Loading...
HomeMy WebLinkAboutDaycare Inspection 239 Graham Road Page 1 of 1 McGann, Sherry From: Our Savior[ospcc@hotmail.com] Sent: Thursday, December 27, 2012 12:62 PM To: McGann, Sherry Subject:follow up to inspection Hi Sherry, I just wanted to let you know that we repainted the boys heating vent, relabeled all bleach and soap bottles, and put a lock on the cabinet in Naomi's room. Have a Happy New Year! Tressa Giordano Director Our Savior Preschool &Child Care 12/27/2012 Page 1 of 1 McGann, Sherry From: Mauldin, David Sent: Wednesday, July 24, 2013 11:23 AM To: McGann, Sherry Subject: FW: Our Savior Preschool Proposal Attachments: toddler room division sketch.pdf From: Our Savior [mailto:ospcc@hotmail.com] Sent: Wednesday,July 24, 2013 10:51 AM To: Mauldin, David Subject: Our Savior Preschool Proposal Hi Dave, I left you a message a few minutes ago. We have been working with the State Licencing Department to divide our large toddler room into two smaller toddler rooms. They have approved the attached sketch. We are hoping that you can take a quick look at the sketch before we begin to make these modifications. We'd like to begin this project as soon as possible so we can have you as well as the town health inspector come in for approval. After your visits our State Inspector will be coming in; she is scheduled to come in on August 22nd. Our opening for this room will be Monday August 26th. Please call me if you have any questions. My cell number is the best number to reach me on. 860-205-8585 Thanks Tressa Giordano Our Savior Preschool & Child Care 7/24/2013 NVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 Date f II pection INSTRUCTIONS Li . Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of E piration Licensed Capacity_ Under 3 Endorsement�� #Children Present #Staff Present—(�— GIAC- Saw,= Q Sc LWN 1 a 68° Pxo ram Name License# Telephone# Address Operator +r Licensed for: /Under 3 Yrs Pre-School 3-5 Years)) School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a 1 License premises clean/ o re lid'1�/ Refrigeration no more than 45' - u„A- 3t� Equipment clean,in ood re a safe/non-toxic Food prep area clean/good repair 3 ree from observable hazards Food safely stored MCAM, ( Food prep hand washing Adequate dishwashing Qe 4 W er Supply in compliance with all PHC requirements Kitchen separated V1'7� MR as appropriate: 4a Customer of a ater Comp��}}n L`1 Snacks served ❑ Cold breakfast Water Comp y Name: C r ❑ Meals served ❑ Meals transported Lead Wat est Date: 1 Other Within Limits LJ E71ceeds Limits -or- UV Bui in Pre 1978 Construction ❑ 4b On-Site Well g� (Lead Inspection Required) No Lead-Based Paint Identified Classification of Well—Cheek One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health De artment) Children,daily at least 60 days per year. (if not,then private well) [] Intact Lead-Based Paint Identified P ❑ Private Well—Serves less than 25 adults&children (Management Plan on file with Local Health Department) Review of Water Ouality Test Results ❑ Building: Post 1978 Construction I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits ors„ ii.Bacteriological Analysis Test Date: ❑ Within Limits [I Exceeds Limits [�iii.Chemical Analysis Test Date: roval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Wovh�S M—Ott �f' Well meets construction and separation distance requirements of CT Public Health Code Sections a-i--«`l— 19-13-B51a-m.❑ Yes ❑ No � r}WSr ❑ 4c Other(Please specify) 09 §�KRequired toilets/sinks/supplies * 7h+�ss►' �r .A-k `T Iva Adequate ventilation in toilet ropm C it►-V s rOUy~_ VV r 7 Sewage disposal adequate pwb�L Outdoor Space 19a-79-7a 0 t �C,GlA( � ,{�s�,,,`�,� °^ ❑ 8 Swimming pool complies with PHC 19-13-B33b ❑ 9 Playground free from observable hazards ❑ 10 Drinking water available,adequate,safe LA Up Ok(;L lRA k tom'� 0VN 1S1rJk.v-c?��c/ tl Sig (Inspector) Date Corrections Due Sign erson in ha e) S:/Division/Li cq&re/Group&C r Environmental Inspection Report 10/08/08 (website) vyj�y„_, VAC-6 'r C( e" ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 1;1, 1 D y Date df In 1 ection INSTRUCTIONS p Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of Ex iration Licensed Capacity �Iq Under 3 Endorsement IS #Children Present 'V), #Staff Present_ O Xc- Cr,.�,koe 1`A60SGk M (may 58 rrogram ame License# Telephone# Address Operator Licensed for: Under 3 Yrs Pre-School(3-5 Years) I�School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a 1 License premises clean/good repair � Refrigeration no more than 45° Tt pp 3$ 7 0 Equipment clean,in good repair,safe/non-toxic Food prep area clean/good repair �v6 3 Free from observable hazards Food safely stored Piz prep hand washing ILS Adequate dishwashing `gyp 4 Water Supply in compliance with all PHC requirements h6 Kitchen separated 17 M knacks served as appropriate: JR/4, Customer of a Water Com n S l ❑ Cold breakfast Water Co any Name: Meals served El Meals transported W Lead r Test Date: Other -,�,,,, � hd Within Limits E ceeds Limits -or- Buii ing: Pre 1978 Construction(Lead Inspection Re uired ❑ 4b On-Site Well No Lead-Based Paint Identified- ebkA- '=O-) Classification of Well-Check One: E3 Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Denartmentl Children,daily at least 60 days per year. (If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Management Plan on file with Local Health Denartment) Review of Water Quality Test Results ❑ Building: Post 1978 Construction I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits « 5„ ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits ill.Chemical Analysis Test Date: JXAp)proval provai recommended. No code violations identified. Within Limits ElExceeds Limits recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. b Well meets construction and separation distance requirements of CT Public Health Code Sections t�W Sdniti � V3* 14-13-B51a-m. Yes ❑ No [I y�r b �" -Ok 3 y� O� El 4c Other(Please specify) —V ,.rt Cn.X r�d3 1a1�1 VRequired toilets/sinks/supplies ,6Adequate ventilation in toilet room •.