Rhyming Thyme INC

The file for Child #3, a young toddler age child, contained a health assessment that was more than 6 months old.

The file for Child #1, who is a preschool aged child, contained two health assessments that were more than 12 months apart. The file for Child #2, who is a older toddler aged child, contained two health assessments that were more than 12 months apart.

The file for Child #3 contained an immunization record that was lacking one dose of HIB and one dose of Pneumococcal vaccines.

In the infant room, soiled diapers were observed being placed into plastic bags and placed out on a deck. The hands-free garbage can in the infant room was not operable.

The facility was lacking information to parents on how to access the regulations electronically.

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: Pediatric first aid and pediatric CPR.

The file of staff person #1 contained a completed disclosure statement, however, it was not on the current form. The NSOR application (dated 1/8/2024) and NSOR verification certificate (dated 1/10/2024) of staff person #1 were both dated after their start date at the facility (see coded LIS sheet). The file of staff person #3 contained PA state police clearances (9/10/2018 and 1/9/2024) and child abuse clearances (9/18/2018 and 1/9/2024) which are dated more than 60 months apart. The PA state police clearances of staff person #5 were dated more than 60 months apart (6/15/2018 and 7/28/2023).

A portion of the fence in the infant/toddler outdoor play space was damaged by a tree that had fallen. A section of the fence was bent in towards the playground and exposed the children to sharp areas of the fence.

The file of child #1, identified as a young toddler (see coded LIS sheet), contained a health assessment dated 5/16/2023 but did not contain an updated health assessment within 6 months. The file of child #2, also identified as a young toddler (see coded LIS sheet), contained a health assessment dated 11/17/2022 and an updated assessment dated 9/21/2023, exceeding 6 months.

The file of child #3, identified as a preschool aged child (see coded LIS sheet), contained health assessment dated 8/10/2022 but did not have documentation of an updated assessment within 12 months. The file of child #4, identified as a preschool aged child (see coded LIS sheet), contained health assessments which were dated more than 12 months apart (1/6/2021 and 1/12/2024). The file of child #5, now identified as an older toddler, contained a health assessment dated 2/11/2022 and did not contain an updated health assessment as a young or older toddler.

The immunization records of child #2 and #5 were not in accordance with the recommendations of the ACIP and acceptable exemptions were not on file.

The file of facility person #4 contained a health assessment dated 5/15/2021 and a signed health assessment form dated 5/22/2023, however, the health assessment form was incomplete and did not confirm a physical exam was conducted, they appear to be free from communicable disease and are suitable to provide child care.

Documentation of fire drills exceeded 60 days on the following dates: 1/3/2023 to 3/3/2023 and 10/26/2023 to 12/26/2023.

The file of child #6, who has been enrolled more than 60 days (see coded LIS sheet), did not have an initial health assessment.

The file of staff person #2, #3, #4, #6 and #7 contained documentation of pediatric first aid and pediatric CPR which was updated after the expiration of the prior certification.

The file of staff person #2 contained documentation of the 1-hour health and safety update training dated 12/5/2023, more than 90 days from staring at the facility (see coded LIS sheet). The file of staff person #8 contained documentation of training listed in subsections (f)1-9 dated 12/10/2023, which was more than 90 days from their start date at the facility (see coded LIS sheet).

The financial agreement of child #1 and #2 did not contain the child's admission date.

The file of child #3 and #5 contained the original financial agreements.

The emergency contact information of child #6 did not include the name, address and telephone number of the child's physician or source of medical care.

The emergency contact information of child #1, #5 and #6 did not include the work address and work telphone number of the enrolling parent.

The emergency contact information of child #1 did not include information on the child's special needs, as specified by the child's parent, physician, physician's assistant or CRNP, which is needed in an emergency situation or documentation this is not applicable to the child.

The emergency contact information of child #1 did not include the address of a release person designated by the parent to whom the child may be released.

Documentation of review and/or update to the emergency contact information and financial agreements exceeded 6 months for child #2 and #3. The file of child #5 contained documentation of the last review and/or update to the emergency contact information and financial agreement being completed on 3/21/2022, lacking a review/update within the past 6 months.

The financial agreement of child #6 was signed, but not dated by the child's parent.

