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Evaluation Form Revised 10/09 ALABA1...�A DEPARTMENT OF HUMAi,-RESOURCES CHILD CARE CENTER LICENSING EVALUATION Name of Center: Date(s) of Evaluation: ieIlCtmy H-eaci S-�n Address: Date(s) of Follow-up: C�c CCC6,.r 'R,dl Purpose of Visit: Telephone #: (rl.�j ) ��'�.. t¢2,y'� Director: coyet�a wi 1l iam,r Licensee:G, (Z60FP"ks , L Day Care ❑ Nighttime Care Licensed Capacity: Day Night Days of Operation: Da Night Age Range:. Day „ Night Hours of Operation: D y Night License Number: Code: O - Observed by DHR Licensing Representative L- C d d D 0 d t I S - Certified by Licensee/Staff in charge Effective Dates of License: D - Discussed with Licensee/Staff in charge X Not Applicable-Not reviewed with From: 8 (ZI I(r TO: g j1Z.f Licensee/Staff in charge Deficiencies Noted: Yes ❑ No DHR Licensing Representative: Sections to be completed at the discretion of the DHR Licensing Representative.. , REGULATIONS C co REGULATIONS a v M Q Q _ Q Q E E a E E a U Q U Q V 0 O V O O Z Z Z Facilities (II. C.,pages 16-22) e. Space for ill or injured child O 1. Indoor area(II.,C.,4.,pages 16-18) f. Items used by ill child disinfected �1 a. Exclusive use of activity areas g. Storage space for teacher's supplies O b. Designated space for each grouping of children O h. Office space provided c. Bathrooms located on same level/under same roof i. Ventilation,lighting,heating(pages 17-18) (1) one flush toilet for each 15 children D (1) Heating(air conditioning provided (2) one handwashing sink for each 15 children (2) Temperature 68-82 at child level (3) One tub(portable plastic acceptable) D (3) Thermometer in each area used by children (4) Fixtures child size or adjusted for easy use (4) Thermometer out of reach of children D d. One handwashing sink with warm running water, (5) Outside windows that are opened are soap,paper towels in each room where children are screened U diapered �/ c:\users\kcan199c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form renewal 10-09:doc m ` L) REGULATIONS C Q REGULATIONS Q O U Q 0 U Q V O O V O O Z Z Z Z (6) Outside doors kept closed 3. Swimming and Wading at the 0 Center(II.,C.,6.,pages 19-21) (7) Lighting adequate for activities a. Pools two feet or more in depth (8) Lighting adequate at nap/rest time to allow (1) Lifeguard at poolside at all times pool is in children to be seen use j. Operational telephone for center business only (2) Lifeguard Training Certificate,First Aid Certificate,CPR Certificate on file k. DHR notified if telephone is out of order or if (3) Lifeguard not counted in ratios number changes v I.-Hazard prevention(page 18)(Indoor Area) (4) Staff-child ratios for children in the pool: (1) Center free of apparent hazards (a) one staff for each child younger than 2% (/ years of age J� (2) Hazardous substances under lock and key or (b) one staff for every 4 children ages 2% combination lock years up to 4 years (3) Containers labeled (c) one staff for every 6 children ages 4 years 20— up to 6 years (4) No firearms or ammunition kept or allowed in (d) one staff for every 10 children ages 6 center except law enforcement S years and older. (5) Stairways have hand railings in child's reach (5) Ratios determined by youngest child in the O pool x (6) Clear glass doors marked at child level x (6) Persons counted in ratios meet child care worker qualifications/in the pool at all times (7) Medicines and drugs kept under lock and key or (7) Staff provided to supervise children in combination lock,separate from harmful items X pool area,but not in pool (8) Barriers around heaters,radiators,fans accessible (8) If any part of a child's body is in the water, to children x child considered in pool (9) Exposed electrical outlets have protective covers ® (9) Pool enclosed with fence or solid wall at least 4 feet in height,constructed to prevent (10) Consumption of alcohol or use of non- accessibility by children prescription narcotic or illegal substances prohibited (11) Smoking or use of tobacco prohibited on b. Wading structures less than 2 feet in depth: premises `V in. Center kept clean/Cleaning done daily (1) At least one staff with.CPR&first aid at each wading structure (1) Floors,bathroom fixtures cleaned/disinfected (2) Required ratios