� ,�}, }}�01,9.0 S�lr�►L—Ler 11ob 7 Sewage disposal adequate v — U &no 4 Outdoor Space 19a-79-7a . _ srk wX.�� �V ❑ Swimming pool complies with PHC 19-13-B33b ,r s�\\ Qoj-b — b !ra V 9 Playground free from observable hazards o 10 Drinking water available,adequate,safe '-O�crr+�7� Sig (Inspecto Date Corrections Due Sufned(P son in Charge) S:/Division/Lice e/Group&Center nvironmental Inspection Reffift 10/08/08 (website) 8605658965 pweh 04:38:35 p;m. 07-23-2013 1/1 i t — " {t _ .. •p T P. F t , 3 C, : : 'V 31 S i t _L_ i t .-.. i i i 3. : s 1.� • , t i F .. u _UA 1 � 2 r i t i tjL C ; i . 1 it t � Zc S F# _ ___ 11f fd f � �rro - Post for 30 Department of Public Health-Child Care Licensing Program Operating 410 Capitol Ave,MS#12 DAC Days PO Box 340308 �+ V Hartford,CT 06134-0308 J/Cp 800-282-6063/(fax)860-509-7541 �O� CHILD CARE CENTER/GROUP INSPECTION FORM SOUrM 3 ❑ INITIAL INSPECTION p"INSPECTION ❑ FOLLOW UP LY DSO Program Nam //� License Nu r Date of ze of U, Sovior frQ JL40") t V���L L(:(PL 7 Inspection: I Arrival: Addr�*3_ q Expiration Date: Licensed G-rah6tl)l RC)Od �-30 � � Capacity: Town: � � j elepho / Under Three So u� W ti �:S�� n : -fJ<L s Endorsement: / )L)(,60Vv f, j ,wan r j "oLt Prts c, Licensed For: Instructions: Number of Children Number of U3 Number of Staff !�cschool der Three(6wks-36m) =Compliance Present: a Present: I0 Present:$'t- (3y-5y) O =Non-Compliance 3 =Not Observed Houxs q Operation: Suum�m��m,,,,ee�r Care School Age(5y&up) 4 =Not Applicable @ this time (-e "No ❑ Night Care(6wks&up) Li nsure Procedures 19a-79-2a Health d Safety 19a-79-6a 1.Local Health Inspection Date: )�-l�'l 0.Nutritious Snacks/Meals(Required Food Groups) Administration 19a-79-3a �1.Proper Refrigeration 451 ®' New Staff/Employee.Orientation �12.Kitchen Separated C3�' 3.Annual Staff Training ❑ 43.Hand Washing Before Eating/Food Handling 4.Documentation of Beh M.Tech Discussed w/Parentso [Jl' 44.First Aid Kit(s):Indoor/Outdoor/Field Trip Ud,,e5.Notification of Change PlivAcal Plant 19a-79-7a U1 6.Policies:Discipline/Supervision/Child Protection/General License Premise Clean/Good Repair/Safe / Operating Policies/Personnel Policies/Closing Time Policy fY �46.Peeling Paint Observed:Yample Taken:l Gd 7.Daily Attendance Records:Children/Staff tJ ta- Lead Management Plan Reviewed:Y/N Ite Posted:Conspicuous/Accessible CYO 48'Sanitary Drinking Fountains/Dis osable Cups /8.License C1" 49.Lead Water Test Date: " - C(/9.Current Fire Marshal Certificate Date: Lj-.q-j,3Within Acceptable Limits 10.DPH Complaint Procedure ��"; On Bottled Water Y(1) Li �- 11.Food Service Certificate Date: .Walkways Maintained ! r 12.Menus Designated Staff Toilet/Sink r .Emergency Plans :P14. 2.All Openings for Ventilation Screened Q'/14.No Smoking Signs 3.Windows Protected to Prevent Falls 0 15.Radon Test Dated jq j Results: e I Glass Protected to 36" Staffing 19a-79-4a -5155.Overhead Doors:Locking Devices/Spring Protectors ❑ 16. Staff Health Records zo� Exits/Hallways and Stairs Unobstructed ❑ 17. Professional Development "7.Individual Storage of Clothing/Bedding 19.Disciplinary Actions "8.Smoking Prohibited Q' .Designated Head Teacher/60% Gf� Matches/Lighters Inaccessible C�//20.Two Staff Present Y 0.Approved Safety Outlets/Covers (YX21.Ratio: 1 Staff to 10 Children 9� Toileting Needs Met Qo%12.Group Size:Maximum 20 Children 91 6*2.Required Toilets/Sinks/Supplies 4l 3.Designated Director 5/f 3.Potty Chairs:Nonporous/Emptied/Disinfected EY 24.CPR Certified Staff G]/ Hand Washing After Toileting:Staff/Children W 25.First Aid Trained Staff ��6� Ventilation in Toilet Room C gsultants 19a-79-4a. Air Temp 650,Thermometer Affixed 26.Agreements/Contracts(Signed Annually) Water Temperature 60°-1150 �❑ 27.Logs/Visits Documented L� `�-B1 68.Portable Space Heaters Y/N Early Ch.Educ Health Dental ��9.Walls/Ceilings/Floors/Rugs:Clean/Good Repair Social Servi Dietitian, �0.Rugs Secured Swimming 19a-79-4a W 71.Hot Water/Steam Pipes Protected 28.Non-Swimmers Identified �/7� Working Phone on Each Level 3 29.Staff/Child Ratios V4: m Eergency Numbers Posted 30.CPR Certified Staff(20 years of age) Adequate Lighting:50/30 Candle Feet 31.Lifeguard Certified/Supervision .Light Fixtures Shielded/Shatter Proof Record Keening 19a-79-5a i5�77. Potentially Hazardous Substances Locked W' 2.Enrollment Information Garbage/Rubbish Disposed Daily I� .Emergency Medical Permission � 8.Stairs Protected/Good Repair/Handrails i�.Authorized Released Permission I� .Pets:Maintained/Care Plan Ie�6. .Field Trip Permission [�0.Operable CO Detector on Each Level �' Transportation Permission 1i�1.Program Space/Adequate Sq.Ft.Per Child GY .Child Health Records/Immunizations/TB 0��82.Equipment Clean/Good Repair/Safe/Non-toxic 0'�.Individual Care Plan(Signed by Parent/Staff) p 3.Cots Stored/Maintained/Adequate Number LY 39.Injury/Illness/Accident Reports 84.Developmentally Appr.Equipment/Materials Signature of Inspector Written Corrective Action Plan Signature of Perso ' Char e r�J Due to PH by: Post for 30 Page 2 of 2 Operating Days " CHILD CARE CENTER/GROUP INSPECTION FORM Program Name: License Number: Date of Inspection: 00.( Sovl,ol, i(96<l l -M" 85.Hot Tubs/Spas/Saunas:Locked/Inaccessible 125.Children's Linens/Clothing/Bedding Stored 5/86.No Weapons/No Facsimile of a Firearm on Premises Individually On door Space t 126.Cribs/Cots Washed/Disinfected p� 7.Outdoor Space Adequate Sq.Ft.Per Child 127.Under 12 Months Placed on Back for Sleeping 88. Impact Absorbing Material under Equipment _5 4�-128.Alternate Sleep Position/Equipment 89.Playground Free from Hazards / Medical Documentation Y/N . 90.Peeling Paint Observed:Y&Sample Taken:10 Gd' Crib/Bed Used for Infant Sleeping �-B- 91.Lead Management Plan Reviewed:Y/N �4,1. 