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Daycare Inspection 1333 Sullivan Avenue
ENVIRONMEiVTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT ' 'y1 Vjkrtuor Department of Public Health-Child Care Licensing Program Tow 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 I'A p 13 Dat of Inspection INSTRUCTIONS i Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Da•e of Expiration Licensed Capacity 6 Under 3 Endorsement /6 t #Children Present #Staff Present S QO,J�W/ r,Aur wu47-CDnkr ' 13315' Program Na33 me License# Telephone# z,,,jk Address Operator Licensed for: M Under 3 Yrs re-School(3-5 Years) Vchool Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a License premises clean/good repair /1W Refrigeration no more than 45' "T I o yo c E ui ment clean in ood re air safe/non-toxic q P g P Food prep area clean/good repair � Ltij 3 Free from observable hazards Food safely stored31 ood prep hand washing b �T Adequate dishwashing L(Vr" Kitchen separated ° 4 Water pply in compliance with all PHC requirements N �y 17 M as appropriate: 4a Customer of a Water Company Snacks served ❑ Cold breakfast Water Company Name: C 'T �,.301 Ik e-r ��,� El Meals served ❑ Meals transported Lead Wat est Date: ��1I&- pd'Other �O Within Limits Exceeds Limits -or- ❑ Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ 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 De artment Children,daily at least 60 days per year.(If not,then private well) El Intact Lead-Based Paint Identified ❑ Private Well—Serves less than 25 adults&children ana ement Plan on file with Local Health De artment 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 Ap iii.Chemical Analysis Test Date: A 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. Well meets construction and separation distance requirements of CT Public Health Code Sections �1 S�hk Wa �'►° 19-13-B51a-m.❑ Yes ❑ No ❑ 4c Other(Please specify) y Required toilets/sinks/supplies A Ak CP A Adequate ventilation in toilet room 7 Sewage disposal adequate V',%W L' Outdoor Space 19a-79-7a ❑ 8 Swimming pool complies with PHC 19-13-B33b !04- /0211 ❑ 9 Playground free from observable hazards ❑ 10 Drinking water available,adequate,safe ^► l� � T Sign e Spector) Date Clorrections Due S' ed(Person in Ch rge) A / S:/Division/Licensur oup&Center/Environmental hispection Report 10/08/08 (website) ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT SO Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 is J 1 L Dat of fnspection INSTR UCTIONS 3131 11Y Check=Compliance; Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date o Expiration Licensed Capacity f_� Under 3 Endorsements_ #Children Present #Staff Present_ Program Name License# Telephone# 1333 t�'�.e � Ve -1�0 � to1 ^a U2- 7 %c-V Address Operator Licensed for: Under 3 Yrs Pre-School(3-5 Years) P<Chool Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a alr� License premises clean/good repair Refrigeration no more than 45' R Ll2u Equipment clean,in good repair,safe/non-toxic Food Food prep area clean/good repair v [� v 3 Free from observable hazards �Set�Cawwt� � Food safely stored "'�' — 31 Food prep hand washing 326 ( Adequate dishwashing 3 CI 16 Kitchen separated Li — '3U6 �4;4a a er Supply in compliance with all PHC requirements �T<'Y-? ❑ 17 ,M�as appropriate: N Q2v Customer of a Water Company W snacks served ❑ Cold breakfast Water Company Name: Ca ❑ Meals served ❑ Meals transported Lead Water Test Date: Z Other`(k>, .4s L'OA4 Lv� [/Within Limits Ex ecds Limits -or- El Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ 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 Quality Test Results Sd/Building: Post 1978 Construction I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS" iL Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits iii.Chemical Analysis Test Date: ,4proval 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 19-13-B51a-m.