Miles of Smiles Family Daycare LLC

Staff #2's file contained an NSOR certificate dated 8/5/2020 which is more than 60 months ago.

In the infant room and the main room both first aid kits were missing nonporous gloves. In the back room the first aid kit was missing nonporous gloves, tweezers, scissors.

In the main room along the windowsills dirt and debris was observed.

In the main room under the front window on the right of the room was damaged plaster. The white paint on the white side of the play barn had peeling paint. In the outside play space was peeling paint along the bottom of the building.

Both bathrooms used by children did not contain a lidded waste receptacle.

The cots in the main room were not labeled for use of a specific child.

Child #4's two most recent health assessments are dated 11/1/22 and 8/27/24 which is more than 12 months apart.

The file for Child #2 and #5, enrolled more than 60 days ago, does not include an immunization record.

At approximately 945am in the main room the staff did not make sure the children washed their hands before snack.

Staff #3's initial health assessment dated 6/25/25 was after date of hire(See LIS Code Sheet).

The files for child #2 and #5, enrolled more than 60 days ago, did not contain a health assessment. The files for child #3 and #4's initial health assessments were more than 60 days after enrollment(See LIS Code Sheet). Health assessment date: Child #3-9/6/23, Child #4-11/1/22

Staff person #1 has not completed the following required pre- service training within 90 days of their date of hire (see LIS code sheet): PA Required Health and Safety for Centers-Group Child Care Part 1 AND PA Required Health and Safety for Centers-Group Child Care Part 2

Child #5's financial agreement did not contain the date on which the fee is to be paid.

Child #2 and 4's, who have been enrolled for more than 6 months(See LIS Code Sheet), files did not contain child service reports. Child #3's file contained a child service report dated 3/2025 which was more than 6 months after date of enrollment.

Child #5's financial agreement did not contain the persons designated by a parent to whom the child may be released.

Child #3's financial agreement did not contain the date of the child's admission.

Child #4's file did not contain written consent signed by a parent for emergency medical care.

Child #1 and 5's files did not contain 3 addresses of the individuals designated by the parent to whom the child may be released. Child #2's file did not contain 5 addresses of the individuals designated by the parent to whom the child may be released.

In the back room the emergency transportation was not posted.

The most recent 6 month review signature for the emergency contact form on file for Child #2, #3, #4, and #5, is dated more than 6 months after the previous 6 month review signature. Child #2-8/13/24, Child #3-6/19/23, Child #4-4/19/22, and Child #5-8/22/24

The most recent 6-month review signature for the financial agreement on file for Child #2, #3, #4, and #5, is dated more than 6 months after the previous 6-month review signature. Child #2-8/13/24, Child #3-6/19/23, Child #4-4/19/22, and Child #5-8/22/24

Child #4's file did not contain signed parental consent for administration of minor first-aid procedures by facility staff.

The operator did not have information on how to access the regulations posted in a conspicuous location.

The file for staff person #1 who was hired as an assistant group supervisor on (See LIS Code Sheet) lacked a signed and dated disclosure statement.

The file for staff person #1 lacked initial emergency plan training (See LIS Code Sheet).

The file for staff person #1 lacked a health assessment that was completed 12 months prior to providing initial service in a child care setting (See LIS Code Sheet). The health assessment in the file was dated 6/25/25 and the TB test was dated 6/27/25.

**At approximately 11:03am staff person #1 left the main room to take one child to the bathroom. This left staff person #2 out of ratio with 2 Preschoolers, 3 Older toddlers, and 2 Young toddlers.

*At approximately 11:03am staff person #1 left the main room to take one child to the bathroom. This left staff person #2 out of ratio with 2 Preschoolers, 3 Older toddlers, and 2 Young toddlers.

In the back room on the table accessible to children there was an open bottle of hand sanitizer and disinfectant wipes that stated keep out of reach of children. In the infant room in the unlocked 3 draw unit was Desitin diaper cream which stated keep out of reach of children, accessible to children.

In the outside space the gate on the fence was broken and hanging by the top hinges.

In the main room on the lower part of the purple wall was a hole exposing damaged plaster.

In the infant room there was no step stool, so the teacher was holding children up to the sink to wash their hands.

The fire drill log contained the date of the last drill being completed on 11/18/24 which is more than 60 days ago.

The fire alarm testing log contained the following dates 10/7/24-11/18/24 which are more than 30 days apart, and it has also been more than 30 days since the alarm was last tested.

Second citation previously cited on 9/10/24. The emergency plan did not address the continuity of operations.

Second citation previously cited on 9/10/24. The letter that is provided to the parent of each enrolled parent explaining the emergency procedures did not contain the method to contact parent when an emergency occurs, method to inform parents emergency has ended and instructions for how to safely be reunited with their children, and accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Second Citation previously cited on 9/10/24. The file for Staff #7 did not contain a health assessment.

