INSTITUTO MEXICO EN TEXAS, LLC

A caregiver completed pediatric CPR training online.

Several cans/bottles of disinfectant sprays were stored under a sink and on top of a sink. This posed a safety hazard as the cleaning supplies were within children reach. Note: This was CORRECTED during the inspection as the cleaning supplies were removed and stored in an area out of children's reach.

Loose fill surfacing (mulch) was not maintained at the proper depth of 6 inches for a play structure in the outdoor play area. The plastic underneath the mulch was visible in different areas.

4 of 7 caregivers records reviewed were missing annual training on the following topics. Two caregivers were missing annual training on the following topics: (1) Preventing and controlling the spread of communicable diseases, including immunizations; (2) Administering medication,; and (3) Understanding building and physical premises safety, including identification and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic. A third caregiver was missing annual training on the following topics for training year 11/01/2021 - 10/31/2022: (1) Recognizing and preventing shaken baby syndrome and abusive head trauma; (2) Understanding and using safe sleep practices and preventing sudden infant death syndrome (SIDS); and (3) Understanding early childhood brain development (4) Emergency preparedness; (5) Preventing and controlling the spread of communicable diseases, including immunizations; (6) Administering medication,; (7) Preventing and responding to emergencies due to food or an allergic reaction; (8) Understanding building and physical premises safety, including identification and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; and (9) Handling, storing, and disposing of hazardous materials including compliance with 746.3425 of this chapter (relating to Must caregivers wear gloves when handling blood or bodily fluids containing blood?). A fourth caregiver was missing annual training on the following topics for training year 8/17/2021 - 8/16/2022: (1) Emergency preparedness; (2) Preventing and controlling the spread of communicable diseases, including immunizations; (3) Administering medication; (4) Preventing and responding to emergencies due to food or an allergic reaction; (5) Understanding building and physical premises safety, including identification and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; and (6) Handling, storing, and disposing of hazardous materials including compliance with 746.3425 of this chapter (relating to Must caregivers wear gloves when handling blood or bodily fluids containing blood?).

6 of 6 cribs in the infant room were supplemented with an additional mattress. Note: This additional mattress was removed from each crib during the inspection.

The fire extinguisher in the transportation vehicle was not currently serviced. The service date on the tag was January 2022.

4 of 6 Children's files reviewed were missing the child's immunization record.

The diaper changing mat in an infant room and a toddler room were observed torn. Note: This was CORRECTED during the inspection as both diaper changing mats were replaced with new mats.

The director was missing annual training on the following topics: (1) Preventing and controlling the spread of communicable diseases, including immunizations; (2) Administering medication, if applicable, including compliance with 746.3803 of this chapter (relating to What authorization must I obtain before administering a medication to a child in my care?); (3) Understanding building and physical premises safety, including identification and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; and (4) Handling, storing, and disposing of hazardous materials including compliance with 746.3425 of this chapter (relating to Must caregivers wear gloves when handling blood or bodily fluids containing blood?). The Second director was missing annual training on the following topics: (1) Preventing and controlling the spread of communicable diseases, including immunizations; (2) Administering medication, if applicable, including compliance with 746.3803 of this chapter (relating to What authorization must I obtain before administering a medication to a child in my care?); (3) Understanding building and physical premises safety, including identification and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic;

Safety straps were not fastened for an infant using a bouncer seat in an infant room. 4 children sitting at a kidney shaped table were did not have a safety strap fastened. Chairs to the kidney shaped table were missing the safety straps in a second infant room.

Two caregivers and a staff were allowed to be present in the operation and have director contact with children in care prior to the operation receiving notice from the CBCU (Centralized Background Check Unit) regarding the person s eligibility. Note: Person left the operation during the inspection.

2 of 10 employees files reviewed were missing the caregivers education documentation. 3 of 10 employees files reviewed did not have the caregivers education documentation translated into English for education received outside of the United States.

The original training certificate for a training completed was not available for review for the director and a caregiver.

An infant's written feeding instructions were not current. The date on the feeding instructions reviewed was 2/04/2022.

4 of 10 Personnel files reviewed were missing annual training clock hours. A caregiver with DOE 1/29/2021 was missing 5 clock hours of annual training. A caregiver with DOE 2/01/2018 was missing 1 clock hour of annual training in prevention, recognition, and reporting of child maltreatment. A caregiver with DOE 8/17/2020 was missing 6 clock hours of annual training. A caregiver with DOE 8/16/2019 was missing 5 clock hours of annual training.

The operational policies reviewed were missing the following information: The Promotion of indoor and outdoor physical activity that is consistent with Subchapter F of this chapter (relating to Developmental Activities and Activity Plan): (A) The benefits of physical activity and outdoor play; (B) The duration of physical activity at your operation, both indoor and outdoor; (C) The type of physical activity (structured and unstructured) that children may engage in at your operation; (D) Each setting in which your physical activity program will take place; (E) The recommended clothing and footwear that will allow a child to participate freely and safely in physical activities; and (F) A plan to ensure physical activity occurs on days when extreme weather conditions prohibit or limit outdoor play. Note: This was CORRECTED during the inspection as the missing information was added to the operational policies.

3 of 10 children's files reviewed were missing the children's immunization record. 2 of 10 children's files reviewed were missing the children's vision and hearing screening results.

The diaper changing mats were observed torn in two different classrooms. Note: This was CORRECTED during the inspection as the diaper changing mats were replaced.

Screen time activity was being provided to a group of toddlers in an infant room. The children were observed sitting around a kidney shaped table watching nursery rhymes on a phone. Three of the five toddlers were under the age of 2 years. Note: This was CORRECTED during the inspection as the phone was stored away and children were provided with age appropriate toys.

Two cribs in use were not numbered or labeled with the infant's name. Note: This was CORRECTED during the inspection as the cribs were labeled with the infant's name.

There was no crib in an infant room for an infant under 12 months of age. A total of 6 infants under 12 months of age were present in the room and only 5 cribs available. Note: This was CORRECTED during the inspection as an additional crib was provided in the infant room.

Two Pre-k classrooms and the afterschool room were out of ratio. A caregiver was caring for 16 pre-k children. In a second pre-k room a caregiver was caring for 17 pre-k children. The specified age of the children in each pre-k group was 3 years of age. According to the ratio chart the maximum number of children a caregiver may supervise is 15 children. In the afterschool room a caregiver was caring for 21 children of varying ages. The specified age of the children in that group was 4 years of age. According to the ratio chart the maximum number of children one caregiver may supervise is 18 children. Note: Changes were made during the inspection and additional caregivers stepped in the rooms to meet child/caregiver ratios.

The emergancy preparedness plan reviewed did not include the procedures on how staff will continue to care for the children until each child has been released.

1 of 5 childrens files reviewed did not have the child's immunization record and the Statement of the child s health.

The emergency preparedness plan reviewed was missing the center's procedures for how children will be evacuated or relocated to the designated safe area or alternate shelter, including specific procedures for evacuating and relocating children who are under 24 months of age, who have limited mobility, or who otherwise may need assistance in an emergency, such as children who have mental, visual, or hearing impairments; Name and address of the alternate shelter away from the center you will use as needed;