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Evaluation Form (5) 'Emergency Preparedness and Response Plans Checklist 0 indicates compliance observed by DHR Licensing Representative -1 indicates not in compliance The plan shall include procedures that will be used to prepare for The plan should also be'inclusive of- d respond to the following types of emergency/disaster situations: - -.c�atheidieikdficiesiniturht'disasters CemergencyenV I '-plans,q'n-d.,proce-du— res 1:o6kddNYn -,.- or-evacuation to threats f­1 Location of ts 0 xio violence file - cifitipish&s 'EVk' d— 'D' uations uc.toj�'�'-� Documen tation of the f6liciivink'quarterly'drills ;: 'Hazardous rnatenals. Tirc spills 1-Tomado iS ". asl e 'U' J, Boffib threats.Infesite and.0 dise ase sease em�6tjencies.. 'Mslte de T61dolikin fbi.on iLoss°of power;water'or heat Location ofthc 17 11i9.41Y'emergency sup bits "Otffdit!ue.t,ning.situ Mow .112e disiistei-,Oldiz shizIlItOude,&tdils h he efe-Fin-.place-ordvactiation ......... Assisting in ants and children q;�."ati-6-n-wtih parents -7,!Sh6lt6i I r;ppaceproce dres Transportation-disaster piocedures',": z ta. traininWreiissi.6 6nt .Plafi iipdated.yearly ---C ntactyi th local eriiergency management officials 16 Revised 9/19 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE, CENTER LICENSING EVALUATION RENEWAL health and Safety Guidelines items shaded Name of Center: Date(s) of Evaluation: SbLA_ I o •19 Address: Date(s) of Follow-up: Purpose of Visit: Pre ►' n Telephone Lj Director: Licensee: l�W D (jYO County: Day ❑ Night ❑ Subsidy Licensed Capacity: Day C) Night Days of Operation: Day Night Oti - F Age Range: Day e Night Day Night X 1; g s �( Hours of Operatio .! p License Number: Code: O - Observed by DHR Licensing Representative S - Certified by Licensee/Staff in charge D - Discussed with Licensee/Staff in charge Effective Dates of License: X -Not Applicable-Not reviewed with From: To: Licensee/Staff in charge Deficiencies Noted: Yes ❑ No icensing Re resentative: Sections to be completed at the discretion of.the DHR Licens' Representative. U U N N lU REGULATIONS o REGULATIONS m o m QCL Q U Q O U Q U U o Z o 0 z z z Facilities (11. C. pages 16-23) c L Space for ill or m�ured child s s� S L 1. Indoor area(II.,C.,4.,- pages 16-18) _ y 5 f�Items used b ilhbhild d�smfected K 1 t you, k � r a Exclusrveuse,of acpv�ty areasz r :`� ,�,s = �,r r ` S SStorage space for:teacher s supplies' r° §f ' { s b Designated space for each gronpmg of children' {` 4 h:Office space provided 0 t c Bathrooms located on"same leveUunder same roof i. Ventilation,lighting,heating(pages 17-18) 1 one flush toilet for each 15 children O O ;,(1} Heatmg/a�r condtriontng provided � r (2) one handwashing sink for each 15 children O (2) Temperature 6842, at°child lever, (3) One tub(portable plastic acceptable) ® t (3) Thermometer m each area used by children, lc. 4 , (i4)Fixtures childze si or ad3ustcd for easy use X (4) Thermometer out of reach of children 4 1 3 t S d rOne handwashmg ijnk with warm running water z ' h.(5) Outside windows that are operiedgare�" soap paper towels rn each room where children are screened diapered [ p J x r {��. 32 3 r � �i �' �.}'2'. '�� � 4 ��'"� +"..e r 1 U U N U a) a) REGULATIONS m v REGULATIONS v E o Q o Q U Q U Q U o 0 U o 0 Z Z Z Z (6) Outside'.doors kept closed 3. Swimming and Wading at the Center(IL, C.,6.,pages 20-21) (7)=Lighting'adequate for activities a. Pools two feet or more in depth (8) Lighting adequate'at naplrest time to allow (l) Lifeguazd at side at all times pool ts;m children to be,ssecn ,use Operational telephone for center business'only (2) L feguard,Training Certificate.First Aid: ;; Certificate CPR°Certification on file." Y k DHR nohfied►f tele Bone►s out of order or if p (3} Lifeguard not counted m ratios: number changes - v, I. Hazard prevention(page 18)(Indoor Area) (4) Staff-child ratios for children in the pool: 7 (1) Centerfree of apparent hazazds , (a) one stafffor each child younger than 2'/x f a_r71 (2)'Hazardous substances under loci.and key or (b) one staf£for every 4 children ages 2% combination lock yyears upto 4 years.; (3).Containers labeled ` 4 r (c) stafff every` 6 ch n ages 4 years �J 3; upto6yeaise '-.0 { o r ildre (4)'No firearms or animunrhon kept or allowed m ' + a r (d)'one staffffor every�10 children ages 6 center except laiv enforcemcnt _, z years and older " ' ,.