❑ Yes ❑ No t�vk -4;� p�Oy`�515 ne�cclb S¢1t wiV ❑ 4c Other(Please specify) r }P✓ �. Si"t4 �•�+$ lOvv LA Required toilets/sinks/supplies N --� I C Adequate ventilation in toilet room 7 Sewage disposal adequate 9waJL Outdoor Space 19a-79-7a Swimming pool complies with PHC 19-13-B33b wPlayground free from observable hazards Drinking water available,adequate,safe Signed pector) Date C rrections=61 S' ned(Person in C arge) C S:/Division/Licensur oup&Center/E a nmental Inspection Report 0/08/08 (website) CONNECTICUT STATE DEPARTMENT OF PUBLIC HEALTH CHILD DAY CARE LICENSIN INff Notification of Proposed Changes in Child Day Care Centers and Group Day Care Homes 9, 0 'v ALERT: Any Change that requires a new application must be submitted to the department 60 da the anticipated date of opening. 1. Name of Program Facility Address: Street&City/Town License # Phone# SCE Cc��nG�Sp�" 1 J5,3 c54lfivn �}c l� tJ Clt irk /C(v?merit G r��t6, c��, sG�,�i CR,0�F4-�(7a 2. Mailing Address: �If different or changed) ,�} SZ�� Completed by:_(_CzQiV r .2,( Title (FLo�{ ,� Date: I, � t Please Check Applicable Sections Regarding CHANGES ❑ PHYSICAL PLANT CHANGES: (Description) ❑ WATER SUPPLY CHANGES: (Enclose attachment 1 Ob) ❑ PROGRAM CHANGES REQUESTED: (Notify DPH at least 30 days Pdor to requested change) a. Current Licensed Capacity: 0-�a Proposed Licensed Capacity: b. Current Under 3 Capacity 8- . Proposed Under 3 Capacity L( C. Current Ages Served: ee-,rn, Proposed Ages Served: i j30,2 = d. Current Months,Days&Hours of Operation: n:—��'G 7-6o;o?) (e.g., Sept.-Dec.,MWF—9:00 a.m.-12:00 p.m.) Proposed Months,Days &Hours of Operation j,�L r n e. CURRENT LICENSE CATEGORIES: PROPOSED LICENSE CATEGORIES: 1. Children 3-5 1. Children 3—5 2. Under 3 2. Under 3 ©� 3. School Age 3. School Age ❑� 4. Night Care ❑ 4. Night Care ❑ ❑ CHANGES IN PLANS,POLICIES&PROCEDURES (Notify DPH within 5 days of change) Policies,Plans&Procedures must be kept on site at your program for department review)—Do Not Submit a Copy Indicate which policy,plan or procedure changed: ❑ Changes in Service Contracts or Current Agreements with Consultants Practitioners&Agencies (Notify DPH within 10 days of change)Service Contracts/Agreements must be kept on site at your program for department review) ❑Health ❑Dental ❑Social Service ❑Education ❑Dietician ❑ NEW DIRECTOR: Name: Date of Hire: Work Schedule(Days/Hours): ❑ NEW HEAD TEACHER: Name: Date of Hire: Work Schedule(Days/Hours): ❑ Other: RETURN THIS FORM TO: Department of Public Health,410 Capitol Avenue—MS#12 DAC P.O.Box 340308,Hartford,CT 06134-0308 T:\Grp&Ctr\Relicensure\G C_NotPropChgs 5/29/13 i I I I STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH SUPPLEMENTARY INFORMATION OF INFANT/TODDLER DAY CARE PROGRAM IN DAY CARE CENTERS AND GROUP DAY CARE HOMES PUBLIC HEALTH CODE SECTION 19A-79-10 UNDER THREE ENDORSEMENT "The operator of a program caring for children under three (3) years of age shall comply with sections 19a-79-la through 19a-79-8a and section 19a-79-10 of the Regulations of Connecticut State Agencies. Complete original application, answering all items as they apply to your Child Care Center/Group Day Care Home: Please submit: original application to your Day Care Licensing Specialist Please submit: one complete copy to your Local Health Department Please keep: one complete copy on file at the licensed premise S1. Name of Center/Home: SoLb�h I j_D(M'��- r (7h ,() PU, � r� Location Address: FS5 Sall(k)z: kw , (Number&Street/Road) _ Town/City/State: JSyr ST Zip Code: 66::,07�( Telephone on Premises: S-&0 S2. LICENSED CAPACITY AND ENROLLMENT: Requested licensed capacity for children under three years of age: S3. GROUPING OF INFANTS/TODDLERS: Sketch indoor program space and specify the following: (Attachment#S3) /a. Dimensions+total square footage(in FEET of each room/program area. .b. Relationship of this space to any other program space. C. How groups of eight are