0.Crib/Bed Free from Observable Hazards D//92.Equipment Anchored/Safely Arranged Infant Toys Separate/Washed/Disinfected Daily Q' 93.Outdoor Play Area Protected/Fenced .No Toys/Objects Less than 1%"Diameter 94.Drinking Water Available/Accessible MK;; 33.Plastic Bags/Balloons/Styrofoam Objects Inaccessible 2f A4.Health Consultant/Documentation of Visits Educational Re uirements 19a-79-8a U-' Y35.Infants Held for Bottles/Indio.Attn/Tummy Time 95.Written Plan for Daily Program Available to Uol 136.Written Statement/Feeding Schedule from Parent / Parents/Staff GV/137.Unused Portions of Liquids Discarded fd' 96.Activity Choices Include• ✓ p_�/138.Clean Bottles/Disp.Bottles/Approved Bottle Washing Indoor/Outdoor Fine/Gross Motor t�1r 139.Food Served from Dish or Whole Jar Served Language Sensory !�140.Bottles Individually Identified w/Child's Name Art/Media �/ Dramatic Play ,/ On Play Space-Under Three Music / Self Concept _�/' ®' 141.Play Space Fenced Health Education Active/Quiet 142.Outdoor Equipment Available/ Child/Staff Initiated-� Exploration _� Developmentally Appropriate' Varied Choices ✓ Indiv/Small Group Snacks/Meals Toileting/Clean Up School Age Children Endorsement 19a-79-11 [� 43.Approved Endorsement Ad 'nistration of Medications 19a-79-9a C2 144.Activity Choices Include: Written Policies/Procedures Free Time _Creative `Homework 98.Training Outline/Med Training Snacks / Physical Special Events_ Nonprescription Topical Medications Small Group Quiet ZSelf Concept O/99. Administration/Parent Permission/MAR Ule 145.Ratio:I Staff to 10 Children E_/ 100. Labeling/Storage 146.Group Size:Max.20 Children L 101. Written Approval 147.Education Consultant Appropriate Olr Topical/Inhalant/Injectable Medications LO/ 102. Authorized Prescriber/Parent Permission/MAR Night Care Endorsement 19a-79-12(101)m-Sam) 03. Labeling/Storage 148.Approved Endorsement [a 104. Unused/Expired Meds Returned/Disposed YIN rL 1 149.Written Plan:Program Activities/Supervision Self Administration Y 150.All Staff Awake/Available g105. Authorized Prescriber/Parent Permission/MAR 151.Individual Cot/Crib/Bedding/Toiletries/ 106. Labeling/Storage Sleeping Apparel 'l' 107.Appvd Petition For Special Medication Authorization L 1 152.Sleeping Apparel/Toiletries Individually Emergency Distribution of Potassium Iodide Labeled/Stored 108. Parent Permission/Storage 153.Bedding/Sleeping Apparel Laundered Weekly Under Three Endorsement 19a-79-10 Monitoring of Diabetes 19a-79-13 E�109.Approved Endorsement 154.Written Policies/Procedures 10.Ratio: 1 Staff to 4 Children 11 155.On Site Staff Trained in First Aid/Glucose Testing Group Size no Larger than$ 11 156.Training Current/Documented LXY 112.Physical Barriers/Groups of 8(Indoors/Outdoors) 157.Supervision of Self Administration /13.Adequate Sinks in Program Space 158.Equipment/Supplies:Labeled/Inaccessible � 114.Free Standing Cribs 159.Signed Agreement w/Parent Regarding Equipment 11115.Washable Cots P 160.Materials to be Discarded:Locked/ 16.Chairs for Feeding/Stable/Safety Straps/Locking Tray Given to Parent / 17.Dev.Appropriate Tables/Chairs/Equipment 161.Authorized Prescriber/Parent Permission L4 118.Refrigerators and Food Prep Facilities 162.Documentation of Test Results/ Di ering Area Action Taken 19.Sturdy/Safety Rail/Nonporous/Exclusive Use ❑ 163.Daily Written Parent Notification ,f20.Washed/Disinfected q/ 1.Disposable Paper Sheets r 2.Covered Waste Receptacle LV 3.Diaper Changing Policy Posted/Followed 52/ 124.Hand Washing Policy Posted/Followed Xrespector Written Corrective Action Plan -Signature of Person in Charge ''� Due to DPH by: INSPECTION ❑ REINSPECTION ❑ COMPLAINT ❑ INVESTIGATION ❑ OTHER SUPPLEMENTAL REPORT OF INSPEC�T`ION NAME OFPROGRAM/PROVIDER Jj/' Soyol— TIME: LOCATION ADDRESS: C>( q C-r-,ra/,a/n d C,/tl l f7 C4�Cl TELEPHONE#:©lt - 6 L1 r6i Y56�- LICENSE NUMBERJ d6 e-�l EXPIRATION DATE: 3U CAPACITY:/O#of CHILDREN PRESENT L / #of STAFF PRESENT: PURPOSE OF VISIT: Consent to Inspect 1 agree to allow the Commissioner's representative to have access to and inspect thisffacility and all Family Day Cure Home child care records as required by Family Day Care Home egulations. Provider/Applicant/Substitute's Signature OBSERVATIONS/CORRECTION NEEDED: f/\S freG, S bo kX�1'h�oa�1 $ t},r•fct/is hr 4A-,/"vsr , rfw t- f.'� r r1%ts.fyucrro-, .l/►C C� e,`, *6 y - t,iiS Cra ccu ci 7ore�llhGJt (Cou',A�,d 7, b0N ,f-©dd&f- r6w n has Sh► IS un daf 3 3 PVg4ya y07-p,?)ecH- Ti l cons uPt,�- Jais - LJA0f calf Gar /-O,'2 S=Substantiated NS=Not Substantiated P=Pending (If applicable) DATE CORRECTIONS DUE: SIGNED: SIGNED: (Inspect 'IDPH) SIGNED: (Person in Charge) s:/Division/Licensure/Family&Center/Field Forms/Report of Inspection 04/06/10 Post for 30 Department of Public Health-Child Care licensing Program Page I of 2 opc.#.g 410 Capitol Ave,MS#12 DAC I- - Days PO Box 340308 �; Hartford,CT 06134-0308VIP l E 800-282-6063/(fax)860-509-7541 CHILD CARE CENTERIGROUP INSPECTION FORM ❑ INITIAL INSPECTION p' INSPECTION ❑ FOLLOW UP ❑ OTHER Program Name: License Number: Date of q1►i� Time of L�, (lf �,� � r Inspection.[_F Arrival Address: Expiration Date: Licensed �yukam L Capacity: to wn: Tel hone. Under Three t �B Endorsement: per or: Licensed For: Instructions: Number of Children Number of U3 Number of Staff 5rUnder Three(6wks-36m) Compliance Present: Present:C Present: } O =Non-Compliance Preschool(3y-5y) 3 =Not Observed Hours of Operation: Su er Care Od School Age(5y&up) 4 =Not Applicable _) (o es o ❑ Night Care(6wks&up) Adipinistration 19a-79-2a Health and SOW.19a-79-6a 1.Local Health Inspection Date: 1A;10 11 V 40.Nutritious Snacks/Meals(Required Food Groups) Adrainistration 19a-79 3a V 4.1.Proper Refrigeration 45° 2.New Staff/Employee Orientation I e 42.Kitchen Separated 3.Annual Staff Training43.Hand Washing Before Eating/Food Handling 4.Documentation o€Beh M.Tech Discussed w/Parents YIN 44.First Aid Kit(s):Indoor/Outdoor/Fieid Trip [�5.Notification of Change Ph rsical Plant 19a-79-7a �6.Policies:Discipline/Supervision/Child Protection/General Or 45.License Premise Clean/Good Repair/Safe