Inspection · 2022-10-31

Based on record review and interview, the center did not ensure that staff shall be evaluated by a health professional and be issued a statement that the individual is determined to be free of communicable tuberculosis (TB). Documentation of the screening shall be submitted at the time of employment and prior to coming into contact with children. The documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician?s designee, or an official of the local health department.
Evidence:
1. Staff #3 (date of hire 9/08/2022) does not have a TB screening statement in their record.
2. Staff #4 (date of hire 9/12/2022) has a TB screening statement in their record dated, 10/21/22, which is after the required timeframe.
3. Staff #5 (date of hire 7/28/22) has a TB screening statement in their record dated, 7/16/2021, which was not completed within the last 30 days of the date of employment.
4. Staff #2 confirmed that Staff #3 does not have a TB screening completed prior to coming in contact with children and that Staff #4 has a TB screening statement after the date of hire. Staff #2 confirmed Staff #3 has a TB screening prior to the required timeframe of 30 days prior of the date of employment.

During record review and interview, it was determined that the center did not ensure that subsequent to initial licensure that an annual approval from the health department was provided.
Evidence:
1) There is no record or documentation of an annual health inspection for the past 12 months. The last know date of the health inspection is from the initial inspection with the date of 6/15/2018.
2) Staff #2 confirmed no inspection was conducted the past 12 months.

Based on observation and interview, it was determined that the center did not ensure that Staff-to-children ratio requirements are implemented when children are in care.
Evidence:
1. During the morning part of the inspection, the infant room, from the age of birth to 16 months, ratio was one staff member to six infants where the ratio requirements are one staff member to four infant children.
2. Towards the latter part of the inspection, the infant room, from the age of birth to 16 months, was observed again approximately an hour and a half later and the ratio in the room was two staff members to nine infants. The ratio requirements are one staff to four children for the infant room.
3. Staff #1 and Staff#2, owners of the center, confirmed that ratio requirements during the morning hours are not met once or twice a week.

Based on observation and interview, it was determined that the center did not ensure that the staff-to-children ratio and group size applicable to the youngest child in the group shall apply to the entire group.
Evidence:
1. Licensing inspector observed 18 children, from the ages 16 months to 3 years old, to one staff member during an unannounced visit to the center. The ratio requirements would be one staff member to five children based on the age range.
2. Staff #1 , owner of the center, confirmed that the ratio requirements during the morning hours are not met and are challenging approximately once or twice a week.

Based on observation and interview, it was determined that the center did not ensure that actions or threats thereof are forbidden where children are enclosure in a small confined space or any space that a child cannot freely exit himself.
Evidence:
1. The licensing inspector observed six children in a classroom that were strapped in their own separate feeding chairs in which the children could not freely exit themselves. There was no food or activity on the feeding chairs.
2. Staff #1 and Staff #2 confirmed strapping the children in their own feeding chair as this helps contain the children in one room prior to other staff coming for their shift.

Based on record review and interview, it was determined that the center did not ensure that at least one staff in each classroom or area where children are present have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children in care from an organization such as the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council.
Evidence:
1. Staff #1 and Staff #2 both have expired First Aid and CPR certificates with the expiration date of 10/24/2022.
2. Staff #6 has an expired First Aid and CPR certificate with the expiration date of November 2021.
3. Staff #2 confirmed that not all staff members are fully trained and have their First Aid and CPR certificate.

Based on observation and interview, it was determined that the center did not ensure that a 911 or local dial number for police, fire and emergency medical services and the number of the regional poison control center be posted in a visible place at each telephone.
Evidence:
1. There is no visible posting of 911, poison control, fire and emergency medical services at the front desk telephone.
2. Staff #2 confirmed there is no posting by the front desk telephone.

Based on record review and interview, it was determined that the center did not ensure that staff records shall have documentation that two or more references as to character and reputation as well as competency were checked before employment or volunteering.
Evidence:
1. Staff #3 (date of hire 09/08/2022) did not have documentation of two reference checks in their record.
2. Staff #2 confirmed that there were no references checks documented to the record for Staff #3.

Based on observation and interview, it was determined that the center did not ensure that the finding of the most recent inspection of the facility was posted on the premises of the facility.
Evidence:
1. The last inspection from May 12, 2022, was not posted on the premises of the facility.
2. Staff #1 confirmed that the last inspection was not posted on the premises of the facility.