Children's Center of Excellence and Daycare

1 out of 4 chidlren's files evaluated did not contain documentation of current immunizations. The record provided was missing 1 dose of MMR and 1 dose of VAR.

During the inspection expired boxes of Benadryl and Neosporin ointment was observed and has not been disposed of. Note: The provider disposed the medication during the inspection.

Documentation showing the smoke detectors have been tested monthly was not available for review upon request.

Children were observed sitting in chairs equipped with safety straps and the safety straps were not secured. Note: The provider secured the straps for each child during the inspection.

7 out of 8 staff files evaluated did not contain a complete personnel record. The following information was missing: 4 were missing the Licensing affidavits were not notarized 2 were missing the Proof of education was missing 3 were missing Signatures that the staff have completed orientation to the center

Documentation showing training in the following topics were not available for review during the inspection: - Recognizing and Reporting Suspected Abuse and Neglect of Children - Transportation Safety Training

Children's files evaluated did not contain a complete record. The following information was missing or incomplete: - Two were missing the address, and phone # of the emergency medical facility - Three were missing the special needs statements - Two were missing the parents signature for receiving a copy of the operational policies

The operational policies were evaluated and did not contain the following information: - A Safe Sleeping Policy for Infants Under 12 months - The benefits of physical activity and outdoor play - The duration of physical activity at your operation, both indoor and outdoor - The type of physical activity (structured and unstructured) that children may engage in at your operation - Each setting in which your physical activity program will take place - The criteria you will use to determine when extreme weather conditions pose a significant health risk that prohibits or limits outdoor play and - A plan to ensure physical activity occurs on days when extreme weather conditions prohibit or limit outdoor play.

1 out of 8 employee files evaluated did not contain current CPR/First Aid training. The certifiate provided had expired on May 4th, 2023.

The operation did not report an outbreak of hand, foot, and mouth to childcare regulation.

A caregiver with a conditonal background check stating they must never be left alone with child was left alone with 6 infant 4-15mo

A caregiver was observed leaving a classroom multiple times during the inspection. The caregiver left another caregiver alone to supervise a total of 14 children 20m-2yrs old. Based on the specified age group (SAG) of the classroom was 2yrs. The caregiver was over ratio by 3 Upon arrival 3 caregiver were observed in the infant room, two caregiver then left the room. One infant caregiver was observed with 6 infants 4-15 mo. The SAG for the group was 0-11mo. The caregiver was over ratio by 2 for approx. 5-10 munites before the caregiver returned.

One child not yet on table food did not have updated feeding instructions. Instructions were last reviewed and signed by the parent 2/1/23

The fire extinguisher was observed to be located in the trunk of the vehicle used for transportation and was not readily accessible by the driver.

2 caregivers in the infant room were not aware of the number of children in their care. When asked, both caregivers stated there were 5 children in care. When asked again, they again stated there were 5. The caregivers were informed CCR counted 6 children. One careigver then stated they forgot a child was just brought into the classroom

The operation does not keep a sign-in/out log for children being transported.

The first aid kit was observed to be located in the truck of the vehicle used for transportation and was not readily accessible by the driver.

The vehicle used for transportation did not have emergency medical authorization for any of the children being transported.

Based on the information obtained during the DFPS investigation, the operation failed to report a child injury that required medical treatment.

Based on the information obtained during the DFPS investigation, the operation failed to ensure the areas were free of all safety hazards. A bottle warmer was stored in a manner that did not ensure the cord was out of reach of the children, resulting in a child injury.

14 children were observed sitting in bucket seat style tables and the straps were not observed to be in use. Two of the seats did not have straps.

2 caregivers were not aware of the number of children in their care. When asked, both caregivers were asked multiple times how many children were in their care, and both stated there were 15. 16 children were counted in care.

In the toddler room, a child was observed to be sleeping on a cot that was placed in front of the emergency exit. The exit could not be accessed without stepping over the child

Two infants not yet on table food did not have updated feeding instructions. Feeding instructions for one child was last completed 5/2022. Feeding instructions for another child was not dated, caregivers were not aware of when the instructions were written.

During the walkthrough, in the infant, toddler, and school age rooms, staff purses were observed to be in reach of children NOTE: Corrected at inspection, all purses were moved to high hooks or shelved and were out of reach of children

Refrigerated medication was observed to be stored next to food.

Records were reviewed for 6 staff including the director, three caregivers did not have training in the following topics: Hazardous materials Building and physical premise safety Emergency preparedness Responding to food and allergic reaction

One caregiver did not have documentation of a high school diploma or equivalent on file.

Records were reviewed for 6 staff including the director. 5 staff did not have a notarized affidavit on file

2 infants between 0-11 mo were observed sitting in a baby swing and bouncer for more than 15 mintues.

