person present at the facility with 2 children in care from 5:30 am - 5:40 am when staff person #3 arrived.

Correction Required: At least two facility persons shall be present in the facility when two or more children are in care. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: On 03/06/2020, observed a ladder partially blocking the exit door from the storage room off of the toddler classroom; the door serves as an emergency exit from the classroom through the storage room. Observed a plastic Little Tykes slide behind the door leading into the storage room, which serves as an emergency exit from the toddler classroom, blocking the door from opening completely. Observed rest mats leaning up against the wall next to the door leading into the storage room, which serves as an emergency exit from the toddler classroom, partially blocking the exit door. Observed plastic crates and a parachute on the floor blocking the exit door in the small classroom to the right of the preschool classroom, which serves as an emergency exit from the preschool classroom.

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: The file for staff person #1 lacked verification of child care experience, education and training prior to service at the facility as an Aide.

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: 2nd CITATION: The files for child #1 and #2 lacked a child service report including information about the child's growth and development. The file for child #1 has a child service report completed on 11/23/2018 and 06/19/2019 with no subsequent child service report on file. PREVIOUSLY CITED ON 10/17/2019.

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: 2nd CITATION: The files for children #1 and #2 lacked a review and update of the emergency contact information and the financial agreement at least once every 6 months. The file for child #1 was last reviewed on 06/26/2019. The file for child #2, with an enrollment date of 06/05/2019; the file was not reviewed within 6 months of enrollment. PREVIOUSLY CITED ON 10/17/2019.

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

Noncompliance Area: 2nd CITATION: On 10/18/2019, the provider was unable to demonstrate that the fire detection system was operable due to her disclosure that she had not been paying for the service to be operational per the plan of correction submitted on 10/17/2019. PREVIOUSLY CITED on 10/17/2019.

Correction Required: Conditions at the facility may not pose a threat to the health or safety of the children. The provider will close the facility until they are able to activate the fire detection system and is able to demonstrate the fire detection system is operable..

Noncompliance Area: Observed a plastic kitchen playset in the toddler classroom with visible dirt and a sticky substance on the surface.

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: At 12:25 pm, observed staff person #2 returning to the infant room after taking trash outside; leaving 2 infants and 1 young toddler unsupervised in the infant room. Children must be supervised at all times.

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: The agreement form for child #4 lacked the signature of the operator.

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

Noncompliance Area: The agreement for child #4 lacked the amount of the fee to be charged per day or week.

Correction Required: An agreement shall specify the amount of the fee to be charged per day or per week.

Noncompliance Area: The agreement form for child #4 lacked the specific 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 #2, with an admission date of 10/26/2018, lacked a Child Service report including information about the child's growth and development at least once every 6 months; there were no completed child services reports on file. The file for child #3, with an admission date of 06/12/2018, lacked a Child Service report including information about the child's growth and development at least once every 6 months; the file contained one completed on 11/23/2018 with no additional child service reports on file.

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 forms for children #3 and #4 lacked the complete address of the child's physician or 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 emergency contact information for child #3 lacked the complete work address of the enrolling parent. The emergency contact information for child #4 lacked the complete home and work address of the enrolling parent.

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

Noncompliance Area: The emergency contact information for children #1, #3 and #4 lacked the complete address 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: At 10:45 am, observed staff person #2 take 1 infant, 1 young toddler, 1 older toddler and 1 preschooler outside to the back of the facility without taking emergency contact information for each child.

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: At 10:45 am, observed staff person #2 take 1 infant, 1 young toddler, 1 older toddler and 1 preschooler outside to the back of the facility without taking a copy of the emergency transportation plan, identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency .

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 #2, a young toddler, lacked an updated health report at least every 6 months; the file contains an initial health report dated 10/23/2018 and a second health report dated 03/27/2019 with no current health report on file. The file for child #3, a young toddler, lacked an update health report at least every 6 months, the file contains a current health report dated 08/30/2019 with a previous health report dated 12/31/2018.

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

Noncompliance Area: The file for child #2, a 22 month old, included a record of the child's immunization status which lacked a 4th dose of DTap and an influenza immunization.

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: Observed staff person #2 check a child's diaper and open the refrigerator door immediately afterwards to retrieve a bottle for another child without washing their hands in between.

