Echo Child Development/Greenwood CTR

In the Older Toddler Room, a white plastic toy bin was observed to not be in good repair having two edges that had pieces broken off allowing for sharp corners.

The child file for Child #1, who is a preschool age child, was observed to lack an updated health report; the most recent health report on file is dated 12/8/23. The child file for Child #2, who is an older toddler, was observed to lack an updated health report; the most recent health report on file is dated 1/30/24.

The staff file for Staff person #4, contained a current health assessment dated 10/10/23 which was conducted more than 24 months from the previously dated 9/7/21 health assessment on file. The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which was conducted more than 24 months from the previously dated 1/23/23 health assessment on file.

The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which lacked an examination for communicable diseases and the results of that examination.

The staff file for Staff person #5, contained a current health assessment dated 2/5/25 which lacked the physician's or CRNP's assessment of the person's suitability to provide childcare.

An annual emergency drill was observed to be conducted on 8/7/24 which was more than 12 months after the previously documented emergency drill dated 3/3/23.

Upon review of the facility's 30-day fire testing documentation, the following tests were observed to have been conducted more than 30 days apart: 2/2/24 to 3/4/24 (31 days).

The child file for Child #2, contained an initial health report that is dated more than 60 days after initial enrollment.

Staff person #3 does not have current pediatric first-aid/CPR training. This is evidenced by the previously documented pediatric first-aid/CPR training expiration date of January 2025.

Staff person #1 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid and CPR.

The staff file for Staff person #5 contained current staff evaluation dated 2/3/25 which was not completed at least one every 12 months from the previous staff evaluation on file dated 1/23/24.

The facility lacked a updated letter to the parents of enrolled children explaining the emergency plan, including any subsequent updates made to the emergency plan.

The operator lacked a section addressing the prevention and identification of Child Maltreatment in their Shaken Baby syndrome, abusive head trauma and child maltreatment policy and procedure to maintain compliance with 45 CFR 98.41(a)(1)(vi) and in accordance with Announcement C-22-03.

Staff file #1 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person in the file.

The electrical outlet next to the microwave lacked a protective outlet cover and was accessible to children 5 years of age or younger.

Child file #1 lacked documentation of receipt of an influenza vaccination received according to the schedule recommended by the ACIP or an exemption from the parents.

Staff file #6 contains valid health assessments dated 6/19/20 and 2/16/23 which exceeded the 24 months as required for health assessments.

The emergency drill log did not include the required information according to Announcement C-22-04 including special accommodations used for infants, toddlers, children with special needs.

Staff person #2 completed the Pennsylvania Health and Safety Update 2022on 2/3/23 which was after the required date of 12/30/22. Staff person #3 completed the Pennsylvania Health and Safety Update 2022on 1/2/23 which was after the required date of 12/30/22. Staff person #5 completed the Pennsylvania Health and Safety Update 2022on 2/7/23 which was after the required date of 12/30/22.

Staff person #4 has an acceptable Pediatric First-Aid/CPR training in an approved curriculum, however the trainer has not provided documentation that they are PQAS-certified in that training topic.

Staff person #4 completed Mandated reporter training on 2/19/22 which was more than more than 90 days after hire. (See LIS CODE SHEET)

Child file #2 lacked written consent signed by a parent for emergency medical care on the emergency contact form.

Child file #2 lacked written consent on the emergency contact form signed by a parent for minor first aid procedures administered by staff persons to the child while in care.

Staff person #5 completed Pediatric First Aid/CPR on 2/7/23 which was more than 90 days after hire at the facility. (See LIS CODE SHEET)

At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

At approximately 10:45 AM, Staff #2 left 2 Preschoolers and 2 Older Toddlers alone in the classroom to answer the door; Ratio 0:4. At approximately 10:50 AM, Staff #3 left 3 Young Toddlers alone in the classroom to go clean highchairs in a separate classroom, Ratio 0:3.

The first aid kit located in the Infant Room lacked soap.

In the Preschool Classroom there were foam toys and small plastic toys with less than an inch in diameter. The toys were accessible to children who are still placing objects in their mouths. In the bathroom there was an unlocked cabinet under the sink that contained plastic bags that were accessible to children still placing items in their mouths.

The Health Reports for the following children lacked verification of ongoing vaccines in accordance with the schedule recommended by the ACIP. The Report for Child #3 lacked an influenza vaccination.

The file for Staff #3 did not contain the results of a tuberculin skin test, x-ray or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The file for Staff #3 contained a Health Assessment that did not include an examination for communicable diseases and the results of the examination.

The Health Assessment for Staff #3 lacked the physician's assessment of the person's suitability to provide childcare.

On the day of inspection, Cert Rep observed Staff heating human milk in the microwave.

The file for Staff #2, employed for more than 90 days, lacked Health and Safety training.

The file for Staff #2, employed for more than 90 days, lacked Mandated Reporter training.

The Emergency Contact Form for Child #1 lacked the address of the individual designated by the parent to whom the child may be released.

The Emergency Contact information was not present in the Infant Room for Child #2. The child was present and receiving care in the room.

Staff #3 was observed acting as an Aide in the Toddler Classroom. The file for Staff #3, lacked verification of childcare experience, education and training prior to service at the facility, to qualify as an Aide.

The file for Staff #3, lacked verification of experience and education or training. Staff was present on the day of inspection acting as an Aide.

The file for Staff #3, lacked two written, nonfamily references from individuals attesting to the suitability to serve as a facility person.

SECOND CITATION: The file for Staff #1, Date of Hire 10/26/20, lacked training by a professional in the field of pediatric first-aid and pediatric cardiopulmonary resuscitation (CPR). Previously cited on 9/28/21.