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Evaluation Form Revise 3/2020 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE HOME LICENSING EVALUATION ANNUAL Licensee: PHYLLIS DENNEY Dates of Evaluation: lQ (Q 0 Name of Facility: PHYLLIS DENNEY Date(s) of Follow-up. Address: 57 LEE ROAD 517 Purpose of Visit: ANNUAL PHENIX CITY,AL 36870 Telephone#: 706 575-5436 Day Care ❑ Night ime Care JK Family ❑ Group ❑ Subsidy i icensed Capacity: Day 6 Night X A e Ran e: D -4F ig it X Days of Operation: Da M-F Night X Hours of O eration: D Nig it X License Number: F41000002 Codes: Effective Dates of License: O—Observed by DHR Licensing Represent t've From:()un o� 9 TO:()Me, 5 � �Q S—Certified by Licensee D—Discussed with Licensee County: LEE X—Not Applicable-Not reviewed with Lice see Deficiencies Noted: Yes ❑ No DHR icensi Representative: i Sections to be completed at the discretion of the DHR Licensing resentative. a) a) a) ai a) REGULATIONS REGULATIONS La M f6 -aU - U E Co E Q Q. Q O O Q- ❑. U oQ U c? o o Z Z Z Z Licensing Procedures(II.,B.,pages 11- (10) Guns/firearms in locked storage 14) Q 1. Provisions of license/permit(II.,BE,7., 01) Ammunition stored separately from pages 12-13 uns/firearms in locked storage IQ a. Number of children in the care of the (12) Stairs have handrails in child's reach licensee does not exceed licensed cap aci ty ` b. Ages range of children in care cAnforms (13) Smoking prohibited during hours of care to a es on licensec. Current license/permit posted (14) Clear glass doors marked at child level The Home(II.C.,pages 15-24) (15) Too s machin1. Indoor area(IL,C.,pages 15-1 (16) Hobbs vere or rdrained uring hours of care a. Injury prevention(II.,C.,2.,a.,pages (17) Working flashlight conveniently located 15-16 (1) Home free of apparent hazardous (18) Consumption of alcohol prohibited during conditions hours of care (2) Home has electricity,water,gas,waste (b9) Non-prescription narcotic or illegal substances, I disposal prohibited (3) Home has working telephone (20)Bio contaminants shall be stored and disposed of properly (4) Dangerous substances locked b. Cleanliness and health(H.,C.,2.,b.,pages 16-17) (5) Aggressive animals not kept (1) Bathroom clean (6).Animals that pose a threat kept away (2) Foot stools for handwashing and toileting from children (7)Fans in reach of children enclosed (3) Potty chairs(if used)emptied,washed, disinfected-after each use (8) Electrical outlets covered (4)Staff shall use Universal Precautions when 101 . I - I diapering or being exposed to bodily fluids Are any guns or firearms k t in the home or (5) Rodent/insect infestation prevented/eliminated on the remises? Yes No ❑ (9) Guns/firearms unloa e OT (6) Garbage-and trash stored in covered water-tight, fly-proof- roof containers and removed regularly 1 i REGULATIONS M REGULATIONS U Co fl. Q a Q : o 0 El E Q U Q U Q U �. U c Z Z o Z (7) Bedding,toys,utensils,toilets, sinks (17) Waterbeds not used by a child used by a sick person cleaned and X disinfected before use by another person / (8) Windows and doors used for (18) Upper/top bunk beds not used by a child _ventilation screened LJ c. Space II. C. 2.,c.,pages 17-18 19 No child sleeps/naps on floors (1),Rooms well-lighted,ventilated, 2. Outdoor area(II.,C.,pages 20-21) comfortably cooled or heated as appropriate to the season (2)Space for providing privacy to a child in a. Outdoor play area,(page 20) care and members of the household as O needed (3)Clean,appropriate facilities for f (1) Children supervised at all times , protection,storage,preparation of food D d.Equipment and furnishings(II.,C., 0 (2) Outdoor play area free from apparent hazards V 2.,d.,pa es 18-19) 1tJ (1)Cribs,bed,playpen or cot provided for (3) Fence at least 4 feet in height,free from sharp, each child for rest/sleep during hours of care D protruding edges(except where prohibited by federal law (2) Number of cribs that meet the US (4) Outdoor play equipment not designed to be O Consumer Product Safety Act of 20 8: portable,anchored 3 Number of playpens: 5 Concrete or asphalt not used under equipment (4) No child shall sleep with an adult (6) Area free of stacked lumber,construction O materials,firewood (5) Each child younger than 12 months (7) Stairs/steps h e hand r is in hild's ch sleeps alone