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Evaluation Form (3) 02/19 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE CENTER LICENSING EVALUATION ANNUAL Health and Safety Guidelines Items Shaded Name of Center: Date(s) of Evaluation: P,eu@MY 11eadSt4,rt' 7 Address: 3 9 Ctdar Road Date(s) of Follow-up: County: `Surh'kr Purpose of Visit: hhnug1 Telephone #: (?,ps13c��.,c�� Director:I yt&V-TkoM4J Licensee: %Ihkt Co. 0 06moy nc. [A Day ❑ Night ❑ Subsidy Licensed Capacity: Day Nighx Days of Operation: Da _p Night Age Range: `a�5 Night Hours of Operation: Dab Nig}'hht License Number: Q.0 dpoWl ( Code: Effective Dates of License' O - Observed by DHR Licensing Representative S - Certified by Licensee/Staff in charge From: To: D -Discussed with Licensee/Staff in charge g1102 12 1Lo X-Not Applicable-Not reviewed with Licensee/Staff in charge Deficiencies Noted' El Yes ® No DHR Lyi�censing Representative: . dJYKcW. C�v+3.�-r Sections to be completed at the discretion of the DHR Licensing Representative. U U a) a) a) a) Q N U cc T (0 REGULATIONS Q REGULATIONS � E Q U Q U Q U o o U o 0 Z Z Z Z Facilities (II. C., pages 16-22) b. Hazard prevention(page 18)(Indoor area) 1. Indoor area(II.,C.,4.,pages 16-18) (1) Center free of apparent hazards = ig+� "p4 HPy ode a>'Bathrooms located an same�leveUunder same roofx �(2}:Hazardous substances under�lock an key or +x � �r s "' �r '+n� � `` iu� hOombIrlatlon�Oe OnlS"idbeltl � � (1) One flush toilet for each 15 children a firearms or,' nttion center-excil ept lari'enforcement t (2) One hand-washing sink for each 15 children (4) Starrways have"handiailmgs m ehiltl s reach , 4 w , 3 One tub(portable plastic acceptable) x O (p p p ) (S} Clear glass doors marked at child le el D �Y li+ *a. s(4) Fixtures child size or adjusted fo �easy use's�z "`^ 1 , 6) Ivledicmesand drugs keptspnderalock,and key �lllattoYt�lOCk'SC�ar 0hfro111[1�at7r1U1lte7n Ji4M a"�p ' + ,.�e �ih ' a` T 1 U U N U U CL) N N CU N M REGULATIONS a ° cl Q ° Q E 0 a REGULATIONS 0 U Q U Q U o 0 U o 0 Z Z Z Z (7) Bamers around heaters radiators fans accessible b. Wading structures less than 2 feet in depth: c 9; " €'m.fiAP^.za 4 9`,�' �, r '',� a�. wy"d !e';�ii - (8) Exposed elec rtcal outlets°have prqjeetive,1covers �) At least one staff with C &first atdrat *� �� ✓ "s t b � CaCh'Wadmg S[NChlie F fflkll ar d �a,- v ,a. +s «.v.'^ �A� iWYi`'.aap IN' ��„ IM (9)Consumption�u alcol bra � ; JZequired ratios met assstaiedopag � y r ur :ptescngiaonnarcohcaorillega� starices'prohi� ed� �� � ,,� � � � ,• �� ���, �. � _e ��� k (10) Smokmg or rise of tobacco rohtbtted on ; a �� ;`ti (3) At least twostaff at ea h�wading sttuctur In s ri � �.. 2. Outdoor area II. C. 5. page 19 ( , p g ) (4�� Cleaawater provided each day/Wadmg ` , See Checklist st ture emptied when,not e gu a Off street loadinglunloat)mg provided b Sep ate areas for children younger than 2%2(mayj a N= 4. Awa from center activities I., he,aehiev(Myschedulmg) _ Y �l 1 C. / page 21 c'Outdoor area adloms or is safely accessible x ' NOTE: The Department of Human p o �Oufoarplay ataafree ohpparent'hazaidolas � p Resources does not inspect activities away from the center, including