= (5) Stairways have hand rulings m clu(d s reach (5) Ratios determined by youngest,child m the � Mc m (6}LCleaz glass doors inazked at child level (6) Persons counted m ratios meet child Gaze :Worker QLLSIIHCSIIO►1SI]n the p001 at all times _ r (7);Medicines and drugs kept under lack and key ora (7)'Staff provided to supervise children m _.. ... P- . _ {Pool az >but not It �n combination lock,se azate from harmful tteins, ear p ua 3 .a.,..F Ai (8}'Bamers around heaters radiators,fens accessible r (8) Many part of a child s body is m the water x to chrenconsidered>n pool ° r (9)tErp-,ed'electncal outlets have protective covers (9) Pool enclosed with fence or solid wall at:,d J least 4",feet m heiglit,constructed to prevent> (10) Consunippon of alcohol or use ofnon -accessibility'by�childrer prescnphon narcotic or illegal substances prohibited �►J- _} t 11 Smokin or use oftobacco' rohibited on b. Wading structures less than 2 feet in depth: ( ) g P premises 4 Contaminants shall be stored and disposed ; m. Center kept clean/Cleaning done daily (1)�Af least one staffwi(h CPRr&`f71 ist aid at " J (1) Floors bathroom fixtures cleaned/disinfected }` (2) Regmred calms met as stated on page'23 �_ r (2).Carpets vacuumed daily t °* (3) .4t least two staff at each=wading structure t „s r } (3)�Clean►ng does not interfere with children's », � r r � (4)°Clean water provided�each day� '` �p activities , z � a 2. Outdoor area(II.,C.,5.,pages 19-20) (5) Wading structure emptied when not in use See Checklist sy r 7 sr 1' r t a Off street loadmg/unloadmg provided ',{ Oxs 4. Away from center activities (Il.,C.,7., �� t r r '• sr r page 21) zb Separate areas for children younger than 2'/x(maybe' x,i NOTE. The Department of Human Resources does not ins ect activities away from the center, achieved by sctedulmg) x, P Y including swimming and wading activties. The licensee shall assume full authority and l�c Outdoor area adjoins or is safe ly,accessible r , responsibility for away from the center activides. d On play area fin a ofappazent hazazdous ' conditions r ' } 2 U U N U U 0 f6 ip (9 M 2 CU REGULATIONS ° ° Q a n. E a REGULATIONS E E a U Q U Q U o o U o 0 z z z Z. 5. Furnishings and equipment (II.,C.,8., Stafftvith infant-child CPR and first aid P pages 21-22) See Checklists ® present during all{hours of operation O Child Care Program (II. D. pages Second staff available wlien 7 or more children 24-37) present/ceaurred iahos met y S 1 Requtred'ratro5 tnatntamed`at all trines 1 No staff, duty more than 8 continuous houis s on a regular basis a. 0 up to 18 honths 1 to 5 } ry fit;'-Staff tfree from other duties while working ` ,with thechildren r b 18 months-up to 2�i years 1`to 7 5. Infant/Toddler Program(II,D., x 2., a es 26-29 X Pg ) ., d 24 monthsup to 36 months r ' It 8 a. Learning/growth activities:(page 26) C. 2%:years up to 4 years 1 Yto 11 S (1) Encouraged to play with a variety of toys f 4years upto school age+ 1 to 18 ACC{ (2) Time outdoors daily,when weather permits g School age sip to 8 years 4 '1 to 21 �', (3) 1?recdom of movement outside`cribs daily h 8fyearsrand older 3 1 io 22 �[€ ;, (4) Placed bi ttimmy past of time while awake and observed 2 Children younger than 2%grouped separately (5) Staff talks to each child and encourages from older children = response AL Exception for group 24 36 months, +; _ '' (6) Cries/signs.of dutress'investigated {.. ' 'immediately A" b.",Exception for individual children s needs r b. Dia erin /toiletin (pages 26-27 P g g:(P g ) 3`Staff counted m ratio only when grvmg fu11 f (1) Clean,drydiapers/clothmg provided r ' attention to the'ehildren 4. Staff coverage (page 25) (2) Wet/soiled diapers/clottimg changed { a All children supervised at all times (3) Changing aiea cleaned and disinfected' b Staff assigned responsibility for same (4) No child left unattended while,being infants/toddlers each day diapered; a' c Substitute staff available 2,r ' j + (5) No child`diapered on the flaor �` .. d Director authorized to conduct center business s (6) Each child`s hands washed after diapendg r, Pr.-,. .. .. ..: _-.n...-? ..n., r..':^.0 ..-«. J. .n...•...,._,... S ..ter. .. �.. ,1 .ir h e Staff person m charge when director is absent, r (7) Staff use universal precautions:when authorised to,conduct center business ` ':Y y, d�apenng �,x' f Staff in each room during nappmg/restigg ' t` +(8) Staff use clean disposable gloves for ' Y �.diapering each child/for each diaper change ' � }; g Staff able to'see all the children - t (9) Wetlsoiled diapers placed in covered plastic lined container and disposed of daily = ` h. Ratio during napping/resting: (10) induah`disposatile wipes used at each ', w diaper change,disposed ofproperly (1)�0 up t�18 months ; 1 to 5 �' (11) Potty chairs emptied,nosed,disinfected , r a 4 (2) 18 months up to 2'/z years 1 to 14 + (12)Diapenng`area sepaiate from &d sernce (3)2%:years and older l to 36 c. Napping/resting(page 27) 3 REGULATIONS = m o C A p c�oa REGULATIONS m c`o M Q Q - Q L - E U CL CL Q o o a U Q o C Z z o 0 z z (1) Infaiits allowed to form ownsleep patfems ;" (12),Toddlers'seated while eating; (2)Infants placed on.backto sleep unless'physician's (13)'Child encouraged to experiment with self statement indicates otherwise ` feedmg,utensils:provided.