Willow Tree Learning CTR

At approximately 11:15 AM, staff #1 left staff #2 alone in room #2 to supervise a group of 22 children of mixed age levels (10 preschool children and 12 school-age children) while staff #2 answered the door; and staff #3 was observed supervising a group of 5 children of mixed age levels (2 infants and 3 younger toddlers) alone in room #1.

Children's lunch boxes containing potentially hazardous food brought from the children's homes were not refrigerated.

It has been more than 60 days since a fire drill was last conducted on 3/7/2025.

It has been more than 30 days since the fire detection system was last tested on 3/28/2025.

Loose sheets were observed in (4) pack n plays being used by infants in room #1, which posed a suffocation risk to the children who were using the equipment.

The record for staff #2 and staff #3 included a current NSOR dated 3/20/2025, which was more than 60 months following the date of their previous NSOR on 1/31/2020.

The facility's emergency plan did not provide a plan for continuity of operations, as per Announcement C-22-04.

The operator did not document in writing their annual review of the emergency plan.

The parent letter did not explain the facility's lockdown procedure and plan to provide accommodations for infants, toddlers, children with disabilities and children with chronic medical conditions.

A section of chain link fencing that measured approximately 2'x2' was missing in the outdoor play space and there were no other natural barriers to restrict children from the unsafe high traffic roadways surrounding the facility.

A Yucca plant that was identified as being toxic to humans was observed in room #1.

Sharp metal pieces were protruding from a damaged section of the chain link fence in the outdoor play space, which posed a hazard to children using the space.

There was less than 2 feet of space on three sides of a pack n play in use by an infant in care in room #1.

The record for staff #2 lacked a current health report.

The record for child #3 contained a current health report dated more than 60 days following their first day of attendance at the facility.

The operator did not notify local traffic safety authorities annually in writing of the location of the facility and the program's use of pedestrian and vehicular routes around the child care facility during the period between 3/19/2024 and 4/4/2025.

Staff #2, #3, #4 and #5 did not participate in annual fire safety training.

Staff #4 did not complete professional development within 90 days of hire as listed in subsections (f)1-10. Staff #1 completed Health and Safety Basics: Building Blocks for Quality on 5/16/2019, which was not an accepted training after 6/30/2018.

A child service report was not completed and provided to the family for child #1 and #2.

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

A parent did not review and update in writing the emergency contact form for child #2 at least once in a 6-month period between 3/5/2024 to 3/18/2025.

The record for staff #1 included a written, nonfamily reference from individual attesting to the person's suitability to serve as a facility person dated 3/19/2025, which was following their first day working in child care.

The facility's current certificate of compliance was not posted.

Staff #2, #4, and #5 did not obtain an annual minimum of 12 clock hours of child care training.

The record for staff #2 lacked a disclosure statement. The record for staff #4 lacked a current FBI clearance.

Staff persons #4 and #5 who were qualified as aides were observed supervising a group of children in room #1 alone without a staff person qualified at minimum as an assistant group supervisor present to supervise them.

At approximately 9:07 AM, staff #1, #3 and #4 were observed supervising a group of 22 children of mixed age levels, including 1 infant, 5, younger toddlers, 2 older toddlers and 14 preschoolers in room #1.

The parent letter explaining the emergency procedures did not include the following subsequent updates to the plan: accommodations for infants, toddlers, children with disabilities, and children with chronic medical conditions; and lockdown.

There were 6 sharp bolts protruding from the chain link fence surrounding the outdoor play space, which posed a potential hazard for children in care.

The sink at the diaper changing area was not at a proper height for children using it or easily approached by means of platform or steps.

The record for child #1, a preschool child, contained a current health report dated more than 12 months following the date of their previous health report.

The record for staff #2 lacked a current health assessment.

The annual emergency drill was not documented and on file at the facility.

The operator's policy and procedure to identify the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment did not address the identification and prevention of child maltreatment, as per Announcement C-22-03. Staff #4 completed the Pennsylvania Health and Safety Update 2022 on 3/21/2024, more than 90 days following their date of hire.

