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HomeMy WebLinkAboutEvaluation Form ALABAMA DEPARTMENT OF HUMAN RESOURCES Revised 11/19 CHILD CARE CENTER LICENSING EVALUATION RENEWAL(Health and Safety Guidelines items shaded Name of Center: F) of Evaluation: a`a "aOaD Gaver''t-v��t�us Y\ Address: Date(s) of Follow-up: Purpose of Visit: Telephone #: Director: Licensee: Gav e� 1�pu�S >° V% County: L✓J,_�/ Day 0 Night Subsidy Licensed Capacity: Day Night Days of Operation: Da Night D Age Range: ay3 S" Night g g Hours of Operation: Day1 aH1 Night License Number: Code: l � 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:3)4 ` b To375`oxcir20 Licensee/Staff in charge Deficiencies Noted: - U4es 0 No DHR 'c s' epresentative.: Sections to be completed at the discretion of the R Licensing Re-presentative. a) a) a) m m REGULATIONS Ua0 to a REGULATIONS cco V p Q 0 p a U w V Y Q O CO Z Z o Z Z Facilities (II. C., pages 16-23) a S}pace for tll or tn3ured clnld 1 Indoor area(II.,C,4, pages 16 a XCIUS1Ye llSelOt aCt1V1 areas � s 1 { � }- y' u ' Y 54 Rt .o .n�1 n 7 i g 7� :.:ems' ; 6z; € tY A �� ,gam StoraDe space for teachers su n� f {r -3' =s v3,�`r-_.: :i ,xv *,r c; €r`'�`lc`r t 'cam " " � r F'l- b Designated space for each grouping of children i E �Officespace provided r 3 'j s* � a c Bathrooms located on same level/un�err�ame roof £ r i. Ventilation,lighting,hcatin-(pages 17-18) 1 one flush toilet for each 15 children (1)�Iieatmg/au•co dthontngpt�ovlded ' ��"�'�' '=`��� �,17�f '�' (2) one handwashing sink for each 15 children �{b�2)�rTemperature 68A82 at'c�tldlevel����'�,}, �, �� (3) One tub(portable plastic acceptable) " t(3)Thermometer ui eachar used 1�yeh ldren ' lot gniZVV t(4) Fixtures chdcl stye or ad3usted foreasy use s�� k � 4)�hetmometer out;of reach of chtldr Y " '-id One handwasluhg sink with waimnnm water 0 P , Outs de w r1dowS7th t are apeltedkare� 'i i fi soap,paper towels�n each room where ch�ldr'en are = - bu k __ � I ti ems. a screened r f {. fi ),, � ,fir 4 U U U U REGULATIONS CU _ a v REGULATIONS @ v a a — E E a E a U � Q �j Y Q 0 o w. z Z O Z Z {�w 3. Swimming and Wading at the Center( ,y aY G n 1 LS�•�k;a.3' r= L"`ti l a d f a.C ' C.,6.,pages 20-21) (7)Lighting_adequa[e for acttviUes � ti a. Pools two feet or more in depth(pages 20-21) (8) Liehhng adequate at nap/rest hme to allow r r ,a1) Lifeguard atpoolstde at all hmes pool=ts m children to be seen t ,I* x� 'ri Miser € r e 'cE � � ol d Operational telephone for center business onl '" � ' �4 �� �'`t` Lifeguard�rainuig Certif cafe First Ai d I�rx f r• + 9 .1" x i r 13a ". ' -4- 6� {�H tt 2 t PV trt 9 r 3 r r r is qny CertlfiCate CPR(j5RIppahon Onflle k DIM nohfie,if tele hone is outof order or if, f t p jai (3) Lifegu rd not counted ut Tahos � � number_changes€ 3 '_ —Ww �- £ � � 01 I. Hazard'prevention(page 18)(Indoor Area) (4) Staff-child ratios for children in the pool: ._ (1) Center free of apparent hazards�a : , Fv% (all s zit one stafffor each child youngetan r ,� ,"'�' ah r"iryl�'r✓ - T'I,t�'ats _ 4 v ♦years of agee s r,, tK tx 3 (2) Hazardous substances under lock and key or t D: r ># 1 (b}{one staff foreyery4 ehildren ages2 x �f combmahon lack e z y � � h �i} 3 p (c) one stafffor every 6 children ages 4 years t � i s` F�✓ (4) No firearms or ammumhon kept or allowed m m h# t Cd) bne siafffor every]0'cfttldre"ages 6 x center exceptflawrenforcement� (5) Stairways have hand railings m chdd s reach Y ` (5)�Raho_s determined by youn est child m'the b C »� 4 (6) Glear glass,doors marled at child level ' ` ' IV ?�is��(6� Persons counted m ratios meek child care�n �. . a�����~,`��, zfir.h s r :+` .c-�' .� n�,k,rc, xz r ` worker, ual)ficatlotf5s7in the qol atalltiines'�' .r r s ;. (�Medicines and dn[gs kept under lock (7) Staffprovided to supervise ehildrenrm� � y combination lock;separatefromharmful items ool are but not spool r - x4 ya (8) Barriers around heaters tadiatorsgfans accessiblean` art of a Childs bod is 7n thexwater <SFr Y.p, Y fij, ip: s,tir r a (9) Exposed electrical outlets have pxotectve covers [ L9) pool enclosedtwilh fence or sohd,wall at z �{t zr A leasf 4 feet m height,rconstructed to present ,� 4 N r ` (10) Consumption of alcohol or use o non t 1 acccssibility by chtldieri F} +vF f prescnphon narcotic or illegal substances prohibited , r y. { (11)f�mokmg or use of tobacco prohibited on _ b. Wading structures less than 2 feet in depth: premises J r (page 21) rk'``z „33- Ypi' l (12} Bio Contanimants shall be stored and disposed m. Center kept clean/Cleaning done daily(pages 18- ---'t At least one staffwtth CPR&firs[aid at � 19 each wading (1)doors,bathroom fixtures cleaned/disinfec�ted t s21 a(2) Required ratio met as stated on p ge'23 ti Epppp ' 2 C etsHvacuuined dailf ter,': t f �� ( ) Y „ r (3) Atleast fwo s aff at each wading structure A � (3) CI anmgd es not interfere with children {4) Clean water r vided each day :=aetlVlhe5 ip Y ._._ • &N..z.