Operating Policies/Personnel Policies/Closing Time Policy V46.Peeling Paint Observed:Y(E Sample Taken:Y/6) O 7.Daily Attendance Records:Children/Staff 47.Lead Management Plan Reviewed:Y/N Items Posted:Conspicuous/Accessible 48.Sanitary Drinking Fountains/Dis os ble Cups 8.License Ci7// 49.Lead Water Test Date: ❑ 9.Current Fire Marshal Certificate Date: 1 I Within Acceptable Li is li{ 10.DPH Complaint Procedure Oa' On Bottled Water Y/10 11.Food Service Certificate Date: 50.Walkways Maintained 12.Menus Designated Staff Toilet/Sink 13.Emergency Plans W'52.All Openings for Ventilation Screened C�®14.No Smoking Signs 3.Windows Protected to Prevent Falls 15.Radon Test Date: L_Results- Id 54.Glass Protected to 36" Staffing 19a-794a 55.Overhead Doors:Locking Devices/Spring Protectors Ur 16. Staff Health Records t 56.Exits/Hallways and Stairs Unobstructed V 17. Professional Development U'*"57.Individual Storage of Clothing/Bedding ,3?r I&Disciplinary Actions Q'�&Smoking Prohibited ir 19.Designated Head Teacher/60% Qf 59.Matches/Lighters Inaccessible V20.Two Staff Present 0.Approved Safety Outlets/Covers VK�21.Ratio: I Staff to 10 Children /�I.Toileting Needs Met 22.Group Size:Maximum 20 Children 5r 62.Required Toilets/Sinks/Supplies 23.Designated Director 63.Potty Chairs:Nonporous/Emptied/Disinfected 4.CPR Certified Staff 4.Hand Washing After Toileting:Staff/Children GY Z5.First Aid Trained Staff Q 65.Ventilation in Toilet Room Consultants 19a-79-4a tip 6.Air Temp 65°,Thermometer Affixed26.Agreements/Contracts(Signed Annually) : 67.Water Temperature 60°-115° D 27.Logs/Visits Documented �68.Portable Space Heaters YJ0 Early Ch.Edugtlon�Health Dental J ❑ 69.Walls/Ceilings/Floors/Rugs:Clean/Good Repair Social Service_ Dietitian V 70.Rugs Secured `Swimming 19a-79-4a tI�71.Hot Water/Steam Pipes Protected 28:Non-Swimmers Identified SK 72.Working Phone on Each Level 29.Staff/Child Ratios �73.Emergency Numbers Posted 30.CPR Certified Staff(20 years of age) 1,74.Adequate Lighting:50/30 Candle Feet 31.Lifeguard Certified/Supervision �75.Light Fixtures Shielded/Shatter Proof Record Keeping 19a-79-5a 76.Potentially Hazardous Substances Locked 32.Enrollment Information 77.Garbage/Rubbish Disposed Daily V 3.Emergency Medical Permission 78.Stairs Protected/Good Repair/Handrails 5Y 34.Authorized Released Permission 79.Pets:Maintained/Care Plan t.t 0 35.Field Trip Permission i r�80.Operable CO Detector on Each Level 4)6 36.Transportation Permission 8I.Program Space/Adequate Sq.Ft.Per Child 4W""37.Child Health Records/Immunizations/TB 82.Equipment"Clean/Good Repair/Safe/Non-toxic 138.Individual Care Plan(Signed by Parent/Staff) VV,,,83.Cots Stored/Maintained/Adequate Number 9.Injury/Illness/Accident Reports t 84.Developmentally A r.E ui ment/Materials Signature of Inspe o Written Corrective Action Plan Signature of Person in Charge Due to DP by: Post for 30 Page 2 of 2 Operating Days ' CHILD CARE CENTER/GROUP INSPECTION FORM Program Name: License Number: Date of Inspection: J85.Hot Tubs/Spas/Saunas:Locked/Inaccessible 125.Children's Linens/Clothing/Bedding Stored 86.No Weapons/No Facsimile of a Firearm on Premises Individually On door Space e 126.Cribs/Cots Washed/Disinfected fiil�,87:Outdoor Space Adequate Sq.Ft.Per Child le 127.Under 12 Months Placed on Back for Sleeping I 88 Impact Absorbing Material under Equipment 128.Alternate Sleep Position/ guipment E71 89.Playground Free from Hazar. s Medical Documentation AN 90.Peeling Paint Observed:Y44Aample Taken:Y/ T) 0"'e129.Crib/Bed Used for Infant Sleeping j� 91.Lead Management Plan Reviewed:Y/N l� 130.Crib/Bed Free from Observable Hazards !1� 92.Equipment Anchored/Safely Arranged id`� 131.Infant Toys Separate/Washed/Disinfected Daily 93.Outdoor Play Area Protected/Fenced 132.No Toys/Objects Less than 1%11 Diameter 94.Drinking Water Available/Accessible 133.Plastic Bags/Balloons/Styrofoam Objects Inaccessible 134.Health Consultant/Documentation of Visits Educational Requirements 19a-79-8a -/135.Infants Held for Bottles/Indiv.Attu/Tummy Time Ir 95.Written Plan for Daily Program Available to 1T 136.Written Statement/Feeding Schedule from Parent Parents/Staff 2"' 137.Unused Portions of Liquids Discarded 96.Activity Choices Include: V 138.Clean Bottles/Disp.Bottles/Approved Bottle Washing Indoor/Outdoor Fine/Gross Motor i" 139.Food Served from Dish or Whole Jar Served Language Sensory �� jr� 140.Bottles Individually Identified w/Child's Name Art/Media Dramatic Play O oor Play Space-Under Three Music Self Concept _� 1/ 141.Play Space Fenced Health Education Active/Quiet 142.Outdoor Equipment Available/ Child/Staff Initiated vf Exploration i.� Developmentally Appropriate Varied Choices Indiv/Small Group Snacks/Meals Toileting/Ciean Up School A e Children Endorsement 19a-79-11 143.Approved Endorsement Administration of Medications 19a-79-9a 144.Activity Choices Include: 97.Written Policies/Procedures Free Time V✓Creative_VHomework 98.Training Outline/Med Training Snacks Physical ✓Special Events Nonprescription Topical Medications Small Group Quiet . Self Concept y7 99. Administration/Parent Permission/MAR N4 145.Ratio: i Staff to 10 Children IL] 100. Labeling/Storage ®'�146.Group Size:Max.20 Children i "101. Written Approval IB° 147.Education Consultant Appropriate Qral/Topical/Inhalant/Injectable Medications 102. Authorized Prescriber/Parent Permission/MAR Night Care Endorsement 19a-79-12(10pm-5am) l 103. Labeling/Storage 148.Approved Endorsement li/104. Unused/Expired Meds Returned/Disposed Y/N 149.Written Plan:Program Activities/Supervision Self Administration 150,All Staff Awake/Available 105. Authorized Prescriber/Parent Permission/MAR 151.Individual Cot/Crib/Bedding/Toiletries/ 106. Labeling/Storage I Sleeping Apparel 107.Appvd Petition For Special Medication Authorization 152.Sleeping Apparel/Toiletries Individually mergency Distribution of Potassium Iodide Labeled/Stored 108. Parent Permission/Storage 153.Bedding/Sleeping Apparel