Wee Kare Child Center

The facility was observed to have a toy lawn mower with the handle broken off in the little play yard.

The file for child #2, a young toddler was observed to lack updated health reports obtained at least every 6 months for an infant or young toddler.

The file for child #1, a preschooler was observed to lack updated health reports obtained at least every 12 months as evidenced by the most recent health report in the file is dated 07/22/2024.

The files for children #2 and #3 were observed to contain immunization records that failed to be in accordance with the recommendations of the ACIP. The files for children #2 and #3 were observed to lack a written exemption regarding immunizations.

During an interview, it was stated that children #1, #2 and #3 were observed playing with a toy box. Child #1 climbed into the toy box and children #2 and #3 overturned the toybox injuring and frightening child #1 who was inside. While staff were in the area, they did not intervene prior to the incident.

Observed a pack n play in the infant area which was not labeled for the use of a specific child.

Observed several of the pack n plays being used in the infant room did not have 2 feet of space on three sides.

Observed in the infant room, a bottle for an infant which was not refrigerated and was left on a rocking chair.

Staff #1 threw 3 toys at child #1 striking child #1 in the head with the hard plastic tiger, causing injury.

Staff #1 threw 3 toys at child #1 striking child #1 in the head with the hard plastic tiger, causing injury.

Staff #1 did not complete an incident report regarding the injury to child #1 after being struck in the head with a hard plastic tiger toy.

The facility was observed to have documentation of providing a letter to the parent of each enrolled child that explains the emergency procedures, however, this letter failed to provide information regarding the accommodations for infants and toddlers.

The file for child #1, a preschool aged child was observed to lack a health report that was updated at least every 12 months as evidenced by a health report dated 08/25/23 present in the file.

The facility was observed to possess Equate Acetaminophen 24 chewable tablets that failed to indicate the name of the child for whom the medication was intended

The facility was observed to possess the prescription medication Albuterol labeled for Child #3 that was expired.

The facility was observed to have medication (Saline nasal spray) Labeled for child #2 but failed to have a parent's written consent for administration.

The facility was observed to possess medication logs for children #3 (Albuterol Ipratropium Bromide) and #4 (Diphenhydramine) that lacked special notes related to problems of administration.

The facility was observed to have an emergency plan that provides for accommodations for children with disabilities, and children with chronic medical conditions, but failed to provide for accommodations for infants and toddlers,

The record of Staff #1 did not include a DHS FBI Clearance and National Sex Offender Registry Certificate when the Certification Representative was at the facility. The record of Staff #2 did not include a valid Child Abuse Clearance when the Certification Representative was at the facility.

2nd citation. Previously cited on 10/3/23. The files of Children #1, #2, and #3 contained the original agreement. The facility did not make a copy for the files and give the original to the parent.

2nd citation. Previously cited on 9/28/23. The facility's current certificate of compliance was not posted in a conspicuous location used by parents.

Certification Representative observed Staff #1 placing garbage in the dumpster outside of the center. Upon entering the building, Certification Representative observed Staff #1 entering the Older Toddler Room. When Certification Representative asked Staff #1 and #2 to name the children in his/her assigned groups, Staff #1 named 5 older toddlers while Staff #2 named 5 older toddlers and 1 preschooler. When Certification Representative asked Staff #1 if another staff had taken his/her place in the room to maintain ratio while he/she was outside, Staff #1 indicated no because there was no extra staff.

On 10/16/23 observed a cot labeled #3 with frayed edges in the Young Toddler Room.

On 10/16/23 observed children with approximately 2 to 12 inches between their cots in the Pre K Classroom.

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. On 10/31/23 the facility had documentation of the most recent fire drill being conducted on 8/1/23.

