Niyla's Clubhouse

In review of records, it was determined the IHA did not have current valid documentation for training(s) listed in number(s) 15 below: 1. First Aid - expired training. 2. First Aid - did not have verification of the completion of First Aid training. 3. First Aid - training taken did not include all age groups and developmental levels of all children in care. 4. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule. 5. CPR - expired training. 6. CPR - had not taken CPR training. 7. CPR - did not have verification of the completion of CPR training. 8. CPR - training taken did not include all age groups and developmental levels of all children in care. 9. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule. 10. CPR- audiovisual or electronic media training taken did not include an in-person component of the training. 11. Communicable Disease - expired training. 12. Communicable Disease - had not taken CD training. 13. Communicable Disease - did not have verification of the completion of full CD training. 14. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule. 15. Child Abuse - expired training 16. Child Abuse - had not taken Child Abuse training 17. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Submit the documentation of current certification with a corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 12/06/2025

During the inspection, it was determined that children were not protected from the following item(s) or condition(s) which may threaten their safety as noted in the following number(s) 1 and 5 below: Page 2 of 8 hiv Department of ~ Children & Youth 1. Surge protectors/outlets did not have childproof receptacle covers. 7 | 2. Toys or other items small enough to be swallowed were present in the space where infants and/or toddlers were in care. 3. The platform provided for the sink or toilet was not sturdy. 4. The platform provided for the sink or toilet posed a safety hazard in that [ ]. 5. Other- can of margarita in bottom shelf. Submit a corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 12/06/2025

During the inspection, it was determined that the IHA did not have a first aid kit [onsite/ on the vehicle/ on a field trip] as required, that included all items listed in the appendix C of the rule. The kit(s) were missing the item(s) or the item(s) were not replaced after use and/or expired listed in number(s) 7, 11, and 13 below: 1. One roll of first-aid tape. 2. Individually wrapped sterile squares in assorted sizes. 3. Sterile adhesive bandages in assorted sizes. 4.Tweezers. 5. Gauze rolled bandage. 6. Triangular bandage. 7. Rounded end scissors. 8. Tooth preservation system or fresh chilled liquid milk in which to transport a lost permanent tooth, including a written reference indicating location of the refrigerator/freezer where milk is stored if a tooth preservation system is not part of the first aid kit (for programs serving school age children only). 9. A working digital thermometer. 10. Disposable non-latex gloves. 11. A working flashlight. 12. An instant cold pack that has not been activated or ice, including a written reference indicating location of the refrigerator/freezer where the ice is stored if an instant cold pack is not part of the first aid kit. 13. Sealable leak-proof plastic bags in assorted sizes or double bagged plastic bags that can be securely tied for materials soiled with blood or bodily fluids. 14. Pocket mask or face shield, appropriate; for all ages of children in care, for cardiopulmonary resuscitation (CPR) administration. 15. Soap or waterless sanitizer (field trip or transporting away from the program only). 16. Bottled water (field trip or transporting away from the program only). Correct the violation and submit a corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 12/06/2025

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) 1 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 IHA. 15. Enrollment form for at least one child was not signed by the IHA. Page 5 of 8 re) ier Department of ~ Children & Youth )] 16. Other [ ]. i Submit a corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 12/06/2025 [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-14-02 In-Home Aide Compliant Application and Approvals [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-02 In-Home Aide Compliant Qualifications [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-02 In-Home Aide Compliant Responsibilities [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-04 Background Checks Compliant | [Rule Status | Documenting Statement(s), If applicable 5180:2-14-05 Handwashing Compliant Po [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-05 Communicable Compliant Diseases [Rule Status | Documenting Statement(s), If applicable 5180:2-14-05 Swimming Permission | Compliant | [Rule i Status | Documenting Statement(s), If applicable 5180:2-14-05 Pets [Compliant | [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-07 Incident/Injury [Compliant | [Rule Status | Documenting Statement(s), If applicable 5180:2-14-06 Health Conditions [Compliant | [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-06 Child Record Retention | Compliant and Confidentiality [Rule Cd Status | Documenting Statement(s), If applicable Page 6 of 8 hiv Department of ~ Children & Youth 5180:2-14-07 Medical, Dental, and Compliant General Emergency Requirements/Drills [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-14-08 Supervision [Compliant | [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-08 Ratio and Group Sze [Compliant ——Ssd|SSSS~* [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-14-08 Child Guidance [Compliant | [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-08 Child Abuse and Compliant Neglect Reporting [Rule Status | Documenting Statement(s), If applicable 5180:2-14-09 Requirements for Field | Compliant Trip Safety [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-09 IHA Driver Compliant Requirements [Rule i Status | Documenting Statements), If applicable 5180:2-14-10 Sleeping and Napping Compliant Requirements [Rule Status | Documenting Statement(s), If applicable 5180:2-14-10 Crib and Playpen Compliant Requirements [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-12 Medication Compliant Requirements [Rule sd Status | Documenting Statement(s), If applicable 5180:2-14-10 Evening and Overnight | Compliant Care [Rule Status | Documenting Statement(s), If applicable 5180:2-14-11MealsandSnacks [Compliant «| C= [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-14-13 Infant Daily Care [Compliant | [Rule Cd Status | Documenting Statement(s), If applicable Page 7 of 8 hiv Department of ~ Children & Youth || 5180:2-14-13 Infant Bottle and Food Compliant i Preparation [Rule Status | Documenting Statement(s), Ifapplicable | 5180:2-14-13 Diapering [Compliant | Page 8 of 8

During the inspection, it was determined the IHA's written emergency preparedness and response plan did not 7 | meet the requirement or was missing the information in number(s) - provider was not able to locate the emergency plan: Procedures: 1. The written emergency preparedness and response plan had not been completed. 2. The plan was not dated. 3. The plan was not reviewed with the parent at least annually. Procedures: 4. Weather emergencies and natural disasters which include severe thunderstorms, tornadoes, flash flooding, major snowfall, blizzards, ice storms or earthquakes 5. Emergency evacuations due to hazardous materials and spills, gas leaks or bomb threats including a designated safe site where children can safely remain when evacuated. 6. Outbreaks, epidemics or other infectious disease emergencies. 7. Loss of power, water or heat 8. Emergencies or disasters that occur during the transport of children or when on a field trip or routine trip. 9. Other threatening situations that may pose a health or safety hazard to the children. 10. Shelter in place, disasters or evacuation. 11. Emergency contact information for parents and the IHA. 12. Plan to contact and work with local emergency management officials. 13. The location of supplies. 14. Procedures for gathering necessary supplies for children. 15. Procedures for communicating with parents during loss of communication including loss of phone or internet service. 16. Procedures for assisting infants, toddlers, and children with special needs and/or health conditions. Add the missing information to the emergency preparedness and response plan. Submit a corrective action plan, which includes the missing information, to verify compliance with the requirements of this rule. Corrective Action Plan Due: 12/06/2025

During the inspection, it was determined that the program had not [performed/documented] monthly inspections of vehicles used for transporting children. The monthly inspection needs to include the following: 1. A visual inspection of the tires for wear and tire pressure. 2. A visual inspection of headlights, taillights, signals, mirrors, wiper blades, and dash gauges. 3. An inspection for properly functioning child and driver restraints. 4. An inspection for properly functioning doors and windows. 5. An inspection for, and cleaning of, debris from the inside of the vehicle. 6. Other - provider's car is in the shop- stated inspections were in the car. Submit a corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 12/06/2025