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Evaluation Form (7) ALABAMA DEPARTMENT OF HUMAN RESOURCES Revised 9/19 CHILD CARE, CENTER LICENSING EVALUATION RENEWAL (Health and Safety Guidelines itenis shaded) r— Name of Center: Date(s) of Evaluation: Address: Date(s) of Follow-up: Purpose of Visit: Telephone #: ft) Director: Licensee: a0 County: n Day ❑ Night ❑ Subsidy Licensed Capacity: Day C) Night Days of Operation: Day �- Night F Age Range: Day � Night Hours of Operatio :, Day l�pp s Night 0 License Number: U IJ o e: 4O - Observed by DHR Licensing Representative 3/®®O® 0� S - Certified by Licensee/Staff in charge D - Discussed with Licensee/Staff'in charge Effective. ��, of License: X _Rot Applicable-Not reviewed with From: (> To: Licensee/Staff in charge Deficiencies Note : Yes ElM' c2ens:in�g No Rebresentative: c� f Z .� Sections to be completed at the discretion of the DHR Lice nsin Representative. REGULATIONS cccu REGULATIONS Q Q _ _ U CL .Q 0 Q E E a Q U Q �j Y Q ° ° o — O Z Z Z Z Facilities 01. C., Pages 16-23) e. Space for ill or m�urcd child t s 1. Indoor area(II.,C.,4.,pages 16-18) f: Items used by ill t htld dstnfected d , a Exclusive use:of activity areas p ;g Storage space focteacher ssuppltes w b ,Designated space for each grouping of children '„ { h` Office space provtded c liathrooms'located on same level/undcr same roof i. Ventilation,lighting,heating(pages 17-18) (1) one flush toilet for each 15 children O Heaitng/atr condittontng provtded (2) one handwashing sink for each 15 children ( (2) Temperature 68 82 at child level'. (3) One tub(portable plastic acceptable) „(3) Thermometerin each area used 6y children (4) Ftxtures child stzc or adjusted for easy use (4) Thermometer out of reach of children ' d One handwashtng sinl.Stith warm running water (5) Outside wtndouvs that are opened are soap paper towels n each room Hhere children are d dipered J sc me a nc r 1 U U N N tv Z REGULATIONS REGULATIONS _ _ _ Q QCL o 0 Q o o a U }. U Q Z Z o 0 Z Z (6) Outside doors kept closed 3. Swimming and Wading at the Center(IL, hF Y t� C.,6.,pages 20-21) (7) Lrglitirig adequate for actrvitles, a. Pools two feet or more in depth (8) Lighting adequate at nap/rest time to allow (]) Lifeguard at poolside at all times pool rs`m � children to:be seen i. use erational tele hone for center business onl y ,, r 1 OP P y (2)-Lifeguard Trainmg Certificate;First Aid , Certificate'CPI3�Certification ori'file k DHR notified if telephone is out of order or if r r (3) Lifeguard not counted in ragos ' s _ number changes 1. Hazard prevention(page 18)(Indoor Area) (4) Staff-child ratios for children in the pool: h - () Center free of apparent hazards a) one staff for each'chdd}Danger than 2V2tj �, - k� ,+ a � (2) Hazardous substances under lock.and key or (b) one stafffor �ev 4 childrenI es 2%:1rtY Y combination Ioc1. up to 4 y �ears` (3) Containers labeled (c) ane stufffor everyb children ages 4 years` up to 6 years z Y (4)No fuearms oragimanlGon kept or allowed m } (d)'one staff for every 10 children ages 6 center except law enforcement years and older r (5) Stairwaw have hand railings m child s reach (5) RaUos determined by youngest child in the pool 2 X (6) Clear glass doors marked at child level , y` p (6) Persons counted m'ratios meeCchild care,L tF 3 ��,. _ worl.er,qualifications/m the pool at all tunes +• + � (7)' -c Icines and dN�s kept under lock and ke}or f dpro (7) Stiffd vide to supervise children mx combinalion lock,separate from harmful items pool area,but not m pool 7 _>-(I)-By Bamers around heaters radiators fans accessible If any part of a c � hi dyld s bo rs m the water ,ir` r children 3 #to ;., child considered