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Evaluation Form (3) 10/19 T T ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE CENTER LICENSING EVALUATION ANNUAL Health and Safety Guidelines Items Shaded Name of Center: Date(s) of Evaluation: I �fed tiinods 12• l1 ' tq Address: -SQ&5Dr%' NL 3b5y5 Date(s) of Follow-up: ILI 1h 3 County: I Purpose of Visit: AnouaQ, Telephone #: ($O L) a S 3 a Director: ., %mel Licensee: [✓f"Day: Night ❑ Excepted Licensed Capacity: Day Night �( Days of Operation: Day r Night Age Range: Day Night ,` Day Night y g g x Hours of Operation• .License Number: LI Code: 1jtr Prn Effective Dates of License' O - Observed by DHR Licensing Representative S - Certified by Licensee/Staff in charge Front: To: D -Discussed with Licensee/Staff in charge . I2.• 2� '.l � 2 • 2 .2 (� X-Not Applicable-Not reviewed with Licensee/Staff in charge Deficiencies.Noted: Yes ❑ No D ensing Rep esentative: Sections to be completed at the discretion of the DHR Licensing Re resentative. U U U U 9 N Co U Ca � U REGULATIONS E E Q REGULATIONS E Q O �? Q O U Q Z Z o 0 Z Z Facilities (H. C., pages 16-23) b. Hazard prevention(page 18)(Indoor area) �r ,t i fr. ti .t T y rye Or 1. Indoor area(II.,C.,4.,pages 16-19) (I) Centerfreeofapparenthazards f§ - a Bathrooms located on same level/under same roof (2) Hazaidous substances under lock and key or O �' ' a' 1 One flush toilet for each 15 children ~ ' r` i. O %� ��(3) No`3f'irearms or ammuntUon kept or allowed In center ezce�t Ia�J enforcement`r 4� t ,� b i� Y ,� �� (2) One hand-washing sink for each 15 children r(4),Statnvays havee.hand nulmgs'n eluld s reach f g rr � (3) One tub(portable plastic acceptable) (5) Clearfglass doors marked i ch d level +, t a 'r '' (4)Fixtlues child size or adjusted for easy use �- �O � - ,, �.(� Medtclnes and drags kept sunder ldck and key" r' � k x� or combtnaGon lock separate from hantifiil Items 1 U U U U fl3 U N U REGULATIONS a - Q - o E Q REGULATIONS E a U �? Q O U Q z Z o 0 z z •(7) Barriers around heaters,radiators,fans accessible b. Wading structures less than 2 feet in depth: to children (page 21) (8) Exposed electrical outlets have protective covers , O (1)"'A t least one staff)with CPR&first aid at ea ch wading structure .; (9) Consumption of alcohol or,use of non (2) Regmrcd ratios met as-stated on page 23 prescription'narcotic or.;illegal;substances prohibited-; r• x; (10) Smoking or use of tobacco prohibited on w (3),At least hvo staff at each wading structure :.'premises. / (l.l):Bio contaminants shall tie stored and disposed'of (4) Clean water provided each'day%Wading properly "structure emptied when not in use ' 2. Outdoor area(II.,C.,5., pages 19-20) See Checklist " a: Off-street loadiag/unloading provided b. Separate areas for children younger than 2V2ay(m be achieved byscheduiing) r 4. Away from center activities (IL, C.,7.,page 21) c. Outdoorarea ad3oins oris•safcly accessible, - O NOTE: . The Department of Human Resources does not inspect activities away d..Outdoor play area free of apparent hazardous from the center, including swimming and conditions �` wading activities. The licensee shall 3. Swimming and Wading at the.Center assume full authority and responsibility for (Il.,C.,6.,pages 20-21) away from the center activities a. Pools two feet or more in depth(pages 20-21) Child Care Program (II., D., (1) Lifeguard at poolside:at all times pool is in.