Staff #4 completed mandated reporter training on 3/21/2024, more than 90 days following their date of hire.

The record for staff #2, who was presented as an AGS, lacked verification of 2 years experience with children.

The record for staff #4, who was presented as an aide, lacked verification of a minimum of an 8th grade education and 2 years of experience with children.

Emergency contact information was not present in room #1 for children receiving care in the space.

Staff #4 completed professional development in pediatric first aid and pediatric CPR on 3/13/2024, more than 90 days following their date of hire.

The facility's current certificate of compliance was not posted.

There were loose sheets observed in a pack n play being used by an infant in the baby room, which posed a suffocation risk to the child in care who was using the equipment.

The record for staff #6 included a signed disclosure statement that was not dated, which makes it invalid.

There were cracks observed on the outdoor play equipment (the slide and the door on the playhouse) in the fenced outdoor play spaces, which posed a potential pinch point for children using the equipment.

The record for child #1, an infant, contained a current health report dated more than 6 months following the date of their previous health report.

The record for child #3, a preschool child, contained a current health report dated more than 12 months following the date of their previous health report.

A fire drill had not been conducted at least once within the past 60 days; The last documented fire drill was conducted on 1/16/2023.

The fire detection system had not been tested in the past 30 days; The last documented test of the fire detection system was on 2/17/2023.

The facility did not document the submission of emergency plan updates to the to the local and county emergency management agencies using the Emergency Plan Delivery Documentation (form CD 355) or other form of proof of emergency plan submission, as per Announcement C-22-04.

The provider did not have a policy and procedure to identify the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment to maintain compliance with 45 CFR 98.41(a)(1)(vi). The facility's emergency plan did not include requirements for volunteer emergency preparedness training, practice drills and continuity of operations to maintain compliance with 45 CFR § 98.41(a)(1)(vii). Staff #1, #2, #3, #4 and #5 completed the Pennsylvania Health and Safety Update 2022 following December 30, 2022, which was the prescribed timeframe required by OCDEL to complete the training, as per Announcement C-22-06.

Staff #5 completed the professional development as listed in subsections (f)1-9 on 2/5/2023, which was more than 90 days following their date of hire - see staff individual codes.

The record for staff #5 included verification of mandated reporter training completed on 2/5/2023, which was more than 90 days following their date of hire - see staff individual codes.

The director did not complete a written evaluation of staff person #2 within the past 12 months; The last written evaluation of staff #2 was completed on 10/20/2021.

The written plan of daily activities was not posted in the therapy room, the space used for toddler's activities and the gross motor room.

The record for child #1 who has been enrolled in child care more than 6 months did not contain a child service report or other Department approved form to provide information to the family about the child's growth and development in the context of the services being provided.

A written plan identifying the means of transporting a child to emergency care and staffing provisions in the event of an emergency was not displayed in the therapy room, the baby room, the young toddler room, the older toddler room, the space used for toddler's activities, and the gross motor room.

The emergency contract information for child #2 had not been reviewed by the child's parent since 4/11/2022. The emergency contact information for child #4 was reviewed by the child's parent on 12/13/2022, which was more than 6-months following the date of the completion of the emergency contact form on 12/9/2021.

Staff #5, who has worked in child care more than 90 days, has not completed professional development in pediatric first aid and pediatric cardiopulmonary resuscitation.

The file for staff #5 contained expired clearances. The dates are as follows; state police 9/30/16, child abuse 10/16/16, and FBI 10/19/16.

Upon entering the infant room at approximately 10:15 am, child #6, an infant, was observed sleeping and buckled into a car seat. Based on statements made by staff, the child arrived around 7:30 am and was asleep in the car seat at the time of arrival.

Based on documentation at the facility, staff have not received emergency plan training on an annual basis. The last documented training occurred 2/24/21. Staff #3, with a start date of 8/16/21, has not yet received emergency plan training.

A bottle of liquid white-out was observed in the top drawer of a plastic teacher's storage tower in the preschool room. The drawer was not locked. The bottle was labeled "Keep out of reach of children."