Laundered Weekly Under Three Endorsement 19a-79-10 Monitoring of Diabetes 19a-79-13 0�,109.Approved Endorsement 154.Written Policies/Procedures 110.Ratio: 1 Staff to 4 Children 155.On Site Staff Trained in First Aid/Glucose Testing 111.Group Size no Larger than 8 156.Training Current/Documented 112.Physical Barriers/Groups of 8(Indoors/Outdoors) 157.Supervision of Self Administration W el 113.Adequate Sinks in Program Space ii 158.Equipment/Supplies:Labeled/Inaccessible 00"'114.Free Standing Cribs l-� 159.Signed Agreement w/Parent Regarding Equipment 6"115.Washable Cots 160.Materials to be Discarded:Locked/ e 116.Chairs for Feeding/Stable/Safety Straps/Locking Tray Given to Parent Le 117.Dev.Appropriate Tables/Chairs/Equipment 161.Authorized Prescriber/Parent Permission V118.Refrigerators and Food Prep Facilities 162.Documentation of Test Results/ pering Area Action Taken ❑ 119.Sturdy/Safety Rail on. orous/Exclusive Us 163.Daily Written Parent Notification Ue'120.Washed/Disinfected We 121.Disposable Paper Sheets U,"122.Covered Waste Receptacle V 123.Diaper Changing Policy Posted/FolIowed V124.Hand Was)iing Policy Posted/Followed Signature of Ins ect Written Corrective Action Plan Signature of Person in Charge �� Due to DPH by- 6 b INSPECTION ❑ REINSPECTION ❑ COMPLAINT ❑ INVESTIGATION ❑ OTHER SUPPLEMENTAL REPORT OF INSPECTION NAME OF PROGRAM/PROVIDER(�(J1 iD"1.a�Cho&W(a0j tR_ DATE: TIME: ;_ LOCATION ADDRESS: &. jl�u � ri1�G'i" D(eagLl- l LI a'a. TELEPHONE#: 04J--&qE LICENSE NUMBER: Iln2­0 EXPIRATION DATE: CAPACITY:( _,._1)03)of CHILDREN PRESENT: ' 9U3 of STAFF PRESENT: l Qr PURPOSE OF VISIT: i> QyCjOv�. Consent to Inspect I agree to allow the Commissioner's representative to have access to and inspect this facility and all Faynily Day Care Horne child care records as required by Family Day Care Home Regulations. Provider/Applicant/Substitute's Signature OBSERVATIONS/CORRECTION NEEDED: -'I(�+� � �Fjt� � Qd�tL�1ti.'� �- iC."�• Q�Q �c�(',��dN�� ,`It �.S � ,3S? a t►�l;�.vvd�.ca.C�_C�sr,�C► �.�C�.c. ,.ti�,� � �-Pecks�1 ,��a.��� ����( � v "o �Qr v,pc*� WM bcac d �e�sv��C �'�' �a'n f �l ,t Y � � 4 S=Substantiated NS=Not Substantiated P=Pending (If applicable) DATE CORRECTIONS DUE: SIGNED: ( Z nsp to DPH) SIGNED: tRk r �. r (Person in Charge) s:/Division/Licensure/Family&Center/Field Forms/Report of Inspection 04/06/1 Q %N A C C p 9o9yc' IMMOEIVIXO— t �z U - Environmental Laboratories, Inc. z 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 FOR: Our Savior Preschool&Childcare 239 Graham Road Analysis Report South Windsor CT 06074 February 09,2011 Sample Information Custody Information Date Time Matrix: DRINKING WATER Collected by: 01/31/11 6:40 Location Code: SPECIAL Received by: SW 01/31/11 13:32 Laboratory Data Client ID: OUR SAVIOR PRESHCOOL&CHILDCARE KITCHEN SINK Phoenix I.D.• AZ99234 Maximum Maximum Analysis Contaminant Advisory Detection Measurement Parameter Result Level Level Limit Units Lead <0.001 0.015 0.001 mg/L Explanation' BDL=Below Detection Level (less than the the value in the detection level column,which is the lowest amount the laboratory can detect and report.) NL=No Limit(no limits established for this parameter.) This sample represents a potable(drinkable)water supply for the parameters tested. If there are any questions regarding this data,please call Phoenix Client Services at extension 200. AOL Phylli hiller,Laboratory Director February 09,2011 Page 1 of 1 ENVIRONMENTAL INSPECTION REPORT IX INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT 'd , ,e Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 D ea Inspection INSTRUCTIONS . a f act el Check=Compliance; Circle=Non-Compliance; 3=Not Observed, 4=Not Applicable Date of Expiration Licensed Capacityj544.. Under 3 Endorsement ✓ #Children Present #Staff Present1� Program Name icens # Telephone# Address Operator Licensed for: ® Under 3 Yrs 0 Pre-School(3-5 Years) `R School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a E: License premises clean/good repair �f Refrigeration no more than 45° VEquipment clean,in good repair,safe/non-toxic Q,12 Food prep area cleantgood repair Free from observable hazards E;-f3 Food safely stored Q14 Food prep hand washing G't5 Adequate dishwashing W 4 Water Supply in compliance with all PHC requirements ( 6 Kitchen separated E?T7. Mark as appropriate: jR 4a Customer ors Water Company ®,Snacks served ❑ Cold breakfast ❑ Meals served Meals transported Water Company Name: C bNN, w�}Te/1`p� ❑ Other Lead Water Test Date: II��=1/ �( Within Limits ❑ ExceedsLimifs -or- Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well A No Lead-Based Paint Identified Classification of Well—Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year. (If not,then private well) _ ❑ Intact Lead-Based Paint Identified ❑ Private Well—Serves less than 25 adults&children (Management Plan on file with Local Health Department) Review of Water Ouality Test Results ❑ Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS" iL Bacteriological Analysis Test Date: ❑ Within Limits El Exceeds Limits iii.Chemical Analysis Test Date: Approval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits ❑ Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of Cr Public Health Code Sections _ 19-13-B51a-m.