The file for staff #3 contained a disclosure statement that was signed, but it was missing a date and witness signature. The file for Staff #6 contained an NSOR clearance dated 7/17/24 which is more than 45 days after date of hire(See LIS Code Sheet), and a disclosure statement that was only signed but not dated or witnessed.

Staff #7, who was identified as an aide, was observed to be working in the infant room without supervision.

On 9/10/24 at approximately 11:55am it was observed that 2 young toddlers in the main room toddler area were asleep in pack and plays and left unsupervised.

On 9/10/24 at approximately 11:55am it was observed that 2 young toddlers in the main room toddler area were asleep and pack and plays and left unsupervised.

On 9/10/24 at approximately 11:55am it was observed that 2 young toddlers in the main room toddler area were asleep and pack and plays and left unsupervised.

The emergency plan did not address the continuity of operations.

The facility did not have proof that the emergency plan was reviewed annually.

The letter that is provided to the parent of each enrolled parent explaining the emergency procedures did not contain the method to contact parent when an emergency occurs, method to inform parents emergency has ended and instructions for how to safely be reunited with their children, and accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

In the SA/PS room on the table next to the TV accessible to children was hand sanitizer, disinfecting wipes, and a container that contained sunscreen. Each stated to keep out of reach of children.

In the SA/PS room in the green dino bathroom the hot water in the sink that the children use was 117.6 degrees.

In the SA/PS room the first aid kit only contained 1 band aid.

The window edge on the left side of the barn had a rough edge. The red wall in the eating area had a white substance running down it. The ceiling tile with a vent in it in the hallway near the eating area was cracked and hanging down from the ceiling. The outside white gate to the play area the hinge on the bottom was detached and the upper hinge had been damaged and was loose. In the green dino bathroom in the SA/PS room the toilet bolts were exposed.

On the windowsills of the play barn is peeling paint. On the outside of the red toddler area on the corner was peeling paint and damaged plaster. Inside the red toddler area was peeling paint near the entrance of the area. In the eating area on the green wall and the red wall was peeling paint. There was peeling paint long the bottom of the garage door in the play space.

In the teal bathroom in the SA/PS room a handwashing sign was missing near the toilet. In the green dino bathroom a handwashing sign was missing near the toilet.

In the teal bathroom in the SA/PS room a lidded trash can was not present.

In the outside play space, there was a climber that was missing its slide. This caused it to be unstable when in use. The changing mat in the toddler area was ripped and exposing foam not in good repair.

Inside the play barn in which toddler were playing small pieces of play food with diameter of less than an inch was observed accessible to children still placing objects in their mouth.

In the main room the taller shelves with buckets were not attached to the wall to make them stable and unable to tip over.

In the main area toddler area, the 4 pack and plays did not have 2 ft on 3 sides while in use.

Child #2, a preschool age child(See LIS Code Sheet), most recent health assessment is dated 2/17/23 which is more than 12 months ago.

The immunization record on file for Child #4, who is an older toddler age child (See LIS Code Sheet), includes 3 of 4 DTAP vaccines recommended by the ACIP for a child this age; 1 of 2 Hepatitis A vaccines recommended by the ACIP for a child this age.

In the infant room it was observed that an infant was being changed on a cloth changing station that was part of a pack and play. No surface covering was available at the time, and it was unable to be properly sanitized.

The 2 most recent health assessments on file for Staff #2 were dated 6/28/21 and 10/11/23, more than 24 months apart. The 2 most recent health assessments on file for Staff #4 were dated 2/9/22 and 8/16/24, which is more than 24 months apart. The 2 most recent health assessments for Staff #5 were dated 2/13/22 and 8/16/24. The initial health assessment on file for Staff #6 is dated 12/4/23 which is after date of hire(See LIS Code Sheet). The file for Staff #7 did not contain a health assessment.

The file for Staff #7 was observed not to contain documentation of a Tuberculosis test.

There was no written statement giving formula and feeding schedule obtained from the parents for enrolled infants.

In the infant room 2 bottles were observed to not be labeled with the infant's name.

The fire alarm testing log contained the following dates 8/9/24-9/10/24, which is more than 30 days apart.

The operator did not have proof of sending the emergency plan and subsequent plan updates to the local municipality and to the county emergency management agency.

Child #1's file who has been enrolled more than 60 days(See LIS Code Sheet) did not contain a health assessment. Child #3 initial health assessment was received more than 60 days after enrollment(See LIS Code Sheet).

Staff #1 file contained fire safety training that was dated 8/10/24, which was more than 12 months after date of hire (See LIS Code Sheet).

The file for staff #7 did not contain proof of a high school diploma or a general educational development certificate.

Child #2's financial agreement did not contain the operator or parent signature.

