Tamika Washington

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 sa i Department of ~ Children & Youth ae 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: 04/19/2026 Rules In-Compliance/Not Verified [Rule Status | Documenting Statement(s), If applicable 5180:2-13-02 Voluntary Temporary Compliant Closure [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable —— a [Rule Status | Documenting Statement(s), If applicable —e— a [Rule Status | Documenting Statement(s), If applicable ee a TG i Department of ~ Children & Youth ae P 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 Statements), If applicable 5180:2-13-04 Fire Safety for Type B Compliant Homes [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-04 Flammable and Compliant Combustible Materials in a Type B Home [Rule i Status | Documenting Statements), If applicable 5180:2-13-04 Heaters in a Type B Compliant Home [Rule Status | Documenting Statements), If applicable 5180:2-13-07 Staff Records Compliant re [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 Written Policies and Compliant Procedures [Rule Status | Documenting Statement(s), If applicable 5180:2-13-07 Type B Provider - Foster | Compliant Parent PRule Status | Documenting Statement{s), If applicable a TG i Department of ~ Children & Youth ae [Rule —S~™~S~SSCSS~*SY Status ——~SCSS~*ditcmenting Statements), aplicable 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 a a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Health Training Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Professional Compliant Development [Rule Status | Documenting Statement(s), If applicable 5180:2-13-11 Indoor Space Compliant re [Rule Status | Documenting Statement(s), If applicable ee a [Rue i 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 a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-12 Safe Environment [Compliant TG i Department of ~ Children & Youth ae [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 oe a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Clean environment and | Compliant equipment | Rule Status | Documenting Statement(s), If applicable ee “™ ee | Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Handwashing Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-13 Toothbrushing Compliant ee | Rule sd Status | Documenting Statements), If applicable 5180:2-13-14 Requirements for Field Compliant and Routine Trips [Rule 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 eee a [Rule Status | Documenting Statement(s), If applicable ee a sa i Department of ~ Children & Youth ae PRule Status | Documenting Statement(s), If applicable a P 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 sd Status | Documenting Statement(s), If applicable 5180:2-13-16 Medical, Dental, and Compliant General Emergency Plan [Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Drills Compliant ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-16 Communicable Diseases | Compliant re [Rule Status | Documenting Statement(s), If applicable — a [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan [Rule Status | Documenting Statement(s), If applicable ee a P Rule Status | Documenting Statement(s), If applicable 5180:2-13-17 Materials and Compliant Equipment PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae a | Rule Cd Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable oe a [Rule i 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 [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-20 Sleep and Nap Compliant Requirements [Rule Status | Documenting Statement(s), If applicable 5180:2-13-19 Child Guidance Compliant re [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 ee a [Rule Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth (a a [Rule Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable a [Rue i Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rue i Status | Documenting Statement(s), If applicable “™ ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 On-site Pools Compliant re pRue Status | Documenting Statement(s), If applicable 5180:2-13-24 Swimming Sites Compliant ee [Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-25 Medication Compliant Requirements

During the inspection, it was determined that the program 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 A 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) 5 below: 1. One roll of first-aid tape; 2. Individually wrapped sterile gauze; 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 the program's corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 04/19/2026