ui pool ' g�' (9)`EKposed electncal outlets have protcetrve covers Y (9) pool enclosed with fence or ohd wall at t x . least 4:feet m height,constructed to prevent r' (l0) Consumption ojo f alcohol or use of non accessibihty by children prescnpun narcotic or illegal substances o prohibited (11) Smoking or use of tobacco prohibited on x b. Wading structures less than 2 feet in depth: premises , a s ' Contaminants shall be stored and disposed y �� { of properly - `�'� m. Center kept clean/Cleaning done daily. (1) At least one A&with CPR&first ,each wading structure ,� �� •�,� r (f)Floors.bathroom fixtures cleaned/disulfected h , F f (2) Regmred:-ahos met.as stated on page 23', 4 (2) Carpetstvacuumel daily " i (3) Ai least ni o staff at each wading structure ' *s _ - - { Cleanm f3) g s _n _ � � +.(4) Clean water provided each day a E flctlVlieS 2. Outdoor area(II.,C.,5.,pages 19-20) (5) Wading structure emptied when not in use+,' See Checklist a 1 Off-street'loadmg/unloadng provided F1 d. Away from center activities (II.,C.,7., page 21) rb Separate areas for children younger than 2%:(may be i NOTE: The Department o/ Human Resources �aciueved by scheduhng) 'hj ' does not inspect activities away from the center, ` including swimming and wading activities. The c Outdoor area adloins:or is safely accessible` licensee shall assume full authority and t responsibility for away from the center activities. i d Outdoor pia}area free of apparent hazardous` _ f � t 2 U U U U t0 CU U (6 @ U REGULATIONS CL Q E EQ REGULATIONS °E Q- a n U V Q U Q U o O o 0 z Z Z Z 5. Furnishings and equipment (II.,C.,8., j Stafl w►th mfarit child CPR and fast aid 7 ' pages 21-22) See Checklists ® present dunng allIours of operation' O 4 Child Care Program (H., D., pages "Li Second staff-ai ailabic When 7 0t more children , 24-37) prescnt/reginred ratwsmet' � T ` 1 Regtured ratios maintained of all times t No staffon duty more than 8 continuous hours' i aregularbasis` on a -0 up to 18 months', d_to 5 , m Staff free from other duties while working with tfic children" ' b b 18 monthsvp to 2%=years Ito 7 i5. Infant/Toddler Program(II.,D., 2.,pages 26-29) d 24 months up to 36 months ..' l to 8 k a. Learning/growth activities:(page 26) c 2%:years up to 4 yearss 3 to 11 (1) Encouraged to play with a variety of toys f years pp'to school age Ito I$ �' ", (2) Time outdoors daily,when weather permits g;School ale up to!.8 years 1 to 21 (3)Frccdom of movement outside`cnbs daily ~ h 8 years and older l to 22 (4) Placed on tummy part of trine while awake and observed s 2 Children younger than 2%a grouped separately 1',F a (5) Staff talks to each child andencourages from older children "? response .11 a. Exception for group 24 36 months k f (6) Cnes/signs of distiess in�esttgated rnlIrlediately b Exceptton for individual children`s needs < b. Diapering/toileting:(pages 26-27) 3 Staff counted m ratto only when giving full S j^. (1) Clean,dry.diapers/clothmg provided 4. Staff coverage (page 25) (2) Wedsoiled diapers/clothmg changed, r t a All children supervised at a114 times p' (3) Changing area cleaned and dumfected b Statf assigned responsibility for same ' ': (4) No child left unattended while being "` ' ` mfanfs/toddlers each day. P diapered A 1 , r c Substttute staff available (5) IVo child diapered oa the floor k g d Director sirthonzedrto conduct center Business , i >"+ ' (6) Eachtchild s hands washed after e Staff person m charge whrn director pr is absent, (7)'Staff use universal ecautions when auorized to conduct center liusrness r Y r r th diapering _f, f Staff in each roomuri nappmg/restm dng g f J: (8) Staff use clean disposable gloves for r diapering each child/for each draper"change >; ,r g Staff able to see all the children y (9) Wet/soiled drapers placed m covered, ,, ri` "plastic lined container and£disposed h. Ratio during napping/resting: (10) Individuals disposable wipes`used at each' dia er chan e'dis sed of ro erl F' t� # P g P°.s.