Stepping Stones Daycare and Ps INC

The facility was observed to lack a posting of the emergency plan in the facility at a conspicuous location

The facility was observed to be providing a letter explaining the emergency procedures to the parent of each enrolled child, however, this letter was observed to lack information regarding accommodations for infants, toddlers, children with disabilities and children with chronic medical conditions.

The facility's Preschool room was observed to have a carpeted toe kick that was torn and frayed along the top.

The facility was observed to have a Highchair with a wide base but lacked a T-shaped safety strap. This was evidenced by staff explaining the strap was sent to laundry but hasn't yet returned.

The facility was observed to have a medication log signed by the parent but lacked a date of the signature.

Staff persons were observed over room capacity in the toddler room which is measured for 5 children. This was evidenced by staff caring for 7 childen in the toddler room. Staff person #1 was observed caring for 5 1-year-olds in the Toddler room along with Staff person #6 who was observed caring for 1 infant and 1 older toddler in the toddler room.

The facility was observed to lack a written policy that addresses Shaken Baby Syndrome and Abusive Head Trauma.

The files for children #1, #2, #3, and #4 were observed to lack documentation of providing the family with the Department's approved form (Child Service Report) to provide information to the family about the child's growth and development in the context of the services being provided.

The files for staff persons #1, #2, #3, #4 and #5 were observed to lack documentation of obtaining an annual minimum of 12 clock hours of child care training

The facility's Emergency Plan did not address continuity of operations.

It was observed a waste receptacle located in the kitchen area of the infant room did not contain a lid containing used tissues that contained human secretions.

It was observed in the infant diaper area and in the bathroom that a lidded waste receptacle was not available.

It was observed in the preschool room, a cracked bin and a wooden oven with a large crack causing pinching and splinters. It was also observed in the infant/toddler room a torn rest mat.

A crib in the infant room was observed to have bite marks on the upper rail.

It was observed in the infant room 3 diaper creams that were not labeled with the name of the child for whom it is intended for.

In the infant room, it was observed that all the staff and children are using the same towel to dry their hands after hand washing.

In the infant room, it was observed that bottles were not labeled with the child's name.

Staff person #1 was observed to be caring for children unsupervised due to the fact she was the only staff present in the toddler room while staff #2 and staff #3 were present in the adjacent infant room with the adjoining door opened. Staff person #1 had not completed the following pre-service training required prior to caring for children unsupervised: Mandated Reporter training, 10-hour health and safety training, and Pediatric First Aid and CPR.

During an unannounced visit, observed rest equipment labeled for child #1, an infant. The rest equipment had loose fitted sheets causing a suffocation hazard.

At the time of the unannounced visit, cert rep observed child #2, an infant sleeping in a pack and play with a hard, plastic mobile activity arch present in the pack and play over the infant's body.

**At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall that runs halfway up from the floor located across the room from where staff #2 was sitting and child #5, the other infant, was sleeping in a pack and play on the far side of the other half wall that runs from ceiling to floor and covers approximately half the width of the infant room. Therefore, staff #2 could not properly supervise child #1 or child #5. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

***At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall that runs halfway up from the floor located across the room from where staff #2 was sitting and child #5, the other infant, was sleeping in a pack and play on the far side of the other half wall that runs from ceiling to floor and covers approximately half the width of the infant room. Therefore, staff #2 could not properly supervise child #1 or child #5. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall that runs halfway up from the floor located across the room from where staff #2 was sitting and child #5, the other infant, was sleeping in a pack and play on the far side of the other half wall that runs from ceiling to floor and covers approximately half the width of the infant room. Therefore, staff #2 could not properly supervise child #1 or child #5. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

**At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall located across the room from where staff #2 was sitting. Therefore, staff #2 could not properly supervise child #1. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

***At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall located across the room from where staff #2 was sitting. Therefore, staff #2 could not properly supervise child #1. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

At approximately 10:15, on 10-20-23 cert rep had staff #1, #2, and #3 identify the children for whom they were responsible. Staff #1 who was present in the toddler room, named 3 toddlers. Staff #2 who was sitting in a chair at the threshold of the toddler and infant room named 2 infants and 1 toddler. However, one of the infants, child #1 was sleeping in a bouncer located on the other side of a half wall located across the room from where staff #2 was sitting. Therefore, staff #2 could not properly supervise child #1. Staff #3 named 2 toddlers. However, staff #3 was present in the infant room and 1 toddler was present in the toddler room; and the other toddler they named was also named by staff #1. No staff named child #3 and child #4 who were present in the infant room.

