Inspection · 2023-07-14

Based upon observation, the facility has not ensured that areas of the center outside are maintained to be safe.
Evidence:
There is poison ivy growing through the chain link fence onto the children?s playground in three areas. There was litter strewn throughout the playground to include tissues and a bandaid.

Based upon observation, the facility has not ensured that hazardous substances are kept in locked places using a safe locking method that prevents access by the children.
Evidence:
1. Upon arrival of the inspector at 11:00 AM, there was a group of children eating lunch in the lunch room directly adjacent to the kitchen. The door to the kitchen was standing open.
A. There were containers of bleach, with warnings labels, in an unlocked cabinet under the sink.
B. There was a container of dish washing liquid with a warning label on the sink.
C. There were five containers of prescription medication in an unlocked cabinet above the counter.
2. The cabinet containing cleaning and sanitizing solutions, located above the changing table in the two year old classroom was observed to be unlocked as children were preparing for nap time.

Based upon observation, the facility has not ensured that children under ten years of age are always within actual sight and sound supervision of staff and children over the age of ten years are within sound supervision.
Evidence:
1. Child 6, three years old, was observed leaving the classroom to go to the bathroom. The bathroom is in the hallway outside of the classroom door. Staff 4 was at the changing table in the corner inside the classroom, Child 6 was not in sight or sound supervision of staff. Staff 4 did not check on child 6 in the bathroom and did not acknowledge the child when child 6 walked back into the classroom after using the restroom.
2. School aged children were observed being sent back and forth from the classroom by the front door to the bathroom in the back hallway. Staff did not accompany these children, nor was a staff person in the back lunchroom alerted to supervise these children.

Based upon observation, the facility has not ensured that there is at least one staff person on duty with every ten children aged three years to age of school eligibility.
Evidence:
Upon arrival of the inspector, there were 21 children in care in the lunch room with one staff, staff 3. Staff 3 identified one child in the grouping as being four years old. Staff 3 sent the four year old child into the two/three year old group, leaving 20 school aged children in care with staff 3. No more than 18 children with one staff person is required of this age grouping. It was ten minutes before a second staff person, staff 5, arrived and corrected the required ratio for the group.

Based upon observation, the facility has not ensured that staff wash their hands after a diaper change.
Evidence:
Staff 4 was observed changing diapers. After a diaper change, staff 4 carried a soiled diaper across the classroom, opened the exterior door and used her hands to throw away the soiled diaper in a lidded trash can outside prior to washing her hands.

Based upon observation, the facility has not ensured that the diapering area has paper towels, diapers are disposed in a leak proof receptacle that is operated in such a way that the staff hands nor the soiled diaper touch the exterior surface and that the diapering surface is cleaned and sanitized after each use.
Evidence;
1. Staff 4 was observed changing a diaper in the two year old classroom There were no paper towels at the changing station. Staff 1 stated out loud to a child that there were no paper towels.
2. Staff 4 did not clean and sanitize the changing table after she was observed changing a child?s soiled diaper.
3. Staff 4 was observed walking with a soiled diaper across the classroom, opening the classroom exterior door and disposing of the soiled diaper in a garbage can outside.

Based upon review of medication procedures and medication stored for emergency administration to children, the facility has not ensured that their procedures include methods to prevent the use of outdated medication.
Evidence:
There was an epinephrine (epi-pen) stored for emergency administration to child 5. The epi-pen expired in May 2023. There was also diphenhydramine stored for the same child that expired in June 2023.

Based upon observation, the facility has not ensured that medication is kept in a locked place using a safe locking method that prevents access by children.
Evidence:
Medication, to include cetirizine, fluticasone, albuterol, epinephrine and diphenhydramine, was stored in an unlocked cabinet above the counter in the kitchen. The door to the kitchen was standing wide open as children were eating in the adjacent lunch room.

Based upon review of the emergency drill documentation, the facility has not ensured that shelter-in-place drills are practiced a minimum of twice per year.
Evidence:
The facility did not have a record of any practiced shelter-in-place drills during the past year. The last shelter-in-place drill documented was in June 2022.

Based upon review of the emergency drill documentation, the facility has not ensured that lock-down procedures are practiced at least annually.
Evidence:
The facility did not have a record of any practice lock-down drills in the past year. The last lock-down drill documented was June 2022.