Shirley Evans

Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA).Walnut Street, Des Moines, IA 50319-0114

“ h” The home shall have at least one single-station, battery-operated, UL-approved smoke detector in each child-occupied room and at the top of every stairway. Each smoke detector shall be installed according to manufacturer’s recommendations. The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes

“ n” Providers shall inform parents of the presence of any pet in the home. 1. Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). 2. Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a...

“h” . The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes. Shirley did not have documentation of monthly testing of smoke detectors. This worker did provide her an updated form for future documentation purposes. 41

“n” Providers shall inform parents of the presence of any pet in the home. Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). Both dogs had an updated exam but they were not documented on the required HHS form. This was also an area where she was out of compliance at last years check. This worker did...

“a” All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a childWalnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director

“a” All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a child. Shirley had chemicals/cleaners under the kitchen sink on the main level of the home and under the kitchen sink on the lower level of the home that were not secured from access by a child. Shirley did secure the cabinet on the main level of the home while this worker was present but needs to secure the cabinet on the lower level of the home or move the cleaners.

“a” have been completed and authorizing or conditionally limiting the person’s involvement with child care. 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated at least every three years. 3. Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code...

An individual file is maintained for each staff assistant and contains: 1. Documentation from the department confirming the record checks required under subrule 110.11(3) have been completed and authorizing or conditionally limiting the person’s involvement with child care 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated...

An individual file is maintained for each staff assistant and contains: Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code section 232.69 within 3 months of employment. Dionnez is an approved assistant, and Shirley could not locate his verification of Mandatory Child Abuse Reporter training. Steven is an assistant and substitute, and Shirley could not locate his verification of Mandatory Child Abuse Reporter training.

An individual file is maintained for each substitute and contains: 1. Documentation from the department confirming the record checks required under

An individual file is maintained for each substitute and contains: Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code section 232.69 within 3 months of employment.Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: a. Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. b. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name, telephone number, and relationship to the child of another adult available in case of emergency. c. A signed medical consent from the...

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: An admission physical examination report signed by a licensed physician or designee in a clinic supervised by a licensed physician The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home. The written report shall include past health history, status of present health, allergies and restrictive conditions, and recommendations for continued care when necessary. For a child who is five years of age or older and enrolled in school, a statement of...

Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA).Walnut Street, Des Moines, IA 50319-0114

“ n” Providers shall inform parents of the presence of any pet in the home. 1. Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). 2. Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a...

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: a. Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number.Walnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director b. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the...

.e Child files. One child needs updated annual statement of health signed by a physician. Suggestions/Recommendations: Contact Lori Mueller, CCRR, for needed assistance with child care items. Lori Mueller Child Care Consultant Child Care Resource & Referral of Southeast Iowa Community Action of Eastern Iowa lomueller@caeiowa.org T: 563-362-8226 500 E 59th St.| Davenport, IA 52807| www.iowaccrr.orgWalnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director Corrective Action Required: A follow up visit will not be required. These items will be checked for compliance...

Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA).Walnut Street, Des Moines, IA 50319-0114

“ h” The home shall have at least one single-station, battery-operated, UL-approved smoke detector in each child-occupied room and at the top of every stairway. Each smoke detector shall be installed according to manufacturer’s recommendations. The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes

“ i” Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. Nonsmoking signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: 1. The telephone number for reporting complaints, and 2. The Internet address of the department of public health (www.iowasmokefreeair.gov)

“ n” Providers shall inform parents of the presence of any pet in the home. 1. Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). 2. Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a...

“c” Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication,...

“d” The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge, or blood. Soiled diapers shall be stored in containers separate from other waste.

“a” Fire and tornado drills shall be practiced monthly and the provider shall keep documentation evidencing compliance with monthly practice on file for the current year and the previous year.

“b” The provider must have procedures in place for the following: 1. evacuation to safely leave the facility 2. relocation to a common, safe location after the evacuation 3. shelter-in-place to take immediate shelter where you are when it is unsafe to leave that location due to the emergent issue 4. lock down protocol to protect children and providers from an external situation 5. communication plan and plans for reunification with families 6. continuity of operations plans 7. Procedures to address the needs of individual children, including those with functional or access needs

“ a” A physician’s examination report for the provider and all members of the provider’s household aged 18 years or older. Acceptable physical examinations shall be documented on Form 470- 5152, Child Care Provider Physical Examination Report. All children residing in the household must have medical documentation outlined in 110.9(4) “d”, 110.9(4) “f”, and 110.9(4) “g”

“ b” (1) I-PoWeR records or certificates verifying required training completion: Prior to registration: • minimum health and safety training, approved by the Department, in required contentWalnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director areas • Iowa’s Mandatory Child Abuse Reporter Training Prior to registration: First Aid and Cardiopulmonary resuscitation. Provider shall maintain a valid certificate indicating date of training and expiration date. During each two year registration period, the provider shall receive a minimum of 24 hours of training from...