divided with physical barriers. d. Where sinks and changing tables are located. S4. NURSE CONSULTATION: Attach a copy of the following: (Attachment#S4) S4 Name,resume and copy of current registered nurse's license. S5. HEALTH AND HYGIENE: You are required to develop and post on site the following written policies and procedures. Do not submit these policies and procedures to the department. S5a. Diapering and toileting, including a description of the diapering procedure, the disposal of soiled diapers,hand washing procedures and sanitizing procedures. S5b. If cloth diapers are used, you are required to develop a plan describing the procedures used to handle soiled non-disposable diapers and clothing. This plan should be kept on site and not submitted to the department. The licensing authority (Department of Public Health) must be notified of any change in plan of operation involving facility, staff, children served at any one time from that indicated on this application. Additional approval is required for continued licensure if there are any changes in the conditions on which any earlier licensure is granted. The official license to operate a child day care center/home must be posted on the premises of the center/home in a conspicuous manner. The facts as stated in completion of this application are true t tom- C�h gnature perator or Legal Representative(as indicated on the Affidavit) 0-i-yatrw-!Spn ��Cv600 Printed Name of Operator or Legal Representative '7U/U cg, C2613 Date T:\Grp&Ctr\Application\G C InitialAppSup.doc 07/15/10 r t l t gB F South Windsor Child Development Center Proposed Toddler Classroom Total Children: 8 Total Square'Feet: 988" window W 26 ft n d 0 Toilets I Changing table sinks C Kitchen area O o 12' L 0 o Door to hall- 6 s way 1 Exit O 0 t I 38 feet 63 South Windsor Child Development Center Evacuation Routes Side Playscape 4 s 3's 2's Preschool Hallway Fi, gl M 0 0 Staff Room w Parking Lot Kitchen ° b7 C Primary irector's OfficeI F Route Seeonda Route Main Entrance . 1nt-1 ; 4--( - Mary Jean Quistorff, R.N. 145 Stockade Road, South Glastonbury, Connecticut 06073 Phone: 860 573-5735 email address: maryjean3@att.net 8/2009-Present CHILD CARE HEALTH CONSULTANT—Observation and review of program practices andwritten policies; makes recommendations to ensure health promotion and prevention of infection and injury. 5/2009-512012CHILD CARE HEALTH CONSULTANT TRAINER-A member of the Connecticut Early Child Care Training Team; Head Start content expert. Participated in planning and presentation at annual Child Care Health Consultant training for health professionals interested in early child care health consulation. 8/2002-Present MANCHESTER PRESCHOOL CENTERIMANCHESTER BOARD OF EDUCATION HEAD START PROGRAM AND SPECIAL EDUCATION PRESCHOOL CLASSES Manchester,CT HEAD START HEALTH&NUTRITION MANAGER/SCHOOL NURSE ❑Address physical,developmental, social-emotional,nutritional and oral health needs of more than 200 Head Start and Special Education preschool students, including the assessment,triage and direct care and exclusion of students and staff. ❑ Initial and ongoing assessment of student health and immunization status. ❑ Identification and case management of students with acute,chronic and potentially life threatening health conditions to include development of health care and action plans. ❑Advocate for students and families with special health care needs. ❑ Promote health and safety of students,families and staff through providing health information,trainings and counseling,on a group and individual basis;competency validation;supervision, parent and staff notices and newsletters;indoor and outdoor safety checks. Knowledgeable in use of ECERS-R, ITERS-R tools. ❑ Participate in weekly management team meetings. ❑ Supervision of health office LPN and overseeing of food service staff. ❑ Collaborate with other disciplines to meet health requirements, provide