met as stated on page 23 (2) Carpets vacuumed daily (3) At least two staff at each wading structure (3) Cleaning does not interfere with children's (4) Clean water provided each day {� activities /` 2. Outdoor area(II.,C.,5.,page 19) (5) Wading structure emptied when not in use V . See Checklist I� a. Off-street loading/unloading provided(for centers 4. Away from center activities initially licensed after 1/22/01) (II.,C.,7.,page 21) b. Separate areas for children younger than 2%(may be NOTE. The Department of Human achieved by scheduling) © Resources does not inspect activities away from the center, including swimming and c. Outdoor area adjoins or is safely accessible wading* activities. The licensee shall assume full authority and responsibility for d. Outdoor play area free of apparent hazardous O away from the center activities. conditions c:\users\kcan199c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form rer2ewal 10-09.doc I 1 U U U U flf co N c0 REGULATIONS Q- LL Q a a Q E E n REGULATIONS' E E a Q U U Q V o O V O O Z Z Z Z 5. Furnishings and equipment (II.,C.,8., j. Staff with infant-child CPR and first aid pages 21-22) See Checklists present during all hours of operation Child Care Program (11., D., pages k. Second staff available when 7 or more children 23-34) present/required ratios met 1. Required ratios maintained at all times 1. No staff on duty more than 8 continuous hours on a regular basis a. 0 up to 18 months 1 to 5 in. Staff free from other duties while working (� with the children J b. 18 months up to 2%years 1 to 7 5. Infant/Toddler Progra;(pa4ge25) D, 2.,pages 25-28) Lq d. 24 months up to 36 months 1 to 8 a. Learning/growth activities: e. 2%z years up to 4.years 1 to 11 (1) Encouraged to play with a variety of toys f 4 years up to school age 1 to 18 (2) Time outdoors daily,when weather permits g. School age up to 8 years 1 to 21 (3) Freedom of movement outside cribs daily h. 8 years and older 1 to 22 (4) Placed on tummy part of time while awake f1 and observed 2. Children younger than 2'%grouped separately (5) Staff talks to each child and encourages �1 from older children response J a. Exception for group 24-36 months (6) Cries/signs of distress investigated J\ immediately b._Exception for individual children's needs 1A I I I b. Diapering/toileting:(pages 25-26) 3. Staff counted in ratio only when giving full (1) Clean,dry diapers/clothing provided attention to the children J 4. Staff coverage (page 24) (2) Wet/soiled diapers/clothing changed (� promptly J a. All children supervised at all times (3) Changing area cleaned and disinfected b. Staff assigned responsibility for same (4) No child left unattended while being infants/toddlers each day diapered c. Substitute staff available o (5) No child diapered on the floor d. Director authorized to conduct center business (6) Each child's hands washed after diapering e. Staff person in charge when director is absent, O (7) Staff wash hands after diapering each child authorized to conduct center business f. Staff in each room during napping/resting (8) Staff use clean disposable gloves for diapering each child/for each diaper change 19 g. Staff able to see all the children (9) Wet/soiled diapers placed in S covered,plastic-lined container and disposed of daily h. Ratio during napping/resting: (10) If diaper service used,proper procedures v followed (1) 0 up to 18 months 1 to 5 (11) Individual,disposable wipes used at each diaper change,disposed of properly (2) 18 months up to 2'/2 years 1 to 14 (12) Potty chairs emptied,rinsed,disinfected after each use (3) 2%years and older 1 to 36 (13)Diapering area separate from food service area c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form rerywal 10-09.doc I 1 cu REGULATIONSREGULATIONS ` cu 0 o a E o a Q ) Y a 0 O 0 O Z z Z c. Napping/resting(page 26) (11) When able,infants allowed to sit in feeding chair (1) Infants allowed to form own sleep pattems (12) Toddlers seated while eating Q (2) Infants placed on back to sleep unless physician's (13) Child encouraged to experiment with self- statement indicates otherwise X feeding,utensils provided (3) Infants who can easily turn placed on back but (14) Disposable utensils used only with close allowed to adopt preferred position