Tammy Powers Nest

The toilet seat in the bathroom off the Main Room was loose and unstable.

The files for Child #1, Child #2, and Child #3 contained the original fee agreement form signed by the parent.

The file for Staff Person #1 contained current clearances dated more than 60 months from previous date: PA State Police Clearance dated 7/24/23 and 6/11/18; PA Child Abuse Clearance dated 12/28/23 and 6/20/18; DHS FBI Clearance dated 8/1/23 and 6/26/18. The file for Staff Person #2 lacked a PA Child Abuse Clearance for Employment. The PA Child Abuse Clearance in the file dated 3/14/23 was a Volunteer clearance.

On 11/12/24, at approximately 1:50pm in the infant room, staff Person #3 was responsible for 1 infant and 3 younger toddlers. Staff #3 was observed asleep in the rocking chair and was not supervising the children.

The facility's parent letter explaining the emergency plan lacked information regarding Lockdown procedures.

The water temperature in the infant room was 139°.

The file for Child #2 lacked a written statement signed by the parent or physician for exemption from immunization. According to the child care manager, the family "is not vaccinating at this time".

The health assessment for Staff Person #1 dated 8/1/23 was obtained more than 24 months from the previous assessment dated 7/8/21.

The facility lacked documentation of the emergency plan and subsequent plan updates were sent to the local municipality and the county emergency management agency.

4TH CITATION: 11/12/24, at the time of renewal inspection, the facility lacked a qualified director employed and present at the facility for a minimum of 30 hours per week. PREVIOUSLY CITED ON 4/16/24, 7/3/24, and 7/9/24.

The Preschool room lacked a daily schedule of activities posted in the group space.

The agreement form for Child #1 lacked the persons designated by a parent to whom the child may be released.

The emergency contact form for Child #3 lacked parental consent for administration of medications or special dietary needs.

The file for Staff Person #2 contained only 1 of the 2 required written letters of reference attesting to the person's suitability to work with children.

The file for Staff Person #1 lacked 6 of the 12 annual training hours required for the review period of December 19, 2022 through December 19, 2023.

3RD CITATION: At the time of renewal inspection, the facility does not have a director on staff. Provider's correction date on previous inspection summary was 7/8/24, as of 7/9/24 facility is still without a director. PREVIOUSLY CITED ON 4/16/24 and 7/3/24.

2ND CITATION: At the time of renewal inspection, the facility does not have a director on staff. PREVIOUSLY CITED ON 4/16/24

2ND CITATION: The files for Child #1, Child #2, Child #3 and Child #4 are lacking reports on information to the family about the child's growth and development in the context of the services being provided. PREVIOUSLY CITED ON 4/16/24

There was no handwashing sign above the changing table in the bathroom.

The file for preschool aged Child #4 was lacking an updated health assessment. The most current health assessment on file is dated 9/21/22.

It was observed in the infant room that the lidded garbage can used for disposable diapers was not hands-free.

The smoke detection log on file contained dates of testing from 7-10-23 to 8-10-23, 10-6-23 to 11-6-23, and 1-5-24 to 2-5-24, all more than 30 days apart.

The file for Staff Person #1 did not contain the one-hour Health and Safety Update 2022 which was required to be completed by 12/30/22.

Staff Person #4 did not complete the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Getting Started with Center-based Care: building Blocks for Quality Revised 2022. The certificate on file for Staff Person #4 is dated 11/14/23.

At the time of renewal inspection, the facility does not have a director on staff.

The fee agreement on file for Child #4 was lacking the amount of the fee to be charged per day or per week.

The fee agreement for Child #4 was lacking the specify the date on which the fee is to be paid.

The files for Child #1, Child #2, Child #3 and Child #4 are lacking reports on information to the family about the child's growth and development in the context of the services being provided.

The fee agreement on file for Child #4 is lacking the arrival and departure times.

The emergency contact form for Child #2 is lacking written consent signed by a parent for emergency medical care.

The emergency contact form on file for Child #2 was lacking signed parental consent for administration of minor first-aid procedures by facility staff.

The file for Staff Person #2 included 7 of 12 required training hours completed between 12/19/22-12/19/23. The file for Staff Person #3 included 3 of 12 required training hours completed between 12/19/22-12/19/23.