in a crib or playpen . (6) Crib sILaV no more than42 3/8 inches b. Injury prevention(page to) apart XZ5 (7) Crib mattress waterproof,good (1) Home and grounds free of apparent hazards condition including abandoned automobiles,unused appliance, \ �� uncovered wells and cisterns,stacked lumber with (�I1 Q D exposed nails,explosives (8) No infant put to sleep on sofa,soft Too s and machinery inacpessible to c 'ldren O mattress or other soft surface d� (9) Each child 12-18 months sleeps alone (3)k.Allll poison kept in locked are C) in a crib, la en or a low cot �AMa(10) Two children over 18 months of the (4) Water hazards on or adjacent to home same sex may share a double or larger bed S inaccessible to children or may sleep alone (11) Beds,cribs,cots,or playpens clean c. Swimming and wading (page 21) and sanitary and free of hazards,maintained (D in good condition (i2) Bedding adequate,appropriate to S Is there a pool on the a ises? season •mJ Yes ❑ No (13),Sheets and covers laundered weekly d (1) Swimming pool 2 feet or more in depth, or more often when soiled enclosed by fence or solid wall at least 4 feet in (14) Number of beds: height,with no doors,windows,or other openings 15 Number of cots: (2) Swimming pool has locking gate/Gate and (16) When not in use by family members, other access areas locked when pool is not in use beds covered with clean linens before used by children in care XJ i 2 I i REGULATIONS Q� C0 REGULATIONS �i Q Q a �- ECL El CL U Q O U Q 0 0 0 0 Z Z Z Z Do children in care use th pool? j. Each child younger than 1 year or weighing less Yes ElN& than 20 pounds secured in infant only or convertible seat used in rear-facie position (3) Adult to child ratio in pool area: k. Each child younger than 5 years or weighing less than 40 pounds secured in forward facing seat (a) One adult to each child younger than L Each child younger than 6 years secured in a 2'/z booster seat (b) One adult to three children 2'/2 to 6 in. No child transported in front seat of vehicle with ears passenger-side air bag (c) One adult to five children 6 years and older 0 (4) Person with current American Red 4. Emergency Preparedness and Response Plans Cross Lifeguard Training certificate in pool (pages 23-24) area at all times pool is in use See Checklist page 9 0 (5) Copy of Lifeguard Training Certificate Licensee and each caregiver has current infant-child on file in home CPR and first-aid certificate/copies on file in home (6) Wading structure less than 2 feet in Licensee and Members of the Household(II.,D., depth,has continuous adult supervision pages 25-33) See checklist (7)Wading structure/pool filled with clean Licensee does not work or attend school during C� water each day,emptied when not in use hours of child care (page 33 V (8) The licensee is present during any Care of the Children(II.E.,pages 34-40) swimming/wadingactivities 3. Transportation(pages 22-23 1. Supervision of the Children(page 34 Does the licensee provide transportation a. Children supervised at all times for children in care? Yes ❑ No NOTE: The Department of HifiRan b. Licensee responsible for care and supervision at Resources does not inspect activities away 1 all times from the home.The licensee shall assume full authority and responsibility for away from the home activities. a. Licensee responsible for children they 2. Infants and children handled gently(page 34) transport b. Licensee responsible for picking child up / 3. Health(pages 34-36) at the designated location and delivering the }1�� child to the care of the designated person c. Transportation Checklist used for a. Illness, injury,change in health reported to parent transporting by vehicle or walking(Sample checked d. Written consent to transport child 1I No ill child admitted to home e. No child left unsupervised in vehicle (2)Ill,injured child separated from group but co inuously supervised f. Driver has valid driver's license (3) Ill or injured child's parent notified immediately g.Vehicle doors locked when moving and required to come-for child or arrange for designated person to come for child h. All passengers and driver secured in a (4) If parent/designated person cannot be reached,or seat belt or child restraint which is properly if illness/injury is severe, licensee shall obtain anchored to