Loading...
Evaluation Form (3) 2/19 ALABAMA LLPARTMENT OF HUMAN RE;,JURCES CHILD CARE HOME LICENSING EVALUATION Licensee:�aA J Date(s) of EvaluationAt� /r "(_ I� Naipe of Facility: Date(s) of Follow-up: ?Addre s/C ty: Purpose of Visit: 6W Ck J 6 #:hone Tele p • ( � ) q2? gS 1 p [ Day are ❑ Nighttime Care Family ❑ Group ❑ Subsidy Licensed Capacity: Day Night Age Range: Da Night �! Days of Operation: Day/ Night Hours of Operation: Day Nightw License Number:F62600046 Codes:O—Observed by DHR Licensing Representative Effective Dates of License: S—Certified by Licensee �� D—Discussed with Licensee Fro m:5 ") To' X Not Applicable-Not reviewed with Licensee Deficiencies Noted: es ❑ No DH Lice 'n Repres nt tive: Sections to be completed at the discretion of the DH Licensing Representative. a) a a) a� REGULATIONS a REGULATIONS a u CU Q Q _ Q Q _ o 0 CL a E O a U Q U Q O o Z Z Z Z Licensing-Procedures(II.,B., pages 11-15) (4) Dangerous substances locked 1'. Provisions of license/permit(IL,B.,7., (5) Aggressive animals not kept ` pages 12-15) X a. Number of children in the care of the licensee does (6) Animals that pose a threat kept away from \/ not exceed licensed capacity, children b. Ages range of children in care conforms to ages ory (7)Fans in reach of children enclosed ,l license. S U c. Current license/permit posted. ® (8) Electrical outlets covered 0 16-24 Are any guns firearms kept in the home or on The Home(II.C. pages ) p the remises. 1. Indoor area (II.,C.,pages 16-20) Yes p No a. Injury prevention(II.,C.,2.,a.,pages 16-17) (9) Guns/firearms unloaded (1) Home free of apparent hazardous conditions (10) Guns/firearms in locked storage (2) Home Has electricity,water,gas,waste disposal (11) Ammunition stored separately from / guns/firearms in locked storage x (3) Home has working telephone (1,2) Stairs have handrails in child's reach 1 U U z C S? REGULATIONS REGULATIONS 2Q Q Q Q a _ o E C- E C' U Q O U Q U o U o 0 Z z Z Z (13) Smoking prohibited during hours of.care (4) No child shall sleep with an adult. (14) Clear glass doors marked at child level (5) Each child younger than 12 months sleeps alone in a crib or playpen. (15) Tools and machinery inaccessible (6) Crib slats no more than 2 3/8 inches apart (16) Hot tubs covered or drained during hours of care (7) Crib mattress waterproof,good condition (17) Working flashlight conveniently located o (8) No infant put to sleep on sofa,soft mattress or other soft surface. (18) Consumption of alcohol prohibited during hours (9) Each child 12-18 months sleeps alone in a of care J crib,play pen or a low cot. (19) Non-prescription narcotic or illegal substances ��yy (10) Two children over 18 months of the same prohibited U' sex may share a double or larger bed or may sleep alone b. Cleanliness and health(II.,C.,2.,b.,pages 17-18) (11) Beds,cribs,cots,or playpens clean and { sanitary and free of hazards,maintained in good (1) Bathroom clean condition (2) Foot stools for handwashing and toileting (12) Bedding adequate,appropriate to season (3) Potty chairs(if used)emptied,washed,disinfected (13) Sheets and covers laundered weekly or after each use more often when soiled. (4) Rodent/insect infestation prevented/eliminated ` (14) Number of beds: (5) Garbage and trash stored in covered water-tight, (15) Number of cots: fly-proof containers and removed regularly v (6) Bedding,toys,utensils,toilets,sinks used by a (16) When not in use by family members,beds sick person cleaned and disinfected before use by covered with clean linens before used by children another person in care. (7) Windows and doors used for ventilation screened (17) Waterbeds not used by a child c. Space(II.,C.,2.,c.,page 18) (18) Upper/top bunk beds not used by a child (1) Rooms well-lighted,ventilated,comfortably (19) No child sleeps/naps on floors cooled or heated as appropriate to the season (2) Space for providing privacy to a child in care and (20) Required indoor equipment provided. members of the household as needed. O (See equipment checklist for details) (3) Clean,appropriate facilities for protection, (21) Recorded/printed material shall be storage,preparation of food. previewed for appropriateness before shown to children d. Equipment and furnishings (II.,C.,2.,d.,pages (22) All material with sexually explicit, 18-20) frightening,or violent content kept inaccessible to children (1) Crib,bed,playpen or cot provided for each child 2. Outdoor area(11.,C.,pages 19-21) for rest/sleep during hours of care. U (2) Number of cribs that meet the US ]� Consumer Product Safety Act of 2008: V (3) Number of playpens: 2 aa)) a) a) 1 W (D N REGULATIONS `m