Inspection · 2022-12-14

Based on record review, the center did not obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center.
Evidence:
1) The record for Child #2 (start date 06/04/2020) did not contain documentation of immunizations.

Based on record review, the center did not ensure that each child has a physical examination by or under the direction of a physician within 30 days after the first day of attendance.
Evidence:
1) The record for Child #2 (start date 06/04/2020) did not contain the results of a physical examination.

Based on record review, staff's orientation training did not include all required topics.
Evidence:
1) The orientation training log in the records for Staff #1 and Staff #2 did not contain documentation that staff had been trained in
prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children.

Based on medication and record review, the center failed to ensure that any child for whom emergency medications have been prescribed is always in the care of a staff member with medication administration certification.
Evidence:
1) Child #1 and Child #2 had been prescribed emergency medication and it is kept in the center. Child #1 and Child #2 are assigned to be under the care of Staff #4 and Staff #5. Staff #4 and Staff #5 are not certified in medication administration.

Based on observation, areas of the center were not maintained in a safe condition.
Evidence:
1) The stall dividers in the children's bathrooms showed rust along some of their borders. Areas with rust were at a low level, within children's reach.

Based on observation, hazardous substances were not kept in a locked place using a safe locking method that prevents access by children.
Evidence:
1) In the Early Foundations Preschool room, a plastic box with diaper cream containers was observed on a windowsill within reach of children.
2) In the woman's bathroom and the men's bathroom that are located in the hallway in front of the toddler's room, rat glue traps were observed on the floor behind the toilets. Both bathrooms were unlocked.
3) In the Toddler's room, cleaning products were observed inside a cabinet under the changing table. The lock on the door to this cabinet did not work leaving these cleaning products accessible to children.

Based on documentation review and interview with staff, the center did not develop written procedures for prevention of shaken baby syndrome or abusive head trauma, including coping with crying babies, safe sleeping practices, and sudden infant death syndrome awareness.
Evidence:
1) On the date of inspection, written procedures for prevention of shaken baby syndrome or abusive head trauma, including coping with crying babies, safe sleeping practices, and sudden infant death syndrome awareness were not available for review.
2) Staff #8 stated that the center has not developed these procedures.

Based on record review, the center did not request at least annually parent confirmation that the required information in the child's record is up to date.
Evidence:
1) The most recent review of the emergency information documented in the record for Child #1 was dated 08/04/2021 and in the record for Child #4 was dated 08/10/2018.

Based on observation, the required 12 inches of space between occupied cots was not maintained.
Evidence:
1) On the date of inspection, the inspector observed in the infant room, three cribs that were occupied. These three cribs were placed one right next to the other without the required separation in between.

Based on observation, staff did not wash children's hands when required.
Evidence:
1) On the date of inspection, the inspector observed Staff #1 change the diaper of a child. After Staff #1 was done, she put the child on the floor and the child went on to play with other children. Staff #1 did not wash the child's hands.

Based on observation and interview with staff, the diapering area did not meet all requirements.
Evidence:
1) The diapering area shall be a changing table or countertop designated for changing - On the date of inspection, the inspector observed in the Early Foundations Preschool room when Staff #1 changed the diaper of a child. The surface that Staff #1 used for diapering was on a sleeping cot that was at the top of a pile of approximately 20 cots.

2) The diapering surface shall be used only for diapering or cleaning children. - Sleeping cots will later be used by children to take their nap. Staff #3 stated that sometimes once the child wakes up, they would change their diaper on their sleeping cot.

Based on medication review, medication was not labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given.
Evidence:
1) On the date of inspection, two inhalers for Child #2 were not labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given.

Based on medication review, the center failed to ensure that when an authorization for medication expires, medication is picked up by the parent within 14 days.
Evidence:
1) On the date of inspection, the authorization form for one medication for Child #2 showed an expiration date of 11/18/2022. The medication was still in the center.

Based on documentation review, the menu listing foods to be served for meals and snacks during the current one-week period did not meet all requirements.
Evidence:
1) The one-week period menu was not dated.
2) The menu did not list substituted food. The menu listed today's lunch as pinto & black beans, flour tortilla, green peppers, corn & shredded carrots, fresh oranges, and milk. Lunch served today was turkey patties, mashed potatoes, gravy, grapes and milk.

Based on record review, children's records did not contain all required information.
Evidence:
1) The records for Child #1 and Child #2 did not contain the work phone number for one parent that has custody. The records for Child #3 and Child #4 did not contain the work phone number for both parents that have custody.
2) The record for Child #2 did not contain documentation of viewing proof of the child's identity and age.