Cheryl L Schmidt Wilkins

Regulation: 3290.123(a)(3)

Description: Services provided

Noncompliance Area: The most recent child service report for child #5 was dated 9/2/25. There was no child service report on file for child #4 (see code sheet for start date).

Correction Required: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. the operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at § 3290.124(e).

Regulation: 3290.124(e)/3290.181(c)

Description: Updated every 6 months/Emergency info/agreement updated 6 mos

Noncompliance Area: The most recent parental review of the emergency contact and fee agreement for child #5 was 7/9/25.

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.

Regulation: 3290.131(b)(2)

Description: Updated toddler/preschool health report: every 12 months

Noncompliance Area: The most recent health report on file for child #4 was dated 11/19/24.

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

Regulation: 3290.134(a)

Description: Child's hands washed

Noncompliance Area: The hands of child #3 were not washed after diapering.

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

Regulation: 3290.135(a)(3)

Description: Disposable diapers

Noncompliance Area: Staff #1 was observed diapering child #3. The soiled diaper was placed on the changing table and then into a plastic bag to be discarded.

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.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: Staff person #1 was observed to be caring for children unsupervised. Staff person #1 does not have current pediatric first-aid/CPR training. This is evidenced by the previously documented pediatric first- aid/CPR training expiration date of 10/17/25.

Correction Required: A facility shall be operated in conformity with applicable Federal and State laws and regulations. State agencies whose regulations may relate to the operation of a facility include the Department of Environmental Resources, the Department of Labor and Industry, the Department of Health, the Department of Education and the Department of Transportation. Conditions at the facility may not pose a threat to the health or safety of the children. Until such time as the required pre- service trainings are completed, staff person #1 must be supervised, when interacting with children at a minimum by, a family child care home staff person who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility.

Regulation: 3290.181(d)

Description: Dated signature affixed

Noncompliance Area: The emergency contact information and fee agreement for child #3 were not signed by the parent.

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

Regulation: 3290.182(1)

Description: Initial and subsequent health assessments

Noncompliance Area: The initial health reports for child #1 and #2 were not on file. The old health reports may have been discarded when files were cleaned out.

Correction Required: A child's record must contain initial and subsequent health reports.

Regulation: 3290.31(f)(4)(i)/3290.32(d)

Description: Age and training/Age and training

Noncompliance Area: Staff person #1 has not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This is evidenced by the previously documented Pediatric first aid and CPR training on file expiring 10/17/25. Documentation of updated Pediatric first aid and CPR training is not on file

Correction Required: Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children at a minimum by, a family child care home staff person who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility. One or more facility persons competent in pediatric first-aid and pediatric cardiopulmonary resuscitation techniques shall be at the facility when one or more children are in care.

Regulation: 3290.32(a)

Description: Comply with CPSL

Noncompliance Area: The state police clearance for person #2 was dated 10/25/24; the child abuse was dated 12/6/24; the FBI clearance was dated 1/10/25. All were past the date person #2 was required to have clearances based on the age of person #2 (see code sheet for date of birth).

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

Regulation: 3290.95(a)

Description: System in compliance

Noncompliance Area: The smoke detector was not approved by a testing laboratory recognized by OSHA.

Correction Required: Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c)).

Regulation: 3290.124(b)(4)/3290.182(3)

Description: Written consent/Consent for emergency medical care required prior to admission

Noncompliance Area: The emergency contact information for child #1 did not include parental consent for emergency medical care.

Correction Required: Emergency contact information must include the written consent signed by a parent for emergency medical care. A child's record must contain signed parental consent for emergency medical care for the child. Written consent is required prior to admission.

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: During the renewal inspection on 9/24/25, the provider could not produce the continuity of operations plan.

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

Regulation: 3290.182(1)

Description: Initial and subsequent health assessments

Noncompliance Area: The initial health assessment for child #2 had been thrown away when files were cleaned up.

Correction Required: A child's record must contain initial and subsequent health reports.

Regulation: 3290.182(5)

Description: Consent for administration of minor first-aid required prior to admission

Noncompliance Area: The emergency contact information for child #1 did not contain parental consent for administration of minor first-aid.

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

Regulation: 3290.22(b)

Description: Availability of certificate of compliance and applicable regulations

Noncompliance Area: During the renewal inspection on 9/24/25, the information on how to access the regulations electronically could not be found.