a positive learning environment for students and successful completion of student and family goals. ❑ Practice cultural sensitivity and cross culture communication. ❑ Develop, review and update policies and procedures with regard to health,safety and nutrition. ❑ Developed, review and update health and safety, developmental health and nutrition plans,which address corresponding federal performance standards and guidelines. ❑ Developed health history questionnaire and health office forms. ❑ Developed and conduct pre—entry system for federally required vision and hearing screenings, growth measurements and nutrition assessments and health history interviews with referrals made as needed. ' ❑ Developed health, nutrition and safety manual used by staff. ❑ Develop monthly breakfast and lunch menus in accordance with CACFP requirements. ❑ Oral Health-developed oral health program through collaboration and partnership with area dentists and clinics and dental hygiene programs, and through State of Connecticut Oral Health Department, Connecticut Dental Association. Participate in Give Kids A Smile Day. Identified and compiled referral lists of health and oral health health providers who accept Husky insurance. ❑ Partner with organizations such as University of Connecticut Nursing program and graduate level dietetics Programs; .Prevent Blindness CT, Manchester Community Health and Dental Clinics; Lincoln College of New England Dental Hygiene Program. ❑ Prepare federal and state reports and participated in four federal reviews with no deficiencies found. E Mary Jean Quistorff, R.N. cont.. 4/2002-5/2005 OPTION CARE Pharmacy Company Huntington,West Virginia NURSE CONSULTANT/HOME TEACHING AND NATIONAL TELEPHONE CALL ❑ Home teaching of Growth Hormone to Yale Pediatric Endocrinology Group patients, ages 3—16 years and their parents.Visit included extensive health history;drug indications;possible side and adverse effects of drug;delivery system;preparation and storage of drug; preparation, selection and rotation of injection sites;subcutaneous administration,self-administration and support of family members for successful outcome. ❑ Telephone teaching sessions and call,nationally,for adult and pediatric patients receiving Growth Hormone. Concerns addressed included drug stability;delivery system failure; possible side or adverse effects.. 8/2001-4/2002 CONNECTICUT CHILDREN'S MEDICAL CENTER Hartford,ConnecticutSTAFF NURSE—PEDIATRIC EMERGENCY DEPARTMENT ❑Responsibilities included assessment,triage;and direct care;conscious sedation;venipuncture; IV therapy; discharge instruction. 1997-2002 LAWRENCE MILLER, ORTHOPEDIC SURGEON/PEER REVIEWS Long Valley, New Jersey NURSE SPECIALIST/PEER REVIEW Home Office-Analyzed health records and test results for pertinent information in response to insurance questions,specific to each case. 1995-1997 Family move to Connecticut—Time off from professional career to acclimate family to move 1992-1995 WINSTON TEMPORARY AGENCY Bergen County, New Jersey SHORT AND LONG TERM NURSING ASSIGNMENTS,WHICH INCLUDED THE FOLLOWING: ❑ Contract Research Organization—Long term assignment—Compassionate Study for experimental AIDS drug, 3TC/Lamivudine. ❑ CIGNA—long term assignment—On site reviews of pediatrician's patient records. ❑ Occupational Health Nurse-Regular substitute for Met Life and Bears Stern ❑ Executive Physicals—Long term assignment. 