Nurturers By Nature Early Learning Center

Staff person #1 has not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): health and safety training part 1 and part 2.

Upon arrival, observed children being care for in unlicensed space. The space was measured and added on the date of the inspection.

Observed a sharp corner on a countertop in the newly measured space. (new side)

Observed peeling paint on various walls and various areas in the outside play space.

The file for child #2 lacks an initial health assessment. Immunizations are on file. The health assessment was due 10/12/24.

The file for child #3 lacks an updated health assessment. The health assessment was due 11/2024.

The file for child #3 contains a health assessment that was obtained late. It was due 8/2024 and obtained 11/2024.

The file for staff #1 contains a health assessment that was updated late. It was due 4/2024 and obtained 5/2024.

Observed 5 children in care at 9:45am in the blue room. The capacity of the blue room is 4.

The file for child #1 lacks a parental update in writing on the emergency contact information and the agreement in a 6-month period. The update was due 9/2024.

PREVIOUSLY CITED ON 5/28/24: On 7/16/24 at approximately 6:56 AM, Staff #1 was observed as the driver and the only staff person in the facility owned vehicle while transporting 4 children (1 Infant, 1 Toddler, 1 Young School-Age, and 1 Older School-Age).

PREVIOUSLY CITED ON 5/28/24: On 7/16/24 at approximately 6:56 AM, Staff #1 was observed as the driver and only staff person in the facility owned vehicle while transporting 4 children (1 Infant, 1 Toddler, 1 Young School-Age, and 1 Older School-Age).

Based on staff interviews, 3 Infants, 1 YT, and 1 PSA are transported daily in the morning and on the facility's van with only Staff #2 present, who is also driving the van. The driver is not considered in staff-child ratio when infants, younger or older toddlers, or preschool-aged children are being transported.

At approximately 11:20 AM, 11 children (3 YT, 4 OT, 5 PSA, and 1 YSA) were observed on the outdoor play space with a max capacity of 10.

A crib in the Blue Room was observed to lack 2 feet on 3 sides while an infant was sleeping in the crib.

Based on staff interviews, 3 Infants, 1 YT, and 1 PSA are transported daily in the morning and on the facility's van with only Staff #2 present, who is also driving the van. The driver is not considered in staff-child ratio when infants, younger or older toddlers, or preschool-aged children are being transported.

The most recent fire alarm test date on file is 4/24/24, more than 30 days prior.

The Pediatric First Aid/CPR on file for Staff #1 is dated 4/14/22, more than 24 months prior.

A loose crib sheet was observed on a crib in the Infant Room, causing the risk of suffocation.

The letter to parents explaining the emergency procedures did not contain lockdown procedures, accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

The First Aid kit in the facility was missing tape.

Cracked and loose floor tiles were observed in the entryway to the bathroom, which could be hazardous to children.

Peeling paint and plaster was observed in the back corner near the floor and next to the the large toilet in the bathroom. Peeling paint was observed on the purple wall near the floor.

In the Orange area, foam blocks were observed with teeth marks and were not in good repair.

A table leg with ripped and torn plastic tape was observed in a room with toddlers, that were less than 1 inch in diameter, located in the Green room.

In the Green room, the 8-seat table only contained 5 of the 8 required T-shaped safety straps. Children were observed in the 3 seats that did not have T-shaped safety straps.

The most recent health assessment on file for Child #2, who is a preschool age child, is dated 12/1/22, more than 12 months prior.

The initial health assessment on file for Child #3 dated 1/6/22 is not signed by the examining health care professional (MD, CRNP, or PA), making it invalid.

The file for Child #2 (5 yr) contained the most recent influenza vaccination dated 2/3/20, which is dated more than 1 year ago, without a Letter of Exemption in the file. The file for Child #4 (2 yr) contained the most recent influenza vaccination dated 1/10/22, which is dated more than 1 year ago, without a Letter of Exemption in the file. Child #2 and Child #4 must be dismissed from care by close of business on 12/7/2023 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

While observing diaper changes in the Infant Room, Staff #3 was observed opening the hands free can for diaper disposal with their hands.