` (3)'Infants who can easily tum placed on,back but g (14) Disposable utensils used only with close t , allowe"d to adopt preferred posttion,. supetvtsion_ . + (4} No pos►ttonmg device used dnless specified by: (15)Foods eaten from a dish ' physician (5).Staff recognize differing needs of toddlers/allow to shes ak bottles unbreable` Pollow,their owvasleep pattpM ' d. Cribs,cots,and bedding(pages 27-28) (17)^aDnnking water offered to toddlers V (1}:Two feef;6ehveen occupied cribs (18) Child notforced to eat ; (2)_Cots positioned to allow space for access or ti (19) Faod not used as reward or punishment kemergency exit^ r + _ a + w E... r (3)'Cribs/cots cleaned and disinfected and sheets and 2* ( 0) Child s hands washed before and after, covers washed before used by another child snacks,after diapering toileUng ,. (4)'For mfanis clean bottom sheets daily.or more t "' (21)"'Staff s hands washed before food b often if needed sheets fit snugtY preparation and service after is with toiletin after diapering 2 '^ (5)-Soft material prohibited in infant s sleeping (22) Individual paper towels for each washing envuoiunent no,ptllows quilts comforters efc :' and drying v _: (ti)No infantput to sleep on sofa,soft mattress ' 6. Preschool/School-age Program (II.,D.,3.,pages 29-32) (7):For toddlers clean bottom sheets and top < a. Learning/growth activities(pages 29-30) covenngs wee(ay momo en ifneeded e. Feeding(page 28-29) (1) Schedule posted (1) Formula,food for infants if providedby center r (2) Variety of indoor/outdoor activities planned with pazent or physician (2) If formula;provtded.by center ready,to feed, (3) Time outdoors daily when weather permits properly stored and handled a (3)Meals and snacks comply with reginNments t (4) Staff permit/encourage conversation among children (4) If formulaprovidedby parent;labeled; efrigeratad (5) Staff give individual attention.to each child Y r' daily (5)'Bottles sent home or contents;discazded at end of ` (6) Radio,TV,videos used only to day supplement/enhance daily plan (6) Small hazd candies nuts not servedto children }' (7) No child required to watchiTY or videos underfour� r (7)'Foods thatmay cause choking prepared l f r (8} Videos previewed by°stafffor r 4 appropriately for.the child '4 appropriateness ; i > (8)Feeding schedule ac""cording to ctuld's needs ` (9) Sexually exphcit,violent,frightening s , 4�47- (9) h�fants held for bottle feeding x b. Napping/resting(page 30) 10 No bottles it pp G ( ) P PP Staffrecogriize differing needs of children (11) When able infants allowed to sit in feeding chair (2) Rest period for children in attendance more IL than 5 hours y 4 U U U U N N REGULATIONS Q REGULATIONS Q U Q U Q U o o U o .- Z Z Z Z i (3) Rest period at least 45 minutes,not more than G (15)Children seated while eating• 2%:hours (4} If a child who does not sleep after 45 minutes, (16) No child forcedto eat quie'ac6viEies pemvtted u ,(5) Cots cleaned and.cleanbottom sheets and top ? ` { 7)-Children iiot all w m kitchen sheets/coversprovided before used by another child r +(6)- Clean sheets/covers provided weekly,more often (18);Children's hands washed before meal's if needed f and sriacl.and'`after toileting r (7)Cots posittoned to allow space for aecess or (19) Staffhands washed.before food emergcncy exit t preparation and service and after assisting with torletmg'or contact vntntbodily flwd= ;(8)At least one staff present m+each room (20) posable gloves used for diapering'• 9 Staff able to see all children 4 J ( }` (21)tIndividual paper towels for each wish { 5 z and drying , c.`Toilehng(page 29} - (22) Catered meals and snacks meet (1) According to each child s needs each child s- C. Disciplinary Practices(page 32) hands wasned' r ._ (2) Staff use Universal Precauttons when diapering (1'Disctplme_appropnafe to age and or handltng.bodily fluiijs ;, develop"mental level of the children d. Feeding(pages 30-31) (2) No corpor, physical punishment } (1) Children m attendance served breakfast or a Nonverbal abuse c a snack lunchp m snack (2f Meals and snacks comply wtth USDA gutdehnes (4) IVo discipline assochtted tv�th food naps or on pages 29 3Q bathroom procedures .. :..., (3) Flutd milk served;no powdered milk for drutkmg (5) No physical restraint as punishment (4) No child deprived of meal or snack (6) No punishment administered by another x. Child (5) Specral dietary needs m'accordance iv�th wrtttenti ' `'. f. Staff-Parent Communication(page 33) instructions � �. ,yk (6) Meals and snacks provtded_bythe center (1) Discipline,behavior problems discussed with parent (7) Vending machtaes prohtbrted m areas used by (2) Center open to visits from parents at any ehtldren r }k , time (8) Small hard candies nuts not served to children ,t (3) Parents informed of right to visit G under four s r W �' J (9) Foods that may cause choking prepared (4) Staff available for communication/ appr'opriatelyforlhe child ' conferences s s (10) Portions of food`smted to child s needs second wz, �° (5) Parents notified of complaint procedures �pOrilO,!available (1.1} Unbreakable or single use duinerware used �+ ' (6) Parents provided with information on G influenza J (12j Single use -ups or glassesbr a drinl:mg fountain ~ r `i g. Health information(pages 33-35) provided for:water S `' (I3) Dn ink wale;offered d'' the'd ` ' (1)�Nohill child admttfed x s ` r (14) Food served 6n4indiwdual dishes or.napkins < t(2),If a child bewmes ill or js in3ured-t-0she,is 'r not d►rectly on table j / separated from group but continuously, 5 V U N U U N C C C REGULATIONS Q a- `—' `—' E Q REGULATIONS E E Q 0 Q U Q 0 0 0 0 Z Z Z Z1 s (3);Parent of ill/injuced child nottfted immediately', (e) Children and staff wash hands after and"required to come for;'child . handling animals (4) If parent cannot beireached or illness/injury h. Emergency Preparedness and Response severe,.emerg-ncy-medical attention1s;obtained- Plans(page 36-37) See Checklist (5) Parents notified of exposure to contagious :`Transportation (II.,E.,pages 38— dtseaselcondition F 40) 4 •, (6).Parents arged to norify cedter tf a child is 1.Transportation provided by the Center exposed to a contagious disease outside center (pages 38-40) (7) Center reports contagious disease/eon,,ition to: x NOTE. The Department of Human Resources does health department as regntred „s w;' not Inspect activities away from the center, Including swimming and wading activities. The (8) Medication/Medical Procedures(pages 34-35) licensee shall assume full authority and responsibility for away from the center activities. Does the center's staff give medication/m is procedures? Yes ❑ No (a) Medication administered only with written Does the center's staff provide transportation? authorization from parent . xr Yes ❑ No ❑ blanket authoriMion'.forms for medication a 2ranspottation checkbsts used as required (c) MedicaUon m original container labeled X b Designated staff complete`and sign,cheeklist' y (d) Measuring device provided c Dnver signs checklist,mdicatmg he/she has_u , i r checked each seat (e) Medication admmistered:by designated staff d Checklists kept 6n file for_`current year plus 2 (f1 Locked storage;prondedfor medwa[ton �(, additional years , (g) Medication ttwned to parent or disposed of a Center responsible for picking up child at f ' whenno longer.needed ;'� designated location and delivering child to f 'destgnate`d person:' Y �' r documented tri�wr►ting,kept iri child s file 7 copies t i f. Supervision in center vehicles(page 39) available to parents on request x (9),Hygtemc practices(page 34) (1) Staff child ratio met for children younger_ than lawful school;age driver not counted X`. (a) Tmlet;articles labeled and stored separately K (2) Children of lawful school age and'older, . ' ifewer than IS transported with only We driver i (b) Used paper towels,wipes Ussues'are disposed /= (3) For 15 or more children of lawful school of itninediately.follotvtng use i + liege one staff in addition(o driver + , (d) Tdiletpaper provided for use by children and ;r(4) For 30 or more children of lawful schooF y staff, 1 _- age two.`staff in addition to driver r ' (d)`Extra children's clothing avarlable;r (5)iNo child left°in a vehicle mthout adult` r _. # `- s f pervision (10) Animals on the premises(pages 35-36) (� Staffaccom"parry each.child under2'/from "vehicle to care ofdestgnated'person (a) Aggressive animals not kept in center or on f' (7) Staff visually supemse each child 2V.and f° t . grounds X ,older i}oni velncle to care of•,destgnated person t (b) Animals that could pose a threat to health and �; (8) Driver checlts eaeh-seat at each'locationto f safety kept away from children :yenfy no'child is left on the eht61 (c) Certificate of rabies vaccination on file for g. Safety precautions in vehicles(pages 39-40) animals (d) Animals confined,cages kept clean,food and ; (1) StattonaryseaUng for'cluld,each child water available yseated while vehicle is moving , locked when vehicle is!" Ar t U U 0 U M Ca N U U REGULATIONS E E Q REGULATIONS .Q U Q U Q 0 0 0 0 Z Z Z Z (3)'Children nottransported in front seat'of vehicle 2. Records on staff(pages 42-44) with.passenger side air bag ;', t (See Staff Checklist) (4).Dever and all passengers secured when vehicle is a Records on staff lept confidential; moving ` (a) Each.child under I year or weighing less than b Records on file at time of employment .