Child #2, 3, and 5's file did not include the fee amount on their financial agreement.

Child #1, 2, 3, and 4's file did not contain a child service report.

Child #2's financial agreement did not contain the persons designated by a parent to whom the child may be released.

Child #1 file did not contain the telephone number of the child's physician or source of medical care. Child #2 file did not contain the address of the child's physician or source of medical care.

Child #4's file did not contain written consent signed by a parent for emergency medical care.

Child #4's file did not contain a policy number for a child under a family policy or Medical Assistance benefits.

Child #1 file was missing 2 addresses of the individuals designated by the parent to whom the child may be released. Child #2 file was missing the addresses for the individuals designated by the parent to whom the child may be released. Child #4's file was missing 1 address of the individual designated by the parent to whom the child may be released.

The file for Child #1 does not include a 6 month update signature for the emergency contact form which is more than 6 months since enrollment(See LIS Code Sheet). Child #2 file most recent 6-month review for the emergency contact form was dated 2/17/23 which is more than 6 months ago. Child #3 file most recent 6-month review for the emergency contact form was dated 6/1/23 which is more than 6 months ago. Child #4's file most recent 6-month review for the emergency contact form was dated 11/8/23 which is more than 6 months ago. Child #5's file most recent 6-month review for the emergency contact form was dated 6/23/23 which is more than 6 months ago.

The file for Child #1 does not include a 6 month update signature for the Financial agreement which is more than 6 months since enrollment(See LIS Code Sheet). Child #2 file does not contain an initial or update signature on the financial agreement. Child #3 file most recent 6-month review for the emergency contact form was dated 6/1/23 which is more than 6 months ago. Child #4's file most recent 6-month review for the financial agreement was dated 11/8/23 which is more than 6 months ago. Child #5's file most recent 6-month review for the financial agreement was dated 6/23/23 which is more than 6 months ago.

Child #4's file did not contain signed parental consent for emergency medical care for the child.

The files for Staff #6 and 7 did not contain 2 written nonfamily references.

The operator did not have their certificate of compliance posted in a conspicuous location used by parents. It was filed away in office. The operator did not have information posted for how to access the regulations electronically and instructions for contacting the appropriate regional child care office.

The file for Staff #2 includes 2 of 12 required annual training hours completed between 6/3/23-6/3/24. The file for Staff #4 includes 4 of 12 required annual training hours completed between 6/3/23-6/3/24. The file for Staff #5 includes 5 of 12 required annual training hours completed between 6/3/23-6/3/24.

The facility's fire detection log documented testing between 4/2/24-5/10/24 and 5/10/24-6/14/24, more than 30 days apart.

The file for Staff Person #1 contained a mandated reporter training dated 9/28/18, more than 60 months prior.

Staff person #4 was observed to be caring for children unsupervised. Staff person #4 has not completed the following pre-service training required prior to caring for children unsupervised: 10-hour Health and Safety Training.

The file for Staff Person #3 did not include an FBI Clearance conducted within the past 60 months. The file for Staff Person #4 did not include a State Police, Child Abuse or FBI Clearance conducted within the past 60 months. The file for Staff Person #6 did not include documentation of an NSOR Certificate. The State Police, FBI and NSOR Certificates in the file for Staff Person #7 were conducted more than 45 days after the staff person's first day in child care. The file for Staff Person #7, who has lived out of state in the past five years, did not include the required clearances for Ohio.

The facility's emergency plan did not include requirements for volunteer emergency preparedness training, practice drills and continuity of operations (backing up or retrieving health and other key records/files and managing financial issues such as paying employees and bills during the aftermath of the disaster) to maintain compliance with 45 CFR § 98.41(a)(1)(vii)

The most recent emergency plan training in the files for Staff Person #2, 4 and 5, exceeded 12 months between trainings.

The first aid kit in the school age room lacked soap, gauze pads, tweezers, scissors and gloves.

Observed protruding bolts at the bases of the toilets in the two school age bathrooms. Observed flaking ceiling tiles in the girl's bathroom. Observed a loose ceiling tile near the bathroom of the school age room and discoloration from water damage on three ceiling tiles in the main room. The double-doors to the squared off office area in the main room where not secure, which creates a potential pinch hazard.

Observed peeling flaking paint by the window and along the bottom of the walls in the outdoor play space.

The diaper changing area in the squared off infant area was not near a source of running water.

Observed a cracked Stanley Junior playset in the outdoor play space.

The file for Child #4, a young toddler, did not include an updated health report conducted within the past 6 months.

The most recent immunization record in the file for Child #1, a 7 month old infant, did not include documentation of 4 and 6 month immunizations recommended by the CDC or a letter of exemption from the parent or physician. The most recent immunization record in the file for Child #2 did not include documentation of a flu shot administered within the past year or a letter of exemption from the parent or physician.

