Allegheny General Hospital Center for Children

When the Early Preschool 1 classroom returned from outdoor play, the backpack containing a first aid kit was placed on a low piece of furniture and was accessible to children.

The first aid kit in the Preschool classroom did not contain scissors.

By the small climber on the toddler play space, there were 2 areas of the rubber surfacing which were splitting apart and able to be pulled up by the children. There is a gap approximately 3 inches between the soft surfacing and walkway in the toddler play space and the surfacing which could cause a tripping hazard for a small child. The privacy mesh along the fence had 4 holes and an area in the toddler play space which was not attached and torn. The holes and tears were low enough for children to put their hands through.

The wall on the left when entering the Early Preschool 2 classroom had a quarter-size area of peeling paint.

Large crayons with a diameter of less than 1 inch were accessible to children in a basket on a shelf in the Early Preschool 2 classroom.

The file of child #1, identified as a young toddler (see LIS code sheet), contained health assessments dated 1/3/2024 and 8/8/2024, exceeding 6 months.

A reference letter in the file of staff #1 was dated 3/12/2024, after their start date at the facility.

The Preschool and Toddler 1 classrooms each contained area rugs which were curling at the edges causing a possible tripping hazard for children. A gap approximately 4 inches existed in the toddler play space between the rubber safety surfacing and cement walkway causing a tripping hazard and the surfacing by the small slide was cracked which could also cause a hazard. A hole approximately 4 x 2 inches was in the wall of the Kindergarten classroom by the large block area. The mesh covering the fencing in the preschool and toddler play spaces contained multiple holes and tears from the entrance of the toddler play space to the far end and side of the preschool play space.

A wheelbarrow on the preschool play space was broken, missing one of the handles, exposing children to sharp, rough edges. The Movement Matters/Enrichment classroom contained a dollhouse which a floor was not attached to the frame and red plastic toolbox on the play workbench which had a hole about an inch in diameter and had a cracked lid.

The file of child #1 contained a health assessment dated 7/6/2022, completed as a young toddler (see coded LIS sheet) but did not have documentation of current health assessment. The file of child #3, identified as an infant (see coded LIS sheet), contained health assessments dated 5/30/2023 and 12/6/2023 exceeding 6 months.

The file of child #2, identified as a preschool age child (see coded LIS sheet), contained a health assessment dated 8/30/2022 and an updated health assessment dated 9/19/2023 exceeding 12 months.

A medication bag in the Kindergarten Prep classroom contained an Epi-pen which had an expiration date of 9/2023.

In the Kindergarten Prep classroom, a child was observed to go to the restroom, and when finished, went back to play with their friends without washing their hands.

The health assessment of facility person #1 did not contain documentation an examination for communicable disease was completed.

Documentation of the review and/or update of the emergency contact form for child #2 exceeded 6 months (8/29/2022 and 9/5/2023).

Documentation of the testing of the fire detection system exceeded 30 days from 5/16/2023 to 6/21/2023 but is now current.

Based on conversation with staff, there have been times when children are not changed right away after nap and are provided their snacks first, then are changed. The time period between the before nap diaper change and after snack diaper change exceeded 2 hours.

Based on conversation with staff and review of documentation, a child was injured at the facility and an incident report was not provided to the parent on the day of the incident, it was provided the next day.

The file of staff #1 contained documentation of the completion of the professional development listed under 31(f)1-10 was dated 3/22/2023 which was over 90 days from their date of hire (see coded LIS sheet).

Though within 45 days of their hire date, the PA state police clearance of facility person #3, was dated 10/7/2017 and renewed on 10/14/2022 exceeding 60 months.

The windows in the K-Prep and Early Preschool 2 classrooms were open, but they were not screened.

The first aid kit in the infant 2 classroom did not contain tape and the kindergarten classroom first aid kit did not contain soap.

The top hinge on the cupboard door below the changing table in toddler 2 was detached from the inside of the cupboard.

A beige cube shelf with 8 spaces for bins, which was being used vertically, was approximately 4'10" high and was not anchored to the wall.

The health assessments of child #1, identified as a preschool age child (see coded LIS sheet), were dated 4/26/2021 and an updated heath assessment dated 7/7/2022, which exceeded 12 months. The health assessment of child #2, also identified as a preschool age child (see coded LIS sheet), contained a health assessment dated 12/9/2021 the with the appointment date documented as 5/9/2021, and a health assessment dated 9/19/2022, which is more than 12 months ago.

The infant 2 classroom contained an unopened box of Desitin which was not labeled for the child which it was intended.

The health assessment of facility person #1 was signed by a nurse practitioner and facility person #2 was signed by a family nurse practitioner and not a physician, physician's assistant or certified registered nurse practitioner.

The lunch the children were having in the toddler 1 and 2 classrooms did not contain a dairy product.

Based on conversation with the director, an emergency drill was conducted within the 12 months prior to the emergency drill on 9/14/2022, but documentation was not provided.

The hypothetical location documented on the fire drill log was used consecutively on 6/22/2022 and 7/14/2022.

Pediatric first aid and CPR of facility person #4 expired 2/2021 and was not renewed until 2/23/2022, after the expiration date.

Fire safety trainings for facility person #4 were dated 2/15/2021 and 6/1/2022 exceeding 12 months.

The insurance information on the emergency contact form for child #1 included the name of the policy, but the policy number was listed it as "unk."

Staff person #1 and 2 were observed to be caring for children unsupervised. Staff person #1 and 2 have not completed the following pre-service training required prior to caring for children unsupervised: Staff person #1: Pediatric first-aid and pediatric CPR in an approved curriculum by a PQAS instructor. Staff person #2: Pediatric first-aid and pediatric CPR by a PQAS trainer.

