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Evaluation Form (3) n 2/19 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE HOME LICENSING EVALUATION Licensee: Date(s) of Evaluation: "!T I Z9 12019 Name of Facility: Date(s) of Follow-up: 40; o i e #0 _- 14Grd ! I c,2 I Z® Address/County: �& Q>^W b4o0 ur ose of Visit: VI; A(,2 14 ba/ t�cm e, Telephone #: ( � ) •�-T 60 Day Care ❑ Nighttime Care [;of amily ❑ Group ❑ Subsidy Licensed Capacity: Day Night Age Range• Day Night Days of Operation: Day Night Hours of Operation: Day Night Lice se Number: Codes: �� j 1,L O—Observed by DHR Licensing Representative Effective Dates of License: S—Certified by Licensee D—Discussed with Licensee From: 9 To: f ` I X—Not Applicable-Not reviewed with Licensee Deficiencies Noted: Q4es ❑ No DHR Licensing Representative: �V' II Ical[C1. l.i if!(, e t Sections to be completed at the discretion of the DHR Licensing Representative. U U N U U REGULATIONS n a M REGULATIONS o 2 CU Q 0 O a. E o CL U Q O U Q U Z Z U Z 0 Licensing Procedures(II.,B.,pagA11-15) (4) Dangerous substances locked Is 1. Provisions of license/permit(II (5) Aggressive animals not kept pages12-15) 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 %S i b. Ages range of children in care conforms to ages on (7)Fans in reach of children enclosed license. c. Current license/permit posted. (8) Electrical outlets covered 0 Are any guns or firearms kept in the home or on The Home(II.C.,pages 16-24) the premises? 1. Indoor area(II.,C.,pages 16-20) Yes (�No Ela. Injury prevention(II.,C.,2.,a.,pages 16-17) (9) Guns/firearms unloaded 's 00 (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 Is (3) Home has working telephone (12) Stairs have handrails in child's reach 1 U U N U U 0) REGULATIONS REGULATIONS 2 o a E o CL L) QU a 0 0 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 X 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 J\ (8) No infant put to sleep on sofa,soft mattress Vor other soft surface. (18) Consumption of alcohol prohibited during hours (9) Each child 12-18 months sleeps alone in a of care crib,play pen or a low cot. Is (19) Non-prescription narcotic or illegal substances (� (10) Two children over 18 months of the same prohibited ! sex may share a double or larger bed or may sleep V 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 Is . (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 S 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 (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 -S 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 Is (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. (See equipment checklist for details) (3) Clean,appropriate facilities for protection, (2 1) Recorded/printed material shall be (" storage,preparation of food. S previewed for appropriateness before shown to ,V\ children d. Equipment and furnishings (II.,C.,2.,d.,pages (22) All material with sexually explicit, 18-20) C) frightening,or violent content kept inaccessible to children (1) Crib,bed,playpen or cot provided for each child 2. Outdoor area(II.,C.,pages 19-21) for rest/sleep during hours of care. Is (2) Number of cribs that meet the US 14 J s, ��•�. Consumer Product Safety Act of 2008: or��" _ tN��••� (3) Number of playpens: 6N t p 2 , (D a) U U REGULATIONS 2 o REGULATIONSICU oCU QE o Q U Q O U Q �Cft Z Z z a. Outdoor play area(pages 20-21) (4) Person with current American Red Cross 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 protruding edges (except where prohibited by federal water each day,emptied when not in use law) (8) The licensee is present during any swimming/wading activities (4) Required outdoor equipment provided (See 3. Transportation(pages 22-23) equipment checklist for details) (5) Outdoor play equipment not designed to be Does the licensee provide portable,anchored transportation for children in care? (6) Concrete or asphalt not used under equipment Yes ❑ No P/1", (7) Area free of stacked lumber,construction NOTE: The Department of Human Resources materials,firewood does not inspect activities away from the home. The licensee shall assume full authority and '6 (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 to the care of the designated person exposed nails,explosives (2) Tools and machinery inaccessible to children c. Transportation Checklist used for transporting 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 1�ls c. Swimming and wading (pages 21-22) f. Driver has valid driver's license Is there a pool onnZo premises? g. Vehicle doors locked when moving Yes [:1 11 (1) Swimming pool 2 feet or more in depth,enclosed e� 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? i. Each child secured in passenger restraint Yes ❑ No 1;1 system appropriate to age and size (3) Adult to child ratio in pool area: j. Each child younger than 1 year or weighing less than 20 pounds secured in infant only or (a) One adult to each child younger than 2%2 convertible seat used in rear-facing position (b) One adult to three children 2'/2 to 6 years 1k i. Each child younger than 5 years or weighing (c) One adult to five children 6 years and older less than 40 pounds secured in forward facing seat 1 S U U 0 0 REGULATIONS _o a REGULATIONS o o cu CL a CL — a E E a 0 Q U Q 0 0 0 0 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 1. 