>__P .Pr. Y_ 1 uP t O inonths to ( ) 18 x $ f(I 1)-Potty chairs emptied;rinsed,disinfected i 1 �.r €S w"g4 :�.r^*t,s9t c z;lac '.•�'_s �r ���r.�. f.r (2) 18 months up tot%:years t 1 to 14 4 (12)piapenng azeaseparate from food semcenwt , (3) 2%:yearss and older 1 to36 c. Napping/resting(page 27) 3 N a) U U tV REGULATIONS C C � to ca co REGULATIONS, C: m .Q .Q o E E U c Q U Y Q o Z o 0 Z z Z (1) Infants allowed to'form otvr steep patterns r' (12),Toddlers seated white eating # q (2)-Infants placed on back to sleep untessyphystctan s (13)=Child*encouraged to eYpentnent with self , statement indicates othenvrse y feeding;utensils'provrded <z (3)i Infants who can easd}tuin;placed on`bacl.but t (14) Disposable utensils used only with close 1 4 r " allowed to adept preferred posiuoti r Y supervision z a rr (4) No positioning device used unless specified by. f (15)Foods eaten from a dish i (5) Staff reeognize differing needs of toddlers/allow to (16)Dishes bottles unbreakable � a7 follow their oven sleep patterns d. Cribs,cots,and bedding(pages 27-28) ' (l7) Dnttking'water offered to toddlers (1)Two feetbehveen occupied cribs (18) Child notforeed to eat (2j Cots positioned to'allow space for access or (19)=Food not used as teivazd or punishment emergency Grit: ( x r (3)_Cnbslcots cleaned;and disinfected d sheets and $ (20) Child s bands vvastied before:and after covers washed before used by another child " �. a v sR8CISS aifter dlapeinng t011eting �,. _'" p' For infazits clean bottom sheets datlypr more (21) .States hands washed before food often if needed'sheets fit snugly ; preparation and service after assistmg with (5) SoR material prohibited m infant s sleepinglndrvtdual paper towels foreach washing° 4envtronment no pillows qudts comforters etc _ (�. and drying : (6) No infantput to sleep on sofa soft mattress �. 6 Preschool/School-age Program S # � (II D 3 pages 29-32) ., (7)Tor toddlers cleanbottotti sheets and top ., a. Learning/growth activities(pages 29-30) coverings weet.ly more often ifneeded � � ,; � ` e. Feeding(page 28-29) (1) Schedule posted (1) Formula,food for infants if provided by cente (2) Variety of indoor/outdoor activities (2) Ifformula*provtded 6y center ready to feed, (3) Time on daily when weather permits properly stored and handled � � (3)Meals and snack comply with requirements (4) Staff permit/encourage conversation among children (4) If formula provtded by pazent,fabefed iefri crated (5) Staff give individual attention.to each child daily i7Z(5)Bottles sent home or contents dtsearded at end of^ s*$ (6) Radio,TV,videos used only to supplement/enhance lement/enhance daily plan _ _ .> ,_ PP y (6) Small hard candies~nuts not served to children " v ' a under four 4 (7) No child required to watch TV orzvideos (7)Foods that may cause cholctng Prepared , ; < { (8) Videos p ,rev awed by staff for ' cs k iWf aPPropnatcly for the child '# ' k , *apPro ateness k ` iv- (8)=Feeding schedule sewidmg to child s needs ' d 9 Sexuall per. het inoleri♦ fn tenth #` t exp � n a '# c ,tfi" 2 .ter`materials ,;� s �(9) Infants held for bottle feeding t s y b. Napping/resting(page 30) �x (10) No bottles propped rr r (I) Staffreeogntze differing needs of children y* r M€<. �. . (1 l) When able m�ants allowed to sign feeding cha�u t t (2) Rest period for children in attendance more Z2- ='� s-i. �. _�. 