Small Town Hope

2nd citation. Previously cited on 1/27/25. The operator did not post the emergency plan in the facility at a conspicuous location.

2nd citation. Previously cited on 1/27/25. Observed Isagel Handwashing No-Rinse Antiseptic Hand Cleansing Gel with Added Moisturizers which indicated "keep out of the reach of children" on the bookcase between the bathrooms located in the kitchen/lunchroom which was accessible to children.

Observed approximately a 1 by 1-inch hole and approximately a 2 by 3-inch hole on the fence to the right of the gate in the Outdoor Play Space on the deck.

Observed peeling paint to the right and left of the gate separating the play spaces in the Outdoor Play Space with grass.

On 1/27/25 observed 1 pack 'n play with a loose sheet in the Infant Room creating a potential suffocation hazard.

The file of Volunteer #8 lacked a State Police Clearance and National Sex Offender Registry Certificate prior to or on the date of initial service in a child care setting (SEE LIS Code Sheet). The file of Volunteer #8 contained a State Police Clearance dated 1/10/25 and a NSOR dated 1/13/25. The file of Volunteer #9 lacked an FBI Clearance updated every 60 months. The file of Volunteer #9 contained an FBI Clearance dated 9/19/23 with a previous one dated 3/1/18. The file of Volunteer #9 lacked a valid FBI Clearance. Volunteer #9 had an FBI Clearance dated 9/19/23 from fieldprint.com. The files of Volunteers #10 and #11 lacked a valid disclosure statement (SEE LIS Code Sheet). The files of Volunteers #10 and #11 did not contain the disclosure statement updated in 2020. The file of Volunteer #11 lacked a valid FBI Clearance. Volunteer #11 had an FBI Clearance dated 8/17/23 from fieldprint.com.

The file of Volunteer #9 lacked documentation of emergency plan training on an annual basis (SEE LIS Code Sheet). The file of Volunteer #9 contained documentation of emergency plan training completed on 3/24/23. The file of Volunteer #11 lacked documentation of emergency plan training at the time of initial service and on an annual basis (SEE LIS Code Sheet). The file of Volunteer #11 did not contain documentation of emergency plan training.

The operator did not post the emergency plan in the facility at a conspicuous location.

The letter provided to the parent explaining emergency procedures did not address accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

On 1/27/25 observed Hello Mineral Sunscreen Lotion which indicated "keep out of the reach of children" hanging on the downstairs bathroom door which was accessible to children. On 1/27/25 observed Equate Hand Sanitizer which indicated "keep out of the reach of children" in the wooden bin by the downstairs bathroom which was accessible to children. On 1/27/25 observed A&D Ointment, 8 tubes of Desitin, and Aquaphor which indicated "keep out of the reach of children" under the changing table in the downstairs which were accessible to children. On 1/27/25 observed a bottle labeled "bleach water" hanging beside the changing table in the downstairs which was accessible to children. On 1/27/25 observed 2 Aquaphor, Desitin, and Parent's Choice Diaper Rash Ointment which indicated "keep out of the reach of children" on the changing table in the Infant Room which were accessible to children.

On 1/27/25 the first-aid kit used for excursions lacked soap, tweezers, and disposable nonporous gloves.

On 1/27/25 observed one sink in the downstairs bathroom that lacked a handwashing sign.

On 1/27/25 observed a round children's table and 5 children's chairs obstructing the front exit from the building in the downstairs classroom.

On 1/27/25 observed a portable space heater in the kitchen/lunchroom used by preschoolers.

On 1/27/25 observed a cracked green square magna tile in the downstairs classroom.

On 1/29/25 observed plastic bags hanging beside the changing table in the downstairs classroom which were accessible to children who are still placing objects in their mouths.

On 1/27/25 observed a shelf containing pretend food which was not anchored in the upstairs classroom creating a potential tipping hazard. On 1/27/25 observed a shelf containing art supplies which was not anchored in the upstairs classroom creating a potential tipping hazard. On 127/25 observed a shelf containing blocks which was not anchored in the upstairs classroom creating a potential tipping hazard.

On 1/27/25 observed rest equipment not labeled for the use of a specific child in the downstairs classroom.

The file of Child #1 lacked an updated health report at least every 6 months for an infant or young toddler. The file of Child #1 contained health reports dated 12/20/22, 8/18/23, and 12/18/24. The file of Child #3 lacked an updated health report at least every 6 months for an infant or young toddler. The file of Child #3 contained health reports dated 12/23/23 and 11/19/24.