�. . :£',r,z�:-.v, .G.�-. 3 ��,:. k.:.�i. �� � ,�t n�x, f€ JX�A�� E' �y�'*�' w 2. Outdoor area(Il.,C.,5.,pages 19-20) x(S Wading sttuctuie emptied when not m rise *� c See Checklists* sa 40ffstreet loading%unloadmg provtdi�d Q� x 4. Away from center activities (II.,C.,7., b Separate areas for Children younger than 2/�(maybe NOTE. The Department of Human Resources chteved;by`s�heduling) sit j s i R does not inspect activities away from the center, Including swimming and wading activities. The "`c Outdoor ores addotns or is safe(yaccesatble a ' ' `" licensee shall assume full authority and responsibility for away from the center activities. t xi s� r s sxi 3 y r s \/1 d Outdoor play area free of apparent hazardous :A mFz CU Ucu REGULATIONS a t° 1Q 0 Ecu a REGULATIONS � EVQ O U C° U r o z z 5. Furnishings and equipment (II.,C.,S., taffwthmfantchYildCPRandfirstazd pages 21-23) See Checklists present duringallltoursofoperallan Child Care Program (11., D , pages k Second aaffavallablewhen7ormorechildren N 24 37) preseii�requued ratios mete 1 Required ratios mamtamed at all Tunes r i � , 1 No�staff�on duty more than 8 continuous hours�� s = y: s Mau - _ ,,:' 2 i - a 0 up to 18 months Into 5 - m Amp from other duties while vvorktng = b 18 months up to 2%ye_ars 1 to 7` _ 5. Infant/T oddle�Program(IL, I x 2 •, pages 26-29) d 24 months up to 36 months 1 to 8 a. Learning/growth activities:(page 26) e2%:years ilp to 4 years= - 1 to 11 _ y-1 (1) Encouraged to play with a variety of toys (J ��f 4 yearsaup to school atre� - � nI io 18 � s� (2) Time outdoors daily,when weather permits (3) kCeedom ofmOvemenoutslde Cnbsdazly j h 8 years and older , to 22 _ (4) Placed on tummy art oftlme while awake` �, r 3 observed 2 Children younger than2`/grouped separately - ¢ (5) Staff talks to each child and encourages from older children A r r response / 'r a Exception for group 24`36mon#hs� ���, ' � � ` � � �(6� CneS%tgns oI'lltstress.t�n_vesttg ted�° � { � � _' b ExcephoriformdiVidual childrensneeds b. Diapering/toileting:(pages 26-27) 4 s 3 Staff counted�niraho only when giving fulls attent►oit to the children ' £(1) Clean,dry dlaperstc) thmgprovlded — �� t= 4. Staff coverage (page 25) x (2 Wet/sotled dlaperslalQllung_changed ' rom fl Al a All children supervised.at alL times - - r t{ d x b Staff assigned responsibility for same }� wwa infants/toddlers each rfa c Substitute staff available � � � x � �` `�' � (5)rNo child diapered onthe floor <� � �� � _ r t'� d Director authorized to conduct centerlusine9s X . xEach}child s hari8s waslieda#ter diapering e Saff person In charge when director is absent x x n � -� �� (7)�Staffuse umversal precautions when authorized to conduct center busmess�, � - �� � n s a �- _ �� �� (8� Staff�ase clean flisposabIg-gioVes Tor � � � -�� � t �x Y 4 � ��` diapermgse ch child/for each�daper chaziges� �� �� , , ::-�g Staff ableto see all the children � .; � � � (9),�eUsoiled dta�ers plat"edm coveied � �� � # k , ° _ plastic lmedy�ontamer and dlspgsed of daily x i { h Ratio during napping/resting(page 25) (10)j�ttdrvtdual,disppsable wipessitsed at each diaper change,�disposed ofllroperly r (I1) Potty-chairsemptted„rinsed,dtsitifected��4���� y r (2) 18 months up to 2'/z years r Ito 14 ": r s(I2�47iapenng are es pardtelromood service - a c. Napping/resting(page 27) _ I REGULATIONS 0 L to m REGULATIONS m m a .2 0 o Q o o a L) rt, U Y Q Z Z Z Z (1) Tnfants'allq�ved to form ownrslee patterns "�� '�� k �� x _ ' 3 0-1- (2) Infants placed on back to sleep untess`phystctan s; f4 13 Cht(d encouraged to e+tpenment wtth self r j statement mdlcafes�othernlse w z r - � i feeding,ufenstls p[4videdr a ' �> � h,. ,,, � � � �I '� (I4) Disposable ulenstls used only�ithtclose ,UP, k 3. u l� allowed to adopt pceerred position r,' "+su ervision € ' « '+tt'x'sir€ � (4) No positioning device used uiless�spectfied by *ti` "r h x (15)Eoo_ds eaten,xfTom a dish a� t r Aphystctltn ti t -ark x p v �rrTpt7 r t th Tv ,i4k2 t` ? •c n : e-Y - .