Shepherd, Robin L

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 numbers 4 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). sa i Department of hj Children & Youth 4. The written permission was missing the destination(s) of the trip(s). 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: 06/05/2026

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 numbers 4,6 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: 06/05/2026 sa i Department of ~ Children & Youth ae

In review of of the children's records, it was determined that completed medical statements were not on file, as required, for children listed on the JFS Children's Record Review For Child Care as indicated in numbers 1,10 below: 1. No medical was on file for at least one child 2. Medical(s) on file was not updated every 13 months 3. Medical(s) were missing child's name and date of birth 4. Medical(s) were missing the date of the medical examination 5. The date of the exam was more than 13 months prior to the date the form was signed 6. Medical(s) were missing a statement that the child has been examined and is in suitable condition for participation in group care 7. Medical(s) were missing the signature, business address and telephone number of the physician, physician's assistant(PA), advance practice nurse (APN) or certified nurse practitioner (CNP) who examined the child 8. Medical(s) were missing a record of immunizations the child has had specifying month, day and year 9. Medical(s) were missing a statement from the physician, PA, APN, or CNP that the child has been immunized or is in the process of being immunized against the diseases required by division 5104.014 of the Revised Code and found in appendix A to this rule 10. Medical(s) were missing a statement from the child’s parent or guardian that he or she has declined to have the child immunized against the disease for reasons of conscience, including religious convictions 11. Other [ ] Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 06/05/2026 Rules In-Compliance/Not Verified [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure TG i Department of ~ Children & Youth ae [Rule ——S~S~SSSS*S Status ——~SS——~*di crenting Statements), applicable ee a [Rule Status | Documenting Statement(s), If applicable a a [Rule Status | Documenting Statement(s), If applicable a | Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-02 Provider Medical Compliant re | 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 [Rule Status | Documenting Statement(s), If applicable 5180:2-13-04 Fire Safety for Type B Compliant Homes P Rule i 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 ee i PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae ON a | 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 Status | Documenting Statement(s), If applicable 5180:2-13-08 Employee Requirements | Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-08 Whistle Blower Compliant re [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-09 Background Checks Compliant re [Rule Status | Documenting Statement(s), If applicable ee a [Rule i Status | Documenting Statements), If applicable 5180:2-13-10 Professional Compliant Development [Rule Status | Documenting Statement(s), If applicable en a [Rule Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable Ne a [Rule Status | Documenting Statement(s), If applicable ee a [Rule i Status | Documenting Statements), If applicable 5180:2-13-12 Safe Equipment Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Environment Compliant re [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 = ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Clean environment and | Compliant equipment [Rule Status | Documenting Statements), If applicable ee a | Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable en a TG i Department of ~ Children & Youth ae [Rule SCS Status —~SCS~S Do crenting Statements), Paplcable 5180:2-13-14 Ratio and Supervision Compliant for Field and Routine Trips [Rule Status | Documenting Statement(s), If applicable ——— a [Rule i Status | Documenting Statement(s), If applicable a a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Vehicle Requirements Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-15 Health Conditions Compliant re [Rule Status | Documenting Statement(s), 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 [Rue i Status | Documenting Statement(s), If applicable — a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 First Aid Kit/Standard Compliant Precautions P Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Incident/Injury [Compliant TG i Department of ~ Children & Youth ae [Rule Cd Status | Documenting Statement(s), If applicable —e a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment [Rule Status | Documenting Statement(s), If applicable — a | Rule i Status | Documenting Statement(s), If applicable 5180:2-13-18 Attendance Compliant re [Rule Status | Documenting Statement(s), If applicable oo _ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-19 School Age Supervision | Compliant ee | Rule i Status | Documenting Statements), If applicable 5180:2-13-21 Evening and Overnight Compliant Care [Rule Status | Documenting Statements), 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 sa i Department of ~ Children & Youth ae P Rule Status | Documenting Statement(s), If applicable 5180:2-13-21 Sanitary Environment Compliant and Hygiene [Rule Status | Documenting Statement(s), If applicable a a [Rule Status | Documenting Statements), If applicable ee a [Rule Cd Status | Documenting Statement(s), If applicable a “™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Daily Care Compliant ee [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 oo a [Rule i Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable oo a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth 5180:2-13-25 Medication Compliant Requirements

During the inspection, it was determined the program’s written emergency preparedness and response plan did not meet the requirement or was missing the information in numbers 9 below: sa i Department of hj Children & Youth Procedures: 1. The written emergency and preparedness and response plan had not been completed 2. The plan was not provided to all child care staff and employees 3. Weather emergencies and natural disasters which include severe thunderstorms, tornadoes, flash flooding, major snowfall, blizzards, ice storms or earthquakes 4. Emergency outdoor and indoor lockdown or evacuation due to threats of violence which includes active shooter, bioterrorism or terrorism including a designated safe site where staff and children can safely remain when evacuated 5. Emergency or disaster evacuations due to hazardous materials and spills, gas leaks or bomb threats including a designated safe site where staff and children can safely remain when evacuated 6. Outbreaks, epidemics or other infectious disease emergencies 7. Loss of power, water, or heat 8. Other threatening situations that may pose a health or safety hazard to the children in the program Details: 9. Shelter in place or evacuation, how the program will care for and account for the children until they can be reunited with the parent 10. Assisting infants, toddlers and children with special needs and/or health conditions 11. Emergency contact information for parents and the program 12. Procedures for notifying and communicating with parents regarding the location of the children if evacuated 13. Procedures for communicating with parents during loss of communications, no phone or internet service available 14. The location of supplies and procedures for gathering necessary supplies for staff and children if required to shelter in place 15. What to do if a disaster occurs during the transport of children or when on a field trip or routine trip 16. Making the plan available to all child care staff members and employees 17. Training of staff or reassignment of staff duties as appropriate 18. Updating the plan on a yearly basis 19. Contact with local emergency management officials 20. The plan was unable to be implemented in that, [ ]. Submit the program’s corrective action plan, which includes the missing information, if applicable, to verify compliance with the requirements of this rule. Corrective Action Plan Due: 06/05/2026