During an unannounced visit, cert rep observed child #1, an infant sleeping in a bouncer; and child #2 sleeping in a pack and play with the base attached approximately halfway up from the bottom frame and hooked along the perimeter of the equipment causing a lack in support and therefore, not a flat, firm, surface as per the recommendation by the American Academy of Pediatrics.

Observed children #1 and #2 sleeping in pack and plays that were less that 2 feet apart from one another.

At the time of the unannounced visit, cert rep observed child #1 present in the infant room. However, there was not an emergency contact form present in the child care space.

Based on conversations with staff, child #1 was in possession of a utility knife with the blade opened. Furthermore, no staff had knowledge of how child #1 obtained said knife.

Based on conversations with staff, child #1 was in possession of a utility knife with the blade opened. Furthermore, no staff had knowledge of how child #1 obtained said knife.

Based on conversations with staff, child #1 was in possession of a utility knife with the blade opened.

It was observed in the infant room an infant sleeping in a bouncy chair and an infant sleeping in a swing. There was no documentation of a medical reason for the infants to sleep in this position on file.

It was observed in the preschool outdoor play space, on the right-hand side of a Little Tikes slide a crack with sharp plastic sticking out causing scraping. It was also observed that stagnant water and dirty wet leaves where in the large blue boat sandbox. It was observed in the indoor large playroom a lid to a big blue tote was cracked.

The health report on file for child #1 did not contain documentation of an influenza immunization being administered within the last year in accordance with the recommendations of the ACIP.

It was observed on the day of inspection a Tylenol bottle in the locked medication box not labeled to identify the name of the child for whom the medication was intended for.

It was observed on the day of inspection a bottle of Tylenol was expired.

The file for Staff Person #1, #2, #3, #4, and staff person #5 was observed not to have completed Pennsylvania Health and Safety Update 2022 by December 30, 2022.

Scissors, water, tape and tweezers were observed to be missing from the facility's Outdoors First Aid Kit.

It was observed in the toddler outdoor play area exposed splintering boards and exposed bolts from boards on the ground of the play space potentially causing scraping and cutting. It was observed that 4 inches of stagnant and dirty water was in the blue Step 2 Boat causing unsanitary conditions.

It was observed that the large green and wooden embedded play structure had peeling paint on the bottom poles.

A red play stove was observed to be cracked in the preschool area. A cracked push lawnmower and cracked tiles on top floor of red/tan/blue rock climb slide and torn netting on Little Tikes playhouse were observed in the outdoor preschool play area. It was also observed that a cracked pink/purple push toy and exposed bolts in the Little Tikes Red/Yellow and Purple/Pink Riding cars in the outdoor play space.

It was observed that the loose fill surface under the embedded large green play structure did not meet the recommendations of the United States Consumer Product Safety Commission due to there only being approximately 5 inches of loose fill in place.

Shale measuring less than 1 inch in diameter was observed in the outdoor play space were toddlers play. Mulch measuring less than 1 inch in diameter was observed in the outdoor play space were toddlers play

A plastic bag was observed in the toddler play space.

It was observed that there was not at least 2 feet of space on three sides of cribs while infants were sleeping.

It was observed that an infant 6 months of age or younger was not being held while being bottle fed.

The file for child #2 was observed not to have documentation of an initial health report no later than 60 days following the first day of attendance at the facility.

The agreement on file for Child#2 was observed not to contain the child's arrival and departure times.

The agreement on file for child #2 was observed not to contain documentation of persons designated by a parent to whom the child may be released.

The Emergency contact form on file for Child #1 was observed not to include information if the child has special disabilities, allergies, medical or dietary information necessary in an emergency situation, medications or special conditions of the child.

It was observed that the facility did not provide the parent of each child in the facility with information on how to access the regulations electronically.