The file of Child #2, a 3-year-old, lacked Hepatitis A immunizations according to the recommendations of the ACIP. Child #2 had documentation of no Hepatitis A immunizations. The file of Child #3, a 20-month-old, lacked DTAP/DTP/TD and Pneumococcal immunizations according to the recommendations of the ACIP. Child #3 had documentation of 3 DTAP/DTP/TD and 3 Pneumococcal immunizations. The file of Child #4, a 7-month-old, lacked DTAP/DTP/TD and Pneumococcal immunizations according to the recommendations of the ACIP. Child #4 had documentation of 2 DTAP/DTP/TD and 2 Pneumococcal immunizations.

The file of Staff #1 lacked a health assessment conducted every 24 months. The file of Staff #1 contained a current health assessment dated 12/17/23 with a previous one dated 5/6/21. The file of Staff #6 lacked a health assessment conducted within 12 months prior to providing initial service in a child care setting (SEE LIS Code Sheet). The file of Staff #6 contained a health assessment dated 10/25/23. The file of Staff #7 lacked a health assessment conducted within 12 months prior to providing initial service in a child care setting (SEE LIS Code Sheet). The file of Staff #7 contained health assessments dated 6/23/22 and 12/27/24. The file of Volunteer #9 lacked a health assessment conducted every 24 months. The file of Volunteer #9 contained a current health assessment dated 4/2/23 with a previous one dated 3/28/21.

The file of Staff #7 lacked an initial health assessment which included tuberculosis screening by Mantoux method at initial employment (SEE LIS Code Sheet). The file of Staff #7 had a Mantoux test read date of 6/27/22.

The operator did not conspicuously post the menu at least 1 week in advance.

The facility did not have an emergency plan that provides for accommodations for evacuation of children from the facility building and evacuation of children to a location away from the facility premises. The evacuation routes and evacuation plans to exit the building may be the same as those required by §3270.94 (relating to fire drills).

The file of Child #3 lacked an initial health report no later than 60 days following the first day of attendance at the facility. Child #3, with an admission date of 9/8/23, contained a health report dated 12/23/23. The file of Child #4 lacked an initial health report no later than 60 days following the first day of attendance at the facility. Child #4, with an admission date of 10/3/24, contained a health report dated 12/19/24.

Staff #5 lacked renewal of their certification in pediatric first aid and pediatric cardiopulmonary resuscitation on or before the expiration of the most current certification. The most current certification on file for Staff #5 was dated 12/21/24 with the previous certification dated 1/4/22.

The files of Staff #3 and #4 lacked documentation of completing health and safety training within 90 days of hire (SEE LIS Code Sheet). The file of Staff #3 contained documentation of completing health and safety training on 1/8/23. The file of Staff #4 contained documentation of completing health and safety training on 1/8/23.

Staff #2 lacked documentation of completing mandated reporter training every 60 months. Staff #2 had documentation of completing mandated reporter training on 12/28/23 with previous training completed on 10/19/18.

The file of Staff #7 lacked documentation of meeting one of the applicable staff qualifications for the position in which the person was performing.

The files of Staff #3 and #6 lacked a written evaluation on a regular basis, a minimum of one evaluation every 12 months (SEE LIS Code Sheet). The file of Staff #3 did not contain a written evaluation for 2023, 2024, or 2025. The file of Staff #6 contained a written evaluation dated 11/1/24.

Emergency contact information for Child #3 did not include the complete work address of the enrolling parent.

Emergency contact information for Child #4 did not include the telephone number of the individual designated by the parent to whom the child may be released.

On 1/27/25 emergency contact information for Children #5 and #6 were not present in the Infant Room when they were receiving care in the space.

The emergency contact and agreement for Child #2 were not reviewed and updated at least once in a 6-month period. Child #2's emergency contact and agreement were reviewed on 11/9/23, 7/18/24, and 1/2/25. The emergency contact and agreement for Child #4 were not reviewed and updated at least once in a 6-month period. Child #4's emergency contact was signed on 9/11/23 and reviewed on 7/18/24 and 12/16/24. Child #4's agreement was signed on 8/14/23 and reviewed on 7/18/24 and 12/16/24.