Correction Required: A facility person shall wash his hands before meals and snacks, and after toileting and after diapering a child.

Noncompliance Area: The operator lacked documentation of current comprehensive general liability insurance; the facilities liability insurance lapsed in June 2019 and was not renewed in a timely manner.

Correction Required: The legal entity shall have comprehensive general liability insurance to cover the persons who are on the premises. A current copy of the insurance policy shall be on file at the facility.

Noncompliance Area: The file for child #2 lacked a review and update of the emergency contact information and the financial agreement at least once every 6 months; the file contains documentation of a review on 04/02/2019 with no subsequent review on file.

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: At the time of arrival, observed the file cabinet in which the children's records are stored unlocked, the office door was also unlocked and open; the door and file cabinet remained unlocked throughout the day.

Correction Required: Child records are confidential and shall be stored in a locked cabinet.

Noncompliance Area: At the time of arrival, observed the file cabinet in which the staff records are stored unlocked, the office door was also unlocked and open; the door and file cabinet remained unlocked throughout the day.

Correction Required: Facility persons' records are confidential and shall be stored in a locked cabinet.

Noncompliance Area: * On 10/17/2019, the provider was unable to demonstrate that the fire detection system was operable due to her disclosure that she had not being paying for the service to be operational.

Correction Required: * Conditions at the facility may not pose a threat to the health or safety of the children. The provider must contact the company which installed the fire detection system to have the system activated and will demonstrate the system is operational.

Noncompliance Area: The emergency plan lacked an update to the plan following staffing changes at the facility.

Correction Required: The operator shall review the emergency plan at least annually and update the plan as needed. The operator shall document in writing each review and update of the emergency plan and kept on file at the facility.

Noncompliance Area: The file for staff person #1 lacked updated clearances within 60 months of the previous clearances; the file contained a criminal history clearance dated 09/03/2014, a child abuse clearance dated 09/18/2014 and an FBI clearance dated 09/08/2014.

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: At 10:10 am, observed staff person #3 bring 1 young toddler, 3 older toddlers and 1 preschooler into the office to look for paperwork; the office electrical outlets lacked protective receptacle covers.

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

Noncompliance Area: Observed a container of Vaseline, labeled "Keep out of Reach of children" on the bottom shelf in an unlocked cabinet on the changing table located in the infant room while toddlers were receiving care in the 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: At 10:45 am, observed staff person #2 take 1 infant, 1 young toddler, 1 older toddler and 1 preschooler outside to the back of the facility without taking a first aid kit.

Correction Required: A first-aid kit shall be in a child care space.

Noncompliance Area: * On 09/25/2019 at approximately 12:05 pm, staff person #1 was working alone at the facility with 8 children (1 infant, 4 young toddlers, 2 older toddlers and 1 preschooler). One young toddler left at 12:10 pm. At 12:25 pm, staff person #1 took 6 of the children to use the restroom and left child #1 unattended in the toddler classroom for approximately 3 - 5 minutes. Staff person #1 also stated she needed to leave the children unsupervised to get lunches, change diapers, take the children on bathroom breaks; and answer the door since she was left alone at the facility when staff person #2 left at approximately 10:30 am. SECOND CITATION: On 01/08/2020, the Department's definition of "supervision", as set forth in 55 Pa. Code 3270.4 was not posted in all child care spaces.

Correction Required: * The operator must post the Department's definition of "supervision", as set forth in 55 Pa. Code 3270.4, in all child care spaces.

Noncompliance Area: On 09/25/2019 at approximately 12:05 pm, staff person #1 was observed working alone at the facility with 8 children (1 infant, 4 young toddlers, 2 older toddlers and 1 preschooler) in care. According to staff person #1, staff person #2 left the facility around 10:30 am and she was left alone with the children. A young toddler left at approximately 12:10 pm. Staff person #3 arrived at 12:30 pm.

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: On 09/25/2019 at approximately 12:05 pm, staff person #1 was observed working alone at the facility with 8 children in care. According to staff person #1, staff person #2 left the facility around 10:30 am and she was left alone with the children. Staff person #3 arrived at 12:30 pm.