swimming and wading activities. The licensee shall 3. Swimming and Wading at the Center assume full authority and responsibility for (I1.,C.,6.,pages 19-21) away from the center activities a. Pools two feet or more in depth Child Care Program Program (II., D., ". anysarsC z e ,a � w�»fi a kt» �," page. 1 Lifeguard at poolsrdefat rill trmes poolis,m use a eS 23-35 _... a :; � 6 � 6ax' (2)Lifeguard Trammg Certificate,Fust Aid 1 --:Required ratios maintamecl stall , t ertifieatg GPRXdrtifoatien on file" : ¢rw ,..c. kx .: g A'3 •� z., by y.: t h n (3) .lfegaard not counted rn ratios; � A � a�0 up to t$months z° (4) Staff-child ratios for children in the pool: .l �1$mods up ta /�yeafsa �Lto',T xa WX (a) on' staff for each child younger khan 2'lz years �i �, , „- c,�24 months up to 3b months log ,-of age'y r�s, »fir, No s 3� , jtf p� �� 1 fo 1P" ' oue staff for eve 4 ch>ldren es 2'!a ears u d, 2/: ears u to "ears a Y P e y p Y 81 �WIN .`'�"�°��'"7 �; Cc) one staff far every 6 children ages 4 years up to fi e 4 years:up to school age i to l8 , ...'Qiti0A 6- .,Y^w"SW�n 10, ,,L :�,z vnw'n` .,.: �. � eky .. k aaliikli w -'� Via. s" (d)�`one stfftareery1'Oitren ag 6 years and �� ° Sc up to years � lItd �oiier � . k� d � ;e=. ,r. s ' y ,.... ? ,a d (5Y Rados determined by youngest 6h1i d m the poor i �� �� g� 8 ycars°and oldar " 1 t 22 v� �$ 1, # - ' +4r naafis ,W° M ,ac ual6iS ations n ffie coun e ool.at all s os child care worker t p 2 Children younger than 2'#grauped separately s ;;.. .. P .. •,.:.: ..: -�,,c't;s, fr Wilder 7 'Sta rove ed fo su eivis ohtldien3n, ool � O fEp d p p areal �� 3. Staff coverage(page 23) �btt not ui`jtnol �� �� x� (S)'If any pa{t a s child s body is in fh water chid k�� Al, Il children supervised at all um E' � � ~';(9) Pool enclosed with fence or solid=wall at least 4 *i fi, Staff in each room durmg,nappmglSestang fret in height,constructed to prevent accessibility°by1 �� b �, a� �r3 G` fa�ffsA�bletoSee_, s�fCh11kEE�aa _ �r ':n 'I .w �... _a.�b,k•s� mow- ,.e,w � `,:.w�'.w, �._ ,u ,.�+: .�- E. �'.�.` w ixam.., 2 C.) C.) U a) CU CU W REGULATIONS E E Q REGULATIONS E E Q U Q U Q U o o U o 0 Z Z Z Z d. Ratio during napping/resting: (3}'Infants t eld for bottle feeding/No bottles` Toddlers'seated WhittY eatin ? ' X Q U 0 18 montltS e g ,..� I ""a q a v s +'s t( .»�§q° n' 7 2 8"months u toy' ear 1 to 14 i' '"� {5) ild�s hanuvfashed lore adrcr v 7hpk s -� : r a- b ti*" ,.n y "t a .,<._ .......< ,a:., : e§ ", °'SnaC1CS�aer dl�pCTtllg�tQ1164ng Ft d ,�t m Frain .,. (3) 2'/z years sand older 1 to 3b " �� {6) Staff's hands washed before food �� ' 5 �w �� �.its - e ua. _ aa -">a t fl°e:�z.- w„a ,w b< x m a 1}repaA, and SerYICL' after aSStSting With w dare Staff wrth infa 31 during all hours of operarionx . .w alp `ti nsya - `' t �+^ ti�s� "'a :. 