The operator did not provide the parent of each child enrolled with information on how to access the regulations in this chapter electronically.

Staff #3 lacked 1.5 hours of annual child care training required from March of 2023 through March of 2024. Staff #3 had 2.5 hours of child care training completed on 12/10/24 used for correction.

2nd citation. Previously cited on 7/15/24. The file of Staff #1 lacked a disclosure statement. The file of Staff #3 lacked a dated and witnessed disclosure statement.

2nd citation. Previously cited on 7/15/24. The file of Staff #2 did not include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. The file of Staff #2 contained only one written reference.

The file of Staff #1, who is currently designated as an Administrative Assistant but formerly was designated as a work study student, lacked a State Police Clearance, Child Abuse Clearance, DHS FBI Clearance, and a National Sex Offender Registry Certificate. The file of Staff #2, who is currently designated as an aide but formerly was designated as a work study student, lacked a State Police Clearance and Child Abuse Clearance.

Based on interviews, on 6/5/24 Staff #3 was left alone with 11 children including preschoolers and school-agers for approximately 15 minutes before a 2nd staff person arrived.

Staff #8 who was designated as a work study and is now designated as an aide lacked an FBI Clearance prior to or on the date of initial service in a child care setting (SEE LIS Code Sheet). The file of Staff #8 contained an FBI Clearance dated 6/7/24. Staff #9 who was designated as a work study and is now designated as an aide lacked a State Police Clearance, Child Abuse Clearance, and FBI Clearance prior to or on the date of initial service in a child care setting (SEE LIS Code Sheet). The file of Staff #9 contained a State Police Clearance dated 1/25/24, a Child Abuse Clearance dated 1/26/24, and an FBI Clearance dated 2/7/24. The file of Staff #9 lacked a disclosure statement.

The file of Staff #9 lacked documentation of receiving training regarding the emergency plan at the time of initial service.

The files of Staff #8 and #9 lacked an initial health assessment conducted within 12 months prior to providing initial service in a child care setting (SEE LIS Code Sheet). The file of Staff #8 contained a health assessment dated 1/24/24. The file of Staff #9 did not contain a health assessment.

The Director or designated staff person who is responsible for compliance with this chapter did not ensure that fire drills were conducted at least once every 60 days. The facility provided documentation of fire drills being conducted on 6/8/23, 8/4/23, 9/29/23, and 11/22/23.

The facility was unable to provide documentation that the fire detection system was manually tested at least every 30 days. The facility provided documentation that the fire detection system was manually tested on 6/8/23, 7/7/23, 8/4/23, 9/1/23, 9/29/23, 10/6/23, 11/3/23, 12/1/23, 12/28/23, 1/2/24, 2/2/24, and 3/1/24.

Staff #1, #2, #3, #5, and #6 lacked renewal of their certification in pediatric first aid and pediatric cardiopulmonary resuscitation on or before the expiration of the most current certification. The most current certification on file for Staff #1, #2, #3, #5 and #6 was dated 2/24/24 with the previous certification dated 1/4/22.

The file of Staff #3 lacked documentation of completing health and safety training within 90 days of hire (SEE LIS Code Sheet). The file of Staff #3 contained documentation of completing health and safety training on 1/17/22.

Staff person #4 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 from a PQAS approved trainer and a PQAS approved curriculum.

The file of Staff #9 lacked documentation of meeting one of the applicable staff qualifications for the position in which the person was performing.

An individual record was not established for Staff #7.

The files of Staff #8 and #9 did not include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. The files of Staff #8 and #9 contained only one written reference.

The facility was observed to have an emergency plan that did not provide a method for facility persons to inform parents that the emergency has ended and to provide instruction as to how parents can safely be reunited with their children.

The facility was observed to have an outlet in the infant room near the bottle warmer at highchair height that did not have a protective outlet cover.

The facility's infant room was observed to have a refrigerator that contained a thermometer that indicated the temperature was greater than 45 degrees F.

The file for child #2, a pre-school aged child was observed to lack an updated health report at least every 12 months as evidenced by health assessments dated 09/27/2022 and 12/15/2023.

The file for Child #4 was observed to lack written verification from a physician, physician's assistant, CRNP, the Department of Health or a local health department of the dates (month, day and year) the child was administered immunizations in accordance with the recommendations of the ACIP within 60 days. This was evidenced by an immunization record dated 11/21/2023 present in the file.

