The Village Clubhouse

During the inspection, cleaning and sanitizing equipment and supplies were not used or stored properly as noted in number(s) 14 below: 1. Cosmetics were accessible to children in the [ ] area. 2. Disinfecting wipes were accessible to children in the [ ] area. sa i Department of ~ Children & Youth ae 3. Fish food was accessible to children in the [ ] area. 4. Hand lotion was accessible to children in the [ ] area. 5. Hand sanitizer (for children under 24 months) was accessible to children in the [ ] area. 6. Laundry detergent was accessible to children in the [ ] area. 7. Powder dish washing soap was accessible to children in the [ ] area. 8. Paint cans were accessible to children in the [ ] area. 9. White out was accessible to children in the [ ] area. 10. Potting Soil was accessible to children in the [ ] area. 11. Other potentially hazardous substance [ ] was accessible to children in the [ ] area. 12. Cleaning/sanitizing supplies had not been clearly labeled. 13. School-age children were using cleaning supplies, agents and/or equipment without adult supervision. 14. A spray aerosol was used in the diapering area while children were in attendance. 15. Other: [ ]. Provide staff training. Submit the program’s corrective action plan, which includes a statement that the potentially hazardous substance is no longer accessible to children and a statement that training was provided, to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 05/24/2026

During the inspection, it was determined that an walking infant child were left unattended and not supervised, in that CCSM went up stairs for restroom and child was not within sight and hearing. Submit the program’s corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 05/24/2026

During the inspection, it was determined the handwashing requirements were not being followed by the provider, or a child in that the child hands were not washed after diapering. Submit the program’s corrective action plan to verify compliance with the requirements of this rule. Corrective Action Plan Due: 05/24/2026

During the inspection, it was determined that unsanitary conditions, as noted in the following number(s) 1,3 below, were in the upstairs restroom: 1. There was no liquid soap. 2. There was no toilet tissue. 3. There were no individually assigned towels or disposable towels. 4. The toilet cleaning brush was accessible to the children. 5. The plunger was accessible to the children. 6. The toilet was not flushed. 7. The trash was not emptied from the day before. 8. There was a strong urine odor. 9. Other [ ]. The restroom(s) must be kept sanitary at all times. Submit the program's corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 05/24/2026

In review of the children’s records, it was determined the program did not meet the requirements for caring for at least one child, indicated on the Children Records Review, with a condition that requires a JFS 01236 "Child Medical/Physical Care Plan" as noted in number(s) 1 below: sa i Department of hj Children & Youth 1. No plan was on file. (Page 1) 2. Child’s name was missing. 3. Name of the condition was missing. 4. Indication if medication or medical food is required was missing. 5. Signs, symptoms or situations that require staff to take action were missing. 6. Activities, foods, environmental conditions to avoid were missing. 7. Training instructions for procedures for staff to follow were missing or incomplete. (Page 2) 8. Child's name was missing or not attached. 9. Child's date of birth was missing or not attached. 10. Child's weight was missing or not attached. 11. Name of the medication/medical food was missing or not attached. 12. Dosage of medication/medical food to be administered was missing or not attached. 13. Time for medication/medical food to be administered was missing or not attached. 14. Expiration date for medication/medical food was missing or not attached. 15. Symptoms that require staff to administer medication/medical food were missing or not attached. 16. Specific instructions to administer the medication/medical food were missing or not attached. 17. Actions to be taken if the symptoms do not subside were missing or not attached. 18. Physician's signature was missing or not attached. 19. The date of the physician's signature was missing or not attached. (Page 3) 20. Child's name was missing. 21. Instructions regarding emergency evacuation, if applicable, were missing. 22. Signature of parent granting permission to implement the plan and verifying training was missing. 23. Date of parent signature was missing. 24. Certified Professional Trainer information was missing. 25. Signature of certified professional who trained the program staff was missing, if parent was not the trainer. 26. Date of trainer signature was missing. 27. Printed name(s)of child care staff member(s) who have received instructions for care and/or have been trained to perform the procedure were missing. 28. Signature(s) of child care staff member(s) who have received instructions for care and/or have been trained to perform the procedure were missing. 29. Date of staff signature was missing. 30. Administrator/Provider signature was missing 31. Date of administrator/Provider was missing. (Page 4) 32. Child's name was missing. 33. Name of medication or medical food was missing. 34. Date the medication/medical food was administered was missing. 35. Time medication/medical food was administered was missing. 36. Dosage of medication/medical food that was administered was missing. 37. Signature of person administering medication/medical food was missing. 38. The plan was not followed or implemented. 39. The plan was not able to be implemented due to conflicting information. 40. None of the child care staff members trained in the procedures on the JFS 01236 were onsite when a child requiring the plan was present. 41. Child care staff members trained in the procedures on the JFS 01236 were not scheduled to be present the entire the time the child requiring the plan was onsite. sa i Department of ~ Children & Youth ae 42. None of the child care staff members trained in the procedures on the JFS 01236 accompanied the child requiring the plan during a trip. 43. A child care staff member who had not been trained in the procedures on the JFS 01236 performed the procedure. 44. Medication listed in the procedures to follow was not onsite available to administer as instructed and alternate instructions for this situation were not included on the plan. Provide staff training. Submit the program’s corrective action plan, which includes a copy of the completed JFS 01236, to the Department to verify compliance with the requirements of this rule. Corrective Action Plan Due: 05/24/2026 Low Risk Non-Compliances