4. Infant/Toddler Program(II.,D.,2., }Tnchduat�pap �ael�o acu w ing G ti �. ,eau ayes a{fir., rt '" pages 25-28) drdrymg et` a. Learning/growth activities:(page 25) 5. Preschool/School-age Program (I) Crieslsrgns ofdistress investagated immediatelye `�` �d (n•,D.,3.,pages 28-31) b. Diapering/toileting:(pages 25-26) a. Learning/growth activities(pages 28-21 1) Each child's hands washed a8er diaenng b. Nappnng/resting(page 29) (2)�St, vash hams afteXdanng ach ihildu r {I�) Cots cle ed arid elbgp bottom ,shee d44 irSM , et` sr 3- '.r��� SM ^ a uP #a 44 a" top"shetslcaers�provtded�befbre pled by°another � � `�� °' F-1111 (3) Staff use clean,disposable gloves'for diapering wa V px � �� x ; k:. .. . .. e �2atv�`J^S "Alf (4}L7iapenng area separate fromood'service area sheetstcovers provided weekly, Amore often if needed m c. Napping/resting(page 26) �% i 3) C�ots�pasrtioned to allow space for access `° ,,or emergency;ez�t `.e _.��7 ;. a s `, r � , 9 i 3. ,. ( lnmiixts place o�back,to sleep�unles y x'c an s a e fai edn :(page 29)according to each;chiid's r stafemeritindreates otherwise � �" �neecis'eackichild"S ItandS WaSlied x d. Cribs,cots,and bedding(pages 26-27) d. Feeding(pages 29-31) t 5^ t,Mr` a. � 4 } r �� F x . MM (L Twt�feet of space�batween occupied cribs n, u1)�� i m attendance served htest of;°i M P; I. a g a:, `- a.rCt SnaCk"IUT►Ch p m.-- '+,4,w.°gip 4,.a ,.�sw=..,-e` 'q' (2)�Cots p silo ed to allowspsee fo�,;access ors ����� '_;: : M�alsacks�complywtt3t patterr►s � _ ernergenCjTelt��),; tzar, - [3 Fo ttifants clean bottom sheats'dail `or mare �' � {3)°small hard candies nu£S nol served; ,- c( } r- -a ,ed as "'>a, fikz 6,n 4ro1P ae ofn lfiieededSheestSnuglyak� .. 13� GT3 UndukOUI3w t r a j"iN wR% (4) Soft"cnatenal prohrbrted'in infant s sleeping ri. ,(4) Foods that may cause choking prepared er1110IlIiient nop1llOwS,C�U11tS,GOm02teIS, wopTlat@�yO � CCi "�, m F.n.�fi:`°zs °fit '. Ina . r .-:�a i�;as ^> I�G' y (5) For toddlers clean bottom sheets and top (5) Chridcen noteaiiowed m kitchen coverings, more often if needed* a e. Feeding(page 27) (Cr} Ghi[dren=='S handsVaSet� beilemcals�h �q andsnaok anil after toileting , M - `(l;}ysnaccanrply with�r�equtte entS k "� �r 4 ) Staff handsgwashed before° ood i „ aa�F.L:6a,:� ' � paTatiori4and Service ad�after c�S51Sing tliw a �" 5i� w ^avvrc I a w sa P ate. a'x ormula prov%ded by parcnt'tlabeled, s '� � t} ~i, ` 7i� ) Indi `:.uai paper towels for each ivastiin 9�: ; "' ^'�� �refrla�te'doil I �e. �4 m ���nFy k q .. . 0 � ^, s 3 CU REGULATIONS a C a �a E Q REGULATIONS E E Q U Q U Q U Z Z Z Z e. Disciplinary Practices(page 31) e. Supervision in center vehicles(page 37) f. Staff-Parent Communication(page 32) Staff-child ratio met foC children youngei than lawful school age,_drover not counted g. Health information(pages 32-35) (2j Childten of lawful school age and,oIder ,fewer than 15 transported with only-.the do ver A t;s `(1) No ill child admitted (3) For 15 or more children of lawful'school 1 F .nib 67k."- z w iN c rt. < >o g t ie� w ageQ one staff i&'addition todnver ; a,child becomes ill orris mjured helsha�s!