1986-1992 Home with three young children STAFF NURSING 01978-1980; 1981-1986 St. Barnabas Medical Center, New Jersey Emergency Department;Pediatric Unit;Oncology Unit ❑l980-1981 Morristown Memorial Hospital,Morristown, New Jersey Circulating and scrub nurse—Operating Room EDUCATION COUNTY COLLEGE OF MORRIS, DOVER, NEW JERSEY LICESNSURE Associate Applied Science Degree—1978 Registered Nurse-Licensed by The State of Connecticut; License#067307 ' ORGANIZATION -National Center on Health/AAP Advisory Committee Member -Chair, Manchester Head Start Health Services Advisory Committee -School Readiness Health Sub-Group committee Member -Leadership Work Group—Participated in developing the health portion of a comprehensive community plan for children age birth-eight in Manchester. € -Safe Kids Connecticut Coalition Member -DCF/Head Start Collaboration Committee Member 3 years f f: i E f e - Mary Jean Quistorff, R.N. cont.. EXPERTISEITRAINER -Completion of FEMA Independent Study course IS-00100.sca/Introduction to Incident Command System -Child Care Health Consultant Trainer—5/2009;Successfully completed 17 week CCHC Trainer course offered by the National Training Institute at University of North Carolina at Chapel Hill, One week on site and 16 weeks long distance learning. -Child Care Health Consultant-2005;training offered by CNA, Early Childhood Partnership;Department of Public Health, CT Charts-A-Course and Childhood Consultant Partnership;modeled after NTI at UNC at Chapel Hill. -Completion of Adult and Pediatric Asthma Educator Training Offered By American Lung Association of Connecticut -Medication Administration Instructor—Train the Trainerprovided by CT Medication Administration in Early Education.and Child Care Settings Curriculum -Shaken Baby Syndrome Trainer—Train the Trainer provided by Children's Trust Fund—Help Me Grow Program, Department Social Services -Certified Freedom From Smoking Clinic Facilitator—Train the Trainer provided by American Lung Association. -Completion of Tuberculosis/Mantoux Training-Offered By CT Department of Public Health in conjunction with American Lung Association of Connecticut -Completion of National Infant Toddler Child Care Initiative @ Zero To Three Infant Toddler Modules for Early—Care Consultants and CT Guidelines for the Development of Infant and Toddler Early Learning Integrated Training—Provided through a collaboration of the CT Department of Social Services Child Care Team and Head Start State Collaboration Office with partners at CT Charts-A-Course and LEARN. 'JGC <•:r TI a u:.TrtA TtT1 CND o pizc HCA t 1 i 5'• '«',E'` mAxrcti.ry MARY JEAN'Q STORFF'`::RN LiC$NSE NO Jy`.LUhIiC y •, 03 :463151 067 '07 r f K .-ldbtuda 06.10 REGISTERED NURSE } ``V - to Page 1 of 1 McGann, Sherry From: Liz Zwick[swcdc@sbcglobal.net] Sent: Friday, December 21, 2012 11:46 AM To: McGann, Sherry Subject: environmental report Hello Sherry, The ceiling tile in the bathroom area was repositioned so that it sits securely on the ceiling brackets. This was completed on December 10, 2012. Liz Z ,Diranr South Windsor CbiIdDeuYqpnxw Center 12/26/2012 PHOENIX*- , Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: South Windsor Child Development Center 1333 Sullivan Ave. August 21, 2012 South Windsor, CT 06074 Sample Information Custody Information Date Time Matrix: DRINKING WATER Collected by: 08/14/12 7:30 Location Code: SPECIAL Received by: LB 08/14/12 15:48 Rush Request: Standard Analyzed by: see"By" below P.O.#: SDG ID: GBC54832 Laboratory Data Phoenix ID: BC54832 Project ID: SOUTH WINDSOR CHILD DEV. CTR Client ID: CLASSROOM KITCHEN SINK RL/ DW Sec Parameter Result PQL Units MCL Goal Date/Time By Reference Lead <0.001 0.001 mg/L 0.015 08/20/12 IRS E200.9 RUPQL=Reporting/Pratical Quantitation Level ND=Not Detected BRL=Below Reporting Level (less than the reporting level, the lowest amount the laboratory can detect and report.) MCL=Maximum Contaminant Level MCLG=Maximum Contaminant Level Goal Comments: Maximum Contaminant Level (Lower of):40 CFR Part 141; CT Public Health Code 19-13-B102 Secondary DW Maximum Contaminant Level Goal(MCLG): (Lower of):40 CFR Part 143; CT Public Health Code 19-13-B102 If there are any questions regarding this data,please call Phoenix Client Services at extension 200. This report must not be reproduced except in full as defined by the attached chain of custody. AOL Phyllis hiller, Laboratory Director August 21,2012 Pagel of 1 Ver 1 ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT S007*'- L✓N11S'n? Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 /.2— ^J:2,0 Date of Inspection INSTRUCTIONS 3—/ —gad yG Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of Expiration Licensed Capacity-/2.?-- Under 3 Endorsement ,/ #Children Present Co #Staff Present/ sd t' 1331s` Ac-ti z.- Program Name License# Telephone# 'L !�- S'�rsTH hr/i�Arpo? . Cr dn,� �/R�eTWt� ARdress Opera Licensed for: aUnder3Yrs gPre-School(3-5 Years) KSchoolAge ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a 91 License premises clean/good repair ,® 11 Refrigeration no more than 45° 2 Equipment clean,in good repair,safe/non-toxic ❑ 12 Food prep 3 Free from observable hazards 13 Food safely stored 14 Food prep hand washing ® 15 Adequate dishwashing 4 Water Supply in compliance with all PHC requirements .® M Kitchen separated ,9 17- Mark as appropriate: P4 4a Customer of a Water Company CR Snacks served ® Cold breakfast Water Company Name: Cp yNdC)-,- T (�grC� ❑ Meals served CH Meals transported Lead Water Test Date: .Z /e f/p El Other IK Within Limits ❑ Exceeds Limits -or- El Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ 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. ❑ Intact Lead-Based Paint Identified (If not,then private well) ❑ 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 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 CT Public Health Code Sections 19-13-B51a-m.El Yes [I No �'"�r2Ai1r6Ti CJ/cy ❑ 4c Other(Please specify) - / C ($a Required toilets/sinks/supplies �/ to, 6 Adequate ventilation in toilet room ® 7 Sewage disposal adequate Outdoor Space 19a-79-7a jRt 9 Playground free from observable hazards ®' 10 Drinking water available,adequate,safe Signe s e r Date Corrections Due S' ed(Person in Char e S:/Diviiion/Licensure/Group&Cenlerf riviromnlEntal Inspection Report 10/08/08 (website) * Post for 30 Department of Public Health-Child Care Licensing Program nie% 14P1D Operating 410 Capitol Ave,MS#12 DAC Days PO Box 340308 AUG ' Hartford,CT 06134-0308 2 0 2a 1? 800-282-6063/(fax)860-509-7541 CHILD CARE CENTER/GROUP INSPECTION FOR7'vvi SOUTH AW pSOR El INITIAL INSPECTION W INSPECTION ❑ FOLLOW UP Pr gram Name: j 7 License Number- Date of �/�Arrival• r� ID0 +n 0/ Chi) De pl)� r 31 Inspectio . _ .1�. j �Q Address: + Expiration Date: Licensed 1 �U!�;I�G ! j.v� /, - Capacity: a a Taw T hone: Under Three t S 0� WU ' �� Endorsement: Z erator: Licensed For: Instructions: _ � deV Sena-er INC. ,_..,/' Number of Children Number of U3 Number of Staff ar Under Three(6wks-36m) `� =Compliance Present: Present: Present: O =Non-Compliance� P��reschoolE3y-Sy) Hours of O eration: Sum er Care tld--School Age 5 &u 3 =Not Observed mp r � g ( y p) 4 =Not Applicable es o ❑ Night Care(6wks&up) aM' - PAI Administration 19a-79-2a.. ` Health and Safety 19a-79-6a 1.Local Health Inspection Date: !a^? -� j/ 40.Nutritious Snacks/Meals(Required Food Groups) Adwinistration 19a-79-3a 1.Proper Refrigeration 45' New Staff/Employee Orientation W 42.Kitchen Separated Annual Staff Training V44. � Hand Washing Before Eating/Food Handling Documentation o€Beh M.Tech Discussed w/Parents�i First Aid Kit(s):Indoor/Outdoor/Field Trip B Notification of Change Physical Plant 19a-79-7a fs7/6.Policies:Discipline/Supervision/Child Protection/General License Premise Clean/Good Repair/Safe Operating Policies/Personnel Policies/Closing Time Policy t 46.Peeling Paint Observed:Y i, ample Taken: W 7.Daily Attendance Records:Childreu/Staff' t;p Lead Management Plan Reviewed:YIN ell Ite Pasted:Conspicuous/Accessible 48.Sanitary Drinking Fountains/Disposable Cups C3� 8.License 49.Lead Water Test Date: 1�9.Current Fire Marshal Certificate Date: J�j 0�� // Within Acceptable Limits Y/N 5 "1 DPH Complaint Procedure ���f//! On Bottled Water Y/N B-,,H Food Service Certificate Date: Gy Walkways Maintained Q/ 2.Menus tY 1.Designated