The two most recent health assessments on file for Staff #1 are dated 9/8/21 and 11/15/23, more than 24 months apart.

The most recent Emergency Drill at the facility was dated 10/18/22, which is more than 12 months ago.

The fire drill log on file included fire drills conducted 8/10/23-10/10/23, more than 60 days apart.

The fire alarm 30-day test log includes test dates 5/2/23-6/2/23, 6/2/23-8/12/23, and 9/8/23-11/9/23, more than 30 days apart.

The facility files lacked evidence of the Emergency Plan and subsequent plan updates were sent to the local municipality and County Emergency Management Services.

The facility's 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 lacked a date, which does not verify if the letter was sent annually.

The two most recent fire safety trainings on file for Staff #1 are dated 4/14/22 and 9/9/23, more than 12 months apart.

The file for Staff #2, classified as an assistant group supervisor, did not contain acceptable proof of education on file.

The file for Child #2 did not contain an financial agreement form.

The financial agreement on file for Child #1 is missing the fee amount.

The emergency contact forms for Child #2 lacked the address for physician or medical care provider and Child #5 lacked the name, address, and phone number for physician or medical care provider.

The emergency contact on file for Child #1 does not include written parental permission for the facility to obtain emergency medical care.

The emergency contact form for Child #2 lacked the Health Insurance/MA Coverage.

The emergency contact form for Child #2 lacked the phone number of the listed release person.

The file for Child #2 (4/18/23) and Child #3 (4/21/23) contained an emergency contact form that was not updated within 6 months of the previous update.

The facility's emergency plan did not include requirements for volunteer emergency preparedness training and continuity of operations plan to maintain compliance with 45 CFR § 98.41(a)(1)(vii)

The following cleaning materials and other toxic materials that were labeled keep out of the reach of children were observed in areas accessible to children in care: White Out and hand sanitizer were observed in an unlocked teacher's desk drawer in the orange room by the entrance to the facility; and Lysol wipes, bleach cleaner and Clorox toilet bowl cleaner were observed in an unlocked utility closet in the bathroom.

A first-aid kit was observed on the director's desk in the blue room, accessible to children in care.

The top of a children's table in the orange room was not in good repair (torn vinyl).

Styrofoam cups and plates were being used by children in care.

The record for child #1, a young toddler, contained a current health report dated more than 6 months following the date of their previous health report.

The record for child #3 contained an initial health report dated more than 60 days following the child's first day of attendance at the facility.

The initial agreement for child #4 was not signed by the parent.

A Child Service Report (the Department's approved form to provide information to the family about the child's growth and development) was not completed for child #1 and #3 who have been in attendance at the child care facility for more than a 6-month period.

The agreement for child #4 did not specify the child's departure time.

The record for child #3 and #4 contained the original copy of the agreement between the parent and the operator.

The emergency contact information for child #2 did not include health insurance coverage.

The emergency contact information for child #1, #3 and #4 who has been in attendance at the facility for more than a 6-month period has not been reviewed by a parent.

SECOND VIOLATION A loose crib sheet was observed on a crib in which an infant was sleeping. Previously cited on SIN-00208800 on 7/22/22.

*SECOND VIOLATION The file for Staff #6 lacked a state police clearance, no receipt for state police clearance and an FBI clearance indicating a record without a RAP sheet. Staff #6 was observed in ratio with children on 9/27/22 Previously cited on SIN-00208800 on 7/22/22.

**SECOND VIOLATION The file for Staff #6 lacked a state police clearance, no receipt for state police clearance and an FBI clearance indicating a record without a RAP sheet. Staff #6 was observed in ratio with children on 9/27/22 Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The cribs were observed to lack labels for the children they were intended for. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION An infant was observed sleeping in a crib which lacked two feet of space on three sides. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Child #3 contained a record of immunization history which lacked a current influenza vaccination. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Staff #6 lacked documentation of an initial health assessment. Previously cited on SIN-00208800 on 7/22/22.

