Inspection · 2022-09-08

Based upon review of children's records and staff interview, the facility has not ensured that each child has a physical examination by or under the direction of a physician.
Evidence:
1. The record provided for child 1, who began attending on 3/8/2022, did not include the results of a physical examination.
2. Staff 1 verified that the record did not include the results of a physical examination.

Based upon observation and review of documents, the facility has not ensured that any child for whom emergency medications have been prescribed is always in the care of a staff member who meets the requirements of subdivision 1 of the subsection that requires Medication Administration Training (MAT).
Evidence:
Two children for whom emergency medications were prescribed and stored by the facility were in care. There was no documentation available to demonstrate Medication Administration Training (MAT) for either staff 1 or staff 2.

Based upon observation, the facility has not ensured that all potentially hazardous substances are kept in locked places using safe locking methods that prevent access by children.
Evidence:
1. Containers of hand sanitizer with a warning label stating "keep out of reach of children", "warning" and "flammable" were on the sign-in table, a table near the entrance to the cafeteria kitchen, a table near the staff lounge and on the window sill.
2. Containers of sanitizing wipes with warning labels stating "caution" and "keep out of reach of children" were on the front sign-in table and on the window sill in the open staff lounge.
3. There was a janitorial mop bucket filled with cleaning mop water in the open staff lounge.
4. There was a container of shaving cream with a warning label in an unlocked cupboard under the sink in the open staff lounge.
5. Staff 1 acknowledged the accessibility of the above.

Based upon document review and staff interview, the facility has not ensured that they have informed all staff who work with children of children's allergies.
Evidence:
When asked about children's allergies, staff 1 referred to a computer screen on which were listed children with allergies and dietary restrictions/preferences. The list was not complete in that child 7 and child 8, both allergic to peanuts and tree nuts according to their allergy management plans, were not listed. Staff 1 stated that the list is compiled by the regional office. The staff were not informed of the allergies of child 7 and child 8.

Based upon document review and staff interview, the facility has not maintained a current list of all children's allergies, sensitivities and dietary restrictions..
Evidence:
When asked about children's allergies, staff 1 referred to a computer screen on which were listed children with allergies and dietary restrictions/preferences. The list was not current in that child 7 and child 8, both allergic to peanuts and tree nuts according to their allergy management plans, were not listed.

Based upon observation and staff interview, the facility has not ensured that medication is labeled with the child's name.
Evidence:
1. There was Benadryl stored in the medication bag. The medication was not labeled with a child's name.
2. Staff 1 assumed the Benadryl was for child 7 whose allergy action plan called for the administration of Benadryl prior to the EpiPen.

Based upon observation and staff interview, the facility has not ensured that there is parent authorization for the administration of medication that would normally be administered by a parent or guardian.
Evidence:
1. There was Benadryl, an EpiPen and an albuterol inhaler stored for emergency administration to child 7. There was no written parent authorization for any of the medication to be administered to child 7.
2. There was Benadryl and an EpiPen stored for emergency administration to child 8. There was no written parent authorization for any of the medication to be administered to child 8.
3. Staff 1 acknowledged that there was no written parent authorization for the above medications to be administered in an emergency.

Based upon review of the documented emergency drills, the facility has not ensured that the documentation of emergency drills includes all required information.
Evidence:
The documented emergency drills provided did not include the following documentation:
- name of person conducting the drill
- the method used to conduct the drill
- the number of staff participating in the drill
- any special conditions simulated during the drill
- any problems encountered during the drill
- weather conditions (evacuation drill)

Based upon observation and staff interview, the facility has not ensured that there is a menu of items to be served for the week that is dated and posted.
Evidence:
1. There was no snack menu posted.
2. Staff 1 stated that the cafeteria did not yet have the week's menu available.

Based upon review of children's records and staff interview, the facility has not ensured that children's records include all required information/documentation.
Evidence:
1. The record provided for Child 2 stated that the mother is "NA". The record did not include any documentation of custody or other circumstances.
2. The record provided for child 2 did not include the street addresses for persons to be contacted in an emergency when a parent cannot be reached.
3. The record provided for child 4 listed the father's address as "NA" but did not include any documentation of custody or other circumstances.
4. Staff 1 verified that the above information was not in the records of the children listed.