the vehicle, installed and used emergency treatment according to manufacturer's instructions and maintained in good condition i. Each child secured in passenger restraint / Does the licensee administer medication/medical system appropriate to age and size 1X procedures? Yes ❑ No C.Medication/med' al procedures administered only: with written authorization from parent j 3 i REGULATIONS U, _U Z Q v REGULATIONS Cal m v E E o n. E' E a- O U Q U Q U o 0 U o 0 z Z Z z (1)Blanket authorization forms are `en or food served on ate of 's't j q�served: , prohibited �'t i (2)Prescription or over the counter drugs in d. Small,hard candies or nuts not served to children original container younger than 4 years (3) Prescription drugs have pharmacy label e. Foods that may cause choking prepared or written physician's written instructions V4 appropriately for the children (4) Over-the—counter drugs labeled with f. Foods served only under close supervision as child's name and directions VN required see page 36 4. Care of Infants(pages 36-37 7. Food Service (pages 38-39 a.Each infant placed on back to sleep unless a. Licensee,caregivers,each child washes hands he/she has written physician's instructions with soap and warm running water as required /vl otherwise b. Soft materials,including pillows,quilts, b. Individual,disposable paper towels used for hand comforters,sheepskins,bumper pads, stuffed drying toys prohibited in sleeping environment c.Diapering area washable,cleaned and c. Formula and food brought from child's home disinfected after each use labeled and stored properly d. Soiled diapers disposed of in plastic-lined Q d.Each infant held for bottle feeding/No bottles containers propped e.Licensee/Caregivers use Universal e. Each child seated while eating Precautions when diapering,or assisting with toiletin f.Individual disposable paper towels used 9. Personal Belongings (page 39) for hand drying g. Clean disposable gloves used for a. Appropriate seasonal clothing for each child diapering each child provided by parent h.Each child's hands washed after diapering b. Sufficient clean,dry diapers and clothing O provided for each infant/toddler i.Diapering area separate from food service, c. Space for each child for storing personal preparation,and storage areas lJ belongings j. Infants handled gently,each infant's head 10. Sign in/Sign out Procedures (page 40) supported,rough or harsh handling prohibited 5. Child Abuse/Neglect Reporting(page a. Each child signed in atarrival S 37 a.Known or suspected Child Abuse/Neglect b. Each child signed out at departure reported as required b. Child abuse/neglect reports confidential 11. Release of Children(page 40 c.Licensee,caregivers,and household a. No child released to anyone without written members cooperate with DHR on any child authorization from parent abuse/neglect investigation,including providing information&allowing access to children and records 6. Meals and Snacks(pages 38-39) b. Photo ID required for unfamiliar persons picking u a child a. Meals and snacks provided as required Administration I. F. pages 41-4 b. Formula or food for infants&other 1. General administrative responsibilities (pages special diets prepared as directed or provided 41-42) by parent/guardian c.Formula,powder or concentrate,shall be QV a. Current license/permit posted prepared by parent I 4 REGULATIONS m cu REGULATIONS m CU E o CL E o Q U 0 Q 0 0 Q 0 0 0 0 Z Z Z Z b. Most recent licensing evaluation posted c. Records on caregivers/substitutes kept at least two ears after person leaves a Corrective/adverse action notices posted d. Certificate of rabies vacc d. Most recent deficiency report posted e. Children's records complete see c ecklist 1 e..Public notice form posted f. Transportation chec ists kept for cu ent year plus two additional f.Emergency Preparedness and Response g. Sign in/sign out sheets kept for current year plus Plan posted two additional years g.Licensee's social security number. G. Nighttime Care(page 46) available to parents on request This section to be Co let d or m,es g care after 7 .nL C5 2. Reports to the Department(pages 42- 1. Number and age range of children does not 43) exceed number and age range on license/permit b. Child abuse/neglect reported as required 2. Bathing (page 46) by law