Correction Required: The operator shall provide the parent of each child enrolled in the facility with information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office.

Regulation: 3290.24(f)

Description: Emergency plan

Noncompliance Area: During the renewal inspection on 9/24/25, the updated letter to parents regarding the emergency plan could not be located.

Correction Required: The operator shall provide to the parent of each enrolled child a letter explaining the emergency procedures described in subsection (a). The operator shall also provide to the parent of each enrolled child a letter explaining any subsequent update to the plan.

Regulation: 3290.94(a)(1)

Description: Every 60 days

Noncompliance Area: During an unannounced inspection on 5/20/25, the most recent fire drill was dated 12/20/24.

Correction Required: The operator or designated staff person who is responsible for compliance with this chapter shall conduct fire drills and ensure that fire drills are conducted at least once every 60 days.

Regulation: 3290.95(a)/3290.95(b)

Description: System in compliance/Operator or designated staff responsibility

Noncompliance Area: During an unannounced inspection on 5/20/25, the most recent fire alarm test was dated 1/15/25.

Correction Required: Fire detection devices or systems must be in compliance with standards established under section 1016(c) of the act (62 P.S. § 1016(c)). The operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

Regulation: 3290.102(c)

Description: Outdoor equip.- protective surfacing

Noncompliance Area: There was insufficient mulch to cover the fall zones around the entire embedded play structure.

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.

Regulation: 3290.106

Description: Refrigerator

Noncompliance Area: The thermometer in the refrigerator was an oven thermometer, therefore, the temperature of the refrigerator could not be determined.

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.

Regulation: 3290.131(b)(2)

Description: Updated toddler/preschool health report: every 12 months

Noncompliance Area: The most recent health report on file for child #1 was dated 10/7/22.

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

Regulation: 3290.18

Description: General Health and Safety

Noncompliance Area: There was no written policy for Shaken Baby/Abusive Head Trauma/Child Maltreatment as required by federal requirements at 45 CFR 98.41(a)(1)(vi) .

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

Regulation: 3290.24(d)

Description: Emergency plan

Noncompliance Area: An emergency drill had not been conducted at the facility.

Correction Required: Emergency drills shall be conducted annually. Annual emergency drills shall be documented and on file at the facility.

Regulation: 3290.32(a)

Description: Comply with CPSL

Noncompliance Area: There was no state police clearance, child abuse clearance, NSOR or signed disclosure statement on file for household member #1 who is over the age of 18.

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

Regulation: 3290.74(a)

Description: Requirements

Noncompliance Area: There was deck board that was loose and sticking up.

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

Regulation: 3290.102(a)

Description: Clean and good repair

Noncompliance Area: It was observed that the slide on the outdoor wooden play equipment was not in good repair; it was missing the two bolts which secures the slide at the top to the wooden play structure.

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.

Regulation: 3290.124(b)(6)

Description: Insurance coverage information

Noncompliance Area: Emergency contact form for child #1 did not contain the child's health insurance coverage 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.

Regulation: 3290.131(d)(5)/3290.131(e)(3)

Description: Immunization record/Dismissal policy

Noncompliance Area: File for child #1 did not contain documentation showing the status of all the immunizations recommended by the ACIP. File for child #1 did not contain information regarding the influenza vaccine.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in child care group settings).

Regulation: 3290.182(3)/3290.182(5)

Description: Consent for emergency medical care required prior to admission/Consent for administration of minor first-aid required prior to admission

Noncompliance Area: File for child #1 did not contain signed parental consent for emergency medical care or signed parental consent for administration of minor first-aid.

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

Regulation: 3290.31(f)/3290.192(4)

Description: Age and training/Required training

Noncompliance Area: It was observed that staff person #1 did not have on file documentation verifying that they completed 12 hours of annual professional development training as required.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training. A facility person's record shall include records of training required by the Department.

Regulation: 3290.32(a)/3290.192(3)

Description: Comply with CPSL/CPSL information

Noncompliance Area: It was observed that household member #2 did not have on file any of their required 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. Household member #2 may not be present when children are in care.

Regulation: 3290.65(c)

Description: No insects or rodents

Noncompliance Area: A wasp's nest was observed between the bathroom window and screen.