Correction Required: At least two facility persons shall be present in the facility when two or more children are in care. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: * On 09/25/2019 at 12:05 pm, there were 8 children (1 infant, 4 young toddlers, 2 older toddlers and 1 preschooler) observed in the infant room; the maximum capacity for the infant room is 4 children. SECOND CITATION: On 01/08/2020, observed the incorrect capacity posted in the preschool and toddler classrooms.

Correction Required: * The operator shall post the established maximum capacity for each classroom in every child care space .

Noncompliance Area: Weather permitting, the infants and toddlers are not taken out doors daily.

Correction Required: Weather permitting, children shall be taken out doors daily.

Noncompliance Area: Observed a baby exersaucer bouncer, a baby walker, a paint bucket, a basket, a vacuum cleaner, and empty 5 gallon water jugs in front of the exit door located in the storage room off of the toddler classroom which is a secondary means of egress from the classroom. . The door was unable to be opened fully due to rest cots and empty 5 gallon water jugs placed in the storage area to the right of the door.

Correction Required: Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed.

Noncompliance Area: On 08/07/2019, at approximately 9:45 am, Cert Rep observed staff person #2 open the door to let a child and parent into the facility, staff person #2 then walked out of the facility passing Cert Rep in the parking lot. Upon entering the facility, Cert Rep observed a 1-year-old standing at the gate in the preschool room trying to enter the toddler room. 5 additional children were observed in the toddler classroom unsupervised while staff person #2 was outside. Staff person #1 was in the bathroom with 2 children, staff person #3 was in the infant room with 3 infants. Staff persons #1 and #3 were unable to see, hear, direct & assess the children in the preschool or toddler room from their locations in the facility while staff person #2 was outside.

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: Child #1 lacked emergency contact information while receiving care in the toddler and preschool classrooms. Child #2 lacked emergency contact information while receiving care in the infant classroom.

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 staff person #3, with a hire date of 08/07/2019, lacked a signed disclosure statement prior to working in a child care position at the facility.

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: On 08/07/2019, at approximately 9:45 am, Cert Rep observed staff person #2 open the door to let a child and parent into the facility, staff person #2 then walked out of the facility passing Cert Rep in the parking lot. Upon entering the facility, Cert Rep observed a 1-year-old standing at the gate in the preschool room trying to enter the toddler room. 5 additional children (1 older toddler, 2 preschoolers and 2 school-agers) were observed in the toddler classroom unsupervised while staff person #2 was outside. Staff person #1 was in the bathroom with 2 children (an older toddler and a preschooler), staff person #3 was in the infant room with 3 infants.

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: Observed a loose connection on the gate between the preschool and toddler classroom; the gate was difficult to keep closed due to the bottom mount on the wall being able to detach from the gate when opened; allowing the gate to be pushed open from the bottom and swing back and forth from the top mounts.

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: Observed staff person #1 take 2 young toddlers and 1 older toddler for a walk around the block; emergency contact information specific to each child was not taken on the walking excursion away from the facility.

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: Observed staff person #1 take 2 young toddlers and 1 older toddler for a walk around the block; the written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not taken on the walking excursion away from the facility.

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: Observed staff person #1 take 2 young toddlers and 1 older toddler for a walk around the block; a second staff or facility person was not present when he children were on the walking excursion away from the facility.

Correction Required: At least two facility persons shall be present when children are on an excursion away from the facility. At a minimum, one of the facility persons shall be a staff person.

Noncompliance Area: Observed a spray bottle labeled bleach/water in an unlocked cabinet under the changing table; the bottle was placed on the same shelf in which food is stored for the infants in care.

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

Noncompliance Area: Observed staff person #1 take 2 young toddlers and 1 older toddler for a walk around the block; a first-aid kit with a bottle of water was not taken on the walking excursion away from the facility.

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: Observed rest mats used by toddler and preschool children in care which were torn on the sides and corners exposing the foam inside.

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

Noncompliance Area: The preschool/ school-age classroom lacked a posting of the written plan of daily activities

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

Noncompliance Area: The file for child #5, with an enrollment date of 01/22/2018, lacked completed child service reports with information about the child's growth and development at least once every 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 #4 lacked the complete address of the child's physician or source of medical care on the emergency contact form.

