Inspection · 2024-05-29

Based on observations made, the findings from the most recent inspection were not posted in the center. Evidence: The Violation Notice from the 3/27/24 inspection were not posted. The 5/11/23 inspection report was posted.

Based on records reviewed, 3 of 6 children's records did not include immunization updated every 6 months until the age of 2 years old.

Evidence:

1. Child #1-The immunizations on-file were dated May 2022, when the child was 4 months old.
2. Child #4-The immunizations on-file were dated December 2022, when the child was 17 months old.
3. Child #5-The immunizations on-file were dated December 202, when the child was 5 months old.

Based on records reviewed, the documentation of orientation training did not include required facility specific topics. Evidence: The documentation for all staff records reviewed did not include the following procedural training topics: preventing food exposures and cross-contamination of foods; and first aid and CPR orientation.

Based on records reviewed, there was no documentation of 6 of 7 staff completing orientation training that included specific training topics, training delivery method, the entity/individual providing the training and the date(s).

Evidence:

1. The following staff had signed a document titled "Policy Handbook Receipt" which the inspector was told is the documentation for watching the orientation training video. The document did not include the required details of said training. Staff #1, #2, #3, #6 and #7.
2. The record for Staff #4 had no documentation of orientation training. ,

Based on observations made, hazardous substances were not kept in a locked place. Evidence: Cleaning supplies, sprays and disinfectant wipe type products, were found to be stored on open shelves and counter tops in classrooms, bathrooms and hallways throughout the center.

Based on records reviewed, there were either no written polices and procedures for the following areas/topics, as required by these standards, or the written policy and procedure did not include required components.

Evidence:

1. The medication policies stated that medications should be stored in a locked place or on a high shelf, which is not consistent with State standards.
2. The medication policies did not include the labeling requirements of medications.
3. The staff TB testing policy stated that they would accept a TB test completed within in 6 months of the date of hire, which is not consistent with State standards.
4. There was no written policy for preventing exposure to specific food and other substances, and preventing cross contamination.

Based on records reviewed, there was no documentation that the center has written procedures for shaken baby syndrome and coping with crying babies. Evidence: Policy and procedure documents given to the inspector did not include these required topics.

Based on records reviewed, 4 of 6 children's records did not include annual documentation of the parent's confirmation that the child's record is up to date. [Note: Previously cited under 60.A.]

Evidence:

1. Child #1-The parent last signed the child's record June 2022.
2. Child #3-The parent last signed the child's record December 2021.
3. Child #4-The parent last signed the child's record December 2022.
4. Child #5-The parent last signed the child's record September 2021.

Based on observations made, 5 occupied cribs in infant rooms did not have at least 30" of space between service sides and other furniture.

Evidence:

1. Crib #1 was touching an empty crib on one service-side, had 6" of clearance on the other service-side, while there was a wall on one end (short side) and an occupied cot on the other end.
2. Crib #2 was touching the wall on one service-side and had approximately 12" of clearance on the other service-side where there was a table and chair in the space.
3. Crib #3 was touching an empty crib on one service-side and had approximately 12" of clearance on the other service-side where there was an infant rocker in the space.
4. Crib #4 was touching the wall on one service-side and had approximately 6" of clearance on the other service-side where there was an occupied cot. The ends of this crib were touching an empty crib on one side and a saucer on the other end.
5. Crib #5 was touching the wall on one service-side and had approximately 6" of clearance on the other service-side where there was a rocking chair.

Based on observations made, 3 of 5 medications were not labeled with the child's name, dosage amount and times to be given.

Evidence:

1. Child #2 - An over-the-counter medication was not labeled.
2. Child #3 - An over-the-counter medication was not labeled.
3. Child #7 - An over-the-counter medication was not labeled.

Based on records reviewed, 1 of 5 medications did not include an acceptable written authorization. Evidence: Child #3 - The medication authorization signed by the parent exceeded 10-days, and was dated 12/2/22-12/2/23. The center did not obtain a renewed parent authorization every 10-days, or a physicians authorization for a long-term medication. The medication remains on-site.