supervision (4) No positioning device used unless specified by �/ (15) Foods eaten from a dish f 1 physician X lJ (5) Staff recognize differing needs of toddlers/allow to Y (16) Dishes,bottles unbreakable follow their own sleep patterns d. Cribs,cots,and bedding'(pages 26-27) (17) Drinking water offered to toddlers �. (1) Two feet between occupied cribs (18) Child not forced to eat (2) Cots positioned to allow space for access or (19) Food not used as reward or punishment emergency exit (3) Cribs/cots cleaned and disinfected and sheets and (20) Child's hands washed before and after covers washed before used by another child snacks,after diapering,toileting (4) For infants,clean bottom sheets daily or more (2 1) Staff's hands washed before food often if needed,sheets fit snugly J preparation and service,after assisting with n toileting,after diapering (5) Soft material prohibited in infant's sleeping (22) Individual paper towels for each washing environment,no pillows,quilts;comforters,etc and drying O (6) No infant put to sleep on sofa,soft mattress ►/ 6. Preschool/School-age Program (II.,D.,3.,pages 28-31) ,(7) For toddlers,clean bottom sheets and top a. Learning/growth activities(page 28-29) coverings weekly,more often if needed e. Feeding(pages 27-28) (1) Schedule posted (1) Formula,food for infants if provided by center, (2) Variety of indoor/outdoor activities planned with parent or physician (2).If formula provided by center,ready to feed, (3) Time outdoors daily when weather permits properly stored and handled J� (3) Meals and snacks comply with requirements S (4) Staff permit/encourage conversation among children (4) If formula provided by parent,labeled,refrigerated (5) Staff give individual attention to each child Q daily J (5) Bottles sent home or contents discarded at end of (6) Radio,TV,videotapes used only to day supplement/enhance daily plan (6) Small hard candies,nuts not served to children (7) No child required to watch TV or videotape (� under four. J (7) Foods that may cause choking prepared (8) Videotapes previewed by staff for appropriately for the child S appropriateness (8) Feeding schedule according to child's needs (9) Sexually explicit,violent,frightening v materials prohibited (9) Infants held for bottle feeding b..Napping/resting(page 29) (10) No bottles propped f (1) Staff recognize differing needs of children c:\users\kcanI99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form reUpwal 10-09.doc 0 p U to T U REGULATIONS C C Q REGULATIONS L CL a O U Q O U Q V 0 O V 0 O Z Z Z Z (2) Rest period for children in attendance more than (1.6) No child forced to eat 5 hours (3) Rest period at least 45 minutes,not more than (17) Children not allowed in kitchen 2%hours . (4) If a child who does not sleep after 45 minutes, (18) Children's hands washed before meals quiet activities permitted and snack and after toileting (5) Cots cleaned and clean bottom sheets and top (19) Staff hands washed before food O sheets/covers provided before used by another child preparation and service,and after assisting with toileting or contact with bodily fluid (6) Clean sheets/covers provided weekly,more often (20) Disposable gloves used for diapering if needed 0 (7) Cots positioned to allow space for access or (2 1) Individual paper towels for each washing emergency exit and drying (8) At least one staff present in each room D (22) Catered meals and snacks meet requirements (9) Staff able to see all children e. Disciplinary Practices(page 31) c. Toileting(page 29)according to each child's needs, (1) Discipline appropriate to age and A each child's hands washed developmental level of the children J d. Feeding(pages 29-31) (2) No corporal/physical punishment (1) Children in attendance served br4fast or a.m. (3) No verbal abuse snack,lu`ch,p.m.snack (2) Meals and snacks comply with patterns shown on (4) No discipline associated with food,naps,or �. page 72 1 _abathroom procedures (3) Fluid milk served,no powdered milk for drinking (5) No physical restraint as punishment (4) No child deprived of meal or snack n (6) No punishment administered by another ,v1 child (5) Special dietary needs in accordance with written f. Staff-Parent Communication(page 32) instructions (6) Meals and snacks provided by the center (1) .Discipline,behavior problems discussed with parent (7) Vending machines prohibited in areas used by (2) Center open to visits from parents at any children time (8) Small hard candies,nuts not served to children (3) Parents informed of right to visit under four J (9) Foods that may cause choking prepared (4) Staff available for communication/ appropriately for the child conferences (10) Portions of food suited to child's needs,second ® (5) Parents notified of complaint procedures portions available (11) Unbreakable or single-use dinnerware used g. Health information(pages 32-34) (12)Single-use cups or glasses or a drinking fountain (1) No ill child admitted provided for water (13) Drinking water offered during the day n (2) If a child becomes ill or is injured,he/she is /A I separated from group,but continuously •(/ supervised, (14) Food served on individual dishes or napkins, (3) Parent of ill/injured child notified not directly on table immediately and required to come for child (15) Children seated while eating (4) If parent cannot be reached or illness/injury severe,emergency medical attention is obtained c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form rer5wal 10-09.doc ` U . U a) N tII' f� REGULATIONS Q a .Q � E E Q REGULATIONS E E Q U Q U Q U o o . U o 0 Z Z Z Z (5) Parents notified of exposure to contagious Transportation (H.,E., pages]351111 disease/condition _38 (6) Parents urged to notify center if a child is 1.Transportation provided by the exposed to a contagious disease outside center Center(pages 35-37) (7) Center reports contagious disease/condition to NOTE: The. Department of Human health dept as required(page 104) Resources does not inspect activities away (8) Medication/Medical Procedures(page 33-34) from the center, including swimming and wading activities. The licensee shall assume Does the center's staff' N medication/medical full authority and responsibility,for away procedures? Yes No ❑ from the center activities. (a) Medication administered only with written Does the center's staff pr vide authorization from parent transportation? Yes No ❑ (b) No blanket authorization forms for medication a. Transportation checklists used as required o (c) Medication in original container,labeled b. Designated staff complete and sign checklist S (d) Measuring device provided c. Driver signs checklist,indicating he/she has x checked each seat (e) Medication administered by designated staff d. Checklists kept on file for current year plus 2 (� additional years v (f) Locked storage provided for medication e. Center responsible for picking up child at designated location and delivering child to (g) Medication returned to parent or disposed of designated person when no longer needed (h) Time and date medication is given is documented in writing,kept in child's file/copies ✓ t: Supervision in center vehicles available to parents on request (9) Hygienic practices(pages 32-33) (1) Staff-child ratio met for children younger n than lawful school-age,driver not counted J (a) Toilet articles labeled and stored separately (2) Children of lawful school age and older, 0 fewer than 15 transported with only the driver X (b) Used paper towels,wipes,tissues are disposed t (3) For 15 or more children of lawful school of immediately following use age,one staff in addition to driver (c) Toilet paper provided for use by children and (4) For 30 or more children of lawful school staff age,two staff in addition to driver (d) Extra children's clothing available O (5) No child left in a vehicle without adult Q supervision ..J (10) Animals on the premises(page 33) (6) Staff accompany each child under 2%2 from vehicle to care of designated person (a) Aggressive animals not kept in center or on (7) Staff visually supervise each child 2'/2 and grounds older from vehicle to care of designated person (b) Animals that could pose a threat to health and (8) Driver checks each seat at each location to C safety kept away from children verify no child is left on the vehicle. v (c) Certificate of rabies vaccination on file for g. Safety precautions in vehicles animals (d) Animals confined,cages kept clean,food and (1) Stationary seating for child,each child water available seated while vehicle is moving (e) Children and