Staff #2 lacked a State Police Clearance updated every 60 months. Staff #2 had a State Police Clearance dated 10/2/23 with a previous one dated 8/13/18. Staff #2 lacked a valid FBI Clearance. Staff #2 had an FBI Clearance from the Department of Education dated 8/14/23. Staff #2 also lacked a National Sex Offender Registry Certificate. Staff #3 lacked a valid FBI Clearance because it did not contain a disposition for charges. Staff #4 lacked a valid FBI Clearance. Staff #4 had an FBI Clearance from the Department of Education dated 9/16/22. Staff #5 lacked a valid Child Abuse Clearance. Staff #5 had a volunteer Child Abuse Clearance dated 4/15/22. Staff #6 lacked a State Police Clearance, Child Abuse Clearance, and DHS FBI Clearance updated every 60 months. Staff #6 had a State Police Clearance dated 8/10/23 with a previous one dated 5/6/18. Staff #6 had a Child Abuse Clearance dated 8/15/23 with a previous one dated 5/14/18. Staff #6 had a DHS FBI Clearance dated 8/15/23 with a previous one dated 5/9/18.

The emergency plan did not address continuity of operations.

On 9/28/23 observed Ajax Dish Soap which indicated "keep out of the reach of children" in the cabinet under the sink in the lunchroom which was accessible to children. On 9/28/23 observed Ajax Dish Soap which indicated "keep out of the reach of children" by the sink in the lunchroom which was accessible to children.

On 9/28/23 the hot water temperature at the sink located by the diapering area was 116 degrees in the Young Toddler Room. On 9/28/23 the hot water temperature at the sink in the bathroom located between the Young and Older Toddler Rooms was 116 degrees. On 9/28/23 the hot water temperature at the sink located by the diapering area in the Older Toddler Room was 112 degrees.

On 9/28/23 the first-aid kit taken outside was in the cubby by the diapering area in the Young Toddler Room which was accessible to children.

On 9/28/23 the first-aid kit for the classroom in the Young Toddler Room lacked nonporous gloves. On 9/28/23 the first-aid kit taken outside in the Young Toddler Room lacked soap, sterile gauze pads, tweezers, tape, and scissors.

On 9/28/23 observed approximately four 1-inch pieces of plaster missing on the wall to the left of the entrance in the Older Toddler Room.

On 9/28/23 the counter height sink in the Infant Room did not have platforms or steps, and staff were holding children to wash their hands.

On 9/28/23 observed a torn foam number in the Pre K Room. On 9/28/23 observed wood blocks with rough edges and splinters in the Pre K Room. On 9/28/23 observed torn foam steps/blocks with exposed foam in the Young Toddler Room. On 9/28/23 observed a torn mat with exposed foam under the climber in the Older Toddler Room. On 9/28/23 observed a missing screw on the top of the toy barn creating pinch points in the Older Toddler Room. On 9/28/23 observed wood blocks with rough edges and splinters in the School-Age Room.

On 9/28/23 observed embedded equipment in the Preschool/School-Age Outdoor Play Space with approximately 2 to 4 inches of mulch. The Consumer Product Safety Commission recommends 9 inches of mulch as protective surface covering.

On 9/28/23 observed foam blocks with bite marks and peg boards with bite marks in the Preschool Room.

On 9/28/23 observed a high chair in the lunchroom which lacked a T-shaped safety strap.

On 9/28/23 the thermometer in the refrigerator to the left of the sink in the lunchroom indicated the temperature was 48 degrees.

The file of Child #5, a 22-month-old, lacked an influenza immunization according to the recommendations of the ACIP. The file of Child #6, a 14-month-old, lacked an influenza immunization according to the recommendations of the ACIP. The file of Child #7, a 9-month-old, lacked an influenza immunization according to the recommendations of the ACIP. The file of Child #8, a 10-month-old, lacked an influenza immunization according to the recommendations of the ACIP.

Staff #1 lacked a health assessment conducted every 24 months. Staff #1 has a current health assessment dated 5/23/22 with a previous one dated 5/21/20.

The files of Children #1 and #2 lacked an initial health report no later than 60 days following the first day of attendance at the facility. Child #1, with an admission date of 7/6/22, contained a health report dated 10/8/22. Child #2, with an admission date of 6/7/23, contained a health report dated 9/15/23.