-, F +t '•'-� �' <e�C�t-`tz ��„� -.,,ssi� � � --#i h'r w -r Y �x'�eke � R (5) Staffrecogrilze diffenng needs"of roddlerslallon to f � a (16) Dishes,bottles unbreakable K ; ". _ ` -- ;'follow their ovvn sleep patterns rr3 }r t d Cribs cots,and bedding(pages 27 28) ti„ (1) Two feet bettveen occu ied cubs; ' t - �°' 4 ,, r ��_P s � t� _ z ,� (18) Child nokforced to eaf� m (19)Food notused as regard or punishment 4 rl (3) Cubs/cots cleaned arld disinfected an`d sheets and ' ° `' � sf' r r (20) Childs hands washed before and after ; covers pvashed before used by another snacl.s,after dtapentg,toiletuig � w f r `7 a. ata - °d�2r.r h:�,„rr _ t(4) FOf Infants=clean bottom_sheets datl or more ""' 7( -� n3` �' �r s a 21) Staff's hands washed before foodx*r , � 3 soften if needed sheets fit snugly hprepazattonand seN)ce after aSslstm Wltj] #x ��1 4 g z _ a g i `(�) Soft mafenal prohibitcdin infant s sle p g � ry '� �,�(22)Indivtdual paper,towels for each washin environment no pillows quilts comforters etc rt >iiid drying ` ' , � y - ,Is *i a K �6}tNo infant ptit to sleep_on sofa sob mattress g y 6. Preschool/School-age Program or d fi b � . .;• ,�T ,- :. ham_ : (II., D.,3.,pages 29-32) (7)For toddlers"clean bottom slieetsand lop_ L a. Learning/growth activities(pages 29=30) covenngs.weekly more often if needed{,�``-rt`' � � i�� - z f k: e Feeding(page 28 29) (1) Schedule posted u j(1a Fornmla food for mfans tf provided by center, r F j (2) Variety of indoor/outdoor activities Fplamli:d wtthtparent or physician .� "' � ��r r 5,�`` :� i _ � _ 'L� Ifformula p%vided by eater,readyj8 feed, e. - (3) Time outdoors daily when weather permits property stored and.handled - ` d (3) Meals and snac(cs comply*with requirements 1 °�, (4) Staff permit/encourage a conversation among O S�',,v iC t ySt g. e s `f ; children 3(4) If formula proyiddd bypazent labeled trefri crated f ,v f z i g fiti (5) Staff give individual attention to each child daily rY(5} Bottles sent home or contefit&Aiscaided a 6 t end of r ) Radio,TV,videos l to GS' �t5 - Jt•°L Xu�, t- tlw) I -�, f T ( ) eos use only supplement/enhance daily plan ztd Kc`Wn'' Ain tix+. }rwt* 7"(i. - .-.e: .fir vks .ksat 3-.'�' v4£$ �' ..r`tsr r W'�,g h r4,= v «tP a^+ r7 (6) Small hard candies,rnirtssiot served to children G ;,s ¢ '" °11 `�'� '� ` , i�c` tinder fours , 7)No cllrld recurred to watclr3'V or videos 5SaAr.t a»F E:y,:. . � =s..rY.} ,;it hr �'c .:�,*!'W-,+ x x• _._5 )a.. z�. 7_ ,h �,- v,,--,,.w,g- (7)Foods that may cause choking preparedVideos previe}ed by staff for kWr appropriately >. .a P raj f f..Kai ):y(8) Feeding}schedule according to child s needs �, f (9} Se*tiia.. ex licit vtolen fn 7 tenui rim ;5,r ��m�tenalsprol�ibtted����i`�� - � (9) InfantsAhedfor�ottleeedmg '= xt #t t� v 2 b. Napping/resting(page 30) - (10) No bottles propped E s 1 r differing kY`(11)When able;infants allowed t sit iri feeding charr � � { ' (2) Rest period for children in attendance more' than 5 hours � rc� j G`r> h S ����. e 9\e ba u ceXy,�Gc+c S r C C U U C C Z fII T Nca REGULATIONS a U M @ o U Q REGULATIONS LL o o Q U Z Z c O Z Z 3 Rest period at least 45 minutes,not more than k c{ ( ) P (15) Ghifdrenseatedwhileeatm k j g r 2h hours z(o) Cots cleaned and clean boltP m sheets , P _ x i (l?,) Cluldred not allowed an kttcheq � Rt4 s sheets/covers provided before used t - - i -.. fit" �'W u. '^'T '�•'_ }�'�r'�`L �i i ( Clean sheets/covers.provtde weekly,more often (18)AChildren s`fiends washed fbeore meals { s :tfeededi wt� - Any a w '.H tend snaoland aftetotleGilg = µ3 � r x ','^5r s a h ' rye rcxaj.-f' tj s � h (7)�Cots positioned to allows ace foroaccess or Staffhattdswasedbeforef`ood� IL enc exit "� r 3 s� x� &. r ` gj 4Y; s � � � �t�s ti,�p�epar�ahon anted serv�ceaand ate�,asststmg Ntilr � �� '�r�sit_ � (8) AYl'easrotie staffptesenttn each�ioom-EF { a =(20)Disposable gloves fused forldiapeing �) (9)'Staffabletoffeeallchildren L` kl2 ) N,1 Individualtpaper tovyelsforeach washing n� and dryrng` a �� c Toil eting(page 29) w i (22)rGatered meals andsnacks meef °r 3 'J (T)Acc iMd to each child s needstadach child � �„ � �, � e. Disciplinary Practices(page 32) hands washed - or handim,bodilyxflutds r,. y � deyelopmental leel,,of the childrenf� , � d FeedID awes 30 31 �� ystcalpunlshment` (1) Children in attendance served breakfast or a m y z � 1 '() erbal s '"` v abuse , snack,lunch p m�snac64 k . r,� •n-,a s,{ '! -`" t 5' k r^9 . Y7 �5.2 .+ -,.,�7-`t #� *#3`° a f '4r - i tz'W s Ev€� _ A'c }(2) Ivieals and snacks comply with USDA guidelines: �r (4) No alsctplme associated-with food �aps o Y' ?� 5S .z . r7� y.aS ¢ ...