The facility was observed to have a medication and written instructions provided by the parent for child #5, that failed to include the dose or amount of medication that should be administered.

The facility was observed to lack written statements from the parents giving the formula and feeding schedules for all enrolled infants.

The facility was observed to have documentation that their emergency plan and subsequent updates had been sent to the county emergency management agency but lacked documentation that the emergency plan and subsequent updates had been sent to the local municipality's emergency management agency.

The file for child #1 was observed to contain an initial health assessment that was not obtained within 60 days of enrollment as evidenced by a health assessment dated 11/3/2023 present in the file.

On 02/16/2024, staff person #1 and staff person #5 had not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet). Staff person #1: pediatric first-aid training and pediatric cardiopulmonary resuscitation (CPR), Staff person #5: Get Started with Center-Based Care: Building Blocks for Quality.

The files for children #2 and #3 were observed to have files that contained an emergency contact form that failed to 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.

The file for child #3 was observed to contain an emergency contact form that failed to include the health insurance coverage and policy number.

The files for Staff person #1, #3, #4 and #5 were observed to lack documentation of completing 12 hours annually of child care training.

The file for staff person #2 was observed to lack verification they received training regarding the emergency plan at the time of initial employment, and after the plan update.

The files for child(ren) #1, #2, #4, and #5 were observed to lack an immunization record that verifies the child's immunized status according to recommendations of ACIP, as there is no documentation that an influenza vaccine was administered or of a request for exemption by the parent.

The file for Child #1 was observed to lack written verification of immunization no later than 60 days following the first day (09/07/2021) of attendance at the facility, as evidenced by an immunization record dated 08/11/2022 present in the file.

The file for Staff person #1 was observed to lack documentation of a tuberculosis screening by the Mantoux method.

The file for Child #1 was observed to lack an initial health report no later than 60 days following the first day (09/07/2021) of attendance at the facility, as evidenced by an initial health report dated 08/11/2022 present in the file.

The facility was observed to lack a policy regarding shaken baby syndrome, abusive head trauma, and child maltreatment.

Staff person #3 had not completed the following pre-service training within 90 days of their date of hire (See LIS code sheet): Valid Pediatric First-Aid training and Pediatric Cardiopulmonary Resuscitation (CPR).

The files for child(ren) #1, #3, and #5 were observed to contain an agreement form that lacked information specifying the services which are to be considered as extra.

The file for Child #4 was observed to contain an emergency contact form that lack the address of the individual designated by the parent to whom the child may be released.

The file for staff person #3 was observed to lack documentation that verifies their age.

The file of staff #1 had clearances more than 60 months apart due to the fact the PA State Police clearances were dated 9-25-15 and 1-7-21; Child abuse clearances dated 9-24-15 and 1-11-21. At the time of reviewing files, the file of staff #2 with a start date in care with children of 6-3-19 had PA State clearance dated 2-5-20 and Child Abuse clearance dated 2-6-20. Therefore, clearances were not on file at the time of hire.

Observed rest mats located in the main room downstairs, not labeled for the use of a specific child and used only by the specified child.

The file of staff #4 with a start date in care with children of 11-3-21 lacked a health assessment.

The file of staff #4 with a start date in care with children of 11-3-21 lacked documentation of tuberculosis screening by the Mantoux method.

At the time of the inspection, the Emergency Plan did not have accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions.

Based on documentation reviewed during the renewal inspection, it was determined an Emergency Plan drill during child care operating hours and with children present was not held on or before 12-19-21

At the time of the inspection on 1-19-22, it was determined fire drills were not conducted every 60 days due to the fact the last fire drill was held 11-19-21.

Upon review of the documentation for testing the smoke detection system, it was determined the system was not check every 30 days based on the following dates recorded: 7-2-21 to 8-2-21 is 31 days; 8-2-21 to 9-3-21 is 32 days.

The file of staff #1 had documentation completing Mandated Reporter training more than 60 months apart based on the fact they were dated 1-4-16 and 1-9-21

The file of child #1 lacked an emergency contact form with the health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable.

The file of staff #4 with a start date in care with children of 11-3-21, lacked a written report of initial health assessment, including the results of initial tuberculin skin tests, x-rays or other medical documentation necessary to confirm freedom from communicable tuberculosis.

The file of staff #3 lacked two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person; none were present in the file.