Banks Learning Center Four INC

Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building by themselves creating a 0:1 staff to child ratio for approximately 15-20 minutes.

****Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building. Child #1 was discovered by a passing pedestrian with whom the child remained for approximately 15-20 minutes until staff #1 came out of the building, thanked the pedestrian, and took the child back into the facility. During the time the child was unsupervised outside the facility, the pedestrian observed the child leave the sidewalk and walk between two cars heading towards a very busy city street.

***Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building. Child #1 was discovered by a passing pedestrian with whom the child remained for approximately 15-20 minutes until staff #1 came out of the building, thanked the pedestrian, and took the child back into the facility. During the time the child was unsupervised outside the facility, the pedestrian observed the child leave the sidewalk and walk between two cars heading towards a very busy city street.

Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building. Child #1 was discovered by a passing pedestrian with whom the child remained for approximately 15-20 minutes until staff #1 came out of the building, thanked the pedestrian, and took the child back into the facility. During the time the child was unsupervised outside the facility, the pedestrian observed the child leave the sidewalk and walk between two cars heading towards a very busy city street.

**Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building. Child #1 was discovered by a passing pedestrian with whom the child remained for approximately 15-20 minutes until staff #1 came out of the building, thanked the pedestrian, and took the child back into the facility. During the time the child was unsupervised outside the facility, the pedestrian observed the child leave the sidewalk and walk between two cars heading towards a very busy city street.

Based on interviews with staff and witnesses, when a fire drill was occurring on 9/3/2024, staff #1, who was supervising child #1, was unaware child #1 exited the building. Child #1 was discovered by a passing pedestrian with whom the child remained for approximately 15-20 minutes until staff #1 came out of the building, thanked the pedestrian, and took the child back into the facility. During the time the child was unsupervised outside the facility, the pedestrian observed the child leave the sidewalk and walk between two cars heading towards a very busy city street. During this time, Staff #1 was unaware of Child #1's whereabouts and was not physically present with Child #1.

Bic Wite-Out Quick Dry Correction Fluid labeled "keep out of the reach of children," was accessible to children on the desk in the preschool/school-age classroom.

A large black trash bag was draped over the half wall between the preschool/school-age and toddler classrooms. The trash bag could be reached and pulled down by a child in either of the classrooms.

The facility did not have documentation of a current annual inspection of the fire detections system. The last inspection was dated 8/2/2023. The facility tested the system manually to verify it was operating properly.

At approximately 10:00 am, staff person #1 identified 4 infants and 1 young toddler in their primary supervisory group in the infant classroom. Since the youngest child, in this case an infant, determines the staff to child ratio, staff person #1 was not in compliance with 1:4 ratio.

SECOND CITATION (FIRST CITATION ON 8/8/2023): The file of child #1 contained an immunization record which did not contain documentation of the recommended immunizations recommended by the ACIP or an acceptable exemption.

The child abuse clearances of facility person #2 exceeded 60 months (8/31/2017 and 1/23/2023).

Upon arrival at the facility at approximately 10:10 am, 13 children were present in the toddler classroom. Facility person #1 identified 3 children (1 infant, 1 young toddler and 1 older toddler), facility person #4 identified 6 children (1 young toddler, 2 older toddlers and 3 preschoolers) and facility person #5 identified 4 children (1 young toddler, 2 older toddlers and 1 preschooler) in their supervisory groups. The supervisory group of facility person #4, who identified 6 children, contained a young toddler creating a 1:5 staff to child ratio.

The file of facility person #1 contained a health assessment which appeared to be manipulated and after a conversation with representatives of the medical facility listed on said health assessment, it was determined facility person #1 had not been seen by the physician assistant who signed, or office listed on the assessment confirming it was in fact falsified.

The emergency plan did not contain a contingency plan or contingency fund which can help strategize how repairs will be paid for, how staff will be paid and continue to run the business after a disaster or emergency.

As the toddlers were sitting at the table waiting for lunch, facility person #4 pumped hand sanitizer into the children's hands. As they assisted in having the children rub their hands together, sanitizer dripped to the table in front of the children where it was easily accessible. The facility did not have signed parental consent as per Announcement C-09-#4 to use hand sanitizer with the children.

As the toddlers were sitting at the table waiting for lunch, facility person #4 pumped hand sanitizer into the children's hands. When asked, facility person #4 stated the children did wash their hands in the bathroom, but since they played with toys since, the hand sanitizer was being used.

The preschool classroom contained a dorm size refrigerator which was not anchored to the child-sized table it was sitting on and could tip over on a child and cause bodily injury.