The file of facility person #1 (see coded LIS sheet) contained a household member child abuse clearance dated 10/21/2021. The file of facility person #2, employed over 45 days (see coded LIS sheet), did not contain a completed NSOR verification certificate and facility person #3 contained an application for the NSOR verification certificate dated 10/27/2022 which was after their start date (see coded LIS sheet) but now has a completed NSOR certificate. The PA state police (dated 2/22/2017) and child abuse (dated 2/22/2017) clearances of facility person #4, who was doing administrative work at the facility, were not current when rehired (see coded LIS date) and their FBI clearance was not renewed prior to its expiration on 7/20/2022. They are now current. The PA state police clearance of facility person #5 was dated 4/20/2022, which was updated more than 60 months from the prior clearance dated 2/14/2017 and their child abuse clearance was dated 2/14/2017 and updated 12/12/2022, which was over 60 months, but was also a child abuse clearance for a household member and not for employment.

The emergency plan did not include a plan for continuity of operations which may include 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, or a contingency plan/contingency fund which can help strategize paying for repairs, paying staff, and continuing to run the business after a disaster or emergency.

A bottle warmer was observed on the shelf below the changing table accessible to children. Based on discussion with facility person #3, the bottle warmer is used on this shelf to warm the bottles. When the warmer was turned on, the heat exceeded 110 degrees F.

The first-aid kit in the blue room, across from the office, did not contain tape.

The immunization record of child #1 (correction #2/added 2/22/2023) did not contain 1 polio, 1 Hep A, and a current influenza vaccination and child #3 did not contain a current influenza vaccination as recommended by the ACIP or an acceptable exemption.

Documentation of the updated health assessment (dated 4/20/2022) of facility person #6 exceeded 24 months from the prior health assessment (dated 8/14/2020).

A bottle, which was in the refrigerator of the kitchen, was not labeled with the name of the child for whom it was intended.

Accommodations for infants and toddlers in the event of an emergency was not located in the emergency plan.

Documentation of emergency drills were not provided at the inspection.

Documentation of testing the fire detection system exceeded 30 days: 1/3/2022 to 2/4/2022 and 3/4/2022 to 4/6/2022 and 5/6/2022 to 6/8/2022 and 7/8/2022 to 8/10/2022.

The requirement of taking an additional one-hour training course titled, "Pennsylvania Health and Safety Update 2022" for facility staff who have taken the "Health and Safety Basics" training or "Get Started with Center- Based Care: Building Blocks for Quality" (taken before 10/4/2022) was completed after 12/30/2022 by facility person #5 (1/5/2023), #6 (1/6/2023), #7 (1/5/2023), #8 (1/5/2023), #9 (1/5/2023) and #10 (1/6/2023).

Documentation of 9/10 health and safety topics listed in subsections (f)1-10 were dated 10/27/2022, which was more than 90 days from the start date of facility person #2 (see coded LIS sheet).

The emergency contact information of child #1 did not contain the address and telephone number and child #3 did not contain the phone number of the child's physician or source of medical care.

The emergency contact information of child #3 did not contain the work address or telephone number of the enrolling parent.

Observed a crack in the electrical plate cover for the cable line in the purple/green room.

Observed cracked plaster above the toilet in the pink bathroom by the infant room.

Observed two cracked toy bins in the purple/green room.

Observed a tear on the blue couch in the young toddler room. This exposed the inner foam which can create a potential choking hazard for children who are still placing objects in their mouths.

The most recent immunization records in the files for child #2, #3, and #4 did not include documentation of a flu shot administered in the past year or a letter of exemption from the parent or physician.

The initial health assessment in the file for child #5 was conducted more than 90 days after the child's first day of attendance in the facility.

The files for staff persons #1 and #2 who have been working at the facility for more than 90 days did not include documentation of Health and Safety training.

The emergency contact form for child #1 did not include the name, address and telephone number of the child's physician or source of medical care.

The emergency contact form for child #2 did not include the work addresses and telephone numbers of the enrolling parent. The emergency contact form for child #3 did not include the home telephone numbers of the enrolling parent.

The emergency contact binder in the purple/green room did not contain the emergency contact form for child #3 who was receiving care in the room.