REGULATIONS m `m_ Q Q _ Q Q _ E E a E E a O V Q 0 Q U o o U o . o Z : Z Z Z (4) Person with current American Red Cross a. Outdoor play area(pages 20-21) Lifeguard Training certificate in pool area at all times pool is in use (1) Children supervised at all times. (5) Copy of Lifeguard Training Certificate on file in home (2) Outdoor play area free from apparent hazards (6) Wading structure less than 2 feet in depth, has continuous adult supervision (3) Fence at least 4 feet in height, free from sharp, (7)Wading structure/pool filled with clean l / protruding edges (except where prohibited by federal water each day,emptied when not in use x law) (8) The licensee is present during any swimming/wading activities (4) Required outdoor equipment provided (See Jl ` 3. Transportation (pages 22-23) equipment checklist for details) 0 (5) Outdoor play equipment not designed to be Does the licensee provide portable,anchored transportation for child en in care? (6) Concrete or asphalt not used under equipment Yes ❑ No (7) Area free of stacked lumber,construction NOTE: The Department of H man Resources materials,firewood does not inspect activities away from the home. The licensee shall assume full authority._and (8) Stairs/steps have hand rails in child's reach responsibility for away from the home activities. b. Injury prevention(page 21) a. Licensee responsible for children they transport (1). Home and grounds free of apparent hazards b. Licensee responsible for picking child up at including abandoned automobiles, unused appliance, the designated location and delivering the child uncovered wells and cisterns, stacked lumber with O to the care of the designated person exposed nails,explosives (2) Tools and machinery inaccessible to children c. Transportation Checklist used for transporting 0 by vehicle or walking(Sample checked) (3) All poison kept in locked area d. Written consent to transport child (4) Water hazards on or adjacent to home inaccessible e. No child left unsupervised in vehicle to children X c. Swimming and wading (pages 21-22) f. Driver has valid driver's license Is there a pool on the premises? g. Vehicle doors locked when moving Yes ❑ No (1).Swimming pool 2 feet or more in depth,enclosed h. All passengers and driver secured in a seat by fence or solid wall at least 4 feet in height,with no belt or child restraint which is properly anchored doors,windows,or other openings to the vehicle,installed and used according to manufacturer's instructions and maintained in (2) Swimming pool has locking gate. Gate and other good condition. access areas locked when pool is not in use Do children-in care use the pool? Vi. ild secured in passenger restraintpropriate to age and sizeYes ❑ No (3) Adult to child ratio in pool area: ild younger than 1 year or weighing less than 20 pounds secured in infant only or (a) One adult to each child younger than 2'/z convertible seat used in rear-facing position (b) One adult to three children 2% to 6 years i. Each child younger than 5 years or weighing less than 40 pounds secured in forward_ facing (c) One adult to five children 6 years and older seat 3 REGULATIONS a ca REGULATIONS c CU Q Q - 'Q Q — 0 a E o a U Q U Q � i p O U U .0 0 c p o Z Z Z Z k. Each child younger than 6 years secured in a booster (5) If parent/designated person cannot be reached,or if seat illness/injury is severe,licensee shall obtain emergency treatment I. Each child 6 years and older secured in an individual (6) Parent urged to notify licensee if child is exposed to seat belt. contagious disease F-Y m. No child transported in front seat of vehicle with Does the licensee administer medication/medical passenger side air bag procedu7No 4. Emergency Procedures(pages 23-24) Yes ❑ a. Emergency list posted C. Medication/medical procedures administered only with written authorization from parent b. Plan for evacuation posted (1) Blanket authorization forms are prohibited c. Substitutes/caregivers informed of responsibilities in (2). Prescription or over-the counter drugs in original emergency container d. Licensee and each caregiver has current infant-child (3) Prescription drugs have pharmacy label or written CPR and first aid certificate. Copies on file in home physician's written instructions Licensee and Members of the Household (4) Over the-counter drugs labeled with child's name (II.,D.,pages 25-31) See checklist and directions 1. Financial resources available (page 30) (5) Measuring device provided 2. At least one substitute available(pages 30-31) (6) Medication for children or household members locked 3. Licensee does not work or attend school during (7) Medicines returned to child's parent when no longer hours of child care (page 31) needed Care of the Children(II. E.,pages 32-39) (8) Time and date of medication documented in writing and kept in child's file in home 1. Supervision of the Children(page 32) (9) Copies of documentation available to parents on request a. Children supervised at all times. 