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

Regulation: 3290.95(b)

Description: Operator or designated staff responsibility

Noncompliance Area: It was observed on the facility's fire alarm testing log that the alarm tests were not being conducted at least once every 30 days. This is evidenced by the previously documented fire alarm tests dated 11/7/22, 12/28/22, 2/9/23, 3/21/23, 4/13/23, 5/22/23, 6/16/23, 7/21/23, and 8/24/23.

Correction Required: The operator or designated staff person who is responsible for compliance with this chapter shall ensure the requirements in § 3290.95(a) are met.

Regulation: 3290.123(a)(5)

Description: Designated release persons

Noncompliance Area: Agreements for child #4 and #5 did not specify designated release persons.

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

Regulation: 3290.124(b)(2)

Description: Physician name, address, phone

Noncompliance Area: Emergency contact form for child #5 did not include the name, address and telephone number 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.

Regulation: 3290.124(b)(3)

Description: Parent home/work address, phone

Noncompliance Area: Emergency contact form for child #5 did not include the enrolling parent's work address.

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

Regulation: 3290.124(b)(6)

Description: Insurance coverage information

Noncompliance Area: Emergency contact form for child #5 did not include the child's health insurance coverage name 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.

Regulation: 3290.181(c)

Description: Emergency info/agreement updated 6 mos

Noncompliance Area: It was observed that although emergency contact forms and agreements for child #1-#5 showed documentation of a review and update within the last 6 months, documentation also shows that these forms are only being reviewed and updated annually and not at least once every 6 months as required.

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.

Regulation: 3290.121(b)

Description: Given parents in writing

Noncompliance Area: It was observed that the facility did not provide to parents, at the time of enrollment, the facility's written transportation policy and provider transported a child the day of inspection.

Correction Required: At the time of enrollment, a parent shall receive in writing the facility's general daily schedule, hours for which care is provided, fees, responsibilities for meals, clothing, health policies, supervision policies, night care policies, dismissal policies, transportation and pick-up arrangements.

Regulation: 3290.176

Description: Transportation First Aid Kit

Noncompliance Area: It was observed that the facility transported a child the day of inspection and the first aid kit located in the vehicle was missing tape.

Correction Required: A first-aid kit, including the contents as specified in §3290.73 (relating to first-aid kit) shall be in the vehicle when children are being transported.

Regulation: 3290.24(a)(1)/3290.24(a)(5)

Description: Emergency plan/Emergency plan

Noncompliance Area: It was observed that the facility's emergency plan did not include a lock-down procedure or accommodations for children with disabilities or chronic medical conditions.

Correction Required: The facility shall have an emergency plan that provides for accommodations for shelter of children during an emergency including lock-down, shelter in place at the facility and shelter at locations away from the facility premises. The facility shall have an emergency plan that provides for accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions.

Regulation: 3290.32(a)

Description: Comply with CPSL

Noncompliance Area: It was observed that household member #2, who is over the age of 18, did not have a signed disclosure statement, PA state police clearance, child abuse clearance, FBI clearance, or NSOR verification certificate on file.

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

Regulation: 3290.32(d)

Description: Age and training

Noncompliance Area: It was observed that staff person #1 did not have documentation on file verifying that training was completed showing they are competent in pediatric first-aid and CPR techniques, and there are no additional staff persons employed at the facility.

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

Regulation: 3290.74(a)

Description: Requirements

Noncompliance Area: It was observed that the childproof fencing surrounding the facility's coal stove, which was not being used at the time of inspection but is used to heat the facility during the winter months, was broken and not in good repair. It was observed in the facility's kitchen that the vent on the ceiling above the stove was greasy and dusty leaving it unclean.

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

Noncompliance Area: Plastic grocery bags were observed in a low drawer in the kitchen, accessible to an older toddler who was observed to still put objects in her mouth.

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: Child #1, an infant observed in care at the facility, does not have a written feeding and formula schedule on file at the facility from the parent.

Correction Required: A written statement giving the formula and feeding schedule for an infant shall be obtained from the parent.

Noncompliance Area: Child #5, who has been enrolled at the facility since 8/27/18, has not had a child service report completed within the last six months, or since 9/15/18.

Correction Required: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. the operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at 3290.124(e).

Noncompliance Area: Provider admitted that the emergency contact form for Child #1 was not present in the vehicle during transportation.

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

Noncompliance Area: The written plans identifying the means of transporting a child to emergency care and staffing provisions were not posted at the facility during the inspection. A copy of this plan was also not accompanying the provider during excursions away from the facility.