staff wash hands after handling (2) Doors locked when vehicle is moving ^ animals _ J h. Emergency procedures(page 34) (1) Plan for evacuation posted c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form rei6wal 10-09.doc n � REGULATIONS C Q REGULATIONS Q 0 U Q U U Q o O o z Z z Z (3) Children not transported in front seat of vehicle 2. Records on staff(pages 39-42) with passenger side air bag (See Staff Checklist) (4) Driver and all passengers secured when vehicle is a.Records on staff kept confidential moving (a) Each child under 1 year or weighing less than b. Records on file at time of employment 20 pounds secured in rear facing child restraint, installed according to manufacturers instructions, X c. Records on staff maintained at least two years maintained in good condition after person has left (b) Each child under 5 years or weighing less than d. Records filed alphabetically 40 pounds secured in forward facing child restraint, installed according to manufacturer's instructions, e. Inactive files maintained separately maintained in good condition. (c) Each child under 6 years secured in a booster 3. Health (page 42) r seat installed according to manufacturer's instructions,. maintained in good condition. a. Medical exam and TB test on file at time of employment to (d) Each child 6 and older,the driver,and each b. Staff with symptoms of contagious adult passenger secured in an individual seat belt, disease/condition not in center properly anchored to the vehicle. h. Vehicle safety check done annually,signed by Charact.er and Suitability(11., mechanic and dated,filed in center G., pages 44-53) 5. Transportation provided by 1. Character and suitability review conducted on parent/guardian(page 37-38) required persons a. Each child accompanied into and out of center a. Persons with determination of unsuitable /f character terminated P b. Each child signed in and signed out b. Licensee informs DHR of any criminal convictions or current charges c. Any child who arrives by walking or bus,signed in Administration (11.,.H., by staff pages 54-58 d. Photo ID required when releasing child to 1. Applicant/licensee(page 54) unfamiliar,designated person Staff(11., F., pages 38-43) a. Licensee assumes full authority and responsibility for meeting and maintaining Minimum Standards 1. Qualifications(pages 38-39) b.Licensee provides operating funds a. Center director meets qualifications c. Licensee designates director and delegates authority and responsibility for operation and management of center to director b. Child care workers/teachers meet qualifications and n d. Written operating policies established have 12 hours of training within 30 days of employment N c. Aides/assistant teachers not counted in ratio D (1) Copy of operating policies provided to parent at time of child's enrollment U d. Service staff not counted in ratio unless they meet (2) Copy of operating policies submitted to qualifications and are giving full attention to children O DHR e. Driver at least 19,valid driver's license O (3) Operating policies do not contradict Minimum Standards f. Substitute staff meet qualifications of staff for whom }� (4) Changes in operating policies provided to f substituting v parents and to DHR v c:\users\kcan199c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form renpwal 10-09.doc U U. d) U a) REGULATIONS E E a REGULATIONS Cl. E Q o U Q o U Q 0 0 0 0 z z z z 2. Reports to the Department(paq54- b. Age range of children in care conforms to O55) ages specified c. Requirements for drop-in care met a. Enrollment reports submitted as requestedpi 4. Children's Records(pages 56-57) . b. The following reported to DHR prior to occurrence: a. Children's records and information about children and their families kept confidential (1) Change in ownership b. Individual records on each child on file on first day of attendance (2) Change in location (1) Children's records maintained 2 years after child has left the center (3) Change in Director of center (2) Records filed,alphabetically (4) Change in chief executive officer of corporation (3)Inactive files maintained separately or members of board (5) Alterations to center or grounds 5. Center Records(page 57) (6) Major change or extension of hours or program The