The bricks on the bottom level of the retaining wall on the left when walking up the ramp to the play space are eroding. There is approximately 3 areas where the blocks are showing erosion. One area is approximately 1 foot, another is approximately 5 feet and the last is approximately 3 feet long. About 3 of the caps on the retaining wall are broken which could fall on a child. At the bottom of the wall across the walkway, an exposed piece of metal is rusted and has sharp areas which can cause injury.

Staff person #2 and 4 had acceptable pediatric first aid/CPR training in an approved curriculum; however, the trainer has not provided documentation that they are PQAS-certified in the training topic.

Staff person #3 completed the required health and safety topics from 3270.31(f)(1) through 3270.31(f)(9) more than 90 days from their start date with children (dated 5/25/2022).

There was no documentation of any emergency plan training on file for Facility Person #7.

There was an uncovered outlet on the wall in the KPrep room.

There were diaper creams accessible to children in a drawer equipped with a faulty lock in the diapering area in the Toddler 1 room.

There was an area of damaged plaster on the wall behind/around a toilet paper holder in the Toddler 1 room

There was a low, child-size wooden stool n the KPrep room with a large crack on the surface, exposing splintering wood and creating a pinch point.

The TB test documentation on file for Facility Person #4 did not include the date the TB test was read.

The current health assessment on file for Facility Person #5 did not include an examination for communicable diseases and the results of that examination.

There was no proof of purchase for the interconnected fire alarm system on file at the facility.

The health assessment on file for child #1, enrolled in August 2021, was completed more than 90 days after the child's first day of attendance at the facility.

The documentation of the most recent (current) fire safety trainings on file for Facility Persons #2, #3, and #6 indicate they were each completed more than 12 months after the previous firesafety training on file for the particular staff person.

There was no documentation of completion of mandated reporter training on file for Facility Person #4, employed at the facility more than 90 days. The current mandated reporter training documented on file for Facility Person #5 was competed more than 60 months after the prior mandated reporter training documented and on file.

There was no documentation on file of the education and/or child care experience needed for Facility Person #8 to qualify for the aid position in which she was classified

There was no daily activity schedule posted in the kindergarten room for the time of day the room is used for child care purposes.

There were no written references on file for Facility Person #8.

There was no documentation of completion of pediatric first aid/CPR on file for Facility Person #4, employed at the facility for more than 90 days.

There was no documentation of completion of training in health and safety topics numbers 1-9 as listed in the regulation 3270.31(f) on file for Faciilty Person #1, employed at the facility for more than 90 days.

The operator indicated they have not provided the parent of each child enrolled with information on how to access the regulations in this chapter electronically.

On 10/27/21, at approximately 2:10 PM Facility Person #1 was supervising 11 older toddlers during naptime in the Early Preschool 2 room, when according to information reported by the operator, she was observed forcefully pushed the leg of Child #1 down onto his cot. Then, when the child sat up on his cot, she was observed grabbing him around his ankle and pulling him up by this ankle with the bottom half of his body off the cot to lay him back down.

On 10/27/21, at approximately 2:10 PM, Facility Person #1 was supervising 11 older toddlers during naptime in the Early Preschool 2 room, when according to information reported by the operator, she was observed yelling to Child #1 to get on his cot. And then was the child was on the cot, but would not lie down, she was observed yelling at him again to lie down.

According to the staff person's statement, on 10/27/21 at approximately 2:15 PM during naptime, Facility Person #1 was supervising 11 older toddlers in the Early Preschool 2 room, and Facility Person #2 was supervising 9 older toddlers in the Early Preschool 1 room. There were no other staff persons present in either room at the time. When Facility Person #2 observed Facility Person #1 yelling at a child who wasn't napping and handling that child in a rough manner, she stepped into the kitchen area between the two rooms and called for another staff person to relieve Facility Person #1. She then asked the Facility Person #1 to leave the classroom. Facility Person #1 left the classroom. Facility Person #2 remained in the kitchen area between the two rooms for a few moments before another staff person arrived to supervise the children in Early Preschool 2, allowing her to return to Early Preschool 1 to supervise the children in that room. On 11/5/21 at approximately 3:00 PM, Facility Person #3 was observed caring for 9 young toddlers in the Toddler 2 room. Although some children were still resting on cots, five of the young toddlers in the room were off of their rest equipment and…

According to the staff person's statement, on 10/27/21 at approximately 2:15 PM during naptime, Facility Person #1 was supervising 11 older toddlers in the Early Preschool 2 room, and Facility Person #2 was supervising 9 older toddlers in the Early Preschool 1 room. There were no other staff persons present in either room at the time. When Facility Person #2 observed Facility Person #1 yelling at a child who wasn't napping and handling that child in a rough manner, she stepped into the kitchen area between the two rooms and called for another staff person to relieve Facility Person #1. She then asked the Facility Person #1 to leave the classroom. Facility Person #1 left the classroom. Facility Person #2 remained in the kitchen area between the two rooms for a few moments before another staff person arrived to supervise the children in Early Preschool 2, allowing her to return to Early Preschool 1 to supervise the children in that room. On 11/5/21 at approximately 2:45 PM, Facility Person #4 was observed supervising 9 preschoolers in the Preschool room as they rested on rest equipment. Facility Person #4 was seated in a chair, in a position where she was unable to see two of the…

On 11/5/21 there were 19 children resting on cots in the K-Prep room. Ten of these children were resting on cots without at least of 2 feet of space on three sides their cot.