Staff person #2 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.

Staff #7 lacked documentation of completing mandated reporter training every 60 months. Staff #7 had documentation of completing mandated reporter training on 9/5/23 with previous training completed on 7/11/18.

Children #4 and #5 lacked child service reports completed at least every 6 months. Child #4 had a child service report completed on 1/12/23. Child #5 had child service reports completed on 7/25/22 and 1/16/23.

The files of Children #3, #5, and #7 contained the original agreement. The facility did not make a copy for the files and give the original to the parent.

Emergency contact information for Children #1 and #4 did not include the telephone number of the child's physician or source of medical care.

Emergency contact information for Child #1 did not include the work telephone number of the enrolling parent.

The file of Child #1 lacked written consent signed by a parent for emergency medical care prior to admission. Child #1 had an admission date of 7/6/22 with an emergency contact form signed on 6/16/23.

Emergency contact information for Child #9 was not present in the Preschool Room where Child #9 was receiving care.

The emergency contact and agreement for Child #1 were not reviewed and updated at least once in a 6-month period. Child #1's emergency contact was reviewed on 6/16/23 and agreement was reviewed on 3/1/22, 9/1/22, and 9/1/23. The emergency contact for Child #4 was not reviewed and updated at least once in a 6-month period. Child #4's emergency contact was reviewed on 8/30/22, 3/14/23, and 9/28/23. The emergency contact for Child #5 was not reviewed and updated at least once in a 6-month period. Child #5's emergency contact was reviewed on 6/23/22, 1/5/23, and 6/8/23.

The file of Child #1 lacked signed parental consent for administration of minor first-aid procedures by facility staff prior to admission. Child #1 had an admission date of 7/6/22 with an emergency contact form signed on 6/16/23.

It was observed that an agreement was not on file at the date of enrollment. Child #7's date of admission was 8/15/23 with an agreement dated 8/29/23.

Staff #3 lacked documentation of completing professional development in pediatric first aid and pediatric cardiopulmonary resuscitation within 90 days of hire (SEE LIS Code Sheet). Staff #3 had documentation of completing pediatric first aid and pediatric cardiopulmonary resuscitation on 6/24/23.

The facility's current certificate of compliance was not posted in a conspicuous location used by parents.

Based on interviews with staff, Staff #1 placed Child #1 between his/her legs during circle time and used his/her hands to keep the child from leaving when he/she attempted to do so. Based on interviews, Staff #2 held Child #2 under his/her arms and around his/her waist allowing the child to move but not get away from staff.

*Based on interviews with staff, Staff #1 placed Child #1 between his/her legs during circle time and used his/her hands to keep the child from leaving when he/she attempted to do so. Based on interviews, Staff #2 held Child #2 under his/her arms and around his/her waist allowing the child to move but not get away from staff.

**Based on interviews with staff, Staff #1 placed Child #1 between his/her legs during circle time and used his/her hands to keep the child from leaving when he/she attempted to do so. Based on interviews, Staff #2 held Child #2 under his/her arms and around his/her waist allowing the child to move but not get away from staff.

Based on interviews with staff, Staff #1 placed Child #1 between his/her legs during circle time and used his/her hands to keep the child from leaving when he/she attempted to do so. Staff #1 indicated he/she thought Child #1 needed to participate in circle time with the librarian.

At approximately 6:30 AM on 6/1/23 Staff #1 was observed caring for a group of 16 mixed-age children which included 10 preschoolers, 5 young school-age children, and 1 older school-age child in the school-age classroom.

The file of Staff #1 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 #1 contained a health assessment dated 9/1/21.

The file of Staff #1 lacked an initial health assessment which included tuberculosis screening by Mantoux method at initial employment (SEE LIS Code Sheet). Staff #1 had a Mantoux read date of 9/3/21.

The facility was unable to provide documentation that the fire detection system was manually tested at least every 30 days or inspected by a fire safety professional annually. The facility provided documentation that the fire detection system was manually tested on 2/10/23, 3/10/23, and 3/21/23.