�� 20 pounds secured m rear facing child restraint, �_ - ..j installed accoi ding to manufacturers mstmctions S c. Records on staff maintained at least two veazs _ ' maintained h good condition /F` r after person has left (b) Each child under 5 years or weighing less than d Records filed alphabeti`oally 40 pounds secured m forward facing child restraint, t: installed aecor'ding to to s mstruoUons ': e Inactive files maintained separately maintained in ood condi tion r g (c) Each'child under 6 years secured m:a booster, 3. Health (page 45) seat installed according to manufacturer s instructions maintained m g`ood condition a Medical exam and TB test on file at time of y} r employment ' (d) Each child 6 and older the driver;and each -b Staff with syinptoms of contagious-.,', adultpassenger_secured,in an individual seat belt, :disease%condition not m center properly anchored to the vehicle _ ' h Vehicle safety check done annually signed by „center CharacterCharacterand Suitability L mechanic and dated filed in G. pages 47-51) 5. Transportation provided by i "Character and'suitability review conducted on , < r parent/guardian(page 40) requiredpersons'(every 5 years) s r .� a Each child accompanied into and out of center s 4 , a 4Persoi►s with detetminaUon of uns6ttable F ch b }Each child si ed m lied si ed out 'b 1. informs DHR of any criminal F ,convictions o%current char c Atiychildwhoamvesbywalkm or gbusisigii4in Administration (IL, Hy a es 52-56 d Photo ID required when releasing child to ', „ - 1. Applicant/licensee(page 52.771 unfaini iar�designated person "` Staff(II., F., pages 41-46) a. Licensee assumes full authority and responsibility for meeting and maintaining Minimum Standards 1. Qualifications(pages 41-42) b.Licensee provides operating funds a. Center director meets qualifications 1 c. Licensee designates director and delegates authority and responsibility for operation and b. Child raze workers/teachers meet qualifications and ® management of center to director have 12 hours of training within 30 days of employment Clild care workers/teachers meet requirements for, $ d. Written operating policies established CCDF training withim days}(if applicable) c. Aides/assistant teachers not counted in ratio (1) Copy of operating policies provided to parent at time of child's enrollment d Service staff riot counted m raho unless they meet" £` ft� f (2) Copy of operating policies submitted to 0 qualifications and are giyTg full attention to childr s�en ss> DHR e Driver at least 19 valid driver s license ss (3) Operating policies do not contradict Minimum Standards f 4 Substttute'stafi meet gualifcagons of staff for�whoin t (4) Changes in operating policies provided to subshtutmg parents and to DHR 7 0 0) (1) 0 Q U Z M CU f6 N W REGULATIONS E E REGULATIONS E E 0 U. 0 0 0 0 o 0 z z z z 2. Reports to the Department(pages 52- b. Age range of children in care conforms to 53) ages specified c. Requirements for drop-in care met X a. The following reported to DHR prior to occurrence: 4. Children's Records(pages 54-55) —777 7 777 w'neirshi Children i'�c6idi aiid,informatiom out' h 11(fitri all Change (2)„Change in location ,b,',jiidivjdUa1,iecbtds on each Phil on,file on t!rs,dayrof attend rice (3) Change in Director of center (1) Children's records maintained 2 years after child has left the center (4) Change in chief executive officer of corporation Records*fidddA0hAb&ic,;i*, or members of board 0 _61iiif" separately' 5 f: rouii& I lfii]1dtW16Be§maintained J9 Mayor'dfiange:orektension.df-b6uit,ot oro#Am':4� 5 Center Rec rds(page 55) 0 T- A 4 The following records kept on file or the current t.WCDhorie'ri'umbdr,.-Chi 'd& sor es year plus two additional years: tiff, J b. The following reported to DHR within 24 hours, -,`- 4, — , __ Daily attendance s an written report within 5 days: children: a 'b",T&fis0dff&ioii 6hebkli§t§ V fil u'ry of child t 7; p _'i'd"d `m_­e'dical treatment �; ­ e,s V _y-of child of staff fe 'K. "ifle'iy­check "Fri medicalemergency treatment -away,2�, '(3)'-Anyd6ftth-6ccdrriiig ift,the center or during out sheets " f.-­,­,! g t activities. 6. Documents to be posted(pages 55- M-Mdjorldamapeu�f�dil 56) 6fthe ecrit6i s'electric' 'Aclephone.i service or gas'st te j giih involving th�q o g. eqpp a. Most recent license,permit,or approval ti accidentinvolving chil rh'�n b. Public notice form in S tioprovidedcenter 16flicen�&stff.� 16j- dt'& OA(8),Any arrest "M' idceritilti:bfisi4g;';.evaluation'`, ct TPA e_ d Most recent deficiency report r investigation involving licensee.