Splintering wood was observed on the lower portion of a door in the older toddler room. Sharp edges were observed on the fence of the outdoor play space. A piece of the fencing was cut out and then put back in place using zip ties leaving sharp areas where the metal had been cut.

A broken bottle containing a bubble mixture was observed on the stoop of the door used to access the outside play area. The broken plastic created sharp edges.

Holes were observed on the cover of a changing pad in the young toddler room. The inner foam filling of the pad was accessible.

The file for child #3 does not contain a current health report. The most recent health report on file was conducted over 24 months ago. The file for child #2 contains a health assessment which was updated after the reinstatement of the regulation. The most recent health report on file for child #2 is now current.

The files for children #3, #4, and #5 contained immunization records which lacked documentation of receiving the influenza vaccine in accordance with the schedule recommended by the ACIP. Written exemptions were not on file.

A bottle of acetaminophen, intended for child #6, was not labeled with the child's name. The medication was observed in the preschool med box.

A bottle of ibuprofen and a bottle of Tylenol were accessible to children in the preschool room. The medications were observed in a staff member's purse sitting on the floor.

Albuterol, intended for child #1, lacked written parental consent for administration. The medication was observed in the preschool med box.

The files for staff #4 and #6 did not contain current health assessments completed in the last 24 months.

An unlabeled bottle was observed in the infant room refrigerator. The bottle was intended for child #6.

The facility has not conducted an annual emergency drill.

The file for staff #3, hired on 8/16/21, did not contain documentation of completing training on the health and safety topics as referenced in 3270.31(f) 1-9. The files for staff #4, #5, and #7, all hired prior to 12/19/20, did not contain documentation of completing training on the health and safety topics as referenced in 3270.31(f) 1-9.

Based on documentation at the facility, staff #3, hired on 8/16/21, has not completed mandated reporter training. Staff #8 did not update mandated reporter training within 60 months as required. Staff #8 previously completed the training on 10/21/16 and updated it on 3/6/22. Staff #5 does not have current mandated reporter training on file. The last training for staff #5 occurred 10/11/16.

The files for staff #4 and #5 did not contain evaluations completed in the last 12 months. The last evaluation for staff #4 was dated 9/03/20. The last evaluation for staff #5 was dated 10/20/20.

The files for children #2 and #3 contained emergency contact information and agreements which have not been updated in over 24 months. The documents for child #2 were last updated 1/13/20. The documents for child #3 were last updated 12/19/19.

The file for staff #3, hired on 8/16/21, did not contain documentation of completing pediatric CPR and pediatric first aid training.

Based on documentation at the facility, staff have not completed 12 annual hours of training. The hours for each staff are as follows; staff #1 and #8 have completed 9 hours, staff #4 and #7 have completed 3 hours, and staff #5 has completed 0 hours.

Based on statements made by staff, child #1, a preschool aged child was hitting and spitting on staff. In response, Staff #1 used his/her finger to tap child #1 on the lips one time. Staff #1 squeezed child #1's cheeks between his/her thumb and fingers.

Based on statements made by staff, child #1 was redirected by staff saying, "stop, or you're going in the chair." Child #1 had been previously restrained in a high chair for unwanted behavior.

Based on statements made by staff, child #1, a preschool aged child, was placed in a high chair on more than one occasion when the child would not follow directions

On 10/29/21, at approximately 9:40 AM, 23 preschool age children were observed with staff #1 and staff #2. Staff #3 was responsible for 3 of the PS children, but was observed leaving the room upon the arrival of the certification representative. Staff #3 was observed leaving the PS room, walking through the kitchen and entering the infant room from the rear door. Staff #3 then returned to the PS room.

On 10/29/21 at approximately 9:43AM, staff #4 was observed in the kitchen with 7 children; 5 older toddlers and 2 young toddlers. Staff #5 was observed in the older toddler room which connects to the kitchen. Staff #5 returned to the kitchen as the certification representative entered and stated they left the kitchen to retrieve the photo cards used to identify the children in their care group.

At the time of the inspection, the operator was unable to provide a written record of monthly testing of the facility's fire alarms or an annual inspection report for those alarms.