❑ Yes ❑ No ❑ 4e Other(Please specify) 9Required toilets/sinkstsupplies Adequate ventilation in toilet room Sewage disposal adequate Outdoor Space 19a-79-7a L�9 Playground free from observable hazards C?14 Drinking water available,adequate,We Signed(I ect ) Date Corrections Due Sided(Pers 'n Charge) S:/Division/L.icensure/Gmup& enter vir ntal Inspection Report 10/08/08 (website) 09/12/2011 MON 14:58 FAX 210 349 2464 ERCC OFFICE U001 *** FAX TX REPORT *** ********************* TRANSMISSION OK JOB NO. 2796 DESTINATION ADDRESS 98605097540 PSWD/SUBADDRESS DESTINATION ID ST. TIME 09/12 14:57 USAGE T 00' 25 PGS. 1 RESULT OK NVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT trd.Sor Department of Public Health-Child Care Licensing Program To 410 Capitol Ave,,MS912 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 Q� Dat Ins tiou LNSTRU�TIONS Check=Compliance; Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Da o Expirati on Licensed Capacity-_ Under 3 Endorsett $ #Children Present #Staff Present Ov e scr v%0r 'p Sri\ CWNc#rc. 12t6� 4Lb iA44 Program N ge�r,a. License# ,- , Telephone# `mil' Address Operator Licensed for: M Under 3 Yrs Pre-School(3-5 Years) ®School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a �� Health and Safety 19a-79-6a V License premises clean/good repair ��1 Refrigeration no more than 45° yNo Equipment clean,in good repair,safe/non-toxic (�'12 Food prep area ciean/good repair Free fromAbservablehazards 13 Food safely stored Food prep hand washing.� � r Adequate dishwashing 5114 Water Supply in compliance with all PHC requirements F17 Kitchen separated Mark as appropriate: 014, Customer of ayVater Company ❑ Snacks served ❑ old breakfast WateV;,1TtND=! ny : ❑ Meals served WMeals transported Lead r ❑ Otherin Limits ❑ Excee s imix fs -or' Bu' tag: Pre 1978 Construction(Lead Inspection Required) ❑ 46 On Site Well No Lead-Based Paint Identified'-Ge.s'�c d,..Ce .= a sification of Well—Check Owe_ ❑ Lead Hazards Identified and Eliminated Public Weil- supplies 25 or more adults and (plan of Correction on file with Local Health Department) (If not,then private welll)) Children,dailyly at at least days per year. ❑ Intact Lead-Based Paint Identified ❑ Private Well—Serves less than 25 adults&children (Management Plan on file with Local Health Department) ReviM of Wafer Quality Test Results ❑ Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits C] Exceeds Limits „ 5„ ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits i/A royal recommended. No code violations identified. iii.Chemical Analysis Test Date- 0 Within Limits ❑ Exceeds Limits ❑ Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections n 19-13-B5la-m.❑ Yes ❑ No r Or,,.x \2.0 \V,,�S ` ❑ 4c Other(Please specify) � 5y�,- _ s c �� � ` •-� 5 Required toilets/sinhs/supplies M !. AA.n...�.o.wu1 K 1 —31-- \w t . _ - wrest%)r�t� r►«..eatto Czt)ei+ NVIRONMENTAL INSPECTION REPORT all3l u INSPECTION D FOLLOW-UP INSPECTION ❑ COMPLAINT SwAOV, W:,JAp r Department of Public Health-Child Care Licensing Program To 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 Dat f Ins ection INSTRUCTIONS '1 Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Did o Expird on — U_xA& -ko k:j, Licensed Capacity—( q— Under 3 Endorsett $ #Children Present #Staff Present ©�.y_ &114Lor Qc�c.sc� _1 C��1�tc 11M Sj t) Lyy—(*ys8 Program N me License# Telephone# swvsm `A3 ra.%Qr �1'c CriO� ��ti to Address Operator Licensed for: ['Under 3 Yrs LE1 Pre-School(3-5 Years) 0 School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a g Xr License premises clean/good repair Refrigeration no more than 450Equipment clean,in good repair,safe/non-toxic 12 Food prep area clean/good repair3 Free from observable hazards Food safely stored Food prep hand washing�J183 Adequate dishwashingM � ti-0-ti-0-- 5/4 Water Supply in compliance with all PHC requirements j�+ Kitchen separated i2 17 Mark as appropriate: 4a Custo/ofater Company ❑ Snacks served ❑ old breakfast Wate Name: �r"C `A{ ❑ Meals served (Meals transported Lead Date: _ r2 , ❑ Other Limits ❑ Exce�s•Limits -or- Bu' m Pre 1978 Construction g� (Lead Inspection Required) ❑ 4b On-Site Well Rr No Lead-Based Paint IdentifiedT4)t_A j".-;=-7 Classification of Well—Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and Children,daily at least 60 days per year. (Plan of Correction on file with Local Health Department) (If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well—Serves less than 25 adults&children (Management Plan on file with Local Health Department) Review of Water Ouality Test Results ❑ Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS" ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits iii.Chemical Analysis Test Date Approval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits ❑ Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections n ` `O 19-13-B ❑ ❑51a-m. Yes No r "CU rt_1* )04— ❑ 4e Other(Please specify) 56ko_,V s' 5 Required toilets/sinks/supplies 10�Z=�t L.,V -Ab Ink- 6 Adequate ventilation in toilet room 11_\U . ��� �� � 7 Sewage disposal adequate VTR tie... 4 utdoor Space 19a-79-7a Q 8 Swimming pool complies with PHC 19-13-B33b 1 rG�•C gg� v►.�r. [�J 9 Playground free from observable hazards �] 10 Drinking water available,adequate,safe -t Sig (Inspector) Date Corrections Due Si ed(Personin Charge) S:/Division ice e/Group&Center/Environmental Inspection Report 0/ 8/08 (websne) SQy1N Sf4 . C� o • r 7.119wn ale soudt V&-mialat c 1540 SULLIVAN AVENUE * SOUTH WINDSOR, CT 06074 r�OSOR•CO TELEPHONE (860) 644-2511 Office of the Fire Marshal Fire Marshal.• Walter Summers Deputy Fire Marshal.• David Mauldin 860-644-2511 x 217 860-644-2511 x 150 September 9,2011 Ms. Tressa Giordono Our Savior Pre-School 239 Graham Road South Windsor, CT 06074 Tressa: After a review of your proposed relocation of the infant nursery,it has been determined that the room meets the requirements of the Connecticut Fire Safety Code with the existence of the NFPA 72 compliant fire alarm system,without the need to modify the existing windows. The code requires that the current windows in the nursery be operational at all times. This room is approved for use as a nursery. If you have any additional questions,please contact the fire marshal's office. Respectfully: David S. Mauldin _ 1 Deputy Fire Marshal Town of South Windsor ENVIRONMENTAL INSPECTION REPORT ' INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT S. ( w rr sa Department of Public Health-Child Care Licensing Program Town — 1 410 Capitol Ave., MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 97—/5c Date of Inspection INSTRUCTIONS ® ya r::�- Check=Compliance; Circle=Non-Compliance; 3=Not Observed; 4=NotApplicahle Date of Expiration Licensed Capacity— Under 3 Endorsement_ #Children Present o #Staff Present f Program Name License# t=P2 �{• i"Yi C t4j �,y& C Telephone# Address � � Oep for r _� � Licensed forfor: Under 3 Yrs Pre-School 3-5 Years School Age�. � � ) � g ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a 1 License premises clean/good repair 11 Refrigeration no more than 45' 2 Equipment clean,in good repair,safe/non-toxic food prep area clean/good repair a 3 Free from observable hazards hood safely stored 14 hood prep hand washing 15 Adequate dishwashing 4 'rater Supply in compliance with all PHC requirements 16 Mtchen separated, 17. Mark as appropriate: N 4a Customer of a Water Company Snacks served ❑ Cold breakfast Water Company Name: �'��[./• �.Q � Meals served )Z Meals transported Lead Water Test Date: —� .