The file for Staff #6 lacked documentation of an initial tuberculosis screening by the Mantoux method.

SECOND VIOLATION The file for Staff #3 contained a health assessment which lacked the medical provider's assessment of the person's suitability to provide child care. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION A written statement giving the formula and feeding schedule was not available at the facility at the time of inspection for one of the infants in care. Previously cited on SIN-00208800 on 7/22/22.

A copy of the renewal inspection SIN-0020880 was not posted in the facility in a conspicuous location on the day of the inspection.

*SECOND VIOLATION The file for Staff #6 lacked documentation of education and contained documentation of 2424 hours. Previously cited on SIN-00208800 on 7/22/22.

**SECOND VIOLATION The file for Staff #6 lacked documentation of education and contained documentation of 2424 hours. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Child #3 contained an agreement which lacked the child's times of care. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The files for Child #1, #2, #3 and #4 contained agreements which lacked release persons for the child. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The files for Child #1, #2, #3 and #4 contained agreements which lacked the children's enrollment dates. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The files for Child #1, and #4 contained emergency contact forms which lacked the work addresses and telephone numbers of the enrolling parents. The file for Child #3 contained an emergency contact form which lacked the work telephone number of the enrolling parent. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Child #3 contained an emergency contact form which lacked the child's health insurance information. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Child #4 contained an emergency contact form which lacked the full address for release persons. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The file for Child #3 contained an emergency contact form which lacked written parental consent for emergency medical care. Previously cited on SIN-00208800 on 7/22/22.

SECOND VIOLATION The files for Child #3 and #4 contained emergency contact forms which lacked written parental consent for the administration of first-aid. Previously cited on SIN-00208800 on 7/22/22.

The file for Staff #6 lacked documentation of two written, nonfamily references.

Staff person #2 was observed to be caring for children unsupervised. Staff person #2 has not completed the following pre-service training required prior to caring for children unsupervised: health and safety training.

A loose crib sheet was observed on a crib in which an infant was sleeping.

The files for Staff #1 and #4 contained state police clearances dated after the first days of employment and lacked receipts for state police clearances. The file for Staff #1 contained a disclosure statement which lacked a date. The file for Staff #2 contained a state police, FBI and NSOR clearance dated after the first day of employment and lacked receipts for those clearances. The file for Staff #4 lacked a child abuse clearance and receipt for child abuse clearance. The file for Staff #4 contained an FBI clearance which lacked dispositions for listed charges. The file for Staff #5 contained a disclosure statement and state police clearance dated after the first day of employment. The file for Staff #5 contained a state police clearance RAP sheet which contained felony charges which had not been submitted for review to the Regional Office. The file for Staff #5 lacked a valid FBI clearance.

Upon assessment of ratio and supervision in the Main Room on 7/22/22 at 11:40 AM, two staff were present with 3 Infants, 5 YT, 1 PS and 1 YSA.

At 12:15 PM on 7/22/22, Staff #2 returned from a nature walk with 7 YSA. Staff #2 was alone on the excursion with the children.

A toy was observed in a pack and play in which an infant was sleeping.

The facility's emergency plan was not available at the time of the inspection.

Toothpaste labeled Keep out of Reach of Children was observed to be accessible to children in an unlocked cabinet by the changing table in the Main Room. Febreze labeled Keep out of Reach of Children was observed to be accessible to children on a low shelf in the bathroom.

Soiled drinking cups and soiled masks were observed on the ground of the outdoor play space.

The front door, which was a solid glass pane, was observed to lack a visual strip or other visual identification.

Small beads were observed to be accessible to small children who may still be placing objects in their mouths in the play kitchen and in the blue bin in the outdoor play space.

The Main Room contained 6 cribs and pack and plays for the 8 infants and toddlers in care in that room. The cribs in the Main Room were observed to lack labels for whom they were intended. The cots in the Blue Room were observed to contain number labels, but no identifying list of child names was available to coordinate with the numbers.