The most recent health assessments in the file for Staff #2 exceeded 24 months between assessments. The file for Staff Person #5 did not include an updated health assessment conducted within the past 24 months. The initial health assessments in the files for Staff Person #6 and #7 were conducted after the staff person's first day working in child care. The file for Staff Person #8 did not include an initial health assessment.

The most current health assessments in the files for Staff Person #3, 4 and 6 do not include an examination for communicable diseases and the results of that examination and the physician's or CRNP's assessment of the person's suitability to provide child care.

Pickup and drop-off procedures were not posted in a conspicuous location at the facility.

An emergency annual drill was not conducted or documented within the past 12 months.

The facility did not have documentation that the emergency plan had been sent to the local municipality and to the county emergency management agency.

An annual letter notifying local traffic safety authorities of the location of the facility and the program's use of pedestrian and vehicular routes around the child care facility was not on file.

The facility did not have a written policy for shaken baby syndrome, abusive head trauma, child maltreatment and strategies for coping with a crying, fussing, or distraught child.

The one-hour health and safety updates in the files for Staff Person #1, #2, #4 and #5 were conducted after the prescribed timeframe of 12/30/23. The file for Staff Person #3 did not include documentation of the one-hour health and safety update.

The files for Staff Person #2 and #3 did not include documentation of annual fire safety training conducted within the past 12 months. The most recent annual fire safety trainings in the file for Staff Person #4 exceeded 12 months between trainings. The first fire safety training in the file for Staff Person #5 as conducted more than 12 months after the staff person's start date. (See LIS Code Sheet).

The pediatric first aid/CPR certification in the files for Staff Person #1 and #6 was conducted more than 90 days after the staff person's start date. (See LIS Code Sheet).

Staff person #4 and #6 has not completed the following required pre-service training within 90 days of their date of hire: 10-hour Health and Safety Training (see LIS code sheet):

The files for Staff Person #2, 3 and 5 did not include an evaluation conducted within the past 12 months.

The files for Child #3 and #4 who have been enrolled for more than 6 months, did not include child service reports.

The fee agreement in the file for Child #1 did not specify the release persons.

The emergency contact form in the file for Child #3 did not include the release person's address.

The fee agreement in the file for Child #3, who has been enrolled for more than 6 months, had not been updated by the parent. The first parent updates for the emergency contact form and fee agreement in the files for Child #4 and #5 were conducted more than 6 months after the child's first day in attendance.

The file for Staff Person #8, an assistant group supervisor, did not include documentation of a high school diploma or GED.

The files for Staff Person #2, 3, and 4 did not include documentation of any annual hours of training for the period 6/3/22-6/3/23. The file for Staff Person #5 contained documentation of 6.5. hours of annual hours of training.

An unused, unprotected electrical outlet was observed in an area accessible to children in the infant room.

An exposed nail was observed protruding from a half-door in an area accessible to children in the eating area. Also observed in the eating area were several staples protruding from the wall in an area accessible to children. Contact with said areas could result in laceration or puncture injuries.

The files for Child #1 and #4 contained immunization records that did not include documentation on an influenza vaccine in the past 12 months as recommended by the ACIP.

The trash can located in the infant room being used for diaper disposal was not a hands-free can.

The file for Staff #2 contained documentation that her TB test results were read after her first date in a childcare position.

The file for Child #5 contained an emergency contact form that did not include the addresses of two listed persons to whom the enrolled child can be released.

The files for Child #1, #2, and #3 did not contain signature of parents indicating that the agreements and emergency contact documents for each child had been reviewed.

The file for Staff #2 did not contain documentation of the completion of high school or a GED.

The files for Staff #1 and #3 did not contain two written, nonfamily references.

The file for Staff #1 contained an incomplete FBI Criminal History Clearance. Staff #1 may not work in the facility until such time as a complete FBI Clearance is obtained.

A wooden playhouse structure located in an area accessible to children in care was observed to have a broken piece of wooden trim positioned on the outside of the structure framing an open faux window. Three approximately 3" in diameter holes were observed in areas accessible to children in care on the vinyl fence enclosing the outdoor space. The edges of said holes were somewhat jagged and sharp. Contact with either the holes in the fence or the broken edge of the trim piece could cause laceration and/or puncture injuries.

Two nearly floor to door top glass entry doors and two identically sized, adjacent sidelights were observed to lack visual identifiers, which would assist in preventing a child from walking/running into the glass, which could cause a blunt force injury.

An approximately 4' x 3' activity table in an area accessible to children in care in the main child care space was observed to have loose legs, which cause the table to wobble and shift when pressure was applied. As the table shifted, visible space would open and close at the areas where the tabletop met the table legs causing pinch points at each of the four corners of the table.

The file for Child #1 contained an emergency contact form that did not include parental consent for the administration of minor first-aid procedures.