Correction Required: Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Noncompliance Area: The file for child #1 lacked the work address of the enrolling parent on the emergency contact form. The file for child #2 lacked the complete address of the enrolling parent on the emergency contact form. The file for child #4 lacked the work address and telephone number of the enrolling parent on the emergency contact form.

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

Noncompliance Area: The files for children #3 and #4 lacked the complete address of the persons designated by the parent to whom the child may be released on the emergency contact form.

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 facility lacked emergency contact information for child #6 while receiving care in the child care space.

Correction Required: When children are in the facility, emergency contact information shall be present in a child care space for children receiving care in the space.

Noncompliance Area: The infant classroom lacked a copy of the emergency transportation plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency posted in a conspicuous location; the emergency transportation plan was located in a folder hanging on the wall.

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 #3, a 5 year old, included a record of the child's immunization status which lacked an influenza immunization. The file for child #5, a 2 years and 9 months old, included a record of the child's immunization status which lacked an influenza immunization.The file for child #2, an 18 month old, included a record of the child's immunization status which lacked a 4th dose of DTaP, 4th dose of Pneumococcal, 1st dose of Hep A, a 3rd dose of Hib, a 1st dose of MMR a 1st dose of Varicella and an influenza immunization. The file for child #4, a 7 month old, included a record of the child's immunization status which lacked a 2nd dose of DTaP, 2nd dose of Hib, a second dose of Polio and a 2nd dose of Pneumococcal immunization.

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: Observed prescription medication for child #4 which was accepted without being in the original prescription container.

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: Observed prescription medications and non-prescription infant Tylenol in the infant room which lacked the name of the child for whom the medication is intended. Observed non-prescription allergy relief medication in the preschool/school-age classroom which lacked the name of the child for whom the medication is 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: Observed prescription and non prescription medication in the infant room which was stored in a basket located in an unlocked cabinet below the changing station. Observed diaper creams, children's allergy relief medication in an unlocked cabinet located in the preschool/school-age classroom which were accessible to children.

Correction Required: Medication shall be stored in a locked area of the facility or in an area that is out of the reach of children.

Noncompliance Area: Observed infant Tylenol for child #4 which lacked written consent from a parent 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 #1 lacked an updated health assessment at least once every 24 months; the file contains a health assessment dated 11/14/2016 with no current health assessment 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.

Noncompliance Area: Observed crackers, cheese curls, chips, flour and sugar in the kitchen cabinet which were in unsealed containers with ants visible in the cabinet where the food was stored.

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

Noncompliance Area: The lunch prepared at the facility lacked a dairy product; the lunch served to the children included spaghetti with meat sauce and a cup of water.

Correction Required: A lunch or dinner prepared at the facility for children of toddler age or older shall include at least one dairy product.

Noncompliance Area: The lunch prepared at the facility lacked a fruit or vegetable; the lunch provided to the children included spaghetti with meat sauce and a cup of water.

Correction Required: A lunch or dinner prepared at the facility for children of toddler age or older shall include at least one fruit or vegetable.

Noncompliance Area: The facility lacked a menu posted in a conspicuous location at least 1 week in advance.

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

Noncompliance Area: The bottles provided by the parent are not sent home nightly or washed in a commercial dishwasher by the facility. The facility lacks a commercial dishwasher and bottles are hand washed in the sink.

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: Observed bottles in the infant room which lacked labels with the child's name for whom it is intended.

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

Noncompliance Area: The facility lacked a posting of the safe routes with pick-up/drop off procedures in a conspicuous location.

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 operator lacked an individual record at the facility for child #6 with a completed emergency contact and agreement form prior to the child's first day of attendance.

Correction Required: An operator shall establish and maintain an individual record for each child enrolled in the facility.

Noncompliance Area: The files for children #1 and #5 lacked an update to the emergency contact information and the financial agreement at least once every 6 months. The file for child #1 contains a current update dated 03/26/2019 with the initial enrollment dated 05/30/2018 with no additional reviews documented. The file for child #5 contains documentation of a review dated 07/20/2018 with the initial enrollment dated 01/22/2018 with no additional reviews documented.

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 office and file cabinet where the child records are stored were unlocked allowing access to the children's files.

Correction Required: Child records are confidential and shall be stored in a locked cabinet.

Noncompliance Area: An individual record for facility person #3 was unable to be located at the facility at the time of the inspection.