--use pages 24-37) (2) Lifeguard Training Certificate First Aid 1 Required ratios maintained at all Certificate,CPR Certification on file X ' �hmes (3):Lifeguard not counted m'ratios a OEup to 18 months to 5 (4) Staff-child ratios for children in the pool: b I8 months ap to 2'/:years 1 to 7.. hh V" (a} one staff for each child younger tham2%2 years X • c 24-months up to 36 months of age . , � x ' � • :•@) one staff for every 4 children ages 2 V2 years up d 2'/z years up to 4 years 1 to 11 to,4,yew (c) one staff-,for every 6 children ages 4 years up to 6 u" e 4:years up to school age 1 to 18 years (d) one staff for every 10 children ages 6 years and f School age up to 8 years I to 21 " older'. xr O>v (5)'Ratio$determined by youngest child in the pool =` g 8µyears and"older 1 to 22' (6)'Persons counted in ratios meet child care worker u;; 2 Children younger than 2'/2 grouped separately qualifications/in the pool at all times x ,`from older chQdren (7).Staff provided to supervise-children in pool area, Y 3. Staff coverage(page 25) but nPori,pool (8)_�If any part of a child s body'is m the water child x l a All'childicfi supervised at all.times R 4 %� c6h§idered in pool "(9) Pool enclosed with fence or solid.wall at least 4 b Staff m each room during napping/resting feet in height constructed to prevent accessibility by" children c Staff able to see all tfie children �1 2 U U N N N C N � C Z U N Cu REGULATIONS E E Q REGULATIONS E E Q U Q o U Q U � o U � 0 z° Z z Z x +; d. Ratio during napping/resting:(page 25) (1) 0 up to 18 months r 1 to 5 (5) Ghild s hands washed before and afterf snacks,;after diapenn t g r _ . g toiletm a� KL (2) L8 months up to 2'/s years 1 tox14 C� Stags hands washed before food ,i r _ t preparation and sernce afteiasstshng with a}r, iu'` `�' z' x� 5 '" t011ettn$�atler,dlBpCtlrlg '„ ,z '# '' w Y (3) 2%:years and older 1 to 36 N {7) Itidtvtdual paper t9wels,for each washing and drying . hint childPRadirs adpsenet Staff wi # R T $ YE g urtrt hours of ope tion € ` `< ,�- - x ` ,a. .�,...,.�•; �-`. ,.%gym, 0 X. Infant oddler Program(II., ,2., Y. 5. Preschool/School-age Program pages 26-29) (II.,D.,3.,pages 29-32) a. Learning/growth activities:(page 26) a. Learning/growth activities(pages 29-30) 3 (1) ,Cneslstgis of distress investigated immediately:+ x b. Diapering/toileting:(pages 26-27) b. Napping/resting(page 30) 1 ,Staffuse Universal l'recauhons aftei dta ertn r ' '# ' > ah ( ) p g ��z ��� ,� � � (1) Cots cleaned and clean bottom sheets and and contact u�th bodil fluids y x � vtop sheets/covers provided before used by another � � �g , sit t..` r "' `' 7 x+,. r ,,. z.cw✓-., Cltdd tea: '` - e at F # su* d ..:. (2) Staff wash hands after diaperin&each child (2) Clean sheets/covers provided weel.ly, s (3) Staff tise clean disposable gloves for diapering * t ' ¥P �# each child/foreachdtaperchange` ,, `` h ` fx , z (3)Cots positioned todallow space for access x f ,� or emergency exit > , (4),Diapenngarea sepaiatefrom food service area x _ a.zx+ c. Napping/resting(page 27) c. Toileting (page 29) (1) Infants placed onback to sleep unless phystetartis° (1)according to each chid s needs each child's • R statement indicates otherwise fi i handsivashed d. Cribs,cots,and bedding(pages 27-28)*K. (2)Sttiffuse Universal Precauti ns after toilettng t and contact ivtth bodily fluids „, y_ ,� � (1) Two feet of spacetet<vicen occupied cribs d. Feeding(pages 30-31) (2) Cots postUoned to allow s(►ace for access or (I) Children m attendance servedbreakfast or ' emergency exit t _,7 a m snack lttch,,p m snack > tt- v 4 r art r r`r?7r {gx", r r 3• t (3) For infants 4clean bottom sheets flatly or more; z m (2) Meals and snacks comply with<pattems f often tf;needed,sheets fits'nugly x rz USDA+ idelmes pages 29 30 '_ , zr s#= > ? (4) Soft material prohibited m ufant s steeping , (3) Small hard candies,�nuts not staved to � {J x a environment,no pillows:quilts comforters eta � , �;;.ehildrenander tour ,� t � � ��a �, "• ,# �:..