Staff ToiletlSink ///��� Emergency Plans E� .All Openings for Ventilation Screened No Smoking Signs &"' .Windows Protected to Prevent Falls 15.Radon Test Date: a-lob 1 Results: 1� CsY S4.Glass Protected to 36" Stan 19a-79-4a -CMF'/�S.Overhead Doors:Locking Devices/Spring Protectors 1� Staff Health Records C�#' 56.Exits/Hallways and Stairs Unobstructed t� . Professional Development t�/ 7.Individual Storage of Clothing/Bedding /8.Disciplinary Actions �8.Smoking Prohibited F� /19.Designated Head Teacher/60% t .Matches/Lighters Inaccessible GY 20.Two Staff Present [ .Approved Safety Outlets/Covers CY/,21.Ratio: 1 Staff to 10 Children Q^�1.Toileting Needs Met 4Y 22.Group Size:Maximum 20 Children 6� Required Toilets/Sinks/Supplies Ga'"23.Designated Director 0,, 63.Potty Chairs:Nonporous/Emptied/Disinfected Cal/24.CPR Certified Staff p/ 4.Hand Washing After Toileting:Staff/Children Fd' 25.First Aid Trained Staff U/65.Ventilation in Toilet Room Camultants 19a-79-4a @' fr6.Air Temp 65°,Thermometer Affixed V26.Agreements/Contracts(Signed Annually) p/67.Water Temperature 60°-115° 27.Logs/Visits Documented -U- 68.Portable Space Heaters Y NO Early Ch.Educa}Yon ✓IlealthjZ Dental✓ � 9•Wails/Ceilings/Floors/Rugs:Clean/Good Repair Social Service-' Dietitian 4 Ed" 70.Rugs Secured Swimming 19a-79-4a V, Hot Water/Steam Pipes Protected 28.Non-Swimmers Identified 0�.Working Phone on Each Level 29.Staff/Child Ratios '�W.Emergency Numbers Posted 30.CPR Certified Staff(20 years of age) 74.Adequate Lighting:50/30 Candle Feet 31.Lifeguard Certified/Supervision U,1 5.Light Fixtures Shielded/Shatter Proof Record Kee in 19a-79-5a M,' &Potentially Hazardous Substances Locked Enrollment Information CY 77.Garbage/Rubbish Disposed Daily C:V/33.Emergency Medical Permission GyZy�78.Stairs Protected/Good Repair/Handrails (4.Authorized Released Permission W 79.Pets:Maintained/Care Plan �5.Field Trip Permission �';s � 0'Operable CO Detector on Each Level �V 36.Transportation Permission 1.Program Space/Adequate Sq.Ft.Per Child �C,37.Child Health Records/Immunizations/TB .Equipment'CleanlGood Repair/Safe/Non-toxic 38.Individual Care Plan(Signed by Parent/Staff) Cf ,dCots Stored/Maintained/Adequate Number 39.Injury/Illness/Accident Reports V 84.Develo mentally Appr.Equipment/Materials Signature of Inspector Written Corrective Action Plan Signature of Person in Charge Ca "S'e F-d,3-6� ( ,-v Due to DPH by: 6 UL,� e`ee 41, Post for 30 Page 2 of 2 Operating Days CHILD CARE CENTER/GROUP INSPECTION FORM Program Name: „� ! � License Number: Date of V/�t W1 i1�I SQ/' Chi!J Ve 1/cep,gyp_ f 3 3 /S Inspection: _J Hot Tubs/Spas/Saunas:Locked/Inaccessible t 25.Children's Linens/Clothing/Bedding Stored 15 86.No Weapons/No Facsimile of a Firearm on Premises Individually O oor Space -@- 126.Cribs/Cots Washed/Disinfected Outdoor Space Adequate Sq.Ft.Per Child -8-- 127.Under 12 Months Placed on Back for Sleeping lk 88. Impact Absorbing Material under Equipment 128.Alternate Sleep Position/Equipment Playground Free from Hazar s � Medical Documentation Y/N We 90.Peeling Paint Observed: ample Taken:YNS�, 29.Crib/Bed Used for Infant Sleeping 401.Lead Management Plan Reviewed:Y/N 30.Crib/Bed Free from Observable Hazards 1 692.Equipment Anchored/Safely Arranged Infant Toys Separate/Washed/Disinfected Daily Outdoor Play Area Protected/Fenced �2.No Toys/Objects Less than 1%11 Diameter LY 94.Drinking Water Available/Accessible D"433.Plastic Bags/Balloons/Styrofoam Objects Inaccessible p"' 134.Health Consultant/Documentation of Visits Edu6ational Requirements 19a-79-8a '0';,135.Infants Held for Bottles/Indiv.Attn/Tummy Time Ur 95.Written Plan for Daily Program Available to : �JX Written Statement/Feeding Schedule from Parent � Parents/Staff LsY 137.Unused Portions of Liquids Discarded 6.Activity Choices Include: 2J •U 138.Clean Bottles/Disp.Bottles/Approved Bottle Washing Indoor/Outdoor Fine/Gross Motor_✓ W1.1,139.Food Served