Correction Required: An individual record is required for each facility person.

Noncompliance Area: The file for staff person #1 lacked verification of child care experience, education and training following the outset of service at the facility to qualify as a director.

Correction Required: 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 person #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 office and file cabinet where the facility persons' records are stored were left unlocked allowing access to the staff files.

Correction Required: Facility persons' records are confidential and shall be stored in a locked cabinet.

Noncompliance Area: The file for staff person #1 lacked documentation of an annual minimum of 6 clock hours of child care training.

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

Noncompliance Area: The file for staff person #1 lacked documentation of annual fire safety training.

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 #2, working as an assistant group supervisor alone in the preschool/school-age classroom with children, lacked verification of education 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: On 04/09/2019, staff persons #2, #3 and #4 were observed working together at the facility with one of more children in care; the files for staff persons #2, #3 and #4 lacked documentation of current first-aid certification.

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: At approximately 11:00 am, observed staff person #2, an aide, working unsupervised in the preschool/toddler classroom with a mixed group of 3 older toddlers and 2 preschoolers without direct supervision by a staff person qualified at minimum as an assistant group supervisor.

Correction Required: An aide or a combination of aides shall be supervised at all times by a staff person qualified at minimum as an assistant group supervisor.

Noncompliance Area: 2nd CITATIION: On 04/09/2019 at 9:00 am observed child #3, a preschooler, sleeping on a rest mat in the Preschool/school-age classroom while another preschool child along with 2 young toddlers, and 2 older toddlers were playing in the same group space. PREVIOUSLY CITED on 11/21/2019.

Correction Required: Preschool and school-age children may not be involved in small or large muscle activity in the same group space in which children are sleeping or resting.

Noncompliance Area: 2nd CITATION: Observed an electrical outlet in the kitchen area above the sink/counter which lacked a protective receptacle cover, during lunch preparation, an older toddler was observed standing on a chair next to the sink/counter making the electrical outlet accessible. Observed an electrical outlet in the preschool/school-age room which lacked a protective receptacle cover; the outlet was covered with a loose piece of duct tape and an older toddler was observed playing with the tape. PREVIOUSLY CITED on 11/21/2018.

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

Noncompliance Area: Observed a can of Lysol disinfectant spray on the floor under the changing table located in the infant room which was accessible to young toddlers receiving care in the infant room. Observed nail polish and antibacterial gel on an open shelf in the preschool/school-age classroom which 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: Observed little black ants in the kitchen cabinets where food, plates and cups are stored, on the counter where food is prepared and on the wall in the kitchen area.

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

Noncompliance Area: Observed bolts protruding into the playground in the back corners of the fence which lacked a protective cap. Observed a loose bracket on the fence post located on left back corner of the playground. Observed loose metal fasteners on the top of the fence post located on the left side of the playground. Observed a food stain on the left side of the kitchen cabinet next to the trash can. Observed the lock on the office door was broken and unable to be locked.

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: Observed damaged plaster on the wall located under the window located in the toddler 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: Observed 2 open Pack 'N Plays and a wooden bench in front of the exit door located in the storage room off of the toddler classroom which is a secondary means of egress from the classroom. Observed cots resting against the exit door located in the storage room next to the preschool/school-age classroom.

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: The facility lacked complete dates of recent fire drills to establish a fire drill was held at least every 60 days; the fire drill log listed a fire drill held on 01/08/2019. 03/ /2019, and 04/ /2019. The exact date of the fire drills held in March and April were blank on the fire drill log.

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: On 11/21/2018 at approximately 1:40 pm, observed staff person #1 sitting in her vehicle talking on a cell phone while children #1 and #2 exited the vehicle and entered the facility. Staff person #1 was observed exiting the vehicle after the children had already entered the facility.

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: On 11/21/2018 at approximately 1:40 pm, observed staff person #1 return to the facility with children #1 and #2 after picking them up from school. Staff person #1 was observed sitting in the drivers seat of the vehicle talking on a cell phone. Staff person #1 was observed opening the door of the vehicle but remained in the vehicle while children #1 and #2 were observed exiting the vehicle and entering the facility.

Correction Required: Children shall be supervised during boarding and exiting vehicles by an adult who remains outside the vehicle.