Nurturing Arms Daycare

At the time of the inspection, staff person #5 did not have a signed disclosure statement at time of hire (see LIS code sheet for date of hire).

At the time of the inspection, in the Preschool classroom, staff person #3's purse was accessible to children. Inside the purse was a bottle of Benadryl and a bottle lavender oil. In the preschool room, in a closet that was only partially closed off by a curtain, there were cans of paint accessible to children.

At the time of the inspection, the baseboard heaters in the middle right room, the Preschool bathroom and the toddler room exceeded 110° F and were accessible to children. The temperatures they measured were 282° F, 142° F and 145° F, respectively.

At the time of the inspection, in the toddler room, the heat vent cover was broken and exposed the metal guard edges, posing a hazard to children. In the school age room, a shelf was not secured to a surface and posed a tipping hazard.

At the time of the inspection, there was peeling paint behind the toilet in the preschool bathroom. There was peeling paint on the blue wall in the toddler room.

At the time of the inspection, the 5 gallon receptacles used for water for handwashing in the infant and toddler rooms were filled with water. This is evidence that they are not emptied daily.

At the time of the inspection, the changing table pad in the middle-left room was torn, and the inside foam was exposed. This prevents the changing pad from being properly cleaned with a sanitizing solution.

At the time of the inspection, the fold down changing tables located in the infant and toddler rooms had a label reading "suitable for child up to 11kg or 12 months." Child #8, a three-year-old, was observed being changed on one of these tables in the toddler room. These changing tables are not appropriate for the children's age and size who were present in care in these spaces.

At the time of the inspection, the Flovent inhaler, which the operator stated was child #7's, was observed inside a plastic bag at the facility. It did not contain a label identifying the name of the child for whom the medication is intended. The medication itself also read to discard after 1/2024.

At the time of the inspection, the trash can used for diapering in the infant and toddler rooms contained used diapers and was not plastic-lined.

At the time of the inspection, staff person #8 did not have a health assessment conducted every 24 months, as required, on file. This is evidenced by the health assessment on file dated 11/3/22.

At the time of the inspection, staff person #2 had acknowledged that written statements giving the formula and feeding schedule for an infant are not obtained from the parent.

At the time of the inspection, written notification of safe routes were not posted in the facility.

During the inspection, there were 4 mixed aged children in the infant room. The maximum capacity for this room is 3 children.

At the time of the inspection on 2/12/25, the last documented testing of the fire detection system was conducted on 1/10/25 and not every 30 days as required.

At the time of the inspection, staff person #8 did not renew the Pediatric First Aid/CPR training until 12/7/24. The previous training date was 7/20/22. This reflects a timeframe of when staff person #8 did not have current Pediatric First Aid/CPR training.

Staff person #14 did not complete the following required pre- service training within 90 days of their date of hire (see LIS code sheet): Pediatric First Aid/CPR training. This is evidenced by the Pediatric First Aid/CPR training on file dated 12/7/24.

On 11/4/24 at approximately 9:23am, 12 children (11 older toddlers and 1 young toddler) were present with staff person #8 and staff person #9. This number and age of children requires there to be three staff people present at all times.

At the time of the inspection, Child #1, a 7-month old (see LIS code sheet for date of birth), as reported by staff and confirmed through enrollment paperwork, was observed sleeping unsupervised in a Fisher Price Infant-to-Toddler Rocker inside a crib in the infant room. The child was not placed in the recommended sleeping position, in approved rest equipment, to sleep. In June 2022, the Consumer Product Safety Commission and Fisher-Price issued a warning for consumers about infant deaths in Fisher-Price Infant-to-Toddler and Newborn-to-Toddler Rockers and advised rockers should never be used for sleep, and infants should never be unsupervised.

On 11/4/24 at approximately 9:30am, Child #1, a 7-month old, was observed sleeping unsupervised in a Fisher Price Infant-to-Toddler Rocker inside a crib in the infant room. Child #1 was assigned to staff #10, who was observed in the young toddler room at this time, and no other adults were present in the infant room with Child #1.

At the time of the inspection, staff person #10 had foreign education on file that was not evaluated and translated and therefore, could not qualify for the position she was performing.

During the inspection on 10/2/24, staff person #1 was observed to be caring for children unsupervised. Staff person #1 has not completed the following pre-service training required prior to caring for children unsupervised: PQAS approved Pediatric First Aid/CPR and Health and Safety training requirements.

During the inspection on 10/2/24, staff person #1, a provisional hire, did not have a completed FBI clearance on file and was observed working unsupervised in the infant room. Staff person #4 did not update the Child Abuse and FBI clearance every 60 months as required. This is evidenced by the current clearance dates of 7/12/24 and 7/13/24, respectively. The previous dates of the clearances on file are 3/28/19 and 3/29/19, respectively. Staff person #8 did not update the PA State Police, Child Abuse clearance and FBI clearance every 60 months as required. This is evidenced by the current clearances on file dated 11/30/23, 12/26/23 and 11/30/23, respectively. The previous clearance dates on file are 11/26/18, 11/26/18 and 11/29/18, respectively.