1" than 5 hours 4 r ' U U (�j U C C m 29 M C: to U REGULATIONS Q a REGULATIONS ° Q E a E a U Q 0 U Q U o o U C 0 Z Z Z Z (3) Rest period at least 45 minutes,not more than (15)Children'seated while eating`s 2%hours (4} If a child who da not sleep after 45 minutes; i (l6);No child forced to eat rqutet achvipes perrnitted t s (5) Cots cleaned and cleanbottom sheets and top' Children not allQvv m l.ttchen sheets/covers providcdrbcforc used b}yanother childi a ; sf (6) Clean sheets/cgvers provided weekly more often a (18) Children's hands washed before meals tf needed and snacl.and after totletmg fr r (7,) Cots.positioned to allow space for access or _ t (19) Staff hands washed`before food emergency exit preparation and service and after assisting with x toileting ar contact vvith.bodily fluid% • (8) At least one staff preserit in each room (20)-Disposable gloves used for diapering ,} 9 Staff a61e to see all children s (_) (21}-;Individual paper towels for eachwashmg sc Toilehng(page 29) _ (22).Catered meals and snacks meet c t regmrements �i (1) Accorilmg to each chtld s needs eadh child s Lti e. Disciplinary Practices(page 32) hands washed 4 (2) Staff use Umvcrsal Precautions when diapering �(1) Dtscipl>ne}appropriate to age and , or handling bodily fluids =r. A 45 developmental level of the children d. Feeding(pages 30-31) r (2) No coiporal/phystcal pumshment r- (t j Children to attendance served breakfast or am Y (3)No,verbal abuse snacl. lunch p m snack z j , (2) Meals and snacks comply with USDr1 guidelines (4)No discipline associated with food naps or on cs 29 30 ' proceifFrcs (3) Fluid milk served no powdered milk for drinking (5) No physical restraint as punishment 3 - (4) No child deprived of meal or snack (6) No punishment administered by another child (5) Special:dietary'needs in accordance wrath written f. Staff-Parent Communication(page 33) instructions a r (6)Meals and snacks proVA etl by the center (1) Discipline,behavior problems discussed } with parent Vendm machines rohibited m areas used b' ( g P ` - (2) Center open to visits from parents at any children +fi time �(8) Small hard candies nuts not served to children ` (3) Parents informed of right to visit under four � � t c(9) Foods that may cause choking prepared s; _ `k ` x (4) Staff available for communication/ appropnatelyfortke child conferences k (10) Portions of food suited to child s needs second �' ` a ' (5) Parents notified of complaint procedures ( ) Unbreakable or single use dinnerware used x�; SJ t,x (6) Parents provided with information on a r influenza x ', (12)Single:use cups orglasses or a drinking foiintam , - ' g, Health information(pages 33-35) provided for i+ater 13 Dnri in �vate'`offered'd the' ( ) g r (I} No ill child admitted (14)rFood served onindmdual dishes or napl.ms; �' 1 rc (2) Ifa child becomes ill or is rn3iued,he/she is not directly on_table ; } €: a {e separated from group buteantmiiq,ly ed supervrs s ' 5 U U U U C C ' UREGULATIONS — �EGZLATIOrS Q L E EE U0 Q Q y Q oo O O z z z z (3) Parentof ill/injured eliild notified immediatelj z ' (e) Children and staff wash hands after and required to come for child . handling animals (4) if parent cannot be reached or illness/mjury ., h. Emergency Preparedness and Response severe emergenc},.medical attention is obtamdd Plans(page 36-37) See Checklist (5) Parents notified`ofexposure to contagious Transportation(II.,E., pages 38— disease/condition 40) (6) Parents urged to nouf}center if a child is 1.Transportation provided by the Center Ye�tposed to a contagious:discase outside,center (pages 38-40) q. (Z) Center reports contagious disease/condition to NOTE: The Department of Human Resources does health departrrient'is.regwred 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 i (a)`Medication admmistered_ont}with written � Does the center's staff provide transportation? iauthonzation from parent z x' Yes ❑ No ❑ (b) No blanket authonzation forms for medication ' .