4. Care of Infants(pages 34-35) b. Licensee responsible for care and supervision at all a. Each infant placed on back to sleep unless he/she has times written physician's instructions otherwise 2. Infants and children handled gently(page 32) b. Each infant placed on stomach part of time he/she is awake and observed 3. Health(pages 32-34) c. Positioning devices that restrict movement not used without written.physician's instructions a. Each child observed for illness or injury upon arrival d. Soft materials,including pillows,quilts,comforters, sheepskins,bumper pads,stuffed toys prohibited in b. Illness,injury,change in health reported to parent sleeping environment (1) Exposure to contagious disease reported to parent e. Diapering area washable,cleaned and disinfected after each use. (2) No child who is ill admitted to home f. Clean diapers and clothing provided for �l infants/toddlers. �f (3) Ill,injured child separated from group but g. Wet,soiled diapers and clothing changed promptly continuously supervised (4) III or injured child's parent notified immediately h. Soiled diapers disposed of in plastic-lined containers and required to come for child or arrange for designated person to come for child 4 REGULATIONS M m ca REGULATIONS m L Ca n a E E CL E o a CL U Q U Q , UU �. 0 o Z o z z z i. Licensee/caregivers wash hands with soap and warm b. Individual,disposable paper towels used for running water after diapering each child,assisting with hand drying f, toileting,and contact with bodily fluids v j. Individual disposable paper towels used for hand 0 c. Feeding chairs provided for infants drying k. Clean disposable gloves used for diapering each d. Feeding chairs and tables cleaned and child disinfected before and after meals and snacks I. Each child's hands washed after diapering e. Each child's food served from an individual b dish m. No child left unattended while being diapered f. Each infant/toddler encouraged to experiment with self-feeding n. Diapering area separate from food service, o g. Utensils provided for each child preparation,and storage areas o. Infants handled gently,each infant's head supported, / h. Disposable utensils and cups used only under rough or harsh handling prohibited. close supervision 5. Child Abuse/Neglect Reporting(pages 35-36) i. Formula and food brought from child's home labeled and stored properly a. Known or suspected Child Abuse/Neglect reported J. Milk and formula refrigerated immediately as required. b. Child abuse/neglect reports confidential k. Previously opened baby food jars not accepted c. Licensee,caregivers,and household members 1. Formula left in bottle after feeding discarded cooperate with DHR on any child abuse/neglect investigation,including providing information& in. Each infant held for bottle feeding. No bottles allowing access to children and records. propped. 6. Meals and Snacks(pages 36-37) n. Size of servings adequate to meet child's needs a. Meals and snacks provided as required. o. Food not forced or withheld Menu or food s;�S n date of visit if observed- 1°C���a p. Each child seated while eating 8. Food protection and preparation(pages 37- 1 38) b. Formula or food for infants&other special diets a. Food in good condition prepared as directed or provided by parent/guardian c. Special foods for children labeled with child's name b. No home-canned foods used and stored as directed d.Formula,powder or concentrate,shall be prepared by c. Food protected from contamination parent e. Fluid milk served. No powdered milk used for d. Food preparation surfaces and utensils cleaned drinking before and after use f. Small,hard candies or nuts not served to children e. Food that has been served to a child not served younger than 4 years again g. Foods that may cause chokin prepared f. Tableware,utensils,food contact surfaces appropriately for the children G�rru 'S cleaned after each use h. Foods served only under close supervision as g. Animals not allowed in food storage, required (see page 36) preparation,or service areas during hours of care 7. Food Service (page 37) h. Floors in food preparation and service areas swept or vacuumed daily,mopped as needed a. Licensee,caregivers,each child washes hands with0 soap and warm running water, required 5 ° U