A caregiver was observed with 8 children 3-21 months. The SAG was 0-11 mo. The caregiver was overratio by 4 children

A container of diaper rash cream was observed in the crib with an 19mo old.

A 3mo old was observed sleeping in a baby swing. The caregiver was unaware that the infant was sleep. The infant was removed after instructed by CCR. According to the caregiver, the infants were in the restrictive devices for at least 20 minutes.

A caregiver was unaware of the ages of children in their care. When asked for the ages, the caregiver stated they guessed the age of the child and then stated they were unsure and did not want to say the wrong thing

A 19 mo old toddler was observed sleep in a crib with toys.

A caregiver was unaware of the ages of children in their care. When asked for the ages, the caregiver stated they had just arrived and did not know.

The director is only present at the operation two days a week and is not routinely present during the hours of operation.

There were 4 children ages 4m-15 mo old observed with children 18-23 mo. There were 24 total children in the building.

Sign-in/out logs for the director was requested and was not made available for review. According to the owner, a log of attendance for the director is not kept.

An infant was observed in a crib with a broken wheel. The crib was observed to be slanted.

The caregiver was observed with 11 children. When asked for the number of children in care there were 10 children present

A caregiver was observed with 11 children 4-23 months. The SAG was 18-23 mo. The caregiver was overratio by 3 children

The director is only present at the operation two days a week and is not routinely present during the hours of operation.

Sign-in/out logs for the director was requested and was not made available for review. According to the owner, a log of attendance for the director is not kept.

Cleaning chemicals in a spray bottle were observed on the table in reach of children.

Several children were observed crawing under tables in the eating area. The children were observed crawling under the table for approx. 3 mintues before the caregivers were aware.

Based on the information obtained during the investigation, parents were not notified immediately that there was a situation that placed their children at risk. NOTE" Two parents were notified immediately, other parents were not notified until pick-up.

Based on the information obtained during the investigation, as a result of the director's frequent absence, the director was unaware of the caregivers' activities prior to and when engaging in a physical altercation. The director failed to ensure all staff were supervised.

Based on he information obtained during the investigation, 2 caregivers engaged in a physical and verbal altercation with children present resulting in two children being pushed over chairs.

based on the information obtained during the investigation, incident reports were not created for the 6 children present and placed at risk when two caregivers had a physical altercation

A review of the Employees Who Left Employment in 2021 data from February 23, 2022 revealed that the center had not reported the number of employees who left employment in 2021 by February 22, 2022 as required. NOTE: The operation reported the number of employees who left in 2021 after the deadline.

Transportation training for the director was not made available for review. NOTE: Training for the owner/driver was reviewed and up-to-date

The operation did not have emergency medical authorization for 13 of 23 of the children being transported.

The operation did not have parent contacts or emergnecy contacts for 13 of the 23 of the children being transported.

A play equipment with a height less than 5 feet did not have at least 6 inches of surfacing

Of the 27 children present only 10 children were signed in. During the inspection, 2 children that left were not signed out

The operation did not have emergency medical authorization for anyl of the children being transported.

Transportation training for the director and owner was not made available for review.

The first aid kit on the vehicle and was observed to be missing the following: Cotton balls Tweezers Scissors Tape Antiseptic solution/wipes Thermometer

The operation did not have a list of all of the children being transported.

A play equipment with a height less than 5 feet did not have at least 6 inches of surfacing

The operation did not have a current fire inspection available for review. The last fire inspection was conducted 1/19/21

The operation did not have parent contacts or emergnecy contacts for any of the children being transported.

A caregiver was observed to be present without notification of eligibility from the background check unit.

During the inspection it was learned that the operation has been providing transportation services without notifing CCR of the additional services. NOTE: According to the owner, transportation began the second week of January 2022.

The Children's Product Safety certificate was not observed to be updated. The CPSC was last completed 1/20/21

A 4 month old who could not yet roll over unassisted wass observed to be placed on their stomach for sleep.

A caregiver and the owner were not aware of the number of children present. 8 children were observed to be present in the infant room. Both stated several times there were 9 children present. When asked anout the ninth child they both lookked around the room and stated there were only 8

A caregiver in charge of a group between 4mo-2 yrs old was not aware of the ahes of children in care. The caregiver indicatied they were unsure of a child's age and I would have to wait for the owner to return to the room

A caregiver was observed to be present without notfication of eligbility from the background check unit. NOTE : The caregiver made an appointment to get fingerprinted during the inspection

The admission forms for children was missing the following information: health statement and address for emergency contact.

6 caregivers including the director did not have training in pediatric first aid with rescue breathing and choking.

6 caregivers including the director did not have training in pediatric CPR

An infant was observed sitting in a baby walker. NOTE: Corrected at inspection the baby walker was removed from the classroom.

A 6 month old infant was observed to be sleep with a bib on their neck. Note: The bib was removed from the child

A 6mo old infant not yet on table food did not have infant feeding instructions available for review.