Algena Lomax

In review of the children's records, it was determined that information had not been secured from the parent/guardian on the JFS 01234 “Child Enrollment and Health Information For Child Care”, as required, for the items in numbers 7,8,10,12, 13 and 14 below: 1. No enrollment form was completed for at least one child 2. The current JFS 01234 was not completed for at least one child 3. Complete child information 4. Complete parent information 5. Complete emergency contact information 6. Complete physician information 7. Information regarding the parent list 8. Health information 9. Additional information for all boxes checked “yes” sa i Department of ~ Children & Youth ae 10. Emergency transportation information 11. Parent/guardian’s signature 12. Diapering Statement 13. Acknowledgement of Policies and Procedures 14. Enrollment form for at least one child was not updated by either the parent or the administrator 15. Enrollment form for at least one child was not signed by the administrator 16. Other [ ] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 03/20/2026

In review of records, it was determined the JFS 01236 "Medical/Physical Care Plan for Child Care" did not meet the requirements of the rule as noted in number 2 below: 1. The JFS 01236 had not been updated annually 2. A separate JFS 01236 had not been used for each condition 3. The program used an old version of the JFS 01236 Submit the corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 03/20/2026 Rules In-Compliance/Not Verified [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure PRule Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable a [Rule Status | Documenting Statement(s), If applicable a [Rule Status | Documenting Statements), If applicable a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-03 Inspection Compliant Requirements [Rule Status | Documenting Statement(s), If applicable 5180:2-13-04 Building Requirements Compliant for Type B Homes [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-04 Fire Safety for Type B Compliant Homes [Rule Status | Documenting Statement(s), If applicable 5180:2-13-04 Flammable and Compliant Combustible Materials in a Type B Home [Rule Status | Documenting Statement(s), If applicable 5180:2-13-04 Heaters in a Type B Compliant Home [Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable a sa i Department of ~ Children & Youth ae P Rule Status | Documenting Statement(s), If applicable 5180:2-13 Written Policies and Compliant Procedures PRule Status | Documenting Statement(s), If applicable 5180:2-13-07 Type B Provider - Foster | Compliant Parent [Rule Status | Documenting Statements), If applicable a [Rule sd Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Whistle Blower Compliant ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-09 Background Checks Compliant re [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Professional Compliant Development [Rule Status | Documenting Statement(s), If applicable ae a P Rule Status | Documenting Statement(s), If applicable ae a PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae ee a | Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable “een a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Environment Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Carbon Monoxide Compliant Detectors - Type B Only [Rule Status | Documenting Statement(s), If applicable a “™ ee [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-13 Clean environment and | Compliant equipment [Rule Status | Documenting Statement(s), If applicable a a [Rule i Status | Documenting Statements), If applicable — a [Rule Status | Documenting Statement(s), If applicable eo a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Requirements for Field Compliant and Routine Trips TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Ratio and Supervision Compliant for Field and Routine Trips [Rule Status | Documenting Statement(s), If applicable ee a [Rue i Status | Documenting Statement(s), If applicable a a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Vehicle Requirements Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-15 Child Records Retention | Compliant and Confidentiality [Rule sd Status | Documenting Statement(s), If applicable 5180:2-13-16 Medical, Dental, and Compliant General Emergency Plan [Rule Status | Documenting Statement(s), If applicable — a [Rue i Status | Documenting Statement(s), If applicable 5180:2-13-16 First Aid Kit/Standard Compliant Precautions | Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable — a TG i Department of ~ Children & Youth ae [Rule —~S~—~S~SSSSS~*SdS Status ——~SS~*diécmenting Statements), applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment | Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-18 Group Size and Ratios Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-18 Attendance Compliant re [Rule Status | Documenting Statement(s), If applicable ee ~™ ee [Rule Status | Documenting Statement(s), If applicable —ee a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-21 Evening and Overnight Compliant Care [| Rule Status | Documenting Statement(s), If applicable 5180:2-13-20 Sleep and Nap Compliant Requirements PRule Status | Documenting Statement(s), If applicable ee a PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae 5180:2-13-20 Crib and Playpen Compliant Requirements | Rule i Status | Documenting Statement(s), If applicable 5180:2-13-21 Sanitary Environment Compliant and Hygiene [Rule Status | Documenting Statement(s), If applicable — a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-22 Food Handling Compliant re [Rule Status | Documenting Statement(s), If applicable a ™ ee [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Daily Care Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rule Status | Documenting Statement(s), If applicable _— a [Rule i Status | Documenting Statements), If applicable ee a [Rule Status | Documenting Statement(s), If applicable —v~ a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming TG i Department of ~ Children & Youth PI

During the inspection, it was determined the program did not meet the requirement(s) for administering a medication, medical food or a prescription topical product to a child as noted in number 1 below: 1. The JFS 01217 “Request for Administration of Medication for Child Care” was not on file for a medication, medical food, or prescription topical product that was not required by a JFS 01236 "Child Medical/Physical Care Plan for Child Care". 2. The child’s name was missing on the JFS 01217. 3. The child’s date of birth was missing on the JFS 01217 and was needed to determine the correct dosage. 4. The child’s weight was missing on the JFS 01217 and was needed to determine the correct dosage. 5. The name of the medication was missing on the JFS 01217. 6. The exact dose was missing on the JFS 01217. 7. The time to administer was missing on the JFS 01217. 8. The time period to administer was missing on the JFS 01217. 9. The medication's expiration date was missing on the JFS 01217. 10. The Parent/Guardian’s dated signature was missing on the JFS 01217. sa i Department of hj Children & Youth 11. Physician instructions were missing on the JFS 01217. 12. Possible side effects were missing on the JFS 01217. 13. Physician’s dated signature was missing on the JFS 01217. 14. Physician’s phone number was missing on the JFS 01217. 15. Date medication was administered was missing on the JFS 01217. 16. Time medication was administered was missing on the JFS 01217. 17. Dosage administered was missing on the JFS 01217. 18. Staff member’s signature was missing on the JFS 01217. 19. A prescription label was not attached to the prescription medication. 20. The medication or product, [ ], was not brought to the program in its original container. 21. Parent instructions conflict with either the manufacturer or physician instructions. Submit the program’s corrective action plan, which includes the completed JFS 01217 for each child needed, verification that the prescription label is now attached, and/or verification that the medication or product is now in its original container, and a statement that training was provided, to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 03/20/2026 Low Risk Non-Compliances