Staff person #2 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.

*At approximately 7:30 AM on 4/10/23 Staff #1 was caring for a group of 12 mixed-aged children which included 8 preschoolers, 3 young school-age children, and 1 older school-age child. At approximately 7:35 AM Staff #2 was caring for a group of 7 mixed-aged children which included 6 infants and 1 young toddler.

**At approximately 7:30 AM on 4/10/23 Staff #1 was caring for a group of 12 mixed-aged children which included 8 preschoolers, 3 young school-age children, and 1 older school-age child. At approximately 7:35 AM Staff #2 was caring for a group of 7 mixed-aged children which included 6 infants and 1 young toddler.

***At approximately 7:30 AM on 4/10/23 Staff #1 was caring for a group of 12 mixed-aged children which included 8 preschoolers, 3 young school-age children, and 1 older school-age child. At approximately 7:35 AM Staff #2 was caring for a group of 7 mixed-aged children which included 6 infants and 1 young toddler.

The file of Staff #3, a provisional hire, lacked application for the National Sex Offender Registry Certificate prior to or on the date of initial hire (SEE LIS Code Sheet). The file of Staff #3 did not contain documentation of applying for the NSOR, and no NSOR was on file.

At approximately 10:15 on 3/22/23 Staff #1 and Staff #2 were caring for 11 mixed-age children including 1 preschooler, 6 older toddlers, and 4 young toddlers. When asked to name the children in their assigned groups, Staff #1 identified 1 preschooler, 4 older toddlers, and 1 young toddler while Staff #2 identified 3 young toddlers and 2 older toddlers.

*At approximately 2:50 PM Certification Staff observed 3 preschoolers lying on rest equipment behind a sofa and bookcases in the School-Age Classroom which did not allow for critical oversight in which the supervisor could see, hear, direct, and assess the activity of the supervisees.

**At approximately 2:50 PM Certification Staff observed 3 preschoolers lying on rest equipment behind a sofa and bookcases in the School-Age Classroom which did not allow for critical oversight in which the supervisor could see, hear, direct, and assess the activity of the supervisees.

***At approximately 2:50 PM Certification Staff observed 3 preschoolers lying on rest equipment behind a sofa and bookcases in the School-Age Classroom which did not allow for critical oversight in which the supervisor could see, hear, direct, and assess the activity of the supervisees.

Staff #1 lacked documentation of completing mandated reporter training every 60 months. Staff #1 had documentation of mandated reporter training completed on 1/10/20 with previous training completed on 12/22/14.

2nd citation. Previously cited on 9/26/22. Observed two Bath and Body Works' hand sanitizers which indicated "keep out of the reach of children" in the top drawer of a filing cabinet which were accessible to children in the Pre-K Classroom.

2nd citation. Previously cited on 9/26/22. Observed a torn multi-color gym mat with exposed foam in the Infant Classroom.

2nd citation. Previously cited on 9/26/22. Observed embedded equipment in the Preschool/School-Age Outdoor Play Space with approximately 1 to 2 inches of mulch. The Consumer Product Safety Commission recommends 9 inches of mulch as protective surface covering.

2nd citation. Previously cited on 9/28/22. The facility had a policy that addressed the recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma and strategies for coping with a crying, fussing, and distraught child, but it did not address the prevention and identification of child maltreatment.

2nd citation. Previously cited on 9/28/22. The facility lacked a group supervisor employed by and present at the facility for a minimum of 30 hours per week for the first group of 45 enrolled children and for each group or partial group of 45 additional enrolled children.

2nd citation. Previously cited on 8/16/22. Staff persons #7 and #8 were observed to be caring for children unsupervised. Staff person #7 has not completed the following pre-service training required prior to caring for children unsupervised: mandated reporter training, pediatric first aid/CPR, and health and safety. Staff person #8 has not completed the following pre-service training required prior to caring for children unsupervised: health and safety. On 9/26/22 and 9/28/22 Certification Staff observed Staff person #6, who was designated as an aide, Staff person #7, a provisional hire, and Staff person #8, who was designated as an assistant group supervisor, working in the Infant Classroom.