��e_ El Other Within Limits ❑ Exceeds Limits -or- NZBuilding: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Sitc Well CR No Lead-Based Paint Identified Classification of Weil—Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (I! Children,daily at least 60 days per year. lar:of Correction on Erie with Local Health Department) (If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well—Serves less than 25 adults&children (Managehient Plan on file with Local Health Department) Review of Water Quality Test Results ❑ Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Excccds Limits "REMARKS" R.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits iii.Chemical Analysis Test Date: Approval recommended. No code violations identified. ❑ Within Limits El Exceeds Limits Approval recommended with conditions(see below). ❑ Approval not recommended di;: to existing serious code inspection of Weli violations. Well meets construction and separation distance requirements of CT Public Health Code Sections 19-13-B51a-m.❑ Yes ❑ No ❑ 4c Other(Please specify) i 5 Required toilets/sinks/supplies 6 Adequate ventilation in toilet room 7 Sewage disposal adequate Outdoor Space 19a-79-7a ❑ fi Rwimmin .. t 1 _ ,y_ ,, 9 Playground free from observable hazards 10 Drinking water available,adequate,safe S'rgnecl sp.!�c, r) Date Corrections Due Sig d(Pars in ;e S:I?ivis WLice sure/Group Center/Env onmental Inspection Report 10/08/08 (website) Post for 30 Department of Public Health-Child Care Licensing Program Page 1 of 2 Operating 410 Capitol Ave,MS#12 DAC Days PO Box 340308 Hartford,CT 06134-0308 800-282-6063/(fax)860-509-7541 CHILD CARE CENTER/GROUP INSPECTION FORM ❑ INITIAL INSPECTION A INSPECTION ❑ FOLLOW UP ❑ OTHER Program Name: License Number: Date of (�,.a Time of ICU / Inspection: �d Arrival: Ad ress: Expiration Date: Licensed J V�hcx � . 1 • j13 Capacity: f T wn: f, ` � � Te ephone• Under Three �-�✓In(AZor r ( rrj Endorsement: Operator: �� Licensed For: Instructions- Number of Children Number of U3 Number of Staff Under Three(6wks-36m) ✓ =Compliance Present:U Present: J1 Present: I 'Q Preschool(3y-5y) O =Non-Compliance 3 =Not Observed Hours of Operation: Summer Care School Age(5y&up) 4 =Not Applicable es o ❑ Night Care(6wks&up) Administration 19a-79-2a Health and Safety 19a-79-6a 1.Local Health Inspe N ction Date:a N11 40.Nutritious Snacks/Meals(Required Food Groups) \Administration 19a-79-3a 41.Proper Refrigeration 450 �j 2.New Staff/Employee Orientation 42.Kitchen Separated 3.Annual Staff Training 43.Hand Washing Before Eating/Food Handling 4.Documentation of Beh M.Tech Discussed w/Parents Y/N ❑ 44.First Aid Kit(s):Indoor/Outdoor/Field Trip 'mod! 5.Notification of Change Physical Plant 19a-79-7a 6.Policies:Disc)ijine/Super ion/Child Prl*ctio /General `- 45.License Premise Clean/Good Repair/Safe Opera�g Policies/Personnel Nicies/Closing Ttihe Policy ''i�i9 46.Peeling Paint Observed:Y 1 ,Sample Taken:Y/N 1� 7.Daily Attendance Records:Children/Staff 4 LT- 47.Lead Management Plan Reviewed:Y/N Items Posted:Conspicuous/Accessible `�1 48.Sanitary Drinking Fountains/Disposable Cups \� 8.License 49.Lead Water Test Dated ' Q mill 9.Current Fire Marshal Certificate Date I 3`Tj Within Acceptable Limits 10.DPH Complaint Procedure On Bottled Water 011.Food Service Certificate Date: ` 50.Walkways Maintained 12.Menus `�t 51.Designated Staff Toilet/Sink 13.Emergency Plans - 52.All Openings for Ventilation Screened 14.No Smoking Signs T9 53.Windows Protected to Prevent Falls 15.Radon Test Date:41 ,qq Results: I .i '**Q 54.Glass Protected to 36" Staffing 19a-79-4a -�- ❑ 55.Overhead Doors:Locking Devices/Spring Protectors l6. Staff Health Records '� 56.Exits/Hallways and Stairs Unobstructed 17. Professional Development 57.Individual Storage of Clothing/Bedding `� 18 Disciplinary Actions 58.Smoking Prohibited 19.Designated Head Teacher/60% �L�i 59.Matches/Lighters Inaccessible 9 20.Two Staff Presenter 60.Approved Safety Outlets/Covers 21.Ratio:I Staff to 10 Children 61'Toileting Needs Met 22.Group Size:Maximum 20 Children 62.Required Toilets/Sinks/Supplies 23.Designated Director 63.Potty Chairs:Non porous/Emptied/Disinfected 24.CPR Certified Staff 64.Hand Washing After Toileting:Staff/Children `6p 25.First Aid Trained Staff 65.Ventilation in Toilet Room Consultants 19a-79-4a 66.Air Temp 65°,Thermometer Affixed �i 26.Agreements/Contracts(Signed Annually) 67.Water Temperature 60°41 ° 27.Logs/Visits Documented \ 68.Portable Space Heaters Y N Early Ch.Education Hea)th_V Dental 69.Walls/Ceilings/Floors/Rugs:Clean/Good Repair Social Service_ Dietitian_ �j 70.Rugs Secured wimming 19a-79-4a 71.Hot Water/Steam Pipes Protected ❑ 28.Non-Swimmers Identified `� 72.Working Phone on Each Level El 29.Staff/Child Ratios 6� 73.Emergency Numbers Posted ❑ 30.CPR Certified Staff(20 years of age) ,gyp 74.Adequate Lighting:50/30 Candle Feet ❑ 31.Lifeguard Certified/Supervision �j 75.Light Fixtures Shielded/Shatter Proof `�ecord Keening 19a-79-5a 76.Potentially Hazardous Substances Locked 32.Enrollment Information '`4 77.Garbage/Rubbish Disposed Daily "S� 33.Emergency Medical