� ri` ;, ` ,u(4} For 30 or more chi] o lawful seh�ool�, 1 separated'from group,but continuously supervised age,two staff in addition to driver J ± ,4 a. ,.r �o Po�G..a„ ;G fr ,�; u (3) Parent of tWinjared child notified unmediately e (S) No child left m-a vehicle without adult and re,uired to come for child,, 'su{�W s s y s.. _ suPe u4 iston y:, .VVI , (4y If, arent cannot be reached or illriessfin (6) Staff accompany each child under Vz a4 J P ,fi„ ,cdm x�. ...vi^ any.;h; 'i. a Y'� - b id „ r w t^` flb , x ' �" ,from vehicl� o care of esignatad person �severe emafganoy�medical"attentionrs'obtained .y (5) Medieation/Medical Procedures(page 33) (7}�Staffavisale to care ally supervise each child 2%and` older fromyuehic of designated person Does the center's st give medication? f. Safety precautions in vehicles(page 38) �❑'�Yes No tiiw r (a)Medication administered only with written (1) Stationary seating for child each child authorisation from.parcnt I v-d y„al ry H - u"n, r seated whileayehicl6j }povmg N! (b) No blanket authorization forms for inedicattgn:, n (2) Doors locked when,vehtcle is moving Err pF } y r i. 6..�-,`' t 4 (cj Medication in ongu_al contamcr labeled/Measunrtg�, �ay � �� r(3)�Children not transported an front seat of device provided vehteIewitli"passenger side air bag << ~' h. Emergency procedures(page 35) ODriver"and all passengers secured'* en vehicleris moving (9)`Plan for,evacuation posted i (a) Each child under I year or weighing less Phan 20 pocinds secured to rearfacing of}iiil ...a �" Transportation (II. E. pages 36— resvamt installed according to manufacturers �msti otions rnaiptalned m goodreondWon : 38) x. k 1.Transportation provided by the Center (b ,Each chil" under 5 years or weighing (pages 36-38) rless;than F4Q:Iiouii4s,secured in forward facing j child restrainf installed according to Does center's staff provide transportation? manufacturer s instructions,;,maintained in ood Yes ❑No Ccondizion., °" NOTE: The Department of Human Resources "p u(c} Each`ahild under 6 years secured in a does not inspect activities away from the center, booster seat installed according to manufacturer s including swimming and wading activities. The instructions maintained to good`condrtion a �' ° ' licensee shall assume full authority and responsibility for away from the center activities (d} I acli';child and'older;the driver;an each adult passenger secured in.an individual seat a Transportation checklists used as required ��,� �,, s ;tbel properly;an,,,'_,,, the vehiclae. .xa• �.r_.0 Y�^aH*...� x -:, ,��., ram.- <<� `, pJ .. _ b Desr Hated staff com let,anrJ st checklist �, � gp M g ^yahtcle safety check done annually s�g>}ed bye �m at z a aye mar, , mechanic and dated filed tn.center C. Checklists kept on file for currentyear plus 2` x , �' ' `'` '' 5. Transportation provided by additional' dditional yearsit parent/guardian(page 38) d. Ccnter iesponsible,for picking up child at designated a Each child accompanied into,and out of center r ,s location acid dehvenng child to destgna}ed person. f' , ` a , 4 a) 0 a) Q) a) (1) CU Q REGULATIONS CL E E REGULATIONS E E 0 0 0 0 Y < < 0 0 0 0 z z z z b Fach cyjLjj-ld signed in and signed out y $ final Ys s T}bton=of ari child-44- -L R 7,7 R--1 A, ��AM ,77 A abuse/neglect vmgqcertsec,', W 0. 7 W, W� 0 NIA 93 1W "W S, i�il aan� 1.