The files of Staff #1, #6, and #7 lacked a valid disclosure statement (SEE LIS Code Sheet). The disclosure statement on file for Staff #1, #6, and #7 was not the one updated in 2020. The file of Staff #3 lacked an FBI Clearance updated every 60 months. The file of Staff #3 contained an FBI Clearance dated 9/18/19 with a previous one dated 9/12/14. The file of Staff #5, a provisional hire, lacked documentation of application for the National Sex Offender Registry Verification Certificate and the State child abuse and neglect registry check and State sex offender registry check from the State(s) in which Staff #5 resided in the last 5 years prior to or on the date of initial hire (SEE LIS Code Sheet). The file of Staff #5 contained a NSOR receipt dated 9/22/22. The file of Staff #5 did not contain applications for the State child abuse and neglect registry check and State sex offender registry check from the State(s) in which Staff #5 resided in the last 5 years. The files of Staff #6 and #7, provisional hires, lacked documentation of the results for the PA Child Abuse Clearance prior to or on the date of initial hire (SEE LIS Code Sheet). The file of Staff #6 contained a PA Child…

At approximately 1:55 PM on 9/28/22 Certification Staff observed 3 children lying on rest equipment behind bookcases in the Older Toddler Room which did not allow for critical oversight in which the supervisor could see, hear, direct, and assess the activity of the supervisee.

On 9/26/22 observed 2 pair of adult scissors on the teacher's desk which were accessible to children in the School-Age Classroom.

On 9/26/22 observed Pen Gear Dry Erase Board Cleaning Spray which indicated "keep out of the reach of children" in a plastic black crate at the changing table which were accessible to children in the Older Toddler Classroom. On 9/26/22 observed Bingo Daubers in the Art area which indicated "keep out of reach of children" which were accessible to children in the Pre K Classroom. On 9/26/22 observed a Bic Lighter and pack of cigarettes in the top drawer of a filing cabinet which were accessible to children in the Pre K Classroom. On 9/26/22 observed Antibacterial Moisturizing Hand Solution Sun-ripened Raspberry which indicated "keep out of the reach of children" on the teacher's desk which was accessible to children in the School-Age Classroom.

The first-aid kit in the Young Toddler Classroom lacked scissors and gloves.

On 9/26/22 observed exposed bolts on the fence in the Infant/Toddler Outdoor Play Space.

On 9/26/22 the urinal in the bathroom between the Young and Older Toddler Classrooms lacked a handwashing sign. On 9/26/22 the urinal and toilet in the bathroom between the Preschool and Pre K Classrooms lacked handwashing signs.

On 9/26/22 observed a torn blue exercise mat with exposed foam in the Young Toddler Classroom. On 9/26/22 observed a torn mat with exposed foam under the slide in the Young Toddler Classroom. On 9/26/22 observed a loose back on the toy oven in the Older Toddler Classroom. On 9/26/22 observed a frayed area rug at the entrance to the Older Toddler Classroom. On 9/26/22 observed a torn multi-color gym mat with exposed foam in the Infant Classroom. On 9/26/22 observed a torn number mat with exposed foam in the Infant Classroom. On 9/28/22 observed a Blue Riding Toy with approximately a 2 inch by 2 inch hole in the right front wheel in the Infant/Toddler Outdoor Play Space. On 9/26/22 observed the 2nd level of a doll house was loose in the Pre K Classroom. On 9/26/22 observed cracked marble connectors in the School-Age Classroom. On 9/26/22 observed a cracked bin containing LEGO construction vehicles in the School-Age Classroom. On 9/26/22 observed a cracked purple bin containing games including Hangman in the School-Age Classroom. On 9/26/22 observed a cracked bin containing Mr. Potato Head pieces in the School-Age Classroom. On 9/26/22 observed a round blue table with loose legs at…

On 9/26/22 observed embedded equipment in the Preschool/School-Age Outdoor Play Space with approximately 1 to 2 inches of mulch. The Consumer Product Safety Commission recommends 9 inches of mulch as protective surface covering

On 9/26/22 observed several bags of small glass gems with a diameter of less than 1 inch in the plastic bin labeled "Wednesday" which were accessible to children by the changing table in the Older Toddler Classroom. On 9/26/22 observed foam letters with bite marks in the Preschool Classroom. On 9/26/22 observed plastic bags in the cabinet under the microwave in the cafeteria which were accessible to children in care.