� bus , ,s _,.la, (3) Fluid mNk s ked no pgwderedkmtlk�for drinking} � r (5) Nop y sical restraint as punishment (4) No child pnved omea�or snackY tj a '" at- (6) No punishment administered by another 1 child (5) Spemal dietary needs m accordaiiFce with written ` } , y f. Staff-Parent Communication(page 33)-. (6) Meals d'snacksfprovtdecf by:the"center { "� 4- _ (1) Discipline,behavior problems discussed with parent ?k(� Vendingmacluties'p[ohtbttedazeas used bye r _ (2) Center open to visits from parents at an time �,8j Small har LcanNes,nuts not�servetlfo htldretix � q (3) Parents informed of right to visit G UndeT011 rr i � b a } 5 i f b J 112 4� E(9)Foods that'may ause cho7.mg�piepaied '� ,, 4 Staff available for communication/ appropnatel�iorthe child # conferences 0) Portions dffood suited to child s needs;second as.2 ;' (5) Parents notified of complaint procedures t' zx3A` .x - � ��x� e �( )Unbredkable�o r$mgle usedrnnerwar�e used � i, 1x_ " (6) Parents provided with information on influenza te (T }Single use cups or glasses or a drinking fountain +} g. Health information(pages 33-35) pzovt a or water g aD ! e s Tdt` -s4�' 'ti•Pai,� f No child"ddtriitte� r` r fix« (13) Dnnkmgwater offered during the days �� T" ( ) i* ; ga - �€'et� r+`�xCN�.rt =r � s'•e t.c fi[#'i+ �.��T 3 �-� ��i ixF"�x ��xr:x� F a� -.-s3 �+'�v c� "`'� k iedia vdooi'sery rnd ttial"dtshesOrI'ld ,kx r t , t 2)oI f.-a c•rh jial€id bec 0 eSrp ltlk)oral m�ltri -VRe'M ed aK# r snot directl on tub e r Tv �r atx {a w�a 01 pontillU(1151 e r v rY =�:(; t utin K� kx t � ,separated ffom gro3tp` Y3 h U U U U U REGULATIONS Q a c sa U E o Q REGULATIONS E E Q U Q 0- 00 Q o O U Z Z Z o z Z (3)'Pazent of tll/m�ured chrld noted nntnedtately ,"1 {ej (e) Children and staff wash hands after and required to'com a forchtld '} jt _ '' ra handling animals (4) If pazent oannot be reached or illness/m3ury h 1✓mergency Preparedness and Response �' severe emergency medical attention`is obtained h Plans(page 36 37)$j`See Checklist ay�� z ? (5)'Pazents notified ofexposurc,to contagious r " Transportation (IL,E., pages 38— diseaselcondition 40) (6)_Pazents urged to notify center if a child is I.Transportation provided-by the Center exposed to a contagious disease outside center (Pages 38-40) (7)Center reports contagious disease/condition to _ ) NOTE. The Department of Human Resources does healthdepartment as required not inspect activities away from the censer, including swimming and wading activities. The (8) Medication/Medical Procedures(pages 3a-35) licensee shall assume full authority and responsibility for away from the center activities. Does the center's staff give edication/medical procedures? Yes [y�_ No, E (a Medication administered only with written Does the center's staff rovide transportation? authonzation:trom parent Yes 0 No (b) No blanket authorization forms for medication a r Transportation fchecl.hsts used as required �rn t t (c) Medication m ongmal confalner`lab_eledb Designated staff complete and sign checklist , ZEN (d) Measuring device provided c Drrver signs checklist,indicatuig he/she lias } "f ClleCki' each seat (e) Medication administered by designated staff •� � , � " � ,d;Checl.lists kept onMile for current yeac,plus 2 R -���" (f)Locked storage provided formedicaton - additional years '' N' (g) Medicatwn returned to parent or disposed of.- _ e";Center responsible for picking up child at 3 when no longer needed t� � � � ,,,designated location and delivering child toy,;� ` �'s� � ' ' (h) Time and date medication is giv n is documented m wrrtmg kept m child's,81e/copies f. Supervision in center vehicles(page 39) available to parents on request " �f �z '' F '� , (9) Hygienic practices(page 3 ) r(1) Staff child ratio met for children younger rx a' z y titan lawful school age driver not counted (a) Toilet articlesalabeled and stored separately (2) Children of lawfuil school age z �t_.r r r .� { <"� i wer than.).