Based on records reviewed, the written authorization for 2 of 5 medications had expired and the medications remained on-site over 14-days from the date of expiration.

Evidence:

1. Child #3 - The written medication authorization expired 12/2/23, and the medication itself expired April 2024 and to-date the medication was on-site.
2. Child #7 - The written medication authorization expired 5/1/24 and to-date the medication was on-site.

Based on observations made, 1 of 4 diaper creams was not labeled as required. Evidence: A diaper cream belonging to Child #8 was not labeled with the child's name.

Based on records reviewed, the center's written emergency preparedness plan did not include documentation of required information.

Evidence:

1. There was no documentation to indicate that the emergency plan was developed in consultation with the local authorities.
2. There was no documentation of who the center emergency officer and back-up officer are and their 24-hour contact phone numbers. The plan included titles like "Center Emergency Officer; Executive Director; and Maintenance Person" but did not include the individual names and phone numbers.
3. There was no documentation of who and how children with allergies and medications would be cared for.
4. There was no documentation of how the center would ensure the continuity of operations during the emergency event.
5. There was no documentation of how infants and toddlers would be moved and cared for during the emergency event. The plan referenced action terms that school-age children would understand, but not younger children.
6. The plan made reference to "predetermined primary and secondary egress" however, no further details were included.
7. The plan stated staff were to "provide a safe area 500' from the site" however, the actual location was not specified. This is an industrial area with a high traffic street on one side and busy trucking traffic on the road leading to the school.
8. The plan provided an address for the off-site relocation, which is 1.6 miles from the center, but does not provide information about how staff are to get the children there. No information was included about who will be providing transportation and how that will occur.
9. The plan includes minimal reference to the reunification of parents and children and how that will be communicated to involved parties.

Based on records reviewed, the center did not practice monthly evacuation drills. Evidence: The emergency drill records did not include documentation of an evacuation drill for February 2024 and April 2024.

Repeat violation.
Based on records reviewed, written injury reports did not include required documentation. [Note: Injury reports reviewed were dated after the last inspection 3/27/24.]

Evidence:

1. 4 of 8 injury reports did not include future actions to prevent recurrence.
2. 3 of 8 injury reports did not include the date and time the parent was notified of the child's injury.
3. 2 of 8 injury reports did not include how the parent was notified of the child's injury.
4. 1 of 8 injury reports did not include the year in the date of the injury (only the month and day were written on the report).
5. 1 of 8 injury reports did not include a description of the first aid given to the child.

Based on observations made, food that children brought from home for their lunch was not labeled with their name and date.

Evidence:

1. Most food/beverage products brought by the children for their lunch today was not labeled with their name, a few items had a first name. There was no name on the lunch bags or the food items inside the bags, or food/beverage items removed from the lunch bags and placed in the refrigerators.
2. None of the food/beverage products brought by the children for their lunch today were labeled with the date.

Repeat violation.
Based on records reviewed, 1 of 6 children's records did not include documentation of verification of the child's proof of identity and age. [Note: Previously cited under 60.A.]
Evidence: Child #1-There was no documentation that the proof of identity and age had been verified. Child enrolled May 2022.

Repeat violation.
Based on records reviewed, 6 of 7 staff records did not include documentation of required information.

Evidence:

1. Staff #1 - 1 of 2 reference checks did not include documentation of the results.
2. Staff #3 - 0 of 2 reference checks signed to identify who conducted the reference checks, the date the reference checks were completed, documentation of verification of job-related experience, including dates of employment.
3. Staff #4 - No date of employment, staff emergency contact information, 0 of 2 reference checks and no related employment documented.
4. Staff #6 - No documentation of education/experience or training was verified to qualify the staff person for their current lead teacher position.
6. Staff #7 - No documentation of dates associated with the previous job-related employment.