Jackson, Angela Y

In review of the program's records, it was determined that requirements for written permission from the parent/guardian for a field trip or routine trip were not met as listed in number(s) #9 below: 1. Written parental permission was not secured for field trips and/or routine trips off the premises. 2. The written permission was missing the child’s name. 3. The written permission was missing the date(s) of the trip(s) (field trips only). 4. The written permission was missing the destination(s) of the trip(s). sa i Department of hj Children & Youth 5. The written permission was missing the departure and return time(s) of the trip(s) (field trips only). 6. The written permission was missing the signature of the parent. 7. The written permission was missing the date on which the permission was signed. 8. The written permission was missing a statement notifying parents how their child will be transported. 9. Permission forms for routine trips were not being updated annually. 10. Written parental permission forms for field trips and/or routine trips were not being maintained on file for at least one year from the date of the trip. 11. Other: [ ]. Submit the program’s corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 03/22/2026

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 number(s) #2 and #4 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 [ ] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 03/22/2026 TG i Department of ~ Children & Youth ae Rules In-Compliance/Not Verified [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure [Rule Status | Documenting Statement(s), If applicable Se a | 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 5180:2-13-02 Provider Medical Compliant ee [Rue i Status | Documenting Statement(s), If applicable 5180:2-13-03 Inspection Compliant Requirements [Rue i Status | Documenting Statement(s), If applicable 5180:2-13-04 Building Requirements Compliant for Type B Homes [Rule Status | Documenting Statement(s), If applicable 5180:2-13-04 Fire Safety for Type B Compliant Homes Rule Status | Documenting Statement(s), If applicable sa i Department of ~ Children & Youth ae 5180:2-13-04 Flammable and Compliant Combustible Materials in a Type B Home [Rule sd Status | Documenting Statement(s), If applicable 5180:2-13-04 Heaters in a Type B Compliant Home [Rule Status | Documenting Statement(s), If applicable a a [Rule i Status | Documenting Statements), If applicable 5180:2-13-07 Provider Responsibilities | Compliant ee | Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13 Written Policies and Compliant Procedures [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-07 Type B Provider - Foster | Compliant Parent [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Employee Requirements | Compliant ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements | Rule Status | Documenting Statement(s), If applicable ee a | Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Health Training [Compliant TG i Department of ~ Children & Youth ae [Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Professional Compliant Development [Rule Status | Documenting Statement(s), If applicable —e a [Rule Status | Documenting Statement(s), If applicable a a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-11 Outdoor Equipment Compliant re | Rule Status | Documenting Statement(s), If applicable ee _ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Equipment Compliant ee | Rule sd 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 _— a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Clean environment and | Compliant equipment sa i Department of ~ Children & Youth ae PRule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statements), If applicable a a [Rule Cd 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 5180:2-13-14 Driver Requirements Compliant ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Vehicle Inspections Compliant re [Rule Status | Documenting Statement(s), If applicable — a [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-15 Child Records Retention | Compliant and Confidentiality [Rule Status | Documenting Statement(s), If applicable a PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae 5180:2-13-16 First Aid Kit/Standard Compliant Precautions | Rule Status | Documenting Statement(s), If applicable ON a [Rule Status | Documenting Statement(s), If applicable — a [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan PRule Status | Documenting Statement(s), If applicable —e ™ ee [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment [Rule Status | Documenting Statement(s), If applicable 5180:2-13-18 Group Size and Ratios Compliant re [Rule Status | Documenting Statement(s), If applicable a a [Rue Status | Documenting Statement(s), If applicable oo a [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable Care TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-20 Sleep and Nap Compliant Requirements [Rule Status | Documenting Statement(s), If applicable ee a [Rule 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 [Rule Status | Documenting Statement(s), If applicable 5180:2-13-22 Meals and Snacks Compliant re [Rule sd Status | Documenting Statement(s), If applicable 5180:2-13-22 Food Handling Compliant ee P Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statements), If applicable Se a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation P Rule Status | Documenting Statement(s), If applicable oe a TG i Department of ~ Children & Youth (a | Rule i Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable —~ a [Rule i Status | Documenting Statements), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming [Rule i 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(s) #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: 03/22/2026

During the inspection, it was determined the JFS 01201 "Dental First Aid" was not posted. Correct the violation and submit the program's corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 03/22/2026