= r a q ransportaUon:chccl.lists:used as required -^ " _(c) Medication mbnginal container labeled ;"b Designated staffcomplete and sign checklist (d) Measunng deyiceptov'ded g r� : c Dnverstgn`schecl.hst,'mdicatinghelshehasr „ checled each seat (e) Medication admtmsten:d by designated sta1P d Checl hits kepfon file for current year plus 2 M. (f) Lacked storage piovided for medications, :4 additional (g):Medication.retumed to parent or disposed of xe CjX enter•responsible for Ptckmg up child at. , when no Ion er needed # g designated loc iiti and de-11' g child to,,;"t r _-, -� 'designated person" =(h) Timc and date medication is given is+ documented iri writing kept m child s le copies f. Supervision in center vehicles(page 39) available to pagents on, 'e'st .� 2: 4 r^r •s (9) Hygienic practices(page 34) (1) Staff child ratio met for children}ounger than lawful school-age drn crrnot counted fir. (a) Tailct articles labeled and stored separately (2)`Children oflawful school a and older,; fewer than l5 transported with on y the dnvcr y t < (b) Used-paper towels wipes tissues are disposedFoqL r 15 or more cfuldren of lawfiil school' ` of immediately folloiviuo use ;age one staff m addition to dnver (c) Toilet paper provided'for use by children and For 30 or more children of lawful school' Staff ,-an _ 'age o` in addition toydn r �' 'fit � � children,s clothing available fi . (5),No child left m a vehicle without adult - � r tab su erviston ; n (10) Animals on the premises(pages 35-36) Staffaccompany.each child under2'/a from' y vehicle to care of desi atedpersonJL '± 2< (a) Aggressive animals not kept in center or on '(7) Staff visually supemse each child 2%:and' 'r grounds older from vehicle'to care of designated person :r t"yi (b) Animals that could pose a threat to health and {8)yDnvcr checks each seat at each locationto r u safety kept away from children xvenfy no child is left on the vehicles (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 (I) Stattonaryseating for child,each child � w' water available nseatedivhilevd"htcaeismovmg ' aN"r'+ t ni:.3.+<t t__...t.a°,e7i.r. :-•+gar, . �;, r a r S)c�,r°�t `' .a 6 U U U (1) C C C C (II � U N V . REGULATIONS Q REGULATIONS ° 0 ° O Q ° 0O O Q U U 0 U U o o Z Z Z mi (3) Children not Uansportedan front seat of vehicle [2. Records on staff(pages 42-44) , ith`passengcr side airbag fi (See Staff Checklist) (4) llnvcr and all passeneers secured when vehicle is �( a Records on staff}.ept confidential moving /\ S (a) Each child under-1}ear or weighing less than b Records on file at Ume of cmployrnent 20`pounds secured m rear facing child restraint, installed according to manufacturers instructions c. Records on staff maintained at least two years_ maintained in good condition .. after person has left (b) Each;child under 5 ycarsbr weighing less than d Records filed alphabetically 40 pounds secured m for�"facing child restraint ' § " uistalled according to manufacturer s instructions a Inactive files maintained separately maintained in good condition.,,,, Y k� (c) Each`child under 6 ycars;secured;in a booster f 3. Health (page 45) seatinstalled according to manufacturer s instructions mmntained m good condition t a Medical exam and TB test on file'at time of \, employment (d) Each child 6 d older the dnver and each b Staffw�th symptoms of contagious 'adult.passengersecured;m an utd'ividualseat belt, j iseaselcondiuon:not mcenter properly anchored to the