Nature and Nurture Discovery School

On 09/03/2025 at approximately 1:06 pm, video footage shows staff person #1 walk toward child #1's rest mat and sit down on the floor on the left side of the mat. After staff person #1 sat down, child #1 moved back to the center of the mat and while lying on their belly pulls their blanket and scrunches it underneath themself between their chin and chest. Staff person #1 reached over the child's body and grabbed the blanket from the right side and begins to pull the blanket out from underneath the child. Child #1 resists and tries to hold on to the blanket. Staff person #1 continues to pull the blanket which causes the blanket to rub against the child's neck from the force causing an abrasion on the right side of the child's neck.

The file for staff person #1 did not include a signed disclosure date at the time of initial hire (see LIS code sheet).

The director or designated staff person did not ensure a test of the fire detection system was completed at least once every 30 days from July - August. The most recent test was completed on 08/05/2025 with the previous conducted on 07/05/2025.

An accident report was not completed for child #1 following an incident which resulted in an injury to the child.

On 07/21/2025 at approximately 1:30 pm, a verbal altercation occurred between staff person #1 and individual #1 in the lobby at the facility. During the altercation, staff person #1 threatened harm to the child by stating, "I hope your baby gets hit by a car."

On 06/13/2025, observed staff person #5 (an aide) working alone in the Inchworms classroom. Staff person #5 was not supervised by a staff person qualified at a minimum as an assistant group supervisor.

On 07/11/2025, the health report on file for child #3 was not updated within 12 months of the previous health report; the most recent health report on file was dated 06/06/2024 and no subsequent report was on file.

The file for child #1 (see LIS code sheet) included a record of the child's immunization status which lacked a 3rd dose of DTap and a 3rd dose of PCV13. The file for child #4 (see LIS code sheet) included a record of the child's immunization status which lacked a 2nd dose of HepB, a 1st dose of DTap, a 1st dose of HiB, a 1st dose of Rotavirus, a 1st dose of PCV13, and a 1st dose of Polio immunizations.

The file for staff person #2 did not include a health assessment prior to providing initial service in a child care setting (see LIS code sheet); the file included a health assessment dated 04/09/2025 and a TB test dated 04/11/2025. The file for staff person #4 included a health assessment that was not updated within 24 months for the previous health assessment; the current assessment on file was dated 05/21/2025 with the previous assessment dated 04/03/2023.

Observed bottles in the refrigerator located in the Inchworms classroom which were not labeled with the child's name.

The file for child #5 did not have an initial health report within 60 days of attendance (see LIS code sheet); the file did not include any health reports.

Staff person #3 did not complete the following required pre- service training within 90 days of their date of hire (see LIS code sheet): Health & Safety (CCDGB) 2025 Part 1 and Part 2 were completed on 05/28/2025.

The agreement for child #6 was not signed by the parent. The agreement for child #7 was not signed by the operator.

The agreement for child #6 did not specify the child's arrival and departure times.

The emergency contact information for child #6 did not include the enrolling parent's work telephone number.

The emergency contact information for child #2 did not include the address of the individuals designated by the parent to whom the child may be released. The emergency contact information for child #5 did not include the complete address of the individuals designated by the parent to whom the child may be released.

On 07/11/2025, emergency contact information was not present in the Honeybees classroom for child #6 while receiving care in the space. Emergency contact information was not present in the Katydids classroom for child #2 and #8 while receiving care in the space.

The file for child #6 did not include signed parental consent for the administration of minor first-aid procedures prior to admission (see LIS code sheet).

The file for child #4 did not include an initial agreement at the time of enrollment.

The file for staff person #1 did not have documentation of an annual minimum of 12 clock hours of child care training; there were 9.5 hours of documented training between 12/2023 - 12/2024.