� a 'a "*' fi s sS� ,}'r ,£ a='iY (g 'xr� -x*c 't �� �' � k;, z .�,„-�? 5 e 3 +� i ie (5) For toddlers clean`bottom sheets and top (4) Fnods that may cause cholang prepared } coverings weekly,more often tf needed, appropriately for the child e. Feeding(pages 28-29) (5) Children tiAt allowed m kitchen € +' ? t+ a a .; ivj ,.,, # # '#� z fi E,,t 7. 1 (1) Meals and snacks comply with requirements (6) Cht(dreiy s hands washed before meals "ht-„t• s J t +F; ,r We v >and snackand aftertoilenng �� �, � c -'- ez, # t €k '"- zl,., -r > .`s^,'`e 1A rvj ✓a = . refrigerated a' preparation."ervice,and after asststmwith ,.,, „+ sin,„ stOileGngorcontactWithbodilyflutd ?.r .t.n's t:;l,'a t?ju k%7€ (8) Itidividual paper towels foenctiwashtng t r {(3) Infants held for bottlefeedmgMo bottles propped P and #rytng "�. °d.¢:' ,ah 3 U U U a) C C REGULATIONS E E E Q REGULATIONS U E L O U Q O U C U � �. c 0 z Z z z e. Disciplinary Practices(page 32) e. Supervision in center vehicles(page 39) f. Staff-Parent Communication(page 33) (1) Staff-"child ratio met forchildren younger than la«.fu]school-age,driver not counted g. Health information(pages 33-35) (2)-Children'of lawfiil'schooi age and older, fewer than t5-trans `only the driver t (1) No-it]child admitted Q) For,15 or-more children o-lawful school �• age one staff in.additio'n4oidnver (2) If a child becomes-ill or is injured,he/she is (4)°For 30 or'more childrenof]awful school ''separated from group,but contindously supervised age .two staff in addition to driver X,, (3) Parent of ill/injured child notified immediately (5) No child left in a vehicle without adult and required to come for child supervision (4) If parent cannot be reached or illness/injury - (6) Staff accompany each child under 2'/z severe;emergency medical attention is obtained from vehicle to care of designated person u 1 (5) Medication/Medical Procedures(pages 34-35) '(7),Staff visually,supervise.each_child 2%.and older`Ironi vehicle to care`of designated person Does the center's s riff iv_e medication? f. Safety precautions in vehicles(pages 39-40) •Yes' No (a) Medication administered onlywith written , (1) Stationary seating for child each child authorization from parent seated while vehicle is moving (b)'No blanket auth6ri7ztion forms for medication ,z `/vim' (2) Doors locked when'vehicle is moving ..� •( h. (c) Medication:in original container,labeled/Measuring (3} Children not transported in front seat oF; device provided vehicle yti�th passenger side.air bag h Emergency;Preparedness and Response Plans (4) Driver and'all passengers secured when. (page 36 37) , ' vehicicis-moving. See Checklist page 9 w (a)-Each child underl year;or weighing less than 20pounds secured in rearfacirig child Transportation (II., E., pages 38— restraint,installed according to manufacturers. mstnictions,maintained in good condition 40) 1. Transportation provided by the Center (b)Each child'under.5 years orweighipg i less thanj40 pounds secured in forward facing—, `{ (Pages 38-40) ' child restraint installed according to; Does the center's staff provi5rNo nsportafion? manufacturer's instructions;maintained in good f ❑ Yes condition NOTE: The Department of uman Resources (c)°Each child under 6years secured in'a does not inspect activities away from the center, booster seat installed according to;rnanufacturer s =, including swimming and wading activities. The / mstrucdons naintamed'm'good condition licensee shall assume full authority and �y` responsibility for away from the center activities. (d);Each child 6 andplddi,the driver,-and each adult passenger secured ui'an in