following records kept on file for the current year plus two additional years: (7) Change in address or telephone number (1 a. Daily attendance records on all staff and l`\+ children c. The following reported to DHR within 24 hours, b. Transportation checklists written report within 5 days: (1) Any illness/injury of child or staff requiring c. Vehicle safety check professional medical treatment v (2) Any illness/injury of child or staff requiring d. Sign in/sign out sheets emergency medical treatment (3) Any death occurring in the center or during away from center activities (4) Major damage to facility S 6. Documents to be posted(page 5E (5) Interruption of the center's electrical,telephone a. Most recent license,permit,or approval or gas service (6) Any litigation involving the center b. Public notice form (7) Any traffic accident involving day care children c. Most recent licensing evaluation using transportation provided by the center Q (8)Any arrest of licensee,staff,employee,volunteer d. Most recent deficiency report (9) Final disposition of any child abuse/neglect e. Corrective/adverse action notices investigation involving licensee,staff,employee, volunteer f. Most recent fire inspection report (10) Any incident in which the health,welfare,or g. Most recent health department inspection safety of a child is at risk V report and food permit or written permission for O catering food d. Child abuse/neglect reported as required by law h. Menu for meals and snacks/dated e. Licensee and all staff,employees,volunteers cooperate with DHR on any child abuse or neglect investigation i. Name and telephone number for: 3. Admission Procedures(pages 55-56) (1) Fire department a. Total number of children in care,including children (2) Law enforcement on the premises,children in transit,children on field trips conforms to number specified (3) Medical assistance(ambulance or rescue) c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form reigwal 10-09.doc 0 U U U -Q C C 12 REGULATIONS E Q REGULATIONS E E Q U Q 0 Q 0 0 0 0 z z z z (4) Poison control center (2) Required ratios for day time maintained while children are awake(see page 23) (5) Substitute help (3) At least one staff,at least 19,meeting child care worker qualifications,with CPR and 1st aid in 1� j. Emergency procedures center during hours of operation (l, k. Name of director/staff person in charge (4) All children supervised at all times I. (5) Each staff assigned responsibility for same 19 Nighttime Centers (II. children nightly pages 59-60) (6) At least one staff in each room of sleeping children In addition to the regulations set forth for day (7) Staff able to see all the children at all times care centers, centers providing nighttime care (after 7 p.m.) shall meet the following /7C` regulations or modifications (8) All staff awake and alert to needs of children Does the center provide care after 7:00 p.m.? Yes ❑ No (9) At least two staff in center whenever v children are present/required ratios met n Does the center provide care after midnight? Yes ❑ No & (10) Lighting maintained so children are v visible while sleeping R 1. Equipment and furnishings b. Nightly activity schedule posted a. In centers operating past midnight,cribs or cots, (1) Outdoor time available during daylight fitted with a waterproof mattress shall be provided for hours each child (2) Staff assist each child as needed,in dressing Y and grooming !� b. In centers operating past midnight,there shall be at c. Food(page 60) least one bathing facility for every 15 children 2. Child Care Program(pages 59. (1) Breakfast served to children going directly x to school a. Staffing (2) Evening meal served to children in attendance (1) Staff child ratio for sleeping children: d. Bathing(page 60)If any child is bathed: (a) 0 up to 18 months I to 5 (1) Clean water provided for each child (b) 18 months up to 2% 1 to 14 (2) Each child bathed separately (c) 2%-up to 4 years 1 to 18 X (3) Each child supervised while bathing (d) 4 years and older 1 to 25 (4) Individual soap,towel and washcloth provided for each child 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 sponsib' 'ty of the licensee to ope ate in compliance with the Minimum Standards. � g 1gnature of licensee or designated staff Date c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form rejgwal 10-09.doc n n Checklist for Infants (O)indicates compliance observed by DHR Licensing Representative (%r)indicates not in compliance (X)indicates not applicable iMANA Name of teacher/room# .