Correction Required: A written plan shall be conspicuously posted which identifies the means of transporting a child to emergency care and the facility staffing provisions in the event of an emergency. The plan must accompany a staff person who leaves the facility on an excursion with children.

Noncompliance Area: The files for Child #2 and Child #4 do not contain valid, signed health assessments from the physician. Each child has immunization records on file, but health assessment paperwork has not been completed or signed by a doctor. Child #2 has been enrolled since 10/1/16, and Child #4 has been enrolled since 1/15/16.

Correction Required: The operator shall require the parent of an enrolled child, including a child, a foster child and a relative of an operator or a facility person, to provide an initial health report no later than 60 days following the first day of attendance at the facility.A 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 last health assessment on file for Child #3 is dated 10/23/18, but this child was a young toddler who required a health assessment update within the last 6 months. The parent did not provide updated immunization records for this child showing updated immunizations in accordance with the ACIP schedule.

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddlerThe 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 last health assessment on file for Child #1, a preschool-aged child, is dated 11/1/17. An updated health assessment since this date has not been provided, though almost 22 months have passed.

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

Noncompliance Area: The file for Child #1 does not contain proof of any vaccination again the flu, but a letter of exemption signed by the parent is not present in the file.

Correction Required: Exemption from immunization for religious belief or strong personal objection equated to a religious belief shall be documented by a written, signed and dated statement from the child's parent or guardian. The statement shall be kept in the child's record.

Noncompliance Area: Child #1 is being transported in a booster seat, but the manufacturer's instructions for use of the safety restraints are not available in the vehicle.

Correction Required: Manufacturers' instructions for use of safety restraints shall be kept in the vehicle at all times.

Noncompliance Area: Records for Individuals #2 and #3, both identified as volunteers at the facility, do not have proof of name, address and telephone number for either individual.

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

Noncompliance Area: According to the first-aid card reviewed during the inspection, the first-aid training for the provider expired two years from the date of the training course, which was 11/2/16. There is no proof of additional valid first-aid training completed since this date on file.

Correction Required: Competence in first-aid is demonstrated by the completion of training by a professional in the field of first-aid. First-aid training shall be renewed on or before expiration of certification or every 3 years, as applicable.

Noncompliance Area: Five outlets in the living room were observed to be uncovered during the inspection, and a four-year-old child was observed to be receiving care.

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

Noncompliance Area: The guard that was erected around the wood-burning stove in the living room has become undone from the wall, allowing children to have access to the stove unless repaired.

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

Noncompliance Area: The provider provides transportation for children at the facility, but provider admitted to not having a first-aid kit present in the vehicle during this time.

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 3290.73(c). A first-aid kit, including the contents as specified in 3290.73 (relating to first-aid kit) shall be in the vehicle when children are being transported.

Noncompliance Area: Older heater covers in the living room have spots of peeling paint, accessible to children. The small mesh gate that the provider uses in the hallway is in poor repair and torn. Multiple ceiling tiles in the kitchen were observed to have peeing surfacing. Two sharp knives were observed in a drawer in the kitchen without a child lock, making the knives accessible to children. The fence mesh that was added to prevent children from having access outside the backyard has multiple sharp spots, accessible to children. A broken ladder was observed to be leaning up against the playhouse in the backyard, with sharp, jagged edges, and able to be pulled down on top of children. Tall grass and weeds were observed around the bottom of the playhouse and in the area of the climber.

Correction Required: Floors, walls, ceilings and other surfaces, including the facility's outdoor play area, shall be kept clean, in good repair and free from visible hazards. Peeled or damaged paint or damaged plaster is not permitted on indoor or outdoor surfaces in the child care facility.

Noncompliance Area: Multiple heater covers have become unhinged, allowing children access to the sharp heating conduits in the living room and bathroom. A piece of exposed brick in the wall in the kitchen had come loose, allowing access to the crumbling wall pieces in the kitchen. The fencing in the backyard at the facility, where the children play outside, has areas where the mesh backing is not complete, as well as areas where a gate is not present, allowing children access to a nearby creek. A covered litter box was accessible to children in the bathroom of the facility.