On 9/26/22 observed t-shaped safety straps missing from 2 built-in seats at the table in the Infant Classroom.

On 9/26/22 observed 9 children with less than 2 feet of space on three sides of their mats in the Pre K Classroom.

The file of Child #7 lacked an updated health report at least every 6 months for an infant or young toddler. The file of Child #7 contained a health assessment dated 12/9/21.

The files of Children #1 and #2 lacked an updated health report at least every 12 months for an older toddler or preschool child. The file of Child #1 contained a health report dated 10/7/19. The file of Child #2 contained a health report dated 6/5/19.

The file of Child #4 lacked a health report which included a review of the child's immunized status according to the recommendations of the ACIP.

Child #1, a 3 year old, lacked DTAP/DTP/TD, Pneumococcal, a current influenza, MMR, Varicella, and Hepatitis A immunizations in accordance with the schedule recommended by the ACIP. Child #1 had documentation of 3 DTAP/DTP/TD, 3 Pneumococcal, and no documentation of MMR, Varicella, and Hepatitis A immunizations. Child #2, a 4 year old, lacked DTAP/DTP/TD, Pneumococcal, MMR, Varicella, and Hepatitis A immunizations in accordance with the schedule recommended by the ACIP. Child #2 had documentation of 3 DTAP/DTP/TD, 3 Pneumococcal, and no documentation of MMR, Varicella, and Hepatitis A immunizations. Child #7, a 2 year old, lacked documentation of a current influenza, Varicella, and Hepatitis A immunizations in accordance with the schedule recommended by the ACIP. Child #7 had documentation of no Varicella immunization and 1 Hepatitis A immunization.

Written notification of safe routes was not posted by the operator at a conspicuous location in the child care facility.

An emergency drill was not conducted annually between 12/19/2020 and 12/19/2021. The facility had documentation of an emergency drill being conducted on 8/30/22.

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's admission date was 7/19/22 with a health report dated 9/22/22.

The facility did not have a policy that addressed the recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma, strategies for coping with a crying, fussing, and distraught child, and the prevention and identification of child maltreatment.

Staff #4 lacked documentation of mandated reporter training completed within 90 days of hire (SEE LIS Code Sheet). Staff #4 had documentation of completing mandated reporter training on 10/6/21.

The file of Staff #2 lacked documentation of a written evaluation on a regular basis, a minimum of one evaluation every 12 months. The file of Staff #2 did not contain a written evaluation for 2021 or 2022.

The facility lacked a group supervisor employed by and present at the facility for a minimum of 30 hours per week for the first group of 45 enrolled children and for each group or partial group of 45 additional enrolled children.

The files of Children #4 and #5 lacked the persons designated by a parent to whom the child may be released on the agreement.

The file of Child #8 lacked the telephone number of the child's physician or source of medical care on the emergency contact form.

The file of Child #1 lacked the work address and work telephone number of the enrolling parent on the emergency contact form. The file of Child #8 lacked the work address of the enrolling parent on the emergency contact form.

The files of Children #1, #2, #4, and #5 lacked 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, on the emergency contact form.

The file of Child #3 lacked the health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable, on the emergency contact form.

The file of Child #1 lacked the complete address of the individual designated by the parent to whom the child may be released on the emergency contact form. The files of Children #2 and #8 lacked the address of the individual designated by the parent to whom the child may be released on the emergency contact form.