� Age of children Z_ Number of children Number of staff Minimum Equipment Required for Each Grou of Children ' 6: Washable soft crib toys-2 per child Mobiles-1 attached to each crib(for infants younger Q than 5 months Push and pull toys-1 Record player,toe player,C D player or radio Age-appropriate records,tapes,or CD's-6 per player Age appropriate books-2 per child Large balls 8+inches-I Nesting and stacking toys-2 sets Washable baby doll-1 Musical toy-1 Colorful pictures and posters Activity boxes,such as busy boxes-3 Additional , Diapering area Sink,warm water,soap,paper towels Plastic-lined,covered container Tub(portable plastic type acceptable) Feeding chairs Cribs/2 feet of space between occupied cribs Waterproof mattress,sheets Indoor thermometer/Out of reach of children Shelving forequipment and supplies/anchored Individual,labeled storage space for each child Furniture child size,clean,good condition Facilities Electrical outlets covered Barriers around heaters,fans Hazardous substances locked Q Containers labeled Medication locked Screens on windows which are opened ,Lightingadequate c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form reroval 10-09.doc I 1 Checklist for Toddlers (age 18 months-2% years) (O)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance (X)indicates not applicable Name of teacher/room# !( Age of children Number of children Number of staff Minimum E ui ment Re uired for Each Grog of Children Required1 1: 1 Large non-toxic crayons/markers Paper(variety) Non-toxic Pla dou h Colorful pictures and posters Record,toe player,or CD la er Age app.Records,tapes,or CD's-6 per player Musical to Xs—2 Push and pull toys-2 Large cars,trucks,boats,etc.-2 Sit-on riding toy-2 Large soft balls-2 Quiet Play Books-2 per child Age appropriate puzzles-2(complete with allpieces) Nesting and stacking toys-2 sets Non-wooden buildin blocks a roximatel 20 Homeliving/Dramatic Play Baby dolls-2(complete with all arts Doll clothes and blankets Doll bed-1 Toy tele hones—2 Pots,pans,buckets,large plastic spoons Child-size stove jDress-up clothes Additional1 Diapering area Sink,warn water,soap,paper towels Plastic-lined,covered container Tub(portable plastic type acceptable) Potty chairs cleaned/disinfected/emptied X Feeding chairs or table and chairs Cribs/cots Waterproofmattress es,sheets,coverings Indoor thermometer/Out of reach of children Shelving forequipment and supplies/anchored Furniture child size,clean,good condition Individual,labeled storage space for each child Facilities Electrical outlets covered Barriers around heaters,fans Hazardous substances locked Containers labeled Medication locked Screens on windows which are opened Lighting adequate c:\users\kcanl99c\appdata\local\temp\2\templ_forms.zip\forms\evaluation form replwal 10-09.doe Ch,_eklist for 24 months up to 3 months (0)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance X indicates not applicable Name of teacher/room# Age of children •. Number of children Number of staff Minimum E ui ment Re wired for Each Grog of Children Required Equipment(page 69) Art 7771 Non-toxic playdough Large non-toxic crayons/markers Paper Non-toxic finger-paints in primary colors Scissors(blunt-tipped) Books-2 per child Record,tape,or compact disc player Appropriate children's records,tapes,or compact discs—6 Rhythm instruments-one for each child in the group DramaticHomelivii 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 Building blocks—approximately 50 Cars,trucks,boats,etc.