� 7, staff employee h Vo t ,up cer _J1 (10) Any incident to which the health welfare or a)Corrective/adverse actioiiiibtk�,"-­, safety of a'Phil is t J 5:a�nsk. ..... c Child Fct!pp tfired b I ­;­ _--,�t inspection, - -_1q., 1.1� , law 'd.:-.Li d all Most t �kjthyddjpo�*heni.ihsp inspection an aPpp_Oyses;vo�q ec n; cooperate with DHR on any child abuse of neglectpermission for -�6ait:oiwrht& 3. Admission Procedures(pages 53-54) �12, dfineWi, d.§riadks1datdd",' i. Name and telephone number for: n dr"fin'e- F' 7 0 �n (pages 52- ,ccu,en]c .10 X -s 5 T tal rfib n the,piem pr emise's children in transit,a,children.9h.fii Cbnf(rrrls (ambula nce ahbe.ori-ps trips 0 J!" 8 U U U U C C � C C � cu REGULATIONS `� � � `� � E Q REGULATIONS E Q a Q U o 0 00 0 Z Z Z Z (4) Pinson control center (2) Regmred ratios for day time ma'intarned while children are a«ake(see page 23) (5) Substitute help (3) Aticast one staff at least 19,meeting child care�4orker qualifications;with CPR and l st aid In', j. Emcrgency Preparcdness,and Response Plans" center during hours_of operation L.;Name of director/staff person in-charge. (4) All,children'supervtsed at all times Nighttime Centers (II., �.� (5) Each staff as"s�gnedrespons�bility for same I " children;mg4gy�in , 1 ages 57-58) (6) tlt least one staff in each room,of sleeping n;'children< �In addition to the regulations set forth for day (7) Staff able to see all the childre-n_at all times -4 re centers, centers providing nighttime care (after 7 p.m.) shall meet the following ; regulations or modifications (8) All staff awake and alert to needs of children( Does the center provide ca e after 7:00 p.m.? Yes ❑ No (9) At,least two.staff to center whenever childremare piesatiUrequired ratios''met, Does the center provide care after midnight? Yes ❑ No (10) Lighting maintained so children are visible sleeping . " ; 1. Equipment and furnishings b. Nightly activity schedule posted (page 58) a. 'In centets,dperating pastmidnight,cnbs_or cots "_. (1) Outdoor time available during daylight hours fitted with a waterproof mattress shall be provided for each child r ch h d� =ariaStaff assist ea c ild"as needed,'m"dressing grooming b In.centers operating'past midriight,there"shall be at e. Food (page 58) least, ne bathiugfacilityfor every 15 children ,: 2. Child Care Program(pages 57-58) Q) Breakfast served to children going directly to school a` /�•� a. Staffing(pages 57-58) ;' (2) Evening meal served to chtldren:in ;}attendance - (1) Staff-child ratio for sleeping children: d. Bathing(page 58) If any child is bathed: (a) 0 up to 18 months l to 5 (1) Clean water prov�ded`for each child t (b) l8 months up.to 2%: Each child bathed separately * (c) 2'/ ip to 4 years 1 to 18 ✓ (3) Each child supemsed while bathing (d) 4 years and older 1 to 25 (4) Indf ivtdual soap towel and washcloth 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 esponsibili the li ense to operate in compliance with the Minimum Standards. Am ignature of icensee or de gnate taff Date 9 T i. Checklist for Infants 0)indicates compliance observed by DHR Licensing Representative I)indicates not in compliance X)indicates not applicable Name of teacher/room.# A ofchildren'ge. -Nu"'bir-!n -bf children: z Ndmber-df staff" Minimum &Ui:gment Reguired for Each Group of Children Required Equipment(Ill.,I., page 66) Washable soft crib toys-2 per child Push and pull toys-I A device that plays a variety of age appropriate music Age appropriate books-2 per child Large balls(8+inches-I Nesting and stacking toys-2 sets V Washable baby doll-1 A Musical toy-I Colorful pictures and posters Activity boxes,such as busy boxes-3 Additional Furnishings and Equipment ri ng.area-�i,,'D i a­p'-e 4- Phiifib-4hfed,-*,66v-6i&cbfiiainer,71; Tub(portable plastic type acceptable) v i7,. Wate roof m&ffess,sheeli ,Indoor'tfieiffioiiietei/,,6ut:o-fr6a6h-6f:childidrit;;-,7-"-',.-�!".:e', Shelvin fore iii meat and ibpp lies/anchored,�'I'`','.-,.,�,'i :ilrfdividoal;-.labdl6d-stokak6'spicb--,f6-r each child 'Fu' Cnbs in accordance wrtfi US Consumer Product Safety� �,` �4, ; a -Actbf2OO8:,"' Facilities Eie&i6i cutlet's c re Barriers bk( Wdicia6&166kedtti jUg tin' ace 4itat6,'�m.-."m�"-'--.-','- 9 10 Checklist for Toddlers (aye 18 months-2% years) 0 indicates compliance observed by DHR Licensing Representative -1 indicates not in compliance X indicates not applicable �Name�0'f-i'each*ei/i�odii.9'�-.,.'.�.-,:-".,��', 'A•6'cdchildken.- �A, Number children .Nu 7 �4- mber'df staff Minimum Eq&jnmeat Reguired for Each GrmLaf Children Required Equipment(Ill.,I.,p.66-67) Art/Music Large non-toxic crayons/markers Paper( ariety) Non-toxic Playdough Colorful pictures and posters A device that plays a variety of age appropriate music Musical to -2 Active Play Push and pull toys-2 Large cars,trucks,boats,etc.