Emergency contact information for Child #9 was not present in the Older Toddler Classroom when Child #9 was receiving care in the space. Emergency contact information for Child #10 was not present in the Preschool Classroom when Child #10 was receiving care in the space. Emergency contact information for Children #11, #12, #13, #14, #15, and #16 were not present in the Pre K Classroom when Children #11, #12, #13, #14, #15, and #16 were receiving care in the space.

The emergency contact and agreement for Children #1 and #2 were not reviewed and updated at least once every 6 months with the reinstating of this regulation on 1/6/22. Child #1's emergency contact form was reviewed on 7/21/21, 2/1/22, and 8/1/22. Child #1's agreement was last reviewed on 7/17/19. Child #2's emergency contact form was reviewed on 2/24/20 and then again on 7/2/22. Child #2's agreement was reviewed on 1/2/20 and then again on 9/1/22. The emergency contact for Child #8 was not reviewed and updated at least once every 6 months with the reinstating of this regulation on 1/6/22. Child #8's emergency contact was reviewed on 7/21/20 and then again on 6/30/22.

It was observed that the agreement was not on file for Children #3, #5, #6, #7, and #8 at the date of enrollment. Child #3's date of admission was 9/19/22 with an agreement dated 9/22/22. Child #5's date of admission was 7/18/22 with an agreement dated 9/1/22. Child #6's date of admission was 3/7/22 with an agreement dated 5/5/22. Child #7's date of admission was 1/28/22 with an agreement dated 3/23/22. Child #8's date of admission was 6/10/22 with an agreement dated 9/20/22.

The file of Staff #2, #3, and #4 lacked documentation of completing an annual minimum of 12 clock hours of child care training.

**At approximately 11:30 AM on 8/23/22 when Staff #1 was asked to name the children in her assigned group, Staff #1 named 13 children which included 1 older school-age child and 12 young school-age children.

*At approximately 11:30 AM on 8/23/22 when Staff #1 was asked to name the children in her assigned group, Staff #1 named 13 children which included 1 older school-age child and 12 young school-age children.

Staff persons #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, and #14 were observed to be caring for children unsupervised. Staff persons #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13 and #14 have not completed the following pre-service training required prior to caring for children unsupervised: pediatric first-aid and CPR. Staff persons #5, #13, and #14 were observed to be caring for children unsupervised. Staff persons #5, #13, and #14 have not completed the following pre-service training required prior to caring for children unsupervised: mandated reporter training and health and safety training. Staff person #10 was observed to be caring for children unsupervised. Staff person #10 has not completed mandated reporter training within the last 60 months. This is evidenced by the previously documented mandated reporter training on file being dated 3/20/16.

The Director or designated staff person did not ensure that fire drills are conducted at least once every 60 days. The Director provided documentation of fire drills being conducted on 1/21/22, 2/3/22, 3/1/22, 4/1/22, 6/1/22, and 8/1/22.

The facility was unable to provide a written record that the fire detection system was manually tested at least once every 30 days. The facility provided a written record that the fire detection system was manually tested on 11/1/21, 12/1/21, 1/3/22, 1/22/22, 2/3/22, 3/1/22, 4/1/22, 5/1/22, 6/1/22, 7/1/22, and 8/1/22.

Staff person #1, #2, #3, #,4, #6, #7, #8, #9, #10, and #12 have not completed the following required pre-service training within 90 days of their date of hire (see LIS code sheet): Pediatric First-aid and CPR.

Staff person #10 has not completed mandated reporter training within the last 60 months. This is evidenced by the previously documented mandated reporter training on file being dated 3/20/16.

Staff #12 lacked documentation of completing Mandated Reporter Training within 90 days of hire (See LIS CODE SHEET). Staff #12 had documentation of completing Mandated Reporter Training on 5/12/22.

On 11/23/21 facility staff verbally confirmed using a highchair to confine child #1 as a means of behavioral management when child #1 had become a danger to self and others by exhibiting assaultive behaviors in the classroom.

On 11/23/21 facility staff verbally conformed that a highchair, which was labeled by the manufacturer to be used for children ages 2 to 2 1/2 years old, was used for a 3 year old child.