vehicle / 61 h Vehicle safeh'check-done annually signed by Character and Suitability (II., mechanic and'dated filed in center , { 3 .. G.; pages 47-51) 5. Transportation provided by 1 Character and smtabihty`review t'onducted on parent/guardian(page 40) regmredpersons;(everySyears)r � a- .k is 4ti t s a Each child accompanied into and out"f center '• a Persons w7th determination of unsuitable r ', . , character termuiated ' b Each child'signed mrand signed out ` b 'Licensee infomrs DHR of anycriminal 4 convictions or'cirrcnt c Any child who sieves by walking or bus signed in ` Administration (11., H., by staff :, a pages 52-56 d Photo iD required when releasing child to 1. Applicant/licensee(page 52) ,unfamiliar destgnated person t; � ` + 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 c. Licensee designates director and delegates b. Child care workers/teachers meet qualifications and authority and responsibility for operation andmanagement of center to director have 12 hours of training within 30 days of employment Child careioders/teachers meet requirements fors a d. Written operating policies established �'��CCDF training withiri�0 daj•s(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 staffnot counted in ratio unless they meet (2) Copy of operating policies submitted to qual�ficat�ons and arc giving full attention to children 7s s , DHR e iDnver at least 19}valid dnver s license r. (3) Operating policies do not contradict Minimum Standards rf SibstRute staffmeet qualifications of staff for wfiom (4) Changes in operating policies provided to substituting r x parents and to DHR 7 ' . 2. Reports to the Department(pages 52- b. Age range of children in care conforms to 53) ages specified 15 c. Requirements for drop-in care met X a. The following reported to DHR R!iff to occurrenc 4. Children's Records(pages 54-55) is (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 or members of board ter 5. Center Records(page 55) The following records kept on file for the current year p us two a b. The following reported to DHR within 24 hours, written report within 5 days: sheets lt7 fw 56 a. Most recent license,permit,or approval %1 b. Public notice form fit d at Iirb inspection all 3. Admission Procedures (pages 53-54) i Name and telephone number for: Is Ich. REGULATIONS ~ 9 Checklist for Infants (0 )indicates compliance observed by DHR Licensing Representative (.r)indicates not in compliance (X)indicates not applicable �Age`of children 4 ° 1°t+2 Number of children ;` w n # - Numbertofstaff ,- Minimum E ui ment Required for Each Group of Children O•& Washable soft crib toys-2 per 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)-1 Nestine and stacking toys-2 sets Washable baby doll-1 Musical toy-1 Colorful pictures and posters Activity boxes,such as busy boxes-3 • i i i ' i i uiprnint Dia erin area'•, _''a.s rt�_ �,.�..:�L"u"y ,�.;.;�s? a l _ - Plastc pried_'coVered:contamer ; ,^ "r ° Tub(portable plastic type acceptable) 717 ceding charts`,. _. ..:::�,_.,� ,-: ..�� . .. .r;� . _: -. . ,�"z �`. +CHW -fectof s ace'behYeen oc6 kd cribs _ 77 t e ,�Wate"roof mattress;sheets Indoor:thermometer•/.Out of reaeh`of,childien ? Sfieivin"fore ui ment-and s`u "lies/anchored Individual;labeled sEor""e s ace for each.chrld a'. Fumitu a child"stce,"clean;ood'eondition:% .. Cnbs;tn accordance witffUS Consu mer Product Safety r Ae[of 2008 ElectircaT"outlets coveiedr ' r ,lt :'y c s• : Barriers azouiid heatersa;fans t ill;`*-' 11 Haiardous�substances'lo''cl.ed•�i��. )h'�"`�,_�.,�r.�:`. y,;..#�.a • :� � h_,� .>" } e Contarners=labeled.<,Ivledieat�ori locked,�uT <_ s� 3 Screens on•.w7ndows:which are'o coed s,�'„�`?�:,,�. ;,_ _ :.