seat a Transportation checklists used as regmred' belt properly anchored to the vehicle v b Designated staff complete and sign checklist g Vehicle safety'check done annually signedby mechanic and dated filed in center c Checklists kept on file for current yeaz phis 2 5. Transportation provided by additional years parent/guardian(page 40) d Center responsible for picking up child at designated a Each.child accompanied into and out of center location and'delivering child to designated person , 4 " U U ll) U U lll N C C REGULATIONS Q °- LL E o Q REGULATIONS E o a U 0 Q U U Q 0 0 0 0 z z b•'Each child signed in and signed out ^ (8) Final disposition of'any child, abuselneglect mveshgadon`involving licensee, staff employee;volunteer c. Any child who ariives by walking or bus,signed in „ 0) Any,incident in which the health,welfare by staff or safety of a child is at risk ; d. Photo ID required when releasing child to (10)Any disastrous event y .unfamiliar,designated person„ Staff(II., F., pages.41-46) O e Child abuse/neglect reported as required by See Staff Checklist law Character and Suitability (II., G., a Licensee and all staff,'employecs,volunteers cooperate with DHR onany'child abuse or neglect pages 47-51) -investigation 3. Admission Procedures(pages 53-54) Administration (II.,H., pages 52- a Number/Age range of children in care conforms to number.and ages specified.on license 56) 4. Children's Records(pages 54-55) See checklist D 1. Applicant/licensee(page 52) 5. Center Records(page 55) 2. Reports to the Department(pages 52-53) The following records kept on file for the current year plus two additional years: a. The following reported to DHR rior to occurrence: a Daily attendance records on all staff and children`= ' (l) Change m owrriership s b Transportahon;chec6hsts r_ (2) Change in location _j c Vehicle safety check (3) Change in Director of center S d Sign'in/signout sheets (4) Change in chief executive officer of corporation x 6. Documents to be posted (pages 55-56) or members of board (5) Alteiations to center or grounds a. Most recent license,permit,or approval l� (6) Major change or-extension hours or progiain �� b. Public notice form (7) Change.in addiess or telephone number ] c. Most recent licensing evaluation b. The following reported to DHR within 24 hours, d` Most recent deficiency report written report within 5 days: L/ (1) Any illness/injury of child or staff requiring a Correctrve/adverse action notices. professional or cri ergency medical treatmedt (2) Any.death occurring m the center or.dunng f Most recent fire inspection report away from center activities x (3),Mador damage to'acility`'.`. g Most recenfhealth department m'spcct-on Sreport and food permit or wntten permission for D cafe d (4)`Interruption of t}ie center's'electncal;telephone h Menu for meals and snacks/dated. or gas service ' (5)"Any litigation involving the center` • i Name and telephone number for 'Fire 5 deparinient/Law enforcement/Medrea]assistance/ r Poison control center/Substitute help_ + ' (6) Any tiaffc accident involving daycare children Emergency Preparedness and Response Plans Y using transportation,Provided by'the center. `�//�/ (7)Any airest of licensee staff,'employee volunteer* k Name of director/stafT person m charge J 5 U C.) a) C C � tU Q3 U REGULATIONS Q ° — E E o 0 CL Q U c p o Z Z Nighttime Centers(II.,1.,pages 57-58) 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 ter 7:00 p.in.? ❑ Yes care in. Does the center provide care ter midnight? ❑ Yes No 1. Equipment and furnishings a In;centers operating past mtdrught,cubs or cots _" fittedwwith a tivaterproof mattress shall be.pro for b In centers operatmg past mtdmgreht khe shag be at least,one bathing".fa il ity everyl5 chtldien ,. 