c. The following reported to DHR within 24 a. Clean water provided for each child hours,written report within 5 days: (1) Any illness/injury requiring b. Each child bathed separately professional medical treatment (2) Any illness/injury requiring emergency c. Each child supervised while bathing medical treatment (3) Any death occurring in the home d. Individual soap,towel,and washcloth provided for each child 4 Changes in caregivers or substitutes 5 Change in licensee's name 3. Sleeping requirements (page 46 (6) Change in name or number of street a. Each child younger than 18 months sleeps alone address in crib (7) Change in telephone number b.. Number of cribs that meet the US Consumer Product Safety Act of 2008: j• (8) Serious accident or illness of the c. Infants placed on back to sleep licensee or members of the household 9 Serious damage to the home or_ rounds d.Each child 18 months and old@r sleeps in a bed (10) Changes in members of the household e. Number of beds: \-NVQ (11) Any arrest of licensee,household 4. Each child's toilet articles labeled with name, member,caregiver,substitute kept separate,kept in sanitary condition (12) Final disposition of any child 5. Breakfast served to each child who goes directly j abuse/neglect investigation involving to school unless provided by school or parent licensee,household member,caregiver, substitute (13)Any disastrous event 6. Evening meal provided for each child continuing from day time care d. Physical/structural changes to home or H. Group Day Care Homes(pages 47-49) grounds reported in advance This section to be completed for homes providing care for 7 to 12 children. e. Any change in location reported in 1. At least two adults present and supervising the advance (New license is required) children when seven of more children are resent 3. Records to be kept by the licensee 2. If a substitute is used,the licensee'or assistant (pages 43-45 care fiver is present a. Record for licensee/household members 3. Complete.re cord for assistant caregiver see checklist i b. Records for caregiver/substitute(see 4. Outdoor play area fenced checklist 5 i REGULATIONS _� M REGULATIONS v °- E a o E o Q- o Q- 0 U Q cU Q U 0 o U o 0 Z Z Z Z I. Group Nighttime Homes(page 511) This section to be completed for homes providing care for 7 to 12 children after 7 .m. 1. At least two adults present and supervising the children when seven of more are present 2. Number and age range of children does not exceed number and age range on license/permit I i 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 by the Department must meet Minimum Standards at all times. It is the responsibility of the licensee to pe a e in compliance with the Minimum Standards. Signature of licensee or designated staff Date i j I I 'I i I I I I 6 I Emergency Preparedness and Response Plans Checklist (O) indicates compliance observed by DHR Licensing Representative (I indicates not in compliance (S) indicates certified by staff in charge(use only for#plan updated yearly,written documentation must be on file) Documentation 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; Current emergency plans and procedures Severe Thunderstorms b Tornadoes Flash flooding Major snowfall C> C" Blizzards Ice storms. Earthquakes Lockdown.or evacuation due to threats of violence ® Location and use of fire extinguishers Evacuations due to; #Documentation of the following quarterly drills; Hazardous materials 0 Fire Spills CP Tornado Gas leaks 0 O Lockdown � Bomb threats-® Relocation Fire Infectious disease emergencies Telephones for on-site and off-site use Loss of power,water,or heat Location of the first aid and emergency supply kits Other threatening situations I I Details The disaster plan shall include details for: The Emergency Preparedness and Response Plans should e: Shelter in place or evacuation Available to all staff and employees01 Assisting infants and children with special needs and/or health Posted in a Conspicuous place conditions Reunification with parents Submitted to the Department Supplies needed for shelter in place procedures 0 Copies provided to all parents/guardians Transportation disaster procedures Staff train ing/reassignment as appropriate Man updated yearly Contact with local emergency management officials i i i 7 i