�: ::� .. ., _ _. � .._: . _ ..ie ..:r-. ;_ .:,..�; . m, ';, ._ ._<�.$�: 10 Checklist for Toddlers (aye 18 months-21/2vears) 0)indicates compliance observed by DHR Licensing Representative -1)indicates not in compliance X)indicates not applicable , Number o be r",0 Minimum Equiement Required for Each GroyR of Children ke4wre1 quipu I 66-67Y usi Large non-toxic cravons/markers Paper(variety) Non-toxic Playdough Colorful pictures and posters A device that plays a variety of age appropriate music Musical toys-2 1 111115 1 ill� 11ii lii�;011111051 Push.and pull toys-2 Push rge'ears,trucks,boats,etc.-2 S�,_O. Sit-on riding toy-2 L L. ar,ge soft balls-2 Q llieitTi��," Books-2 per child 7 Age appropriate puzzles-2(complete with all pieces) Nestina and stacking toys-2 sets INon-wooden building blocks(aUroximately 20 non-interlocking) v� eLZ I'v­1 n"g"ID"ra"imi 4­4 Baby dolls-2(complete with all parts) Doll clothes and blankets Doll bed—I To telephones-2 Pots,pans,buckets,large plastic spoons ,Child-size stove Dress-up clothes 'P -WM:66i;v, Tub(portable plastic type acceptable) 7 7 -Teiding'aaK§)of iib[6 Xribi'w&;Water" 'ofmattress(es -shcets.'co�crin.` _77- jd&d r hejftjojjfCjjj./"rOdf of jeacEj)f.Chjjdjj&Ij, :Shehft'fbr iijuipriint isid iipplieslanchorid -FumrtuFechil3si.e.clean'`. I:IridWidtail,Ai sliisgii' ace f6r.&cW'child'to`-" El '6W'6uilets-covered-.��m-l-l'-,�,'-,-���,2�.--.".,.-i.��..'� lhzticis afbuhd heaters:fans �.. . 0 _;2 e �RRF, 7,774 ,77, Fzwt kg', Md d i dk i oh 10 k d d 6 11 Checklist for 24 months up to 36 months (O)indicates compliance observed by DHR Licensing Representative (d)indicates not in compliance X indicates not applicable Numtier,.ofchildren Number.ofstaffe. � Minimum E ui ment Required for Each Group of Children Non-toxic playdough Large non-toxic crayons/markers Paper Non-toxic finger-paints in primary colors Scissors(blupt-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 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 non-interlocking Cars,trucks,boats,etc.—3 Age appropriate puzzles-4(complete with all pieces) Interlocking manipulative play sets of different types—3 sets D�a erm arere a. ', r.°w. ., w,::;'..._ Su1k;=Waiin,,i $oa a cutowc s .,_. ihii ,p Plastie-lrned'wveied'contazners Ta61e s ace,and chaiifor eacll`chdd �ti1 re' j.t n � T. - ".s c . r :-; { r s Cots/.sheetsarid covers ,_ _ 3 < ... Written daily plan or schedule posted Sfielvin for'e"ui men€arid lies/anchored, •. M �, . _ 4«f ,a,,, Designated activity areas Electrical`.outlets covered r =ss e Bame[S:around heaters fans Hazardous substances lbched -.. -r s t �, aGTedic`atiorilocled Screens on:windov.5 i'vhich are Lt ft idiFildaie 12 Checklist for Preschool (K 21/2 y aWtto school a2) (O)indicates compliance observed by DHR licensing representative ( I)indicates not in compliance X)indicates not applicable - Age'of children Number of childr'•en'� i:: Number of staff r s )C;' . .� , Easel Non-toxic playdough or clay Large non-toxic crayons/watercolor markers 0 Large sheets of paper 0 Non-toxic finger/cold water paints-primary colors n 0 Scissors(blunt tip)-2 pr.Per 5 children (-) 0 71 1 Non-toxic glue or paste;tape 0 Paint brushes four 1/2 and 1 inch in width [� i i Large/medium building blocks-app. 15 non-interlocking Small building blocks-app. 100 non-interlocking Small cars,trucks,boats,etc.