�Arry'lin #ff"VY,��V, Y. 111 2-, W7 e Arty childwho eideutinfi�fiib Tf 0" A staff lId 02 k�-,Y%-g 'd as required b o o,'Ph t requirediUdbuse ne ect.pppqqe, y N M � designa�eddl)eTSari A" E F, U" ,F M vemp rqers�� " ��""s Staff(H., F., pages 39-44) d'd Z See Staff Checklist DHRoa any child oQ#eglect Character and Suitability (11., G., 3. Admission Procedures(pages 51-52) pages 45-49) up, R 9 Ttll$, Administration (11.,H., pages 50- 4. Children's Records(pages 52-53) See 54) checklist 5. Center Records(page 53) 1. Applicant/licensee(page 50) The following records kept on file for the current year plus two additional years: at y�attendance, Oct)ds 2. Reports to the Department(pages 50-51) fi " ," '-, ' 11b 1 —,,1 xmo 4 J, a. The following reported to DHR Rdff to occurrence: 6., ft96ohrjcficckfis`is N OF'Y Zt A A P N W 7 (4)X-hA[ge,ih,o rs p N . ...... ` Sign , 7 7 (3) Change in Director of center 6. Documents to be posted(pages 53-54)_ (4) Change in chief executive officer of corporation a. Most recent license,permit,or approval or members of board A� -A b F "AQg", W "V3, A, 'or*tin Public notice form a WX N"T c. Most recent licensing evaluation ,(6),Ma f1ditirs,j ftarige�o v (7), angejit address q4te itpAone,number"" ?h t �"--,-QrrCC -diders ctibh�h6ticts b. The following reported to DHR within 24 hours, C" 'Q' q v written report within 5 days: W%i W", U WIV P,"00,6—u" 'v`-Mk FEW E "W" j"� '0-t N S F- Iouf po c IN63 a. IP t -P Ail 'death c "t- J, t qF, %bc�, M, wri, �n,ppjr.rmSSionlj h caterm V, M �4 Pl Tsnaq A -eAls and, ks/da d—r a "op to�!a q "A111114 1� M4 ai R"', , k Q �,$N 1� W, 1�,V`NO' ,Nameh" 'E' noou"fi#g and 0,0, �Vl'9 7A, the -(4)�4ntej,4) rruption�6 I f, "n electrical, t 00 as service C ut,",W X`A N, "'W,�VaW� "A or"9 N, 1 'j, k5 Ef66fgqnck C ures; Al X-4 accident' I a— ' , V N� lR 1 tc ttpe uyc atftU q acing transportatton"provided by ffite -4 (7)Any arrest of licensee,staff,employee,volunteer Ck JC.P CA T*Ifs mc C62C -�U-.-41 PS F*r-4 C14410- A;1?-, U U C C -0 f0 M CL REGULATIONS o E CL Q U Y Q o O Z Z Nighttime Centers(II.,I.,pages 55-56) In addition to the regulations set forth for day care centers,centers providing nighttime care(after 7 p.m.)shall meet the following regulations or modifications Does the center provide care after 7:00 p.m.? ❑ Yes U,No Does the center provide care after midnight? ❑ Yes 16 No 1. Equipment and furnishings a: In den ers o erarin asimidm h crib c is fitted with a waterprogf�mattress shall he provxdi f0ra � $ '" - a„,gym .; leech enlld 3. , t,„ax.ar`a�m',Crvu .rvce'ewe .bA�,3� 2m ib' ,in centers operating pastmidn"ght there shalt be a V 41 �P. least one bathing facilrty for every017 Ichild#en F '* ; 2. Child Care Program(pages 55-56) a. Staffing(pages 55-56) (1)//Staff-child ratio for sleeping children: {b} 18 months up tb2%Z c^, .�� l to14 k a I ; {e� 2lz up fo 4}ears t to 18 (d� years and alders a 1#0 25' x f m s4 T M e 14 un a...m9 s sY -t»tf zi u,1 ..- „ . (2} Required ratsos forda ittne mhrntained while children are awake{see pager23}* � 1 3 ��>A.. _ _ e ..w {3 At least one staff (least 4 ,� Min child care s �� worker quahficattgns with PRI.andlst'aiR0§e to during hours of operataon (4} All children supervised at all times� �, �$y � w., (5) Each staff assigned iespansrbtltty for samecltil4d en N rightly ; ; �a +� � a ` b .N a,­ (6) At least one staff in each room of sieepmgchdren yc.. 