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) 15 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 TG i Department of ~ Children & Youth ae 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: 05/24/2026 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 5180:2-13-02 License Visible Compliant re [Rule Status | Documenting Statement(s), If applicable ee i [Rule Status | Documenting Statement(s), If applicable ——, a [Rule Status | Documenting Statements), If applicable — a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-03 Inspection Compliant Requirements P Rule Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae 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 [Rule 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 Statement(s), 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 | Rule Status | Documenting Statement(s), If applicable ——— a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Child Care Staff Compliant Requirements P Rule Status | Documenting Statement(s), If applicable 5180:2-13-08 Whistle Blower [Compliant TG i Department of ~ Children & Youth ae [Rule sd Status | Documenting Statement(s), If applicable ee a [Rule Status | Documenting Statement(s), If applicable 5180:2-13-10 Professional Compliant Development [Rule Status | Documenting Statement(s), If applicable a a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-11 Outdoor Space Compliant re | Rule Status | Documenting Statement(s), If applicable 5180:2-13-11 Outdoor Equipment Compliant re [Rule i Status | Documenting Statement(s), If applicable a _ ee | Rule i Status | Documenting Statements), If applicable ee a [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 _— a [Rule Status | Documenting Statement(s), If applicable —oe a sa i Department of ~ Children & Youth ae P Rule Status | Documenting Statement(s), If applicable oo a [Rule Status | Documenting Statement(s), 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 Cd 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 ee [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 Child Records Retention | Compliant and Confidentiality [Rule i Status | Documenting Statement(s), If applicable 5180:2-13-16 Medical, Dental, and Compliant General Emergency Plan [Rule Status | Documenting Statement(s), If applicable ee a PRule Status | Documenting Statement(s), If applicable a a PRule i Status | Documenting Statement(s), If applicable TG i Department of ~ Children & Youth ae ee a | Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-16 Emergency Compliant Preparedness and Response Plan [Rule 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 5180:2-13-18 Group Size and Ratios Compliant re [Rule Cd Status | Documenting Statement(s), If applicable 5180:2-13-18 Attendance Compliant re [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 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 TG i Department of ~ Children & Youth ae a [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 Statements), If applicable a ™ ee | Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Daily Care Compliant re [Rule Status | Documenting Statement(s), If applicable 5180:2-13-23 Infant Bottle and Food Compliant Preparation [Rule Status | Documenting Statement(s), If applicable oo = ee [Rule Status | Documenting Statement(s), If applicable —ee a [Rule Status | Documenting Statements), If applicable —~ a | Rule Status | Documenting Statement(s), If applicable 5180:2-13-24 Parent Permission for Compliant Swimming P Rule Status | Documenting Statement(s), If applicable 5180:2-13-25 Medication Compliant Requirements TG i Department of ~ Children & Youth

During this inspection it was determined that television were on during meals and snacks. Correct the violation and submit the program's corrective action plan to verify compliance with the requirement of the rule. Corrective Action Plan Due: 05/24/2026