Observed staff person #1, a provisional hire (see LIS code sheet) working in the Inchworms classroom with staff person #3. Staff person #3 did not have a complete file to qualify as a permanent employee to supervise staff person #1. The file for staff person #1 did not have a current State Police clearance. The file included a State Police Clearance dated 06/14/2016 and documentation of a request dated 03/0/2025 without the final clearance results. The file for staff person #2 did not have the results of the NSOR certificate prior to working in a child care position at the facility (see LIS code sheet); the NSOR clearance was requested on 04/14/2025. The file for staff person #2 did not have a copy of the request or the results of the FBI clearance on file. Staff person #2 was observed caring for children in the Junebug's classroom. The file for staff person #5 included a copy of an FBI clearance dated 07/14/2022 with the name blacked out on the certificate. The file for staff person #7 did not have the results of the NSOR certificate prior to working in a child care position at the facility (see LIS code sheet); the NSOR clearance was requested on 03/07/2025. The file for staff…

Observed staff person #7, an aide, working unsupervised in the Honeybees classroom. The file for staff person #1 included a HS diploma and 1 year of verified child care experience.

The file for staff person #5 did not include a health assessment prior to providing initial service in a child care setting. The file included a TB test result dated 03/05/2025 in lieu of a complete health assessment. The file for staff person #9 did not include an updated health assessment within 24 months of the previous health assessment; the most recent health assessment on file was completed on 11/08/2022.

Staff person #1 has completed the health and safety course titled ·Get Started with Center-Based Care: Building Blocks for Quality (10 hours) dated 12/09/2019 but did not have documentation on file of completing the required health and safety update course titled Pennsylvania Health and Safety Update 2022 (1 hour) training.

Staff person #3 has not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This is evidenced by the previously documented Pediatric first aid and CPR training on file expiring 04/2025. Documentation of updated Pediatric first aid and CPR training is not on file Staff person #3 was observed to be working in the Inchworms classroom with staff person #1. Staff person #1 did not have a complete file to qualify as a permanent employee to supervise staff person #3.

The file for staff person #2 did not include verification of child care experience or education at the time of initial hire (see LIS code sheet). The file for staff person #4 and #6 did not include verification of education at the time of initial hire (see LIS code sheet).

The file for staff person #1, #2, #6, #8 and #9 did not include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person.

On 07/25/2024 at approximately 10:00 am, staff at the facility observed staff person #1 place child #1 into their crib on their stomach to sleep. According to the AAP, it is recommended infants be placed on their back for safe sleep.

Staff at the facility observed numerous occasions where infants' diapers were soaking wet and diaper changes were not documented in the morning. On 07/19/2024, child #2 arrived at 9:17 am and the first logged diaper change was documented at 1:38 pm. On 07/19/2024, child #3 arrived at 7:29 am and the first logged diaper change was documented at 1:34 pm. During the week of 07/22 - 07/26/2024, diaper logs for child #1, #2 and #4 showed several times throughout the day when diaper changes were not documented at least every 2 hours. Observed the daily schedule in the Honey Bees classroom lists the following diaper changing times- 9:00 - 9:30, 12:00-12:15, 2:35 - 2:45 and 3:50 - 4:30. The scheduled diaper changes between 9:00 - 12:00 exceeds 2 hours.

The written feeding schedules for child #1, #2, #3 and #4 were not followed by staff person #1. The feeding schedule for child #1 indicates feeding times as "on demand" every 3 hours (9:00, 11:00 and 1:00 pm). During the week of 07/22 - 07/26/2024, the feeding log for child #1 listed several times when feeding times for child #1 exceeded 3 hours and the first feeding was not documented until after 10:00 am. On 07/19/2024, morning feedings were not documented for child #2 and #3. The first documented feeding for child #2 was listed at 1:57 pm. The first documented feeding for child #3 was listed at 1:47 pm. On 07/23/2023, the first feeding time for child #4 was listed at 10:38 am with the afternoon feeding documented at 3:19 pm. On 07/25/2023, the first feeding time for child #4 was listed at 8:35 am with the afternoon feeding documented at 12:38 pm.

The file for staff person #1, who has resided outside of PA in the previous 5 years, did not include documentation of out of state clearances within 45 days of hire (see LIS code sheet).