U 1 U U REGULATIONS a m ca REGULATIONS M 0 a E E n V V Q U n Q C Z Z Z Z 9. Personal Belongings (page 38) a. Current license/permit posted a. Appropriate seasonal clothing for each child j, b. Most recent licensing evaluation posted provided by parent U b. Sufficient clean,dry diapers and clothing provided c. Most recent deficiency report posted j\ for each infant/toddler B— c. Space for each child for storing personal belongings d. Public notice form posted 10. Disciplinary Practices(pages 38-39) e. Corrective/adverse action notices posted a. Discipline appropriate to age and developmental f. Information about children kept confidential level of the children b. No corporal/physical punishment g. Written rules and policies provided to parents when child is enrolled c. No verbal abuse h. Parents and DHR notified of changes in written rules and policies d. Discipline not associated with food,naps,or i. Licensee's social security number available to bathroom procedures parents on request e. No physical restraint as punishment 2. Reports to the Department(pages 41-42) f. No punishment administered by another child a. Enrollment reports submitted as requested g. Rough or harsh handling prohibited b. Child abuse/neglect reported as required by law 11. Outdoor Play (page 39) c. The following reported to DHR within 24 hours,written report within 5 days: Children spend time outdoors each day,when weather (1) Any illness/injury requiring professional permits medical treatment 12. Sign in/Sign out Procedures (page 39) (2) Any illness/injury requiring emergency medical treatment a. Each child signed in at arrival (3) Any death occurring in the home b. Each'child signed out at departure �) (4) Changes in caregivers or substitutes. 13. Release of Children(page 39) �! (5) Change in licensee's name. a. No child released to anyone without written (6) Change in name or number of street address authorization from parent b. Photo ID required for unfamiliar persons picking up (7) Change in telephone number a child 14. Visits by parents/guardians(page 39) (8) Serious accident or illness of the licensee or members of the household 24 a. Parents have right to visit at any time (9) Serious damage to the home or grounds b. Parents informed of right to visit (10) Changes in members of the household. Administration (II.,F.,pages 40-44) (11) Any arrest of licensee,household member, caregiver,substitute 1. General administrative responsibilities (pages (12) Final disposition of any child 40-41) abuse/neglect investigation involving licensee, household member,caregiver,substitute 6 �. REGULATIONS o a cc REGULATIONS a o Q E E a E E CL V Q U Q o Z Z Z Z d. Physical/structural changes to home or grounds / d. Individual soap,towel,and washcloth provided reported in advance L for each child e. Any change in location reported in advance (New 3.Sleeping requirements (page 45) license is required) 3. Records to be kept by the licensee(pages 42-44) a. Each child younger than 18 months sleeps alone in crib a. Record for licensee/household members(see b. Number of cribs that meet the US checklist) Ill Consumer Product Safety Act of 2008: b. Records for caregiver/substitute(see checklist) c. Infants placed on back to sleep c. Records on caregivers/substitutes kept at least two d. Each child 18 months and older sleeps in a bed years after person leaves d. Certificate of rabies vaccination e. Number of beds' e� Children's records complete(see checklist) (\ 4. Each child's toilet articles labeled with name,. �f kept separate,kept in sanitary condition f. Children's records kept at least two years after child 5. Breakfast served to each child who goes leaves `�� directly to school unless provided by school or W parent �( g. Children's records and information about children 6. Evening meal provided for each child / and their families'kept confidential continuing from day time care x h. Confidential information accessible only to �j H. Group Day Care Homes(pages 46- authorized persons U 47) This sectioiz to be completed for i. Transportation checklists kept for current year plus (tomes providing care for 7 to 12 two additional years children. j. Sign in/sign out sheets-kept for current year plus two 1. At least two adults present and supervising the additional years children when seven of more children are present X G. Nighttime Care(page 45) 2. If a substitute is used,the licensee or assistant caregiver is present This section to be Completed for homes 3. Complete record for assistant caregiver / providing care after 7p.m. X 1. Number and age range of children does not exceed 4. Outdoor play.area