Facility reported that their director resigned and they currently do not have a director.

The file for staff person #1 was observed to have documentation Mandated Reporter training that was not renewed before the expiration date of the most current certification required under CPSL. The two most current trainings are dated 6/29/17 and 11/2/22. The file for staff person #4 was observed not to contain documentation of completion of Mandated Reporter Training within the first 90 days of hire (See LIS CODE SHEET). Mandated Reporter Training on file for staff person #4 is dated 10/14/22. The file for facility person #6 was observed not to contain documentation of application of a PA FBI Clearance prior to date of hire (See IS CODE SHEET) required for provisional hiring under the CPSL. Facility person #6 cannot work in the facility until the PA FBI clearance results are verified.

The emergency plan for the facility did not include requirements for continuity of operations (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). The file for staff person #1 lacked completion of the required 1-hour health and safety training update prior to 12/30/22. The file for staff person #3 had documentation of the required 1-hour health and safety training that was completed on 3/19/23, which is past 12/30/22.

The two most recent emergency plan trainings on file for staff persons #3 and #4 are dated more than 12-months apart. Staff person #3 has completion dates of 1/13/22 and 2/25/23, and staff person #4 has completion dates of 1/7/22 and 2/8/23.

In the Main room, handwashing signs were not posted at the two toilets in bathroom #1 and were not posted at the diapering area and the toilet in bathroom #2.

In the outdoor play space #2, a plastic children's playhouse was cracked near the front door of the playhouse. To the left of the door, a piece of the equipment was observed to be broken off. These conditions expose the children in care to rough edges, sharp corners and pinch points.

The file for child #1, with an enrollment date of 1/23/23, lacked documentation of the child's immunized status according to recommendations of the ACIP and has been enrolled more than 60 days at the facility.

In the medicine cabinet in the kitchen, children's Benadryl for a child enrolled was observed to be expired on 1/2023.

The file for staff person #2 was observed to have documentation of a health assessment that was not renewed before the expiration date of the most current certification: 11/11/20 and 1/11/23. The file for facility person #6 lacked documentation of a health assessment conducted within 12 months prior to providing initial service in a child care setting.

The file for staff person #5 lacked documentation of a tuberculosis screening at initial employment. (See LIS CODE SHEET). The TB screening on file is dated 7/22/22.

The health assessments on file for staff persons #1 and #4 lacked an examination for communicable diseases and the results of that examination, and lacked the physician's assessment of the staff person's suitability to provide child care.

The facility lacked a written statement giving the formula and feeding schedule for an infant observed receiving care.

In the Baby Room, an infant's bottle was not labeled with the child's name.

The facility's documentation of testing the fire alarm detection system exceeded 30 days from 10/7/22 to 11/7/22 and from 2/20/23 to 3/27/23.

The two most recent fire safety trainings in the file for staff person #3 are dated more than one year apart: 2/8/22 and 3/27/22.

The files for staff persons #1, #7, and #8 lacked completion of the required Health and Safety pre-service training by April 29, 2022. The Health and Safety training on file for staff person #1 is dated 10/14//22, staff person #7 has a completion date of 12/21/22, and staff person #8 has a completion date of 12/1/22.

The two most recent staff evaluations on file for staff person #3 are dated more than 12-months apart: 1/7/22 and 2/28/23.

The agreement form on file for child #3 lacked the date on which the fee is to be paid.

The agreement forms on file for children #2 and #3 lacked the child's arrive and departure times. The agreement form on file for child #1 lacked the child's departure time.

The emergency contact form on file for child #2 lacked the address of the child's physician.

The emergency contact form on file for child #4 lacked the health insurance coverage and policy number.

A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not posted in the Pre-Preschool Room.

Staff persons #1, #2, #3, and #4 were observed to be caring for children unsupervised. Staff persons #1-4 have not completed the following pre-service training required prior to caring for children unsupervised: Health and Safety and Mandated reporter training.