The emergency plan training for staff person #3 was not updated within 12 months of the previous training; the most recent training was dated 05/26/2023 with no documentation of subsequent training.

The file for child #2 and #3 included a health report which was not updated within 6 months of the previous health report for an infant or young toddler (see LIS code sheet). A current health report on file for child #2 was dated 06/11/2024 with the previous health report dated 06/13/2023 and an initial health report dated 10/21/2022. A subsequent health assessment for 12/2023 was not on file. The current health report on file for child #3, dated 06/06/2024, was not completed within 6 months of the initial health report dated 09/05/2023.

The file for child #1 included a health report which was not updated within 12 months of the previous health report for an older toddler or preschool child (see LIS code sheet). The current health report on file was dated 06/06/2024 with the previous health report dated 08/30/2022.

The initial health report dated 03/26/2024 for child #5 was not completed in its entirety. The sections regarding health problems or special needs, including information regarding abnormal results of screening tests for vision, hearing or lead poisoning and a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted were left blank by the MD/CRNP/PA who completed the form.

The initial health report dated 03/26/2024 for child #5 was not completed in its entirety. The section regarding whether the child is able to participate in child care and appears to be free from contagious or communicable disease was. left blank by the MD/CRNP/PA who completed the form.

The emergency contact information for child #4 did not include the complete address of the child's physician or source of medical care. The emergency contact information for child #3 did not include the complete telephone number of the child's physician or source of medical care. The emergency contact information for child #1 and #5 did not include the work telephone number of the enrolling parent.

The emergency contact and financial agreement for child #3 was not updated within 6 months of initial enrollment (see LIS code sheet). The most recent review was completed on 04/16/2024.

The file for staff person #2 did not include verification of education at the time of initial hire (see LIS code sheet).

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 & CPR in a PQAS approved curriculum from a PQAS approved trainer. The file for staff person #1 included American Heart Association Heartsaver for K-12 Schools training dated 01/10/2023.

Observed a young toddler being lifted by a staff person to reach the sink to wash their hands; the sink in the Inchworms classroom was not a proper height for use by young toddlers and did not include a platform or steps for the children to easily approach the sink for handwashing.

Observed hand soap in a hand sanitizer bottle in the Monarch classroom which was not in an original labeled container that specified the content.

Observed the crib located in the Honeybees classroom, used by Child #1, was not labeled for the use by the specified child.

The health report for child #2 and #4 was not updated at least once every 6 months for an infant or young toddler (see LIS code sheet) The most recent health report on file for child #2 was dated 06/21/2022 with no additional health reports on file. The most recent health report on file for child #4 was dated 08/30/2022 with the previous health report on file dated 04/14/2021.

The file for child #3 (see LIS code sheet) did not include initial and subsequent health reports. The most recent health report on file dated 10/26/2022 did not include a copy of the child's immunization record.

The file for child #2 (see LIS code sheet) included a record of the child's immunization status which lacked a 4th dose of DTap, a 4th dose of PCV13, an MMR, a Varicella and an influenza immunization. The file for child #4 (see LIS code sheet) included a record of the child's immunization status which lacked a 2nd dose of Hep A and an influenza immunization. The file for child #5 (see LIS code sheet) included a record of the child's immunization status which lacked a current influenza immunization. The file for child #6 (see LIS code sheet) included a record of the child's immunization status which lacked an influenza immunization.

Observed diaper creams stored on the bottom shelf of an unlocked cabinet on the changing tables located in the Katydids and Ladybugs classrooms which were accessible to children in care.

Staff person #2 did not complete the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Get Started with Center Based Care - Revised 2022; the training was completed on 04/30/2023.

The director did not complete a written evaluation for staff person #1 within 12 months of hire (see LIS Code Sheet).

Observed the emergency contact information for child #2, #3, #4, #6 and #7 were not updated by a parent at least once every 6 months. The emergency contact information for child #3, #4 and #6 was last reviewed in October 2022. The emergency contact information for child #2 was reviewed in June 2023 with the previous review in October 2022. The emergency contact information for child #7 was reviewed April 2022. A subsequent review in September 2022 was not signed by the parent.

