Benton, Erica

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 itemsinnumber 2 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” 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 [ ] TG i Department of ~ Children & Youth ae Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 02/22/2026 Rules In-Compliance/Not Verified [Rule Status | Documenting Statements), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 License Visible Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Change of Location Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Information in OCLQS —_| Compliant re [Rule Status | Documenting Statement(s), 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 sa i Department of ~ Children & Youth ae [Rule i 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 Cd Status | Documenting Statement(s), If applicable 5180:2-13-07 Staff Records Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-07 Provider Responsibilities | Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13 Written Policies and Compliant Procedures [Rule Status | Documenting Statement(s), If applicable 5180:2-13-07 Type B Provider - Foster | Compliant Parent [Rule i Status | Documenting Statement(s), If applicable a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements [Rule Status | Documenting Statement(s), If applicable ee i PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae a | 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 5180:2-13-11 Indoor Space Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-11 Outdoor Space Compliant re [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-11 Outdoor Equipment Compliant re [Rule Status | Documenting Statement(s), If applicable — _ ee [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statements), If applicable ee a [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 TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Clean environment and | Compliant equipment [Rule Status | Documenting Statement(s), If applicable ee a [Rule i Status | Documenting Statements), If applicable ee a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Toothbrushing Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Requirements for Field | Compliant and Routine Trips [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 a [Rule Status | Documenting Statements), If applicable ee a | Rule Status | Documenting Statement(s), If applicable a P Rule Status | Documenting Statement(s), If applicable ee a TG i Department of ~ Children & Youth ae [Rule ————SCS—S Status ——~SCS~S Do curenting Statements), Paplicable 5180:2-13-15 Child Records Retention | Compliant and Confidentiality [Rule Status | Documenting Statement(s), If applicable ——e a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 First Aid Kit/Standard Compliant Precautions | Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Communicable Diseases | Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Incident/Injury Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan [Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statements), If applicable 5180:2-13-17 Materials and Compliant Equipment | Rule Status | Documenting Statement(s), If applicable —eC a [Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-19 Supervision [Compliant TG i Department of ~ Children & Youth ae [Rule Status | Documenting Statement(s), If applicable —— a [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 | Rule Status | Documenting Statement(s), If applicable 5180:2-13-19 Child Guidance Compliant re | Rule i Status | Documenting Statement(s), If applicable 5180:2-13-20 Crib and Playpen Compliant Requirements [Rule Status | Documenting Statement(s), If applicable 5180:2-13-21 Sanitary Environment Compliant and Hygiene P Rue Status | Documenting Statement(s), If applicable ee a [Rue i Status | Documenting Statement(s), If applicable ee a | Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable — a TG i Department of ~ Children & Youth (a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rule Status | Documenting Statement(s), If applicable oe a [Rule Status | Documenting Statement(s), If applicable a a [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-24 Swimming Sites Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming [Rule Status | Documenting Statement(s), If applicable 5180:2-13-25 Medication Compliant Requirements

During the inspection, it was determined the requirements for the JFS 01242 "Medical, Dental and General Emergency Plan" were not followed as noted in number 7 below: 1. The plan was not posted on each level of the home used for child care. 2. The name, address and telephone number of the program were not complete. 3. The location of the first aid kit, fire extinguisher and fire alarm system, fire alarm pull stations and electrical circuit box were not complete. 4. The telephone number for emergency squad, fire department hospital, poison control program, public children services agency, local health department, local emergency management agency and police department were not complete. 5. Location of children's records was not complete. 6. Emergency information including any medications or supplies needed i the event of an evacuation was not complete. 7. The current version of the prescribed form was not used. 8. The plan was not implemented when necessary in that [ ]. Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 02/22/2026