Inspection · 2022-11-16

Based on record review, two staff records did not have documentation of an updated central registry finding every five years from the date of the most recent central registry finding.

Evidence:
1. The record for staff #5, (prior central registry finding 2/17/17) had documentation of an updated central registry finding on 5/11/22. An updated central registry finding was required by 2/17/22.
2. The record for staff #6, (prior central registry finding 3/06/17) had documentation of an updated central registry finding on 5/11/22. An updated central registry finding was required by 3/06/22.

Based on a review of children's records, the provider did not ensure each record contained additional immunizations once every six months for children under the age of two years.

Evidence:
1. The record for child #5, (start date: 9/07/21) had one immunization record documented on 7/30/21. Upon enrollment child #5, was under two years of age and no additional immunizations were obtained.
2. The record for child #6, (start date: 10/11/21) had two immunization records documented on 9/28/21 and 8/22/22. Child #6, is under two years of age and documentation of additional immunizations shall be once every six months for children under the age of two years.

Based on a review of children's records, the center did not ensure that each child shall have a physical examination by or under the direction of a physician before the child's attendance or within one month after attendance.

Evidence:
The records for child #5 (start date: 9/07/21) and child #7 (start date: 8/22/22), did not have a physical examination within the required timeframe.

Based on observation, the center did not ensure that all hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children.

Evidence:
1. In room #3, one container of multi surface cleaner was sitting on a child size chair in the classroom accessible to children.
2. In room #5, one container of Febreze labeled, "Warning" and "Keep Out of Reach of Children" and one container of Clorox wipes, labeled "Caution" and Keep Out of Reach of Children" were located in an unlocked container next to the diaper changing table. The inspector did not observe diapering at the time the hazardous substances were observed.

Based on observation and interview, the center did not maintain a staff to children ratio of 1:4 for infants, children birth up to 16 months.

Evidence:
1. In room #1, at approximately 1:00 PM on 11/16/22, one staff was observed with 5 infants.
2. In room #2, staff #10 was observed with 9 infants. Staff #10 and staff #11, reported that room #2 had been out of ratio during a teachers lunch break.

Based on observation and an interview, the center did not ensure medication, except for those prescriptions designated otherwise by written physician's orders, including refrigerated medication and staff's personal medication, were kept in a locked place using a safe locking method that prevents access by children.

Evidence:
1. A shared closet in-between room #3 and room #4, had one bottle of Tylenol Extra Strength on a shelf. The closet door from room #3 and room #4 were unlocked.