Sy, Ramata

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: 06/11/2026 Rules In-Compliance/Not Verified [Rule sd Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure [Rule i Status | Documenting Statements), If applicable 5180:2-13-02 License Visible Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Change of Location Compliant re [Rule Status | Documenting Statement(s), If applicable —, a [Rule Status | Documenting Statement(s), If applicable — a PRule 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 TG i Department of ~ Children & Youth ae [Rule —S~S~S~SSSS~*SdS Status —~SCSS~*dicrenting Statements), 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 i Status | Documenting Statements), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-07 Provider Responsibilities | Compliant re [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 ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements [Rule Status | Documenting Statement(s), If applicable ee a [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 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 TG i Department of ~ Children & Youth ae a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Requirements for Field Compliant and Routine Trips [Rule Status | Documenting Statement(s), If applicable 5180:2-13-14 Ratio and Supervision Compliant for Field and Routine Trips [Rule i Status | Documenting Statements), If applicable — a | 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 sd Status | Documenting Statement(s), If applicable 5180:2-13-16 Medical, Dental, and Compliant General Emergency Plan PRule Status | Documenting Statement(s), If applicable — a [Rule Status | Documenting Statements), If applicable aoe a | Rule Status | Documenting Statement(s), If applicable — a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan TG i Department of ~ Children & Youth ae [Rule SCS Status ———~SCS~S Do curenting Statements), applicable oe a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment [Rule Status | Documenting Statement(s), If applicable ——oe a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-18 Attendance Compliant re | Rule Status | Documenting Statement(s), If applicable oe “™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-19 School Age Supervision | Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-21 Evening and Overnight Compliant Care P 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 PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae 5180:2-13-21 Sanitary Environment Compliant and Hygiene | Rule Status | Documenting Statement(s), If applicable a [Rule Status | Documenting Statement(s), If applicable a a [Rule Status | Documenting Statement(s), If applicable a ~™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Daily Care Compliant re [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rule Status | Documenting Statement(s), If applicable _ ee [Rule Status | Documenting Statement(s), If applicable oo a [Rule 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

During the inspection, it was determined that the Type B Home did not have a working smoke alarm in the basement or smoke alarm(s) were not placed/installed/tested/maintained in accordance with sa i Department of hj Children & Youth manufacturer's recommendations. A working smoke alarm must be placed, installed, tested, and maintained in accordance with manufacturer's recommendations. Submit the program’s corrective action plan to verify compliance with this rule. Corrective Action Plan Due: 06/11/2026

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) 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 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 [ ] 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: 06/11/2026