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

Noncompliance Area: RECITE: During an inspection 11/14/18, a wood stove was observed to be operating at the facility in the living room, which is a child care space. The stove was extremely hot to the touch, and is not safeguarded to make the stove inaccessible to children. The stove and pipe were so hot that the inspector could not touch the stove for longer than a second, nor could she place her whole hand on the stove. During a follow-up inspection on 11/29/18, provider had extended a new fencing around the stove. However, the fencing was not secured to the wall or any other object to make the fence immovable. The fence was easily able to be moved away from the stove and the stove remained accessible.

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

Noncompliance Area: Emergency contact forms for Child#1-Child #6 were reviewed during an unannounced inspection on 11/14/18. There was no insurance coverage information for any of the children's forms.

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: During an inspection 11/14/18, a wood stove was observed to be operating at the facility in the living room, which is a child care space. The stove was extremely hot to the touch, and is not safeguarded to make the stove inaccessible to children. The stove and pipe were so hot that the inspector could not touch the stove for longer than a second, nor could she place her whole hand on the stove.

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

Noncompliance Area: During the inspection on 9/11/18, the inspector inquired about rest equipment for the children who do nap. One child was identified to sleep in an observed pack and play, two children were identified as sleeping on blankets placed on the ground, and one child was identified to sleep on the couch.

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.Bed linens may not be used alone as age-appropriate rest equipment.

Noncompliance Area: Throughout the inspection, children were observed to move freely between the kitchen, living room and hallway leading to the bathroom. These areas are all separated by walls, and once a child enters the next room, is unable to be properly supervised by the operator. At multiple times during the inspection, children were observed to be unsupervised in different rooms at the facility for periods of time. There are no barriers to prevent children from leaving the room where the operator is, in order to ensure that children are properly 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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio). Children must be supervised at all times. The legal entity must arrange for all facility staff to receive a minimum of two hours of training regarding supervision of children. The legal entity must receive DHS approval of the training content prior to scheduling the training.

Noncompliance Area: The records for Child #1 and #5 were reviewed during the inspection on 9/11/18. Child Service reports in the files have not been updated within the last 6 months for either child. Report for Child #1 was last provided on 10/5/16, and the report for Child #5 was last provided on 10/1/17.

Correction Required: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. the operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at 3290.124(e).

Noncompliance Area: The records for Child #2 and #3 do not contain emergency contact forms or agreement forms signed by the parent.

Correction Required: An agreement shall be signed by the operator and the parent. Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency.

Noncompliance Area: The record for Child #2 was reviewed during the inspection on 9/11/18. The child file contains a health assessment conducted on 12/13/16, but an updated health assessment has not been provided since.

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

Noncompliance Area: A tube containing Miconazole-7, as identified on the tube and the box, was observed in an unlocked drawer in the bathroom during the inspection on 9/11/18 and accessible to children using the bathroom.

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: During the inspection on 9/11/18, children were observed to be playing, then transition right to the kitchen table to prepare for lunch. Children were served lunch after this, and no handwashing took place at any point prior to eating. There was no soap present at either sink in the bathroom during the inspection on 9/11/18 in order for children or adults to use to wash their hands properly.

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: During the inspection on 9/11/18, there were no paper towels observed in the bathroom for use after handwashing. One child's bath towel was observed on the counter, and this towel was not labeled for use by any individual at the facility.

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

Noncompliance Area: A cup of toothbrushes was identified by the provider during the inspection on 9/11/18 to be the toothbrushes used by child care children at the facility. However, the toothbrushes were not labeled for the individual children. Another toothbrush was identified to be located in a child's backpack, and not stored with the bristles up and exposed to the circulating air.

Correction Required: A child shall have a labeled toothbrush if brushing teeth is a program activity. Toothbrushes shall be stored with the bristles up and exposed to circulating air.

Noncompliance Area: During an inspection conducted on 9/11/18, child files were reviewed. Child #4, #6, #7, #8, #9, #10, #11, #12, and #13 do not have records at the facility. Child #8, #9, #11, #12 and #13 were observed to be receiving care during the inspection. The remaining children were identified as enrolled by the provider, and identified as having received care.

Correction Required: An operator shall establish and maintain an individual record for each child enrolled in the facility. Provider is required to attend an Existing Provider Orientation at the Regional Office. Provider must contact the Regional Office to enroll for this orientation.

Noncompliance Area: Records containing the emergency contact forms and fee agreements for Child #1 and Child #5 have not been reviewed and updated within the last six-month period. The last documented update on file for Child #1 was on 10/21/16, and the last documented update for Child #5 was on 10/1/17.