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/approved 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. / d11�D,k. Signature of Licensee/Designated Staff Date 6 Checklist for Infants/Toddlers 0)indicates compliance observed by DHR Licensing Representative (ir)indicates not in compliance (X)indicates not applicable V.PI, g,4 F,`te#�hej�,�� M .ge of children , J f IN; AN -6 q ?ft A tA MW�v V,TVNA,� ft1h, F- Additional Furnishings and Equipment 'Da V" 0-4-; ,"Ex W Tub(portable lactic type acceptable) -,Wli.; Ai®RI' 67'77 7T77777 7"'7�F�mum ""T"m -CribsJii,,id66rda66e ikith, 1 g x—w W M 'y A P M C "Ch go 4 0� ,W aterp iiiattressxh,ce V,,,,486k d � 00 m!",4 'She 777 7��77 7 WT 'bi '5z%;Vk- dividdidjabeliditbi, fd" M X, ,T ituie 10A 1 (011, Facilities 1Electricaliutle ,covered 11WITIM-0, "C p �7— tg 77,7i 77- � ft 4 Hailid6pi s'-u'bsfi6ces,-)q&6d,,,',, 4- Y- Coh fi&0661 Auk 101I Q 7 t . 77 #,A 77- A" XNFX�4, ""A 4 L 'A Ala.. prt eA16UPS'ex� Checklist for 24 months up to 36 months 0 indicates compliance observed by DHR Licensing Representative r indicates not in compliance X indicates not applicable gq f 0011!1�1 0 1 4 OR, Ex� Number of aio ii ',t,Number z ofstaff-;' Additional Furnishings and Equipment P P"'IM RN A% 777777 7.7.74'ap" aw, IC P �T AIIIV"`NW74' 0�1%"'-�01� -J, R." Written daily plan or schedule posted 0 Ne Tabeledastor Z I 711'1'�M RIMPAIN Designated activity areas Facilities X F R 7 77 07 77, 7,7,7,7 77-7- 7 Corit in&s"Ubei &,,,i' M APU-MM Screens 4in ai '4,"FI.4 1R *W-T 3"""t 7 Checklist for Preschool/School-Age (O)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance (X)indicates not applicable '° tr ?! ""Wig e"°_ a 4 Name of teacher%room#. ��= .. Age of clildren F ( x NuIbC Of cbil(� e►1 �" '"' z, a -ok"„St � Npyn]uer of staffs �. 3 Additional Furidslihigs and Equipment �ible:s.,ace,`and chair for eaela chitd' ; �r z - . �'OtSW ShCet$>CAVCLS f T:CaCh'Clllld. l "v > e K Ut hId00T,`thCTn10I11CteI,`�>OUYOfICSCh sIW $ ..*~... b ., , Written daily plan or schedule posted a � sitelvari f0i a Ui relent aTld:"sU lieSlallC}IOXed,r v �+ y� h Desi ated activi as Facilities M64im OUY d COVOGd�1V"'1 ;"TW P-R, Bamers:ar"ozndaheaters,.fans t <, :�" :" . ..° dam. .t Hazardous'substance'srlockedlH`. s, -` w. �_ <.. w 'W-Ak o5m .....,..': . ,...yam r , A a Containeis'labeled ;4ate:.. - a5- a r..,",ku.�.wa. . °Wdicaffon locked ryUtM,�" t ? ,. AR*< IV, Saieen4MM''urdows;whi`ch aie.o erred;<, ri ttrlade Uflte s�"a-771 Playground Checklist (O)indicates compliance observed by DHR Licensing Representative (%r)indicates not in compliance (X)indicates not applicable Facilities utdoor" la"area enc sed fe ee�o waft cast 4 nz her ht h � . t '�"9 wr`^. " � h"" tr: a ea'f •'" .N,... C,f.a-_f es seour>e.dN14 6 ^ ',-€kv ' d.: ,.,� g a ' Sic, wA£« > ra„ Shade and`sun areas provided l:" X dr � 'IRKY,-,TyMh a $ s-;" " a x , �, 4utdoor,play area free off.appariqpt,}azarc�ous condrhons , .al *� a� .ram: a3-,A.�.��3. .."s. '���€n t6hn rete(asphalt Mgt used jj`ier e * Ar1�1efl WeI�R dalIlCd{y �` � et#' � �yd rWPM � 4 fif . r. . i E ur meaYnotdeli edtolie ortable seeurei'ariahOred € R x t 4 p gn P SYiIITS50 s0iehandaTatlslnChlld-reaeh a'aA^gv ^'$� }+'�' »" 'n"°"wa,-Mb"aq'' tr L n m 8