The file of child #1 contained an immunization record which did not contain documentation of the recommended immunizations recommended by the ACIP or an acceptable exemption.

Child #1, who is 6 months of age or younger (see coded LIS sheet), was being fed a bottle by facility person #4 while sitting in an infant seat was not being held.

Documentation of the inspection of the fire detection system by fire safety professionals exceeded 12 months (5/11/2022 and 8/2/2023).

The file of facility person #6, who had taken the required health and safety topics under regulation 3270.31(f)(1-9) on the "Better Kid Care - Penn State Extension" between 9/30/2016 and 10/4/2022, contained documentation of completion of the 1 hour "Pennsylvania Health and Safety Update 2022"after 12/30/2022 (dated 3/8/2023).

The file of facility person #1, identified as an aide, did not have documentation of education or experience.

A written plan of daily activities was not posted in the indoor play space.

Child #1, identified as an infant (see coded LIS sheet) was in an infant seat from the time of the certification representative's arrival at approximately 10:10 am until approximately 11:20 am when the child was taken out of the seat to finish being fed.

The file of child #2 did not contain a financial agreement.

The financial agreement of child #1 did not include the services to be provided to the family and the child.

The financial agreement of child #1 did not include the persons designated by the parent to whom the child may be released.

The financial agreement of child #1 did not include the child's admission date.

The file of child #1 contained the original financial agreement.

A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not posted in the indoor play space.

The file of facility person #2 contained documentation of 6 training hours between their annual training year of 12/19/2021 to 12/19/2022. An additional 6 hours was taken on 1/3/2023 providing facility person #2 with 12 hours. The file of facility person #4 and #5 each contained documentation of 9 training hours between their annual training year of 12/19/2021 to 12/19/2022. An additional 3 hours were taken on 1/2/2023 providing facility persons #4 and #5 each with 12 hours.

The infant room was documented as the hypothetical location of the consecutive fire drills conducted on 12/6/2022 and 1/10/2023.

Documentation of the current annual inspection of the fire detection system was dated 7/18/2023 with the prior inspection documented as conducted 4/2022 which is more than 12 months between inspections.

The files of facility person #2, #3 and #4 and #5 who took the 6- or 10-hour health and safety training prior to 10/4/2022, contained documentation of the required one-hour updated health and safety training course, "Pennsylvania Health and Safety Update" dated after the required completion date of 12/30/2022. The file of facility person #6 contained the acceptable health and safety training prior to 10/4/2022 but did not include documentation of completion of the additional one-hour "Pennsylvania Health and Safety Update."

At approximately 11:50 am, the certification representative arrived at the door of the facility and rang the doorbell. At approximately 11:52 am, facility person #1 opened the door about 6-10 inches. The certification representative identified themselves while presenting their identification. Facility person #1 stated they needed to get someone and closed the door. Certification representative was let in approximately 8 minutes later when the door was opened by the buzzer system in the facility.

The PA state police clearance of facility person #1 and 2, both dated 1/31/2021, stated the "request was under review," and lacked a dissemination date to verify the PA state police clearances were not complete. Facility person #1 and 2 were observed caring for children during the inspection.

The facilities emergency plan did not include a plan for continuity of operations in the event of a disaster or emergency in the area.

An unlit cigarette was observed on the floor of the Infant/Toddler Classroom in front of the facility person and within direct reach of 2 young children.

Cleaning materials were stored on top of the cubby in the children's restroom off of the Toddler Classroom. The toxic cleaning materials were labeled "keep out of the reach of children," and would constitute a hazard to the children if any of the containers leaked onto the diapers directly below the cleaning materials.

The Infant/Toddler and Toddler Classrooms and the office each contained 1 cordless phone which did not contain the telephone number of the nearest hospital, police department, fire department, ambulance and poison control center and the other did not contain the number of the nearest hospital. The Infant/Toddler Classroom contained an additional phone which did not have the telephone number of the nearest hospital.

The Toddler Classroom contained a green play Jeep, and the push bar to push the Jeep was broken/cracked in half causing an opening on each side with rough edges. The broken push bar exposed the children to pinch and crush points and rough edges.

The immunization record of child #1 lacked 1 Rotavirus, 2 DTAP, 1 HIB, 2 Pneumococcal and 1 Polio vaccinations.

The facility did not have documentation of an annual emergency drill between 12/19/2020 and 12/19/2021, but did contain one dated 5/16/2022.

The emergency contact information of child #1 did not contain the address of 1 release person, and the information of child #2 did not contain the addresses of 3, and telephone numbers of 2 release persons designated by the parent to whom the child may be released.