Infants were observed sleeping in cribs which did not have two feet of space on at least three sides.

The files for Child #1 and #3 contained records of immunization history which lacked current influenza vaccinations.

The file for Staff #3 lacked documentation of an initial health assessment. The file for Staff #5 contained a health assessment dated after the first day of employment.

The files for Staff #4 and #5 contained health assessments which lacked he physician's or CRNP's assessment of the person's suitability to provide child care.

The menu was not posted at the facility nor was it provided to each family, per operator report.

Written statements from the parents giving the formula and feeding schedules were not available for the infants in care.

Bottles containing liquids were not labeled with children's names.

Written notification of safe routes was not posted in the facility.

The fire drill log was observed to contain drills which lacked the place of the hypothetical location of the fire and the number of children involved in the drill.

Documentation of 30 day testing of the fire detection system was observed to contain testing dates more than 30 days apart.

The facility lacked documentation of a policy regarding Prevention of Shaken Baby, Syndrome, Abusive Head Trauma, and Child Maltreatment.

Staff person #2 had not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): health and safety training.

The file for Staff #1 contained documentation of more than two years of child care experience yet lacked documentation of education. The file for Staff #5 lacked documentation of education and/or experience to qualify him in a position in the facility.

The file for Child #5 contained an agreement which lacked the due date for payment.

The file for Child #3 contained an agreement which lacked the child's times of care.

The files for Child #1, #2, #3, #4 and #5 contained agreements which lacked the release persons.

The files for Child #1, #2, #3, #4 and #5 contained agreements which lacked the enrollment dates for the children.

The files for Child #1, #4 and #5 contained emergency contact forms which lacked the work addresses and telephone numbers of the enrolling parents. The file for Child #3 contained an emergency contact form which lacked the work telephone number of the enrolling parent.

The files for Child #3 and #5 contained emergency contact forms which lacked the health insurance coverage for the child.

The files for Child #4 and #5 contained emergency contact forms which lacked full addresses for release persons.

Emergency contact forms were not present in the Blue Room for children being cared for in that room. According to operator report, emergency contact forms did not accompany the children in the outdoor play space.

While SA children were on a walking excursion on 7/22/22, emergency contact forms did not accompany the children.

The files for Child #3 and #5 contained emergency contact forms which lacked written parental consent for emergency medical care.

The files for Child #3, #4 and #5 contained emergency contact forms which lacked written parental consent for administration of first-aid.

A toxic compounding substance was observed to be accessible to children in an unlidded can on the floor of the main room, two toxic paint cans were observed to be accessible to children in unlidded cans on the floor of the main room, a toxic super glue was observed to be accessible to children in an unlocked cabinet drawer in he kitchen area of the main room, a toxic cleaner was observed to be accessible to children on the back of the toilet in the bathroom, a toxic air freshener was observed to be accessible to children on a shelf in the bathroom and a toxic hand sanitizer was observed to be accessible to children on the sink in the bathroom.

Peeling paint was observed on the white gate posts in the outdoor play space.

The toilets in the unisex bathroom and the children's bathroom were observed to lack handwashing signs.

The unisex bathroom was observed to lack a lidded waste receptacle.

A broken toy bin was observed in the outdoor play space, causing a rough edge.

Foam cushioning, which was observed around the edge of a low window sill and was crumbling off to the touch, was in an area of the main room meant for toddlers, accessible to children who may still be placing objects in their mouths. Small marble-like balls, with a diameter of less than one inch were observed to be accessible to children who may still be placing objects in their mouths, in a play table in the main area.

The refrigerator was observed to lack a thermometer.

The file for Staff #1 lacked a completed initial health assessment.

The observed emergency plan was reported to be sent to the local municipality but not to the county emergency management agency.

Standing water was observed in a bucket next to the toilet in the unisex bathroom.

The file for Staff #1, designated as the Director, contained a diploma designating a bachelor's degree in an unnamed major and lacked documentation of 1 year of experience with children.

The file for Staff #1 contained 1 of the 2 required written, nonfamily references.