$franspOrted Wlth Only the dr1YfI�� fe Yeti �. (b) Used paper towels wipes tissues are disposed M t' (3) kar15 ormorechildren of lawful school r r of immediately following use "Y _ r' agex one staff m addition toAm,14 dnver (c) Toilet paper provided for use by children and f �' k(4) For 30 or more hddren of lawful school F ,l ' j ` $ x t(d)'Ertra children s clothing available �� h"(5 No child left u�avehicle without"adtilt`�Y' ' �-� `���;t, )t ,� t}superviston (10) Animals on the premises(pages 35-36) y3{6) Staff accompany each child under3%:from gar F �v�etiicle to care of designated person �'z�`�R i � '� (a) Aggressive animals not kept in center or on Staffvtsually sit ervise each child 2%z4and' 3 grounds Folder from vehicle`{o care of desi ated�"erson '' " (b) Animals that could pose a threat to health and <',(8) Drrver checks each seat at each locatto to "ti safety kept away from children verify no child is le$on the vehicle c k7! i (e) Certificate of rabies vaccination on file for C g. Safety precautions in vehicles(pages 39-40) animals J (d) Animals confined,cages kept clean,food and y5 (1)*Stationary seating for childt Bach child :r water available seated while vehicle is moving �� � ,� �,�$� �f.i�� % (2) Daors`locked when vehicle is mov�itg r r 5 f � ����"�� a) a) m tea Q M m two REGULATIONS o U Q REGULATIONS E L Q U � Q o U C c o U o �. 0 z z Z Z (3)Childrennot�tiansported iontsea ofucle 2. Records on staff(pages 42-44) with assenger=side alC bag it, !", (See Staff Checklist) (4) Dnver,and all passengers secured when vehicle is �,�ka Records on staff{kept confidential ' 3r 1 ;" mOVm� k y v 3 7151 ' z a e°1 - Ise Sj 1tZ . �u a)y,Each child under 1 year or weighing Tess than a ti 2 t �i bRecords on file athme of eriiployment r Sri 20 popes secured m rear facing child restraint r t r u x' r c. Records on staff maintained at least two ears maintained m good condition t�,t ,., `'�,, x �' � � - Y after person has left S �;(6) Each ctildunder°5 years gi weighing less than �3 ;�3 d R�coids filed alphabetically r' ice ' ' Installed according to manufachirer s instructions (c)tEach'cl ild under 6 years secured to a booster ; 3. Health (page 4z) 1➢ seat installed according to manufacturer s mstrucGons 1 �� maintained m ood condition rt Y t t t �, zx � � � a Medtcal exam and TB test on file attune of s a 2�`� r rah 5 f c3 z ° , a _.z w ;y, employment�,� ' `(d) Each clild 6 and older the driver Arid each ?t � � `{ � Staff with sympfoins of contagious aa�'� *��( � � � r �_ adult passenger secured nr an individual seat belt, t ks dlseasc ndmon noun center n z h Vehicle safety check done annually signed bye ' ��r ' t ,Character and-Suitability (II., mechanic and dated filed in center'x'� �' 4, _ � ,. * n`' G., pages-47-51) E 5. Transportation provided by 1 Characterandsuitabthtyrevlewconductedon�t "' F parent/guardian(page 40) regarredpersons(everyr5years) _ 1 3 a'fEac}i child accornpamed into and out of center r r y` a `Persons with determmatiou of unsuitable „.f a r Yz� i 3'3. c 3 �y < s 3 chazacter temunatel f .�'.p .r� �.r�t �, '•. 3 b Each child stgned inrand signed out fi �� "' ,, �t � I ��; b Licensee informs;DHR of any crunmal � �� i �-�� ,a � zi£ ,_COnVICtlOns'orCutrent'd r�CS c Any child�vho amves by walking or bus stgned m Q s" b Staff x Adm nistratioIt(II ,..H.; _ Q Y a v � �- _ ,., a es 52-56 id-. Phofo`ID required when releasing child to 1. Applicant/licensee-(page 52) unfamiliar deslgnatedperson �r Staff.(II., F., pages 41=�6) a. Licensee assumes full authority and responsibility for meeting and maintaining Minimum Standards 1. Qualifications(pages 41=4.2). b.Licensee provides operating funds 5 a. Center director meets qualifications c. Licensee designates director and delegates authority and responsibility for operation and b. Child care workers/teachers meet qualifications and � management of center to director have 12 hours of training within 30 days of employment Chili(�eare workers/leachers meet,equuements Sorg F �5ts d. Written operating policies established GCDF�training�wittthinf9Q days cif applicable) t �f # 1"1 c Aides/assistant teachers not counted in ratio (1) Copy of operating policies provided to parent at time of child's enrollment Fd Se1'v�ce staff not counted miatiorunless the meet h ' a atR 3 } y a (2) Copy of operating policies submitted to qualificationsand are giving full attentton to children DHR vx e Driver at least 19 vand driver s license " ( ) .t 3 Operating policies do not contradict Minimum Standards fi �raPde n `a4x� - air Kkv. 4�` 7s�; mp f Silbstitute staffmeet quaycations of staff for�yham (4) Chan es in operating substitu in Ito- r + g Policies provided to g T xt1 _ _ ,'. = Parents and to DHR f'L. - I f REGULATIONS c- REGULATIONS CL 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 -a. The following reported to DHR RELuto.occurrence: 4. Children's Records(pages 54-55) (See Children's Checklist) lwt (3) Chance in Director of center (1) Children's records ' maintained 2 years5 after child has left the center (4) Change in chief executive officer of corporation or members of