At approximately 10:40 a.m., observed staff person #1 and staff person #2 supervising a group of 17 children in the outdoor gross motor space. Staff person #1 identified responsibility for 2 younger school -age children and staff person #2 identified responsibility for two young toddlers and three older toddlers, leaving ten children not identified by the staff present. Staff person #1 and #2 stated that the remaining 10 children were being supervised by staff person #3, who was observed to be on an excursion with a group of younger and older school-age children at a location off the facility premises. Staff person #3 stated that they left their supervisory group to cover another staff person's group.

Observed an accessible first aid kit on a bench at the playground where a group of older and younger school-aged children were on an excursion.

The emergency contact information for the group of younger and older school-age children on an excursion to a local playground was not present.

The file for staff person #1 contains an expired FBI clearance. The two most recent child abuse and FBI clearances on file for staff person #5 are dated in an interval greater than 5 years or 60 month. Current CPSL requires clearances to be renewed on or before 5 years or 60 months from the date of the previous clearance.

The file for child #3 and child #4 contains a health report which lacks a statement that the child is able to participate in child care and a statement that age-appropriate screenings recommended by the American Academy of Pediatrics were conducted since the time of the previous health report required by this section.

The file for child #1 and child #4 lacks verification of a current Influenza vaccine administered in accordance with the schedule recommended by the ACIP.

The two most recent health assessments on file for staff person #2 are dated more than 24 months apart. The file for staff person #4 is dated after staff person #4 began in a child care taking position.

The facility lacks a documented emergency drill held during 2021.

A review of the fire detection system testing log revealed that during the interval of 8/27/21-9/28/21, the testing occurred more than 30 days from the previous test. The last documented fire detection system testing recorded is dated 3/22/22, more than 30 days ago.

The initial health reports on file for child #1 and child #5 are dated more than 60 and 90 days after the first day of attendance at the facility.

The file for staff person #5 contains verification of Baisic first aid and CPR which lack the pediatric endorsement, making the trainings invalid.

The file for staff person #3 and staff person #4 contain verification of Health and Safety training completed more than 90 days after both staff began in a child care taking position. The verification of Health and Safety training on file for staff person #1 is an expired version of the training, making it invalid.

The file for staff person #3 and staff person #4 contains verification of mandated reporter training completed more than 90 days after staff person #3 began in a child care taking position.

The file for staff person #7 lacks verification of one year of experience to qualify as director, the position assigned to and currently being performed by staff person #7.

At the time of inspection, the facility lacks a director employed by and present at the facility a minimum of 30 hours per week.

The file for staff person #3, staff person #4, #6 and #8 lacks verification of 2 years' experience with children to qualify for the position of assistant group supervisor, the role assigned to and being performed by staff person #3, #4, #6, and #8.

The file for child #3, #4, and #7 contain emergency contact information which lacks the complete address of the child's physician.

The file for child #4 contains emergency contact information which lacks the complete work address of the enrolling parent.

The file for child #2 and #3 contains emergency contact information which lacks the complete address of the parent-designed release person(s). The file for child #7 contains emergency contact information which lacks the complete address and phone number of the parent-designated release person(s).

The following rooms lacked a posting of the emergency transportation plan: pre-preschool and preschool.

The most recent updates to the emergency contact information and agreement on file for child #1, child #3, child #5 are dated more than 6 months apart.

The file for staff person #8 contains one reference letter dated after staff person #8 began in a child care taking position.

At the time of inspection, the facility lacked a posting which provided parents information on how to access the regulations in this chapter electronically and with instructions for contacting the appropriate regional child care office

The file for staff person #1 and staff person #5 lack verification of 12 clock hours of child care training completed in the most recent service year.

** During staff interviews staff stated that while children are standing facing the wall for time out they have held the children's hands behind their backs and placed their knee up against the child so the child stayed against the wall.

*During staff interviews staff stated that while children are standing facing the wall for time out they have held the children's hands behind their backs and placed their knee up against the child so the child stayed against the wall.

** During staff interviews staff stated that while children are standing facing the wall for time out they have held the children's hands behind their backs and placed their knee up against the child so the child stayed against the wall.

*During staff interviews staff stated that while children are standing facing the wall for time out they have held the children's hands behind their backs and placed their knee up against the child so the child stayed against the wall.

Staff person #1 could only identify four of the seven children she was supervising.