Mosier, Julie

In review of the staff records, it was determined that the medical statement for the provider did not include the required information listed below in number(s) 1, 2 AND 3A: sa i Department of ~ Children & Youth ae 1. Date of examination; 2. Signature, business address, and telephone number of the licensed physician, physician assistant, advanced practice nurse, certified midwife, or certified nurse practitioner who completed the examination; 3. A statement that verifies that the employee is: a. Physically fit for employment as a provider caring for children; b. Immunized against Measles, Mumps, and Rubella (MMR). c. Immunized against tetanus, diphtheria and pertussis (Tdap). Submit the program’s corrective action plan, which includes a copy of the completed medical statement, to verify compliance with the requirements of this rule. Corrective Action Plan Due: 05/17/2026

During the inspection, it was determined the provider did not have a completed JFS 01933 "Liability Insurance Statement for Family Child Care Providers" completed for each child in care. Correct the violation and submit proof of insurance with the program's corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 05/17/2026

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) 4,5,10, 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 sa i Department of hj Children & Youth 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: 05/17/2026