Payne, Yolanda

It was determined, the provider was not responsible for creating, maintaining or implementing the policies and procedures detailed in appendix C and D of this rule. Correct the violation and submit the program's corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 07/01/2026 Rules In-Compliance/Not Verified [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure [Rule Status | Documenting Statements), If applicable ee a [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable a P Rule Status | Documenting Statement(s), If applicable ee a sa i Department of ~ Children & Youth ae | Rule sd 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 P 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 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 5180:2-13-07 Staff Records Compliant ee [Rule Status | Documenting Statement(s), If applicable eee a [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-07 Type B Provider - Foster | Compliant Parent [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable ee i PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae ae a | Rule Status | Documenting Statement(s), If applicable en a [Rule Status | Documenting Statement(s), If applicable — a [Rule Status | Documenting Statement(s), If applicable ee ~™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Equipment Compliant re [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Environment Compliant re [Rule i 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 Statements), If applicable 5180:2-13-13 Clean environment and | Compliant equipment [Rule Status | Documenting Statement(s), If applicable ee a [Rule 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 5180:2-13-14 Requirements for Field Compliant and Routine Trips [Rule i Status | Documenting Statements), 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 re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Vehicle Inspections Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Vehicle Requirements Compliant ee [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statements), If applicable 5180:2-13-15 Child Records Retention | Compliant and Confidentiality | Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Medical, Dental, and Compliant General Emergency Plan P Rule Status | Documenting Statement(s), If applicable ——oe a TG i Department of ~ Children & Youth ae [Rule ——~S~S~S~SSSSS~*SdS Status ——~SCSS~*dié cumenting Statements), Haplicable 5180:2-13-16 First Aid Kit/Standard Compliant Precautions [Rule Status | Documenting Statement(s), If applicable Ne a [Rule Status | Documenting Statement(s), If applicable ee a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan | Rule Status | Documenting Statement(s), If applicable —e “™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment [Rule Status | Documenting Statement(s), If applicable — a [Rue i Status | Documenting Statement(s), If applicable ee a | Rule Status | Documenting Statement(s), If applicable oo a [Rule Status | Documenting Statement(s), If applicable eee a PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae 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 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 i Status | Documenting Statement(s), If applicable 5180:2-13-22 Food Handling Compliant re [Rule Status | Documenting Statement(s), If applicable a a [Rule Status | Documenting Statements), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rule Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth (a a [Rule Status | Documenting Statement(s), If applicable a a [Rule Status | Documenting Statement(s), If applicable —~C a [Rule i Status | Documenting Statements), 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

In review of the staff records, it was determined the training requirements were not met for the Child Care Staff Member(s) listed on the Employee Record Chart, as required. Submit the program's corrective action plan, which includes copies of verification of training, to verify compliance with the requirements of this rule. Corrective Action Plan Due: 07/01/2026

In review of the staff records, it was determined that the medical statements for those individuals listed on the Employee Record Chart did not include the required information listed below in number 1. 1. A medical statement was not on file; 2. The medical statement(s) on file were not dated within 12 months of the individual's first day of employment; 3. Date of examination was missing; 4. Signature, business address, or telephone number of the licensed physician, physician assistant, advanced practice nurse, certified midwife, or certified nurse practitioner who completed the examination was missing; 5. A statement was missing that verifies the individual is: a. Physically fit for employment in a program caring for children; b. Immunized against Tetanus, Diphtheria, Pertussis (Tdap); c. Immunized against Measles, Mumps, and Rubella (MMR); Submit the program’s corrective action plan, which includes a copy of the completed medical statement, to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 07/01/2026

In review of the staff records, it was determined that child care staff member(s) or substitute child care staff member(s) did not meet the requirements for completing the online orientation training as noted in number 1 below: 1. The training was not completed within 30 days of starting employment at the program as a child care staff member. 2. No documentation of completing the training after December 31, 2016. 3. Completion of the training was not verified in the OPR. 4. A child care staff member had sole responsibility of children and had not completed the online orientation. sa i Department of hj Children & Youth Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 07/01/2026

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 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 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: 07/01/2026 TG i Department of ~ Children & Youth