-2 Sit-on riding toy-2 Larae soft balls-2 Quiet Play Books-2 per child Age appropriate puzzles-2(co plete with all pieces) Nesting and stacking toys-2 sets Non-wooden buildin blocks,1WL92&Ntelv 20 non-interlockin7) Hdn�eliving/Dramiatic Play Baby dolls-2(complete with all parts) Doll clothes and blankets Doll bed—I To telephones-2 V Pots,pans,buckets,large plastic spoons Child-size stove I Dress-up clothes . .Lddition*�] F�rnishinljs and E*'ipm�ht .Dr qtki a6ednj area !'Sifik;ivarrn'Nvatir;soap, 'S P Tub(portable plastic type acceptable) Potty chairs clianed/disifif6dedlirdptied` -Ai&g c6air(i).6itabiti'and ckbifi —, Tfibi/666 ,.-Wate Indoor thennornete"rI.Oa of reekh of 6h0dhin, 2; ,Shelvink'foiegiiipmeatindiuppfiestatich6rid-,, Furniftiri.dhild size,clean,jG6d condition-.-', ;Individual labeled sfory"e-ioa6efdr each WIC Fa�ilities E16ciiiU'6uti6ts"covered',-," S :fafi Barridit around heiftis,- Ii4kaMoui i6hkafficeg locked 4 iWi',Containers labeled_ 4',',"-.-;'-'�'4,"-.-.---,:�-".,,----.,.--,.,-- Medf6fiorilocked 1.4 L"i thin eqivaitb Checklist for 24 months up to 36 months 0 indicates compliance observed by DHR Licensing Representative -1 indicates not in compliance X) indicates not applicable 3 Namii, teichei%i6onik,;' K Num6ir.of children'—"','i"- Id Number,,o staff Minimum E ui ment Re uired for Each Grouv_of Children Required Equipment(pacre 67) Art Non-toxic playdough Large non-toxic crayons/markers Paper Non-toxic finger-paints in primary colors Scissors(blunt-tipped) Literature/Music Books-2 per child N. A device that plays a variety of age appropriate music Rhythm instruments-one for each child in the group Homeliving/Dramatic Play Baby dolls—2(complete with all parts) Child-size stove and sink or combination Cooking utensils and dishes Doll bed Doll clothes and blankets Dress up clothes Toy telephones—2 Educational/Creative Building blocks—approximately 50 non-interlocking Cars,trucks,boats,etc.—3 Age appropriate puzzles-4(complete with all pieces) Interlocking manipulative play sets of different types—3 sets Additional �urnishings and Equipment rD_ia e�ii_figarea _T" ivateij's6ip,paIier 6� -Plaiiic'-Iiiied'6bviii'd-'6ofit'ainers 'Tibi -�oi�iand,bhiii'for"eac-h"h'Id'*-'- 1'. e c i 'ZV .Cots;Tshectsi ah-4 d'c"'overs Written daily plan or schedule posted Labeled rage4ace at fi d sto 7t_i 'Iddo'oi',thdrfiioftidfir.,/4'outbf�-re'�Ldii, fchild fi� �;Sh@viiig"%V60i�rherifaiid Designated activity areas BIeFacilities ctii6T"OutIc6­_-— Zi Hiizai&us:6-sf 1o6ked_:-.. Contam&flabded_ R iScreens ohmind w_94whibfi'are!bpen6C-'_- Y 7 12 Checklist for 24 months up to 36 months 0 indicates compliance observed by DHR Licensing Representative -1 indicates not in compliance X) indicates not applicable 3 Namii, teichei%i6onik,;' K Num6ir.of children'—"','i"- Id Number,,o staff Minimum E ui ment Re uired for Each Grouv_of Children Required Equipment(pacre 67) Art Non-toxic playdough Large non-toxic crayons/markers Paper Non-toxic finger-paints in primary colors Scissors(blunt-tipped) Literature/Music Books-2 per child N. A device that plays a variety of age appropriate music Rhythm instruments-one for each child in the group Homeliving/Dramatic Play Baby dolls—2(complete with all parts) Child-size stove and sink or combination Cooking utensils and dishes Doll bed Doll clothes and blankets Dress up clothes Toy telephones—2 Educational/Creative Building blocks—approximately 50 non-interlocking Cars,trucks,boats,etc.—3 Age appropriate puzzles-4(complete with all pieces) Interlocking manipulative play sets of different types—3 sets Additional �urnishings and Equipment rD_ia e�ii_figarea _T" ivateij's6ip,paIier 6� -Plaiiic'-Iiiied'6bviii'd-'6ofit'ainers 'Tibi -�oi�iand,bhiii'for"eac-h"h'Id'*-'- 1'. e c i 'ZV .Cots;Tshectsi ah-4 d'c"'overs Written daily plan or schedule posted Labeled rage4ace at fi d sto 7t_i 'Iddo'oi',thdrfiioftidfir.,/4'outbf�-re'�Ldii, fchild fi� �;Sh@viiig"%V60i�rherifaiid Designated activity areas BIeFacilities ctii6T"OutIc6­_-— Zi Hiizai&us:6-sf 1o6ked_:-.. Contam&flabded_ R iScreens ohmind w_94whibfi'are!bpen6C-'_- Y 7 12 AV CPA Checklist for Pres hool (agh% yeaWto school a2e) 0)indicates compliance observed by DHR licensing representative I)indicates.not in compliance X)indicates not applicable Name j IL Age.- 1�"children p. um er o --c i b f hildre"n. X, Number X` Requ,ired,E4uipment(Ill.,I.,p.67-68) Minimuni Equipment Reqidredfor Each Group of Children Art' Ease] Non-toxic playdough or clay C) 0 Large non-toxic crayons/watercolor markers 0 Large sheets of paper 0 0 Non-toxic finger/cold water paints-primary colors 0 Scissors(blunt tip)-2 pr.Per 5 children C) Non-toxic glue or paste;tape 0 FPaint brushes four 1/2 and I inch in width n Educational and Creative.Toys Large/medium building blocks-app. 15 non-interlocking Small building blocks-app. 100 non-interlocking 0 0 Small cars,trucks,boats,etc.