board The following records kept on file for the CUrr -,j year plus two additional years: b. The.following reported to DHR--%vithin.24 hours, qZ written report Within 5 days: 6. Documents to be posted (pages 55- a. Most recent llicen permit,or approval ice form X19 ern jn i en JI IYR fin paL i. Name and telephone number for:(page 5 RZ m ai m REGULATIONS Q Q a REGULATIONS ° Q U U Q O U C C 0 U C 0 Z Z Z Z (4) POlson C011tCol Center +i ` �{"r o `� C ' .i 5 , 2)Required rattos for da yFtime maitltamed t +r ,i{r .. w file children are a wake(see.page 23)XNO- (5) Substitute help �.:' (3) At least one staffL at least 19 meeting child I Emergency Preparedness and Response Plans }.� care worker qualifications Guth CPR and lstatd m ��' ��,~ ' M center dorm°hours o o eration k Name of dtrector/staffperson m charge f', " (4) All chtldreq supervised a all tiniest x tq + Nighttime Centers-(II., L, (a) Each staff assignedre`sponstbilttyforsame- } children m�htly �` pages 57-58) C Y (6) At least one staff m each room of sleeping '� �u,�. 5 w In addition to the regulations set forth for d gF�r1 3i,�V _ "x x care-centers, centers providing.nighttime caret;O Staff able to see all the childrenakallfimes �� (after 7 p.m.) shall meet the following regulations dr.modifications y� (8) All staffawal.e and alert to needs of children ' Does the,cedter provide car.e-a ter 7;00 p.m.? ❑ No d(9)t At least two staffm center wheneverr Yeschildren are presenU required rattos Does the center provide care.a er midnight? Yes ❑ No2 F x N (10) LtgliUng maintained sdxhilded'are visible k I. Equipment and furnishings b. Nightly activity schedule posted (page 59) a In centers operating past midnight 'cribs or cots n t cR ( (1) Outdoor time available during daylight hours fitted with a waterproof mattressrshall beprovided for `� $} , `' Y� �� ,,� �, (2) Staff assist each child as needed to dressing: ,� b In centers operatutg past ny ntglit,there shall be at e. Food (page 58) least one bathing facility for every Y:5 children , 2. Child Care Program_;(pilges-57-58) (1)Breakfast se`rve�to children going directly toy a.. Staffing(pages 57-58) (2) Evening meal served to children m' t *' ' attendance - s:r+' ;,ems � � (1) Staff-child ratio for sleeptng,children: %d. Bathing(page 58) If any child is bathed: T8 months Y 1 to 5 i (1) Clean water provided for each child s Ks) { 'y" s-4 - a +•. � ,fair -_ w z ,e �� ��P (b) 18 monthsiip to 2% 1 to 14 ` (2) Each c7iild bathed separately Ft,t� (c) 2ls up to 4 years l to J 8, x} " ach ch ild su eivised while bathm art (3) ��E p 4 - (d) 4 years and older r 1 to 25 h r 3 (4)Indrvtdual soap towel and washcloth z1k rw "` Yss t { z`.r Y ' provt'ded for each cliilii' - •r,The deficiencies noted have been discussed with me. Failure to correct the deficiencies can be the basis for adverse action. None of these requirements are to be interpreted to allow anyone to operate in violation of the Minimum Standards. A facility licensed/approved by the Department must meet Minimum Standards at all times. It is the responsibility of the licensee to operate in compliance with the Minimum Standards. Signature of licensee or designated staff Date Checklist for Infants (O)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance (X)indicates not applicable `�_�1 Numlier,of children - - v Number of staff "� 3 � N . :�- x � �` r,.,.-�. �' � z; t � � �' � � ,y� }•, Minim tin E . _n enfRe aired or Each._Crocr ,.o Children. Washable soft crib toes-2 er child Push and pull toys-1 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 Washable baby doll-I Musical toy-1 Colorful pictures and posters Activity boxes,such as busy boxes-3 ))la ernlg area Sink warm water'soa a fer towels Tub(portable plastic type acceptable) m r rye " a Mafeipib6fmattress sheets:` +4M 331 � �. Shelvtn�fore ui`ment t+nd su lies`/anchored' � �; 4 *f -� � � �Indrndual labeled stora es ace for each child �' ���•�'� ,. ;, ,� � ,�� - >s.; �� ��.�r� �4�� � r�r R 99 Fumtture child size clean•;"ood condthon ," n ;.,� s �r� y _ ��. Cnbs m accordance��tth US ConsumerProduct Safety Act,of2008 Y kaY _ r f On Hazardous substatees lockedr f,x,� ;f:7 - �7- �.'011talnerS labeled t{ .-y._. w xIK Screens on wmdo�vs which aie o ened~a x��-� �.a.;. �" ��y� � �° z� $ ';7 '"-`�' ° - {•%.� �r c - _ ,� * ..-,max Y its s .mot c� t s1 .. Li tin ode uate-_= _ ;� Y.. _. ._ �,.