2. Child Care Program(pages 57-58) a. Staffing(pages 57-58) (1) Staff-child ratio for sleeping children: (a) 0 up to 18 months'G ]p to 5 {b).;IB months up to 2'%z 1 to 14 (d) 4 ycars and older to 25 F t` (2) Regmred mhos for day hrne mamtamed�whtle'�t� � � ; s 'children are a}vale(see page 23) t` � � t'' � >' (3) Afleast onestaff at,least 19 nieehng child care s t worker qualifications with CPR and 1st aid to center ,r ' 3 dunrtg hours of operation. o (4) All chti&en'supervised at all times " ` f -t (5) Each staff assigned responsibility for same children x " nightly f (6)At'least one`staff m each room bf sleeping children 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 lic sed/approved by the Department i must meet Minimum Standards at all times. It the reslAon bility f the licensee to operate in compliance with the Minimum Standards. I / Sign a e o license esignat taff� atek 6 Checklist for Infants/'Toddlers (O)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance (X)indicates not applicable Nai ie'of teacher/room# Age otchildren ) . Number-.of children: Number,of staff . Additional Dia enn area Furnishings Si eater,soap.pap&towels �. lastic-lined Jovercd container- Tub( ortable plastic type acceptable) :Feeditig chairs Cribs.in accordance with US Consumer Product Safety Act,of 2008 Cribs/2'feet of space between occupied cribs Waterproof mattress,sheets Indoor thermomeier/Out of reach of childrenV. Shelvin 'fore equipment and'sii lies/anchored Individual,labeled'storage spice for.each child . Furniture child siz`e,•cleah, ood conditioh. Potty chairs cleaned/disinfected/emptied(Toddlers pnly) ' Electrical outlets covered. " Barriers around-heaters,fans Hazardous substances locked'-,, Containers labeled', . Medication locked Scicens on windows which are'o ened Li Ittina ade uate Checklist for 24 months up to 36 months (0) indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance X indicates not applicable Name of teacher/room# A eW children Number of children Number of staff ,Diapering area :Sink,wartnVatcr' soa ,pa ertowels. := Plastic=lined covered containers; :;•..s< ,Tables ace and chair;for'each child 'Cots/sheets'and cover's. Jhdoor'theitnome'ter/Out of reach of children eXV Written daily Ian or schedule posted Label ed storage s "ace at child-level Shelvin 'for.e ui m `ent:and`si lies/anchored Designated activity areas Electrical outlets covered -; 77 Barriers a%ound�healers,�fans'- + •" Hazardous substances locked; Containers labeled. Medication locked r Screension windows which are.o ened Lighti i jade uate 7 Checklist for Preschool/School-Aee (0)indicates compliance observed by DHR Licensing Representative fp— — indicates not in compliance (X)indicates not applicable 7 1 Age Of Z, yen ....................... Number of staff ` ALI Additional Furnishings and Equipment -,f V-7'77-77, W` n dail Ian or schedule posted -z ShOlvifig fore quipment an "s Designated acfiyi areas Facilities I,Eie6ifi6d,-6flets C'O'Verid V Iiaiw&6s' iubS'6ii&S:'locked Y.,, J, ilfw Sc'feens`oh-4idddis'wfiich.ife:6`6nid Li tin`ade`uate T, 77,771 y Playground Checklist 0)indicates compliance observed by DHR Licensing Representative (,r)indicates not in compliance X)indicates not applicable "Facilffies" Outdoor play area fence or enc-e,or, ri6 p,!(d' Z, AL V V- Gates d :Sha&and sun-areas tA( Outdoor play �-e iiea;frde df-j76bjjjjft-hj7srddi" itiiiq n) 76 t d:tyidd IM�pmen Well-drainedi�', 10 merit ho -desi d"-'b le.secure v aft &W nz� Sta dos'have ve hand rails to child's reach--: IA,% er'L 0 �a'.s Crau.) 5p&6e-. bru:51-N ) k.r1e:5