During the inspection on 10/2/24, the emergency plan was last updated on 2/27/24 with continuity of operations added. Facility and staff persons were not trained at the time of this plan update. This is evidenced by the last date of emergency plan training being conducted on 12/20/23.

During the inspection on 10/2/24, a protective receptacle cover was missing from the outlet in the toddler room. There were two holes in the wall above the wooden vent cover in the young toddler room.

During the inspection on 10/2/24, the two sliding glass doors in the toddler room which lead to the outdoor play space did not have a visual strip or other visual identification on them.

During the inspection on 10/2/24, the changing table pad used for diapering in the toddler room was torn and the inside foam was exposed. This prevents the changing table pad from being properly sanitized after each use.

During the inspection on 10/2/24 at rest time in the preschool room, there was not at least 2 feet of space on three sides of each child's cot.

During the inspection on 10/2/24, the TB screening on file for staff person #1 was conducted on 5/12/23 and not within 12 months of initial hire at the facility (see LIS code sheet for date of hire). Staff person #8 did not update the health assessment on file every 24 months as required. This is evidenced by the most current health assessment on file dated 7/7/22.

During the inspection on 10/2/24, the health assessment dated 8/18/23 on file for staff person #2 did not include an examination for communicable diseases and the results of that examination or include the physician's or CRNP's assessment of the person's suitability to provide childcare.

During the inspection on 10/2/24, the operator acknowledged that she has never had documentation on file regarding conducting annual emergency drills.

During the inspection on 10/2/24, the manual monthly monitoring of the fire detection device was last documented as being conducted on 8/14/24 and not every 30 days as required.

During the inspection on 10/2/24, the operator acknowledged that she did not have a policy and procedure to identify the recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and addressing the prevention and identification of child maltreatment. Infants and toddlers receive care at this facility.

During the inspection on 10/2/24, staff persons #1, #2 and #3 did not have documentation of 2,500 hours of childcare experience on file and therefore, could not qualify as assistant group supervisors.

During the inspection, the operator acknowledged that the parents are not provided Chapter 3270 regulations electronically.

A renewal inspection was conducted on 2/27/24. At that time, the staff files were reviewed. The file for Staff Person #3 included an FBI clearance request dated 7/6/23, which was after the staff's date of hire. The file did not include a completed FBI Clearance for Staff Person #3.

A renewal inspection was conducted on 2/27/24. At that time, the facility bus used for field trips was inspected. The bus had not been inspected under Title 75 §4705 that requires all school buses be inspected annually by the PSP Commercial Vehicle Safety Division.

A renewal inspection was conducted on 2/27/24. At that time, Clorox cleaning spray was observed in an unlocked, floor level cabinet under the sink the overflow bathroom and was accessible to the children using the bathroom. The Clorox spray was labeled "keep out of reach of children."

A renewal inspection was conducted on 2/27/24. At that time, three small windows in the upstairs classroom were used for ventilation but were not equipped with screens.

A renewal inspection was conducted on 2/27/24. At that time, there was no sink or source of running water in the young toddler 2 room or the infant room, where the children's diapers are changed at the changing table.

A renewal inspection was conducted on 2/27/24. At that time, plastic bags containing diapers and wipes were observed in an unlocked drawer next to the changing table, approximately 18 inches high, where they were accessible to the toddlers in care.

A renewal inspection was conducted on 2/27/24. At that time, the thirty day testing log for the fire detection system was reviewed. The dates of testing were as follows, showing more than 30 days between testing on occasion: 3/15/23, 4/27/23, 5/16/23, 6/28/23, 7/10/23, 8/18/23, 9/26/23, 10/20/23, 11/9/23, 12/12/23, 1/23/24, 2/22/24.

A renewal inspection was conducted on 2/27/24. At that time, the staff files were reviewed. The file for Staff Person #1 contained the six hour health and safety training completed 11/30/18, which is outside of the acceptable date range for the six hour training. The file for Staff Person #2 contained the six hour health and safety training completed 7/1/29, which is outside of the acceptable date range for the six hour training.

A renewal inspection was conducted on 2/27/24. At that time, the staff files were reviewed. Staff Person #3, an assistant group supervisor, did not have verification of any experience working with children on file at the facility.

A renewal inspection was conducted on 2/27/24. At that time, the financial agreement for the following children did not include the names of the release persons: Child #1, Child #3, and Child #4,

A renewal inspection was conducted on 2/27/24. At that time, the emergency contact information for the following children did not include the work address and phone number of the parents: Child #1, Child #2, and Child #4,

A renewal inspection was conducted on 2/27/24. At that time, the emergency contact information was not located in each child care space.

Staff #1 hired as a provisional staff does not have a record of a PA State Police Clearance and a NSOR clearance.

Per investigation on 9/22/22, staff interviews and observation revealed that on 9/16/22 and as an ongoing practice, child #1 and child #2 had been placed to sleep in infant seats that did not allow them to be in the sleeping position recommended by the American Academy of Pediatrics.