Permission 0-78.Stairs Protected/Good RepairMandrails �f' 34.Authorized Released Permission 79.Pets:Maintained/Care Plan 35.Field Trip Permission 80.Operable CO Detector on Each Level 36.Transportation Permission '*V 81.Program Space/Adequate Sq.Ft.Per Child 37.Child Health Records/Immunizations/TB N'�Q1 82.Equipment Clean/Good Repair/Safe/Non-toxic `6d 38.Individual Care Plan(Signed by Parent/Staff) N�f 83.Cots Stored/Maintained/Adequate Number 39.Injury/Illness/Accident Reports "N� 84.Developmentally Appr.E ui ment/Materials Signature of Inspector Written Corrective Action Plan Signature of Person in Charge Due to DPH by: I 4 Post for 30 Page 2 of 2 Operating Days CHILD CARE CENTER/GROUP INSPECTION FORM Program Name: License Number: Date of Inspection: r �Y �' (06 - 10 85.Hot Tubs/Spas/Saunas: Locked/Inaccessible V 125. hildren's Linens/ClothingBedding Stored "**4 86.No Weapons/No Facsimile of a Firearm on Premises ` Individually Outdoor Space \�•1' 126.Cribs/Cots Washed/Disinfected �i 87.Outdoor Space Adequate Sq.Ft.Per Child 127.Under 12 Months Placed on Back for Sleeping 88. Impact Absorbing Material under Equipment 128.Alternate Sleep Position( uipment 89.Playground Free from Hazards \ Medical Documentatio Y t 90.Peeling Paint Observed:YI&Sampie Taken:Y/N 129.Crib/Bed Used for Infant Sleeping ♦�^p 91.Lead Management Plan Reviewed:Y/N 130.Crib/Bed Free from Observable Hazards V 92.Equipment Anchored/Safely Arranged 131.Infant Toys Separate/Washed/Disinfected Daily 93.Outdoor Play Area Protected/Fenced 132.No Toys/Objects Less than 1 YA"Diameter 94.Drinking Water AvailabletAccessible �l 133.Plastic Bags/Balloons/Styrofoam Objects Inaccessible ❑ 134.Health ConsultantfDocumentation of Visits Educational Requirements 19a-79-8a 135.Infants Held for Bottles/Indiv.Attn/Tummy Time 95.Written Plan for Daily Program Available to 136.Written Statement/Feeding Schedule from Parent \ Parents/Staff \44 137.Unused Portions of Liquids Discarded a 96.Activity Choices Include: 138.Clean Bottles/Disp.Bottles/Approved Bottle Washing Indoor/Outdoor �_ Fine/Gross Motor 139.Food Served from Dish or Whole Jar Served Language _N Sensory ❑ 140.Bottles Individually Identified w/Child's Name Art/Media Dramatic Play � utdoor Play Space-Under Three Music Self Concept �9 141.Play Space Fenced Health Education Active/Quiet 142.Outdoor Equipment Available/ Child/Staff Initiated Exploration Developmentally Appropriate Varied Choices Indiv/Small Group Snacks/Meals Toileting/Clean Up� School A e Children Endorsement 19a-79-11 143.Approved Endorsement Administration of Medications 19a-79-9a �I 144.Activity Choices Include. � 97.Written Policies/Procedures Free Time Creative Homework _ 98.Training Outline/Med Training Snacks Physic 1_Special Events_ Nonprescription Topical Medications Small Group Quiet Self Concept 99. Administration/Parent Permission 145.Ratio: 1 Staff to 10 Children i 100. Labeling/Storage 146.Group Size:Max.20 Children ❑� 101. Trained Person Present/Written Approval 147.Education Consultant Appropriate al/Topical/Inhalant/Injectable Medications 102. Authorized Prescriber/Parent Permission/MAR -Night Care Endorsement 19a-79-12 10 m-5am ❑ 103. Labeling/Storage ❑ 148.Approved Endorsement 104. Unused/Expired Meds Returned/Disposed�I ❑ 149.Written Plan: Program Activities/Supervision elf Administration ❑ 150.All Staff Awake/Available ❑ 105. Authorized Prescriber/Parent Permission/MAR ❑ 151.Individual Cot/Crib/Bedding/Toiletries/ ❑ 106. Labeling/Storage i�. Sleeping Apparel ❑ 107.Appvd Petition For Special Medication Authorization �� ❑ 152.Sleeping Apparel/Toiletries Individually Emergency Distribution of Potassium Iodide Labeled/Stored ❑ 108. Parent Permission/Storage ❑ 153.Bedding/Sleeping Apparel Laundered Weekly Under Three Endorsement 19a-79-10 , onitoring of Diabetes 19a-79-13 109.Approved Endorsement ❑ 154.Written Policies/Procedures 110.Ratio: 1 Staff to 4 Children ❑ 155.On Site Staff Trained in First Aid/Glucose Testing �f 111.Group Size no Larger than 8 Cl 156.Training Current/Documented �e9 112.Physical Barriers/Groups of 8(Indoors/Outdoors) ❑ 157.Supervision of Self Administration 113.Adequate Sinks in Program Space ❑ 158.Equipment/Supplies:Labeled/Inaccessible 114.Free Standing Cribs ❑ 159.Signed Agreement w/Parent Regarding Equipment �7 115.Washable Cots ❑ 160.Materials to be Discarded:Locked/ 116.Chairs for Feeding/Stable/Safety Straps/Locking Tray Given to Parent 117.Dev.Appropriate Tables/Chairs/Equipment ❑ 161.Authorized Prescriber/Parent Permission 118.Refrigerators and Food Prep Facilities ❑ 162.Documentation of Test Results/ `Diapering Area Action Taken 73 119.Sturdy/Safety Rail/Nonporous/Exclusive Use ❑ 163.Daily Written Parent Notification N120.Washed/Disinfected 121.Disposable Paper Sheets 122.Covered Waste Receptacle 123.Diaper Changing Policy Posted/Followed 124.Hand Washing Policy Posted/Followed Signature of Inspector Written Corrective Action Plan Signature of Person in Charge Due to DPH by: \(I A 12 t V S I INSPECTION ❑ REINSPECTION ❑ COMPLAINT ❑ INVESTIGATION ❑ OTHER REPORT OF INSPECTION TO GROUP DAY CARE HOME OR CHILD DAY CARE CENTER NAME OF CENTER:ac1ULl�( _ t�y^�I DATE:& � Tom: DIRECTOR: 77fea-;,-�. 0bridzi,no CAPACITY:1,p 1� #PRESENT: �;Z 4� ADDRESS: Ct G fCLhcxrn 12 d STAFF PRESENT: ncLmy L, mph-no( cl— EXPIRATION DATE:�{ • 1 TELEPHONE#: Co Lf q' G Lf`jS LICENSE NUMBER:—) (n 75 A' PURPOSE OF VISIT:i rrZve<:•-1 t c1 r i +C 1 J OBSERVATIONS/CORRECTION NEEDED: , 1 t o n _4tftt; O�D DO q/ 4\1knot noi-)0Ck:e& �tc� Act m r n.c�� IP�I Ic�,-I�ron Cork& 9 �� prior +0 en+ry q .� y� ,..J '�D v'rr, m-��-►r (to - 'b°�#to ham} I2cl�e 1J .2 bens t� a�- t,u®aC( � ,- Puyz�5eS OCCe66%)o P I.b 1 11 1 --), *,'05 Aorck�e Gla6t4, hoc S=Substantiated NS=Not Substantiated P=Pending (If applicable) DATE CORRECTIONS DUE:(04 is a 1 d SIGNED: �(Amoo (Inspector—DPf) r SIGNED: & , (Person in Charge) s:/Division/Licensure/Grp&ctr/Field Forms/Report of Inspection 11/5/03