- % .',: - Checklist for Toddlers (age 18 months-2% years) (0)indicates compliance observed by DHR Licensing Representative (-1) indicates not in compliance (X) indicates not applicable (�5C30, Name Of teacher/room#` ' ' ff "'tis _ �' r`x r r r�1ft �Sri 7=j A e of children a k Nid ofchildren= F Ire n Tf WM1i Number,of sfaff Minimum'.E ui memt Re aired for Each.Groin o Children - Lame non to;oc cravonsimarkers - - - • -- .: --- - _ :: Pa er variety) Ci Non-toxic Plavdough Colorful pictures and posters A deuce that plays a variety of age appropriate music Musical tovs.-2 . 1 -Push and all toys-2' - Lar•e cars.trucks,boats,etc.-2 Sit-on riding toy-2 large_s,oft balls-2,-- Books-2 per child. - - _ Age appropriate Puzzles-2(complete with allpieces) Nesting and stacking tovs-2 sets Non-v-vooden building blocks_(aonroximately 20 non-interlocking), Baby dolls-2(com Leta with all pdkO Doll clothes and blankets Doll bed—] Toy telephones-2 Pots,pans,buckets,lame plastic spoons Child-size stove Dress-up clothes Dta end-area ? 3 t wvj Smk waint water s'oa a er towels t } , Plastic=pried,=covered Tub(portable plasti6 ri e acceptable) Po chairs cleaned/dlsmfected%em hed — ` r Feedm chal s)Vftable and chairs Cribs/cots' t - Indoor tpeilnometer COut of reach of childien d rr, � , � - ,,,Ins. a � } &�+ � s Spelvm for e m ment and sli pes/ancpoied ` ,N Furwture clnld stze;",'clean ood't:ondiuon'_k a � ^ -' � � _ fir= _ �"7�ax '•Indrndual;Atbeled stora es ace for eacp'cluld Electrlcal,outlets covered fi f a r� nit t9 G+: 7. •,s -- � .'�t�. � Jl �i U � 5.�.r't- �Sx�G., �q1� � 3 ��-et#Mr�y'St.•. Confhii;s labeled �M Medication locked f ,z J s = s r Screens on winddiWwhich are o eded OatrT z Lt htin ade uate��-,�-.,�,��.- �.�t�• ` - y,W�k ��. , ��� -E ;� t .� � �.�.�; aa € .. Checklist for 24 months up to 36 months (0) indicates compliance observed by DHR Licensing Representative (wr)indicates not in compliance X indicates not applicable Name of teacher/room# Y � A e of children fi x — - }5v Nuiuber.of.staff. .x .x x i - : Minim E rrt ,nrent.Re uirecl or Each Grou ..o Chil�fren_,. Nontoxic pfaydou;h _ Large non-toxic crayons/markers Paper Non-toxic finger-paints in primary colors 7!7. Scissors(blunt-tipped) Books-2,per child A device that plays a variety of age appropriate music Rhythm instruments-one for each child in the group Baby"dolfs—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"SOnon-interlocking Cars,trucks,boats,etc.—3 Age ap}ropriate puzzles-4(complete with all pieces) Interlocking manipulative_play sets of different types—3 sets Dia er�n�area n s f> r n7k rt Sink warren water°soa a_er towels a? v , Plastic9ined covered containers = y Table s-ace and cliav for each child = ���- ti.' � �- f �� Cots 1=sheets and covers t x htd&Fthgffi im6ter It Out,af.reach bf children G _ T. _ r Written daily Ian or schedule posted Shelvm `"for`e ai ment and_su " lieslan6hored2., Designated activity areas Electncal-outlets coveredgF * y Bamers around heaters fans h r f _ xr Hazardous substances locked N - ' _ �'` "�'�x �`�. � a �-. -gat i "� �z �''` �"S '•s :� _`� � �", Medicatl4n'loP V k fi# Screens on windows which ate o erred;` v - Fs Li htin fide—OateEy �,:- Checklist for Preschool (age 21/2 years to school aQe) (0)indicates compliance observed by DHR licensing representative ( 1)indicates not in compliance N � � X indicates not applicable - - �a t� �, .� y = r,, '3s �r ,�r S 1 �.,� t� s a �zk xr fs •rx''d:a{'r� •�r t��icl 1 r Age of children ° Number4of childrenY , Number,of�staff� SAMs 'N t zF r` r , Easel _ ... , Non-toxic playdough or clay Large non-toxic crayonshvatercolor 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 77 Paintbrushes four l/2,and 1 inch in width Large/medium building blocks-app.'15-non-interfocking Small building blocks-app. 100 non-interlocking Small cars,trucks,boats,etc.-6 Age appropriate puzzles-8(complete with all pieces) Interlockine manipulative play sets,different types-6 Matching games-6(no more than 2 electronic) Puppets-2 Child-size.stove%sink(or combo) Small table and chairs/benches Cooking utensils/dishes(unbreakable) Doll bed or cradle Dolls(complete with all parts)-2 777) 6�� _ Doll clothes and blankets Dress-up clothes for boys and girls Storage for dress-up clothes Unbreakable mirror-full lensth Toy telephones-2 Age Appropriate children's books-2 per child A device that plays a variety of age appropriate music Rhvthm instruments,—I per child in group• Magnifying glass Magnets Nature collections Measuring and pouring equipment T able,90 ace and chair for each child Cots Sheets covers for each child u' a 1 a r` t F` +nd60rthe'ometer/Otlt ofrea''4 r i 3 h.1 ` Written daily-plan or schedule posted 3-rF _ -��.