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: During a renewal inspection conducted on 9/11/18, 10 children were observed to be receiving care. Three of the children were related to the provider and 7 of the children were unrelated to the operator.

Correction Required: The number of children in care may not exceed six children at any one time who are unrelated to the operator.

Noncompliance Area: An outlet with two receptacles close to the floor behind the kitchen table was observed to be uncovered and accessible to children during the whole inspection.

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

Noncompliance Area: The drawers in the bathroom at the facility do not have child proof locks preventing children from having access to the contents. During the inspection on 9/11/18, three tubes of toothpaste, a bottle of mouthwash, St. Ive's face wash, Aussie hairspray and Designline hairspray were all observed in multiple drawers in the bathroom, unlocked and accessible to children using the bathroom. All items were labeled "Keep Out of Reach of Children" except the hairspray, which was labeled flammable.

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

Noncompliance Area: During the inspection on 9/11/18, the provider was observed to make grilled cheese sandwiches for lunch on the flat-top stove. The stove has a guard that extends around 3 sides of the stove, except for the side where the provider stood to cook. During the cooking, the provider was observed to walk away from the stove, and a child climbed the cabinets and placed her hands near to the hot stove surface. Another child was also observed to walk near the stove when the provider was not standing at the stove, and remove a grilled cheese sandwich from a plate that was directly next to the hot stove.

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

Noncompliance Area: During the inspection on 9/11/18, the covers for the baseboard heating conduits were observed to be missing on two heaters in the bathroom, exposing the sharp metal inside conduits of the heaters. In the living room, two of the covers were observed to be falling off, with sharp edges and also exposing the sharp metal inside conduits. Multiple cords around the TV in the living room were draped along the floor to an outlet, posing a tripping hazard in the room. In the walkway between the living room and kitchen, a piece of tile was observed to be cracked, with sharp edges and able to be removed from the floor.

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

Noncompliance Area: During the inspection on 9/11/18, the inspector walked down a hallway to the bathroom used by the children. The light in the hallway was not working, and the hallway was dark enough that the inspector could not make out the doorways in the hallway.

Correction Required: Hallways and stairways used by children shall be well-lighted.

Noncompliance Area: During the inspection on 9/11/18, multiple ride-on toys were observed to be parked in front of the front door to the facility, blocking an exit and means of egress.

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: CHILDREN TRAVELED FREELY BETWEEN THE KITCHEN AND LIVING ROOM AND WERE NOT 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. The requirement for supervision on and off the facility premises includes compliance with the staff:child ratio requirements in 3290.51-3290.52 (relating to maximum number of children; and staff:child ratio).

Noncompliance Area: THERE IS MEDICATION STORED ON THE BOTTOM SHELF OF A CUPBOARD THAT IS ACCESSIBLE TO THE 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: THE FOLLOWING CHILDREN DO NOT HAVE AN INDIVIDUAL CHILD RECORD AT THE FACILITY: CHILD #1, #2, AND #3.

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

Noncompliance Area: NONE OF THE FACILITY PERSONS HAVE A DISCLOSURE STATEMENT ON FILE 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: STAFF #1 DOES NOT HAVE A HIGH SCHOOL DIPLOMA ON FILE AT THE FACILITY.

Correction Required: The operator shall have a high school diploma or a general educational development certificate and submit proof to the appropriate regional office of the Department at the time of registration renewal.

Noncompliance Area: THERE IS A BROKEN GLASS DOOR NEXT TO THE DRIVEWAY ON THE WAY TO THE FENCED-IN PLAY SPACE IN THE BACK YARD.

Correction Required: If unsafe areas or conditions are in or near an outdoor play space, fencing or natural barriers are required to restrict children from those unsafe areas or conditions.

Noncompliance Area: THERE ARE ELECTRICAL OUTLETS IN THE KITCHEN AND LIVING ROOM THAT DID NOT HAVE PROTECTIVE COVERS.

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

Noncompliance Area: THERE ARE MANY ITEMS LABELED "KEEP OUT OF REACH OF CHILDREN" IN THE LOW CUPBOARDS AND DRAWERS IN THE BATHROOM, INCLUDING TOOTHPASTE, DEODORANT, CAULKING, AND SHAVING CREAM.

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

Noncompliance Area: THE FIRST AID KIT DOES NOT CONTAIN SOAP OR GLOVES.

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