-6 0 Age appropriate puzzles-8(complete with all pieces) 10 0 Interlocking manipulative play sets,different types-6 0 C) Matching games-6(no more than 2 electronic) I Puppets-2 Homeliving Area Child-size stove/sink(or combo) Small table and chairs/benches C) Cooking utensils/dishes(unbreakable) 0 Doll bed or cradle 0 Dolls(complete with all parts)-2 0 Doll clothes and blankets Dress-up clothes for boys and girls Storage for dress-up clothes 0 Unbreakable mirror-full length Toy telephones-2 D liteia'ture'and Music Age Appropriate children's books-2 per child A device that plays a variety of age appropriate music Rhythm instruments—1 per child in group NAture Study"and Science Magnifying glass 0 U Magnets Nature collections Q0 Measuring and pouring equipment Aa-ditional"F�rn4shi�gs a`ndEqu'i'pmctt' �,,T.alk space:and'chAii,f6i, child bts"Sh6ets,-covers:orca&child-,-�_ ,C 31 ti �"Indoor,thermometer"/:6ut'ofreach Written daily plan or schedule posted 4e:) 7-7,­ 7 IabcW k6ra� Facilities Desi Hated activi areas t f" Bfifirk "-'d'hea ers,ers'aroun fans,,; ,H&4d6iii substances'locked-/.-'. containers label cd,-,:'. Medicafionl6cked_,`,'_-�� 77 jLigh tin k'adequatc�- Z Clk 2(V Ck Jb CL 2(P C&,2 6 1 3 1 13 Lj I � —T— a _T_ ,L+ Checklist for School-Age (o )indicates compliance observed by DHR Licensing Representative (,)indicates not in compliance (X)indicates not applicable Name of teain cher/room# s Nu'm6er-of children '` Number'of staff. Minimum E ui meat Re jUMd_f9_r_E_adzGrouv of Children Required Equipment(Ill.,I.,p. 68- 69) Jig-sawpuzzle-1 per 5 children Games:choose indoor or table games Suited to age of children-1 per 5 children Games:choose outdoor or active games Suited to age of children-1 per 5 children Books suited to age of children-2 per child Non-toxic playdough or modeling clay Non-toxic tempera paint Brushes Non-toxic crayons Paper(variety) Non-toxic glue or paste,tape Scissors A device that plays a variety of age appropriate music Interlocking manipulative play sets—1 per 5 children Addit]'06al Furnishifigs and Equipment sTatile s`ace•aiid�chaicfor each.child . �_ ., . Cots/sheets/covdis for'`each`6 iild who n �7ndoor thenroine[er-/outof>•eabh%" ,t.' Written daily Ian or schedule posted ,Labeledstora'e i a'oe'avchild level„_ ,Shelvin foi u�menf and su lies/ancho�ed s _ ;'. Designated activity areas Facilities `EICidri cal�outlets covered ' Barriers around fieatets;fans: ' 'Hazardous'sutistances locked. 1x, Coritaine*rs Iabeled'�'-­, Ivledication�locked : ��` ti '` - Screens.on windows Khich are o`erred . ,' I i 'tin `ade sate ` 14 Playground Checklist (o)indicates compliance,observed by DHR Licensing Representative (sr) indicates not in compliance (X)indicates not applicable Required i 6' Minimum Equipment Required for groups of twenty-five children or fewer on the playground Location or age group Wheel vehicles to sit on and maneuver-2 Wheel vehicles to pull or push-2 ; O Balls-3 Climbing apparatus Crawl-through equipment Digging or sand area Toys for digging 70 Facilities Outdoor play afea enclosed by,a fence or wall at least 4 feet inot height 4 ', Fence of wall free of sharp edges 1 Gates secured f' ' �t Q K J� F Sha&and sun aieas provided Outdoor play area free o£apparent liazardous'condrtioiis Concrete/asphalt not used under.'equrpmeiit s } Area well drained r ` Equipment not designed to,be portable securely anchored,f1 Stairs/steps have hand rails m cluld's reach' r ° 15 Emergency Preparedness and Response Plans Checklist (O)indicates compliance observed by DHR Licensing Representative (,�) indicates not in compliance -Proccd�re��Jlll., The plan shall include procedures that will be used to prepare for The-plan'should also be inclusive of and respond to the following types of emergency/disaster situations: Weather emergencies/natural disasters n Current emergency plans:and procedures ookdo vn or evacuation due to threats ofviolence ':-, Location and l us.'e offire'eittmguishers (� Evacuations due to Documentation of the following quarterly~drills Hazardo riiatenals Fire uss 3 Spills r Tornado Gas leaks t > �Y' Lockdown ; Bomb.ttiieats =:r r.'.Relocahon` Infectious disease emergencies' r Telephones for•on site and off site use Los"s;of power;water,' Location of the firsYard and emer"enc 'su I kit or e s 0." g Y O[her,threatening sItuations _ 1 • sThedisaster /dn,shall,rnclude°deta"ils`or. , Shelt'eimplaceorevacuatron,f.� -y' t. Assisitng infants and children w6.9b6cial needs and/or healtl'conditions ®. I2eunificauon.with parents Shelter m place;procedures 'v Transportation disaster procedures, „F r Stafftiainmp/reasstgnment f t s r Plan updated yearly r F` b ' Contact mth local emergency management officials ;' 16