•,".i} �,z.:,�`., ` 1"v Labeled stora e s ace atclild level r i t r t r Ir kj 1 �Shelvin '=forte rri ment'and`sti liesLanchored : ,.,,i �_ f+S � e f �� _= FI.s ,� a _ J-y _s.� �'ta1,u �fi��4p' Designated activitv.areas WIWI Hazardous substances locked/ fir' rLL s"`6a �-��:1 � 3$ 3 i zaf�l �•J wl� c ���j�,� P xT��_ "i+ lx IK,�,s containers labeled f L , t a + Y r cif ra 1 g i Medication locked Y s µ r a K+ �x r-tl �'� � -:. ��•�N� '�t 51��r .���^�."1} sk ��ati=�� r� a» rS' _ e s „ sa a�,S'$ ��r'.x s r.� � te•s`S�,. Checklist for School-Age (O )indicates compliance observed by DHR Licensing Representative (-1)indicates not in compliance (X)indicates not applicable Name of teacher/room# � :;h '` ,�{fi ,.s4 . � ' �� a��,•s ��: fr.�x ,k�z � �,�$�,,��:$S � t r Number of children Number of--- fj Miiq im E ui .meat Re •uired or Each Grou of Children, lie-saw uzile-1 er 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-1per-5 children = Books suited to age of children-2 per child Non-toxic plqdough 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 X Interlocking manipulative play sets—1 per 5 children Tables ace and chavfor;each cluld r Cots/sheets/covers for each chrld who na Y Indoorfhermotneter/ouf:of reach_ " e g � a t Written daily plan orschedule posted Labeled`stora e s`ace atcfiild level - ti' .r Y _Yri� - k � t Shelving fore"ui inentarid su `lies/aricllor`ed Designated activity areas Y Electrical outlets'covered _ � , �' - t�� -�3•. �1 �-�- � - --� �.,�.: • Barrrers around heaters fans '•- Hazaiilous substances locked -. Conta�iers labeled - Medi cat ion',locked ... s. < Screens on wmdo�s which:are o ened ti N x -s r f_ t. ,u , x - - - -= r :d..: �a = }�• r ,,,-.i Ti 1_ 'a. ; -+e iYr ti�yy",�6 Emergency Preparedness and Response Plans Checklist ( O) indicates compliance observed by DHR Licensing Representative (-1 indicates not in compliance ( S )'indicates certified by staff in charge(use only for*plan updated yearly,written documentation must be on file) The plan shall inchide procedures tlral will be used,to prepare for The plan should also be inclusive of and respond to the following types of emergency/disaster situations: Weather emer enc�es/natural disasters ki' L Current emergency plans and procedures Severe Thunderstorms r i s 3a i r iTN da Flash flooding tir {s l ` t a r J [ r* V 41 •G �S r F Ma dr snowfall a i L 6 E� 6c k 4 z�' ci cii k p iF 23 {K i Bl�izards d �� u t u 9 y a r a{ L �i Kati r�+" ,y. aIcesforms .ir s`� Lockdown ore acu�t�on due to threats of violence{ , � ^ Location rand use of fire extinguishers p m ` � a - Evacuattons r �Iazardous materials Documentation of the following quarterly drills, ,r ,, Spills r � �,-- i � r •` r Tornado y{, +ReloCatlOn `'3 x ?- �� �, ��+' n - r 7 Cv n} i i s �*5 t'"Nr -...� .trk X � �-k - _ ""•Y- �'i� ., ; x Infectious disease emergenc►es _ �� Telephones foron Loss of power,�,water,or�heat � �:� � � � - I ,/ Location,of the,�first a�d'and emergency sppplyslurts �?, 4 Other thre�tenmg s�tuat�onsS u, f t t�,+�r •};�� �`,� -� �, r The disaster plan shall include details for h e Emergency Preparedness and Response Plans should be: Ass�shng mtfanfs'and children with"special needs and/or health '� � ��'Posted m a Consptcuous'place � '"�� �'`-� �� "_ Reunification with parents e ri Submitted�o theDe arfinent ; Supplies needed for shelter�n place procedures } t � ay Copes provtded'to all parents% ardi ans gu �ransporfat�on disaster procedures r � f u_ `,r� x*+'�``� Staff tramurigrreass�gnmentas'app opri`ate'' r r�? �f� � ��� LL Plan updated yearly -�� Y���'�� ?'` •� -� .+� �r k 'A % '�`+''s` `'' 1 tg ,-.%3F I-fn:­ , ,r 311 �y f� y"!' .!, Contact with local emergency management r _ _ I Playground Checklist (0)indicates compliance observed by DHR Licensing Representative (-1 indicates not in compliance (X)indicates not applicable Minimum Equipment Required for groups of twenty-five children or few r 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 " Crawl-through equipment Digging or sand area Toys for digging Outdoor'play azea enclosed by a fence or wall'atleast 4 feet�n het ht ; , r Fence or wall free of harp x e k 4 Shade and sun areas provtded Y..TJ Outdoor play area free o£apparent Hazardous condtttlinsF ' � � { X } �' x )k- Conciete/aspl M r e � f lea well drained x '` Ft ,Y a t x x r ENO quipment notdestgned to beplirtable securely anchored r s�r r �$ N� � 4 Stairs/steps havewgand rails to child s reach x xAA-, - I