fenced / number and age range on license/permit 2. Bathing (page 45) 5. Required equipment provided(See checklist for q ' details) a. Clean water provided for each child I. Group Nighttime Homes(page 48) This section to be completed for homes b. Each child bathed separately 7 p.m. providing Care for 7 to 12 children after / C. Each child supervised while bathing 1. At least two adults present and supervising the children when seven of more are present 2. Number and age range of children does not exceed number and age range on license/permit The deficiencies noted have been discussed with me. Failure to correct the deficiencies can be the basis for adverse action. None of these requirements are to be interpreted to allow anyone to operate in violation of the Minimum Standards. A facility licensed by the Department must meet Minimum Standards at all times. It is the responsibility of the licensee to operate in compliance with the Minimum Standards. S n ure ofLicknsee or designated staff / Date 7 F Equipment Checklist Codes: Use the following code when completing the columns for each category. ( O ) indicates compliance observed N) indicates not in compliance ( X ) indicates not applicable The licensee shall provide a variety of toys,games,and other play equipment appropriate to the ages of children specified on the license/permit and to the interests of the children. For Family Day Care Homes,the licensee shall provide at least two(2)items from each category for each age group for which the home is licensed or permitted. For Group Day Care Homes the licensee shall provide at least four(4)items from each category for each age group. 1 markers,paper,chalk,blunt-end 2. Equipment for Children 2/Z 1. Equipment for Children Scissors,paste,glue,playdough, U to 21/2 Years Years u to 6_Years paints(tempera or water color), pa. • for • • • Ion' handled brushes,finger paints V • • • • • A variety of age-appropriate booksa. Toys r� ay accessible to the children V Play Sand or digging area with items for !� A device that plays a variety of age- Small wheel toys. digging,filling,sifting,and pouring19 1 appropriate music Push and pull toys Climbing structure with soft l� Rhythm instruments Boxes of assorted.sizes surface undemeath 7� Wheel toys U Nature,and Science Swings with safety seat,infant swing Buckets for water play,items for Materials Sand or digging area, toys for pouring,measuring,:floating Collections of rocks,leaves,seeds; digging,pouring,sifting b. Toys for Quiet Play etc. Large Balls D Puzzles 0- Aquarium with fish (must be �/ ' Quiet!toys Beads or spools and string for covered )4 Simple puzzles stringing X Magnifying glass Nesting and stacking toys Peg boards and pegs Magnets O Soft dolls and clothes Matching games such as lotto, Measuring equipment Cars,trucks,trains picture dominoes and other simple 3. Equipment for Children 6 Large beads or spools to string games O Years and Older Creative construction sets Picture books Blocks a. Storage Small cars,trucks,boats,trains Children shall have a separate area Paper k -believe Play Make for storing their personal items and Non-toxic crayons rojects Non-toxic water color markers Dolls,with clothes,blankets, O • Books storage area Non-toxic play dough Doll stroller Non-toxic art materials:a variety of kinds of paper, scissors, glue, • to Doll bed or cradle X crayons, markers, chalk, paints, Crib mobiles(for infants younger living area-kitchen clothesa- clay, la dou h V than 5 months Home likitchen Books and magazines appropriate Washable teething rings appliances may a- purchased or to the ages of the children A device that plays a variety of age- made from cardboard boxes r� Rattle toys � appro riate mytsic and stories \J Play dishes,plastic baby bottles, Squeeze toys pots and pans,measurin spoons -0 Dramatic Play Props Soft cuddly toys Puppets Dress-up clothes (� Busy boxes Sheet or bedspread for making a Dolls and dolls clothes U e. Make-believe Play tent Costumes and masks Dolls,and clothes and blankets Cardboard boxes in assorted sizes d. Toys for quiet time Dress-up clothes Minor Interlocking manipulative play sets V Homeliving area-pretend kitchen Toy telephone Jigsaw puzzles appliances may be made from boxes v . Board games.and playing cards Toys,dishes,pans,'spoons,plastic O Dish pan e. Equipment for containers with lids Toy telephone Sponges 0Active/Outdoor Play Puppets Bubble mixture U Balls Strainers Bats Funnels Egg beaters Tether ball Small boats and other floating toys .--Ik: Croquet set Books, Badminton set Non-toxic art materials-large / Horseshoes pencils and crayons,water color v Wheel toys 10