—3 Age appropriate puzzles 4(complete with all pieces) Interlocking manipulative play sets of different types—3 sets Adait'i'onal Furnishings and Equipment Diapering area Sink,warm water,soap,paper towels Plastic-lined covered containers Tables ace and chair for each child Cots/sheets and covers Indoor thermometer/Out of reach of children Written daily plan or schedule posted Labeled storage space at child level Shelving fore ui ment and supplies/anchored Designated activity areas Electrical outlets covered Barriers around heaters,fans Hazardous substances locked Containers labeled Medication locked Screens on windows which are opened ,Lighting adequate c:\users\kcanl99c\appdata\local\temp\2\templ—forms.zip\forms\evaluation form rep2val 10-09.doc Check>r c for Preschool (age 2V2 yea..to school age) (O,)indicates compliance observed by DHR licensing representative ( ir)indicates not in compliance l 1I X indicates not applicable ` (�•7 Name of teacher/room# Age of children .. Number of children a, Number of staff IRequiredfor Each Group of Childrell Art Easel Non-toxic playdough or clay Large non-toxic crayons/watercolor markers Large sheets of paper Non-toxic finger/cold water paints-primary colors Scissors(blunt tip)-2 pr.Per 5 children Non-toxic glue or paste;tape ===EE I I I I I I I Paint brushes four 1/2 and I inch in width Educational and Creative Toys Large/medium building blocks-app. 15 Small building blocks-app. 100 Small cars,trucks,boats,etc.-6 Age appropriate puzzles-8(complete with all pieces) Interlocking manipulative play sets,different types-6 Matching games (no more than 2 electronic) Q Puppets-2 Homeliving Area Child-size stove/sink(or combo) Small table and chairs/benches Cooking utensils/dishes(unbreakable) Doll bed or cradle 6 Dolls(complete with all parts)-2 Doll clothes and blankets Dress-up clothes for boys and girls Storage for dress-up clothes Unbreakable mirror-full length Toy telephones-2 Literature and Music Age Appropriate children's b6oks-2 per child Piano,record player,tape player,or CD player Children's records,tapes,or CD's-I dozen Rhythm instruments—r per child in group Nature Study and Science Magnifying glass Magnets Nature collections Measuring and pouring equipment Additional Furnislihigs and Equipment Tables ace and chair for each child Cots.Sheets,covers for each child Indoor thermometer/out of reach Written daily plan or schedule posted Labeled storage space-at child level Shelving forequipment and supplies/anchored Designated activity areas Facilities Electrical outlets covered Barriers around heaters,fans Hazardous substances locked/ containers labeled Medication locked Screens on windows which are opened ILighting adequate c:\users\kcan199c\appdata\local\temp\2\tempi—forms.zip\forms\evaluation form rergwal 10-09.doc Checklist for School-Age (O )indicates compliance observed by DHR Licensing Representative (,tf)indicates not in compliance (X)indicates not applicable Name of teacher/room# Age of children Number of children Number of staff Minimum E ui ment Re uired for Each Group of Children Required Equipment (Ill., 1., 1). I Ji =sawpuzzle-1 per 5 children Games:choose indoor or table games Suited to a e 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 Record player,toe player,or CD player A e-a. ro riate records,tapes,or CD's Interlocking manipulative play sets—1 per 5 children Additional Furnishings and Equipment Tables ace and chair for each child Cots/sheets/covers for each child who nap Indoor thermometer/out of reach Written daily plan or schedule posted Labeled storage space at child level Shelving forequipment and supplies/anchored Designated activity areas Facilities Electrical outlets covered Barriers around heaters,fans X Hazardous substances locked K Containers labeled Medication locked Screens on windows which are opened Lighting adequate c:\users\kcan199c\appdata\local\temp\2\tempi—forms.zip\forms\evaluation form rep4wal 10-09.doc Playround Checklist g (O)indicates compliance observed by DHR Licensing Representative (I indicates not in compliance (X)indicates not applicable Required Equipment(Ill., I., p. 71) 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 Balls-3 Climbing apparatus Walking board Crawl-through equipment Digging or sand area 19 Toys for digging Facilities Outdoor play area enclosed by a fence or wall at least 4 feet in height Fence or wall free of sharp edges Gates secured Shade and sun areas provided Outdoor play area free of apparent hazardous conditions •� Concrete/asphalt not used under equipment Area well-drained Equipment not designed to be portable,securely anchored Stairs/steps have hand rails in child's reach Mf/J10,A:;,W c:\users\kcanl99c\appdataVocal\temp\2\templ_forms.zip\forms\evaluation form rep wal 10-09.doc