“a” have been completed and authorizing or conditionally limiting the person’s involvement with child care. 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated at least every three years. 3. Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code...

An individual file is maintained for each staff assistant and contains: 1. Documentation from the department confirming the record checks required under subrule 110.11(3) have been completed and authorizing or conditionally limiting the person’s involvement with child care 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated...

An individual file is maintained for each substitute and contains: 1. Documentation from the department confirming the record checks required under

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: a. Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. b. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name, telephone number, and relationship to the child of another adult available in case of emergency. c. A signed medical consent from the...

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. Need updated parent signature and date on form for A.H., Z.S., Z.J.(4), D.B., S.B., M.H., P.T., K.J. This was observed to be completed. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name,...

Check with the appropriate authorities to determine how the following local, state, or federal laws apply to you: • Zoning code • Building code • Fire code • Business license • State and federal income tax • Unemployment insurance • Worker’s Compensation • Minimum wage and hour requirements • OSHA • Americans with Disabilities Act (ADA).Walnut Street, Des Moines, IA 50319-0114

“ h” The home shall have at least one single-station, battery-operated, UL-approved smoke detector in each child-occupied room and at the top of every stairway. Each smoke detector shall be installed according to manufacturer’s recommendations. The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes

“ i” Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. Nonsmoking signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: 1. The telephone number for reporting complaints, and 2. The Internet address of the department of public health (www.iowasmokefreeair.gov)

“ n” Providers shall inform parents of the presence of any pet in the home. 1. Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). 2. Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a...

“c” Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication,...

“d” The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge, or blood. Soiled diapers shall be stored in containers separate from other waste.

“a” Fire and tornado drills shall be practiced monthly and the provider shall keep documentation evidencing compliance with monthly practice on file for the current year and the previous year.

“b” The provider must have procedures in place for the following: 1. evacuation to safely leave the facility 2. relocation to a common, safe location after the evacuation 3. shelter-in-place to take immediate shelter where you are when it is unsafe to leave that location due to the emergent issue 4. lock down protocol to protect children and providers from an external situation 5. communication plan and plans for reunification with families 6. continuity of operations plans 7. Procedures to address the needs of individual children, including those with functional or access needs

“ a” A physician’s examination report for the provider and all members of the provider’s household aged 18 years or older. Acceptable physical examinations shall be documented on Form 470- 5152, Child Care Provider Physical Examination Report. All children residing in the household must have medical documentation outlined in 110.9(4) “d”, 110.9(4) “f”, and 110.9(4) “g”

“ b” (1) I-PoWeR records or certificates verifying required training completion: Prior to registration: • minimum health and safety training, approved by the Department, in required contentWalnut Street, Des Moines, IA 50319-0114 Iowa Department of Health And Human Services Kim Reynolds Governor Adam Gregg Lt. Governor Kelly K. Garcia Director areas • Iowa’s Mandatory Child Abuse Reporter Training Prior to registration: First Aid and Cardiopulmonary resuscitation. Provider shall maintain a valid certificate indicating date of training and expiration date. During each two year registration period, the provider shall receive a minimum of 24 hours of training from...

“a” have been completed and authorizing or conditionally limiting the person’s involvement with child care. 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated at least every three years. 3. Certification of two hours of approved training related to identification and reporting of child abuse as required by Iowa Code...

An individual file is maintained for each staff assistant and contains: 1. Documentation from the department confirming the record checks required under subrule 110.11(3) have been completed and authorizing or conditionally limiting the person’s involvement with child care 2. A completed Form 470-5152, Child Care Provider Physical Examination Report. The examination shall include any necessary testing for communicable diseases; a discussion of recommended vaccinations; completed no more than six months prior to approval to assist or be a household member; completed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner; and repeated...

An individual file is maintained for each substitute and contains: 1. Documentation from the department confirming the record checks required under

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: a. Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. b. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name, telephone number, and relationship to the child of another adult available in case of emergency. c. A signed medical consent from the...

Children’s Files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: Identifying information including, at a minimum, the child’s name, birth date, parent’s name, address, telephone number, special needs of the child, and the parent’s work address and telephone number. Need updated parent signature and date on form for A.H., Z.S., Z.J.(4), D.B., S.B., M.H., P.T., K.J. Emergency information including, at a minimum, where the parent can be reached, the name, street address, city and telephone number of the child’s regular source of health care, and the name, telephone number, and relationship to the...