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 in. No child transported in front seat of vehicle with Does the licensee administer medication/medical passenger side air bag procedures? 4. Emergency Procedures(pages 23-24) Yes ❑ No 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 Y emergency container J� d. Licensee and each caregiver has current i an i ,t (3) Prescription drugs have pharmacy label or written CPR and first aid certificate p e i 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 check and directions ' 1. Financial resources available (page 30) c t )Measuring device provided 2. At least one substitute available(pages 30-31) (6) Medication for children or household members V 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. %S 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 Swritten physician's instructions otherwise ks 2. Infants and children handled gently(page 32) . b. Each infant placed on stomach part of time he/she is I-,S awake and observed SS 3. Health(pages 32-34) c. Positioning devices that restrict movement not used without written physician's instructions %S a. Each child observed for illness or injury upon arrival d. Soft materials,including pillows,quilts,comforters, sheepskins,bumper pads,stuffed toys prohibited in "Is 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 ,Is infants/toddlers. %S (3) Ill,injured child separated from group but g. Wet,soiled diapers and clothing changed promptly continuously supervised Is (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 -Is I'S designated person to come for child 4 � n • U U � U U � REGULATIONS A o m REGULATIONS a a M CL E E CL a E 0 0. a U Q O U Q U t_ U o O o O Z Z Z Z i. Licensee/caregivers wash hands with soap and warn b. Individual,disposable paper towels used for running water after diapering each child,assisting with hand drying toileting,and contact with bodily fluids IS j. Individual disposable paper towels used for hand 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 dish m. No child left unattended while being diapered f Each infant/toddler encouraged to experiment c Is with self-feeding v n. Diapering area separate from food service, g. Utensils provided for each child preparation,and storage areas IS S 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 Is a. Known or suspected Child Abuse/Neglect reported j. Milk and formula refrigerated immediately as required. �Is .S b. Child abuse/neglect reports confidential C_ k. Previously opened baby food jars not accepted Is 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& m. 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 Is a. Meals and snacks provided as required. S I o. Food not forced or withheld Menu or food served on date of visit if observed:(1���C Each child seated while eating K` �ya � � � ��� `/ �v +►�biV 8. Food protection and preparation(pages.' 38) b. Formula or food for infants&other special diets a. Food in good condition prepared as directed or provided by parent/guardian I's 'S c. Special foods for children labeled with child's name b. No home-canned foods used and stored as directed -Is d.Formula,powder or concentrate,shall be prepared by c. Food protected from contamination parent "Is I I 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 Is g. Foods that may cause choking prepared f. Tableware,utensils,food contact surfaces _ c appropriately for the children cleaned after each use 'V h. Foods served only under close supervision as g. Animals not allowed in food storage, required (see page 36) I .S1preparation,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 with soap and warm running water as required 5 U U U REGULATIONS REGULATIONS c o cu CL E o Q E o Q o °- U Q 0 Q o O o 0 Z Z Z Z 9. Personal Belongings (page 38) a. Current license/permit posted a. Appropriate seasonal clothing for each child b. Most recent licensing evaluatio osted provided by parent Isv b. Sufficient clean,dry diapers and clothing provided c. Most recent deficiency report posted for each infant/toddler 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 Is when child is enrolled c. No verbal abuse h. Parents and DHR notified of changes in Is , written rules and policies Iss d. Discipline not associated with food,naps,or i. Licensee's social security number available to bathroom procedures Isparents on request III's 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 S g. Rough or harsh handling prohibited b. Child abuse/neglect reported as required by law Is 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 Is 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. Is a. No child released to anyone without written (6) Change in name or number of street address authorization from parent Is 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 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 .IS 1. General administrative responsibilities (pages (12) Final disposition of any child 40-41) abuse/neglect investigation involving licensee, household member,caregiver,substitute \S 6 � n N N v N UC S? M a REGULATIONS co: m REGULATIONS CU Q 0 Q a E E a o 0 Q U U ¢ U c Z Z Z Z d. Physical/structural changes to home or grounds d. Individual soap,towel,and washcloth provided reported in advanceS for each child 3.Sleeping requirements (page 45) e. Any change in location reported in advance (New license is required) a. Each child younger than 18 months sleeps 3. Records to be kept by the licensee(pages 42-44) alone in crib a. Record for licensee/household members(see Lai l C. b. Number of cribs that meet the US checklist) � Consumer Product Safety Act of 2008: c. I fants placed on back to sleep b. Records for caregiver/substitute( c c. Records on caregivers/substitutes kept at least two �� d. hach 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, kept separate,kept in sanitary condition f. Children's records kept at least two years after child Breakfast served to each child who goes �( rectly to school unless provided by school or leaves l L ent 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 h. Confidential information accessible only to H. Group Day Care Homes(pages 46- authorized persons Is 47) This section to be completed for homes providing care for 7 to 12 i. Transportation checklists kept for current year plus children.two additional years 1. At least two adults present and supervising the j. Sign in/sign out sheets kept for current year plus two children when seven of more children are present additional years 2. If a substitute is used,the licensee or assistant G. Nighttime Care(page 45) care iver is resent This section to be completed for homes 3. Complete record for assistant caregiver providing care after 7 p.m. 4. Outdoor play area fenced 1. Number and age range of children does not exceed number and age range on license/permit 5. Required equipment provided(See checklist for 2. Bathing (page 45) details) I. Group Nighttime Homes(page 48) a. Clean water provided for each child This section to be completed for homes providing care for 7 to 12 children after b. Each child bathed separately 7 p.m. 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 . t Minimum Standards at all times. It is the responsibility of Standards A facility licensed by the Department must mee the licensee to operate in compliance with the Minimum Sta ards. S ff / Date e 7 Equipment Checklist Codes: Use the following code when completing the columns for each category. ( O ) indicates compliance observed 0) 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. i markers,paper,chalk,blunt-end 1. Equipment for Children 2. Equipment for Children 2/z scissors,paste,glue,playdough, Up to 2Yz Years Years u to 6 Years paints(tempera or water color), ( 1 a. Toys for Active/Outdoor long handled brushes,finger paints a. Toys For Active/Outdoor Play A variety of age-appropriate books Play Sand or digging area with items for accessible to the children gg g ®Small wheel toys digging,filling,siftin ,and pouringA device that plays a variety of age- Push riate music Push and pull toys Climbing structure with soft ® Rhythm instruments Boxes of assorted sizes surface underneath Wheel toys f. 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 Large Balls b. Toys for Quiet Playetc. Puzzles Aquarium with fish (must be b. Quiet toys Beads or?pools and string for covered Simple puzzles stringing Magnifying glass Nesting and stacking toys Peg boards and pegs Magnets 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 ames CreatiVe construction sets Years and Older Picture books Blocks a. Storage c. Art materials Small cars,trucks,boats,trains Children shall have a separate area Paper for storing their personal items and Non-toxic crayons c. Make-believe ro'ects Dolls,with clothes,blankets, b. Art, Music, Books Non-toxic water color markers storage area Non-toxic art materials:a variety of Non-toxic play dough Doll stroller d Doll bed or cradle kinds of paper, scissors, glue, crayons, markers, chalk, paints, Crib mobiles(for infants younger Dress-up clothes clay,playdough than 5 months) Home living area-kitchen Books and magazines appropriate Washable teething rings appliances may be purchased or to the ages of the children made from cardboard boxes A device that plays a variety of age- Rattle toys a ro riate music and stories Squeeze toys Play dishes,plastic baby bottles,pots and pans,measuring spoons c. Dramatic Soft cuddly toys Puppets Dress-up clothes Busy boxes Sheet or bedspread for making a Dolls and dolls clothes Make-believee. tent Costumes and masks 77 Dolls,and clothes and blankets Cardboard boxes in assorted sizes Dress-upclothes Mirror d. Toys for quiet time Interlocking manipulative play sets Homelivin area-pretend kitchen Toy telephone g p Jigsaw puzzles appliances may be made from boxes d. Water Play Board games and playing cazds Toys,dishes,pans,spoons,plastic Dish pan containers with lids e. Equipment for Toy telephone Sponges Active/Outdoor Puppets Bubble mixture Balls Strainers Funnels Bats Egg beaters Tether ball Small boats and other floating toys Croquet set e. Art, Books, Music Badminton set Non-toxic art materials-large Horseshoes pencils and crayons,water color ® Wheel toys 10