-6 C Age'appropriate puzzles-8(complete with all pieces) 0 Interlocking manipulative play sets,different types-6 Matching games-6(no more than 2 electronic) Puppets-2 (� o+ Child-size stove/sink(or combo) Small table and chairs/benches �1 Cooking utensil's/dishes(unbreakable) 0 Doll bed or cradle Dolls(complete with all parts)-2 (' Doll clothes and blankets np Dress-up clothes for boys and girls Storage for dress-up clothes Unbreakable mirror-full length Toy telephones-2 (� Age Appropriate children's books-2 per child A device that plays a variety of age appropriate music Rhythm instruments—I per child in group Magnifying glass Magnets 0 (� Nature collections (a Measuring and pouring equipment ® 0 D r® 'u61i :Table- ace and chair for each child f% ? 7 - Cots:Sheets,covers"for each child.-.! M77 77s ? Indoor thermometer/out of reach."- Written daily plan or schedule posted Labeled sto e spade at`child.levcl r - 'Shelvin for a ui merit and'su lies/anchored ^_ - Desi aced activi areas ('� Facilities Electrical outlets covered- Barriers around heaters;'fans t ; H dous substances'locked/&h r containers labeled _ _ �'-� _ - Medication locked :. Screens on windows which are opened _ - ? ti tin,�'adc uate CA 2(c xb (: . 6 Checklist for School-Age 0 indicates compliance observed by DHR Licensing Representative I indicates not in compliance X indicates not applicable Name of a ge of children " ' - e And r"of j reP" Number sa Minimum Edilipment Re tired for Each Groye of Children -4uire ,W iI'Eq`u'fp' ifieht(III.,-14"P* -.68 6 Jig-saw T)uzzle-I per 5 children Games:choose indoor or table games Suited to age of children-1per 5 children Games:choose outdoor or active games Suited to age of children-I per 5 children Books suited to age of children-2 per child Non-toxic la dough 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—I per 5 children % BU q Ipm a able'=6 orn�Io ritherm -T s abi.' '6hAiir-,f666a6h.c'hild �v I 4V t �n, ,Z, Ind --t Written Written d _'._iq 7� n daily plan or schedule posted b', 7��72TM7 7- 77�1�'Iiil'�W 75 I&M 1-11A!�� Designated activity areas B"aineis around heaters:fans,—.- Ma iaidoug-s6sfiin6ds locked :Contaiiserslabeled -41 Me I whic h 'u— "-'ad'Lighting equate 14 Playground Checklist (0 indicates compliance observed by DHR Licensing Representative (4) indicates not in compliance (X)indicates not applicable NM 7,vilz unt Equipment Regttired 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 0 Balls-3 Climbing apparatus Crawl-through equipment Digging or sand area Toys for digging `Outdoor play area enclosed by a fence or wall at least 4 feet in height a �Fenae'ar wall free of sharp edges sates secared Shade and sun areas provided A Outdoor pla}a;ea free.of.apparenhha= ou"s conditions T Concretetasplialt:not used under egwpment Area well drained , r Equipmenfnot designed totbeportable securely anchored` A n ` 0 Stairs%steps have hand rails m child s reach`. ..y� '' �- 15 Emergency Preparedness and Response Plans Checklist (0)indicates compliance observed by DHR Licensing Representative (�) indicates not in compliance 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: R'eathcr emcrgcnc�cs/natural disasters Current emergency plans_and procedures (f Lockdown:oi'evacuationdue to,threats of violence` Location and use of fire eztinguishcrs Evacuations due to Documentation of the following puarterly drills Hazardous materials; Firc _ Spills Tornado # � Gas leaks o Lockdo�m Bomb thieats <.Relocagon Infectious disease emeigenc�es `- Telephones'foi on site andoff site use <; rLoss of pow wat er, er or heat Location of the first aid and emergency supply l.rts Othefthreatening situations 1 • The:disdster 'Ian shall_rnclude:details or <:{ Shelter m place_or evacuation f ry Assisting infants and children with special needs and%or healtfi,00nd�Uons Y 'Reunification with parents 1 Shelter m place procedtires + � _ `Fi � _ ' •, • Transportation.disastei procedures. r .{ Staff,tiaimng/reassignment Q Contact with 1ooal emergency'management officals r l 16