Staff person #1 did not complete mandated reporter training within 60 months of the previous training. The current Mandated Reporter training was completed on 11/07/2022 and the previous documented mandated reporter training on file was dated 03/12/2017. On 11/08/2022, the file for staff person #2 included a volunteer Child Abuse Clearance dated 08/29/2018 in lieu of a child abuse clearance for employment.

On 11/21/2022, the health report for child #3 did not include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

Potentially hazardous food brought from the child's home are not being refrigerated by the facility. Ice packs are used in lunchboxes for lunches packed by the parents in lieu of being refrigerated.

On 11/08/2022, a written plan of daily activities was not posted in the "Inchworms" (infants) classroom.

On 11/21/2022, the file for child #1 and #2 did not contain an initial health report (see LIS code sheet). The current health report on file for child #1 was dated 09/01/2022, with no prior health report on file. The current health report on file for child #4 was dated 08/05/2022, with no prior health report on file.

On 11/08/2022, the file for staff person #2 had one written, nonfamily reference.

On 01/03/2022, the file for staff person #1, start date 10/18/2021, included CPSL provisional hire documentation which was not complete prior to working with children. The file contained requests for the State Police Clearance dated 10/18/2021, a request for the Child Abuse Clearance dated 10/18/2021, FBI fingerprint receipt dated 10/25/2021 and NSOR request dated 11/01/2021. The results of the PA State Police Clearance or FBI Clearance was not on file prior to their start date. The file contains a State Police Clearance dated 12/02/2021, a child abuse clearance dated 12/02/2021, an FBI Clearance dated 10/25/2021 and an NSOR certificate dated 11/01/2021. The file for staff person #3, start date 07/19/2021, included CPSL provisional hire documentation which was not complete prior to working with children. The file contained requests for the State Police Clearance dated 08/09/2021, and a request for the Child Abuse Clearance dated 08/09/2021. The results of the PA State Police Clearance or FBI Clearance was not on file prior to their start date. Documentation of the receipt with the date of FBI fingerprinting and proof of submission for the NOSR clearance was not on file. The file…

On 12/21/2021, observed the bag containing the first-aid kit was accessible to children on the ground next to the table in the pavilion, while the 3 year old class was outside playing on the playground.

On 01/03/2022, the Well Child Report, dated 11/24/2021, for child #1 did not include a statement that the child is able to participate in child care and appears to be free from contagious or communicable disease.

On 01/03/2022, the file for child #2, a 17 month old, included a record of the child's immunization status which lacked an influenza immunization. The file for child #3, a 3-year-old, included a record of the child's immunization status which lacked an influenza immunization.

On 01/03/2022, the file for staff person #6 included a health assessment & results of tuberculosis screening completed after providing initial service in a child care setting; the health assessment was dated 06/20/2021 and the TB screening was dated 06/30/2021. The initial start date caring for children for staff person #6 was 06/07/2021.

On 01/03/2022, the file for child #1, with an enrollment date of 07/06/2021 did not include an initial health report within 90 days (under the COVID suspended regulations) following the first day of attendance at the facility. The file contained an immunization record dated 07/21/2021 and a Well Child Report dated 11/24/2021. The file for child #3, with an enrollment date of 11/03/2020 did not include an initial health report within 90 days (under the COVID suspended regulations) following the first day of attendance at the facility; the file contained an immunization record dated 10/21/2020 in lieu of a complete health report.

On 12/21/2021, observed staff person #7 working alone in the infant classroom as an Assistant Group Supervisor; the file for staff person #7 included documentation of a high school diploma but did not include verification child care experience or credit hours from an accredited college or university to qualify as an AGS.

On 01/03/2022, the emergency contact information for child #3 did not include the addresses of the individuals designated by the parent to whom the child may be released.

On 01/03/2022, the file for staff person #5 and #7 did not include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person