from Dish or Whole Jar Served Language _� Sensory _✓ 3-9•- 140.Bottles Individually Identified w/Child's Name Art/Media _ Dramatic Play _✓ Out ✓ oor Play Space-Under Three �Music _ Self Concept •�� 1141.Play Space Fenced Health Education __LZ'Active/Quiet L--'142.Outdoor Equipment Available/ Child/Staff Initiated_�Exploration Developmentally Appropriate Varied Choices _j/' ndiv/Small Group �[. Snacks/Meals oileting/Clean Up_,zt- School Me Children Endorsement 19a-79-11 all 3.Approved Endorsement Administration of Medications 19a-79-9a 144.Activity Choices Include: �7.Written Policies/Procedures Free Time Creative +i'Homework r/ 8.Training Outline/Med Training Snacks ✓Physical ✓S ecial Events_ scription Topical Medications Small Group o 1f�uiet ,/Self Concept 99. Administration/Parent Permission/MAR MO'145.Ratio:1 Staff t0 Children GY A00. Labeling/Storage 4,-146.Group Size:Max.20 Children Lloo 101. Written Approval P,.,11.47.Education Consultant Appropriate Or01/Topical/lnhalant/Injectable Medications pl/A02. Authorized Prescriber/Parent Permission/MAR Ni ht Care Endorsement 19a-79-12 10 m-5am GV 103. Labeling/Storage 148.Approved Endorsement --a -104. Unused/Expired Meds Returned/Disposed Y/N 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 Sleeping Apparel -®- 107.Appvd Petition For Special Medication Authorization 152.Sleeping Apparel/Toiletries Individually Emergency Distribution of Potassium Iodide Labeled/Stored i 1y 108. Parent Permission/Storage ❑ 153.Bedding/Sleeping Apparel Laundered Weekly UnXer Three Endorsement 19a-79-10 Monitoring of Diabetes 19a-79-13 /09.Approved Endorsement 3 154.Written Policies/Procedures 0.Ratio:1 Staff to 4 Children 3 155.On Site Staff Trained in First Aid/Glucose Testing 11.Group Size no Larger than 8 3 156.Training Current/Documented /112.Physical Barriers/Groups of 8(Indoors/Outdoors) 3 157.Supervision of Self Administration C 113.Adequate Sinks in Program Space 3 158.Equipment/Supplies:Labeled/Inaccessible c� -.-114.Free Standing Cribs 159.Signed Agreement w/Parent Regarding Equipment 115.Washable Cots 3 160.Materials to be Discarded:Locked/ q�116.Chairs for Feeding/Stable/Safety Straps/Locking Tray Given to Parent 117.Dev.Appropriate Tables/Chairs/Equipment 3 161.Authorized Prescriber/Parent Permission' l 118.Refrigerators and Food Prep Facilities 162.Documentation of Test Results/ Diaq'ering Area Action Taken Q/ 119.Sturdy/Safety Rail/Nonporous/Exclusive Use ❑ 163.Daily Written Parent Notification ® 120.WashedMisinfected �121.Disposable Paper Sheets 122.Covered Waste Receptacle V123.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: ,t� Lid INSPECTION ❑ REINSPECTION ❑ COMPLAINT ❑ INVESTIGATION ❑ OTHER SUPPLEMENTAL REPORT OF INSPECTION r NAME OF PROGRAM/PROVIDER: 5Vt� W r�i dsa , C&l d- De D CQ,/) LOCATION ADDRESS: � � 5 U P t Van a y- SO L)4- l (A1',17d5 0 TELEPHONE#: $-60 - q LICENSE NUMBER: ) EXPIRATION DATE: ii y CAPACITY:l)I( #of CHILDREN PRESENT�6�#of STAFF PRESENT: PURPOSE OF VISIT: 50 Consent to Inspect I agree to allow the Commissioner's representative to have access to and inspect this facility and all Family Day Care Home child care records as required by Family Day Care Home Regulations. Provider/Applicant/Substitute's Signature OBSERVATIONS/CORRECTION NEEDED: -J4 06- soc, �, + sukilcer exl \ wa I�5 vry.11ue.l Q tJ�- ((U m p Y ao^S J not It-'uC�v �1l'S S=Substantiated NS=Not Substantiated P=Pending (If applicable) DATE CORRECTIONS DUE: SIGNED: �� (Inspector—DPH) SIGNED: (Person in Ch s:/Division/Licensure/Family&Center/Field Forms/Report of Inspection 04/06/10 ge) - Post for 30 " Department of Public Health-Child Care Licensing Program 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 [W INSPECTION ❑ FOLLOW UP ❑ OTHER Program Name: License Number: Date of la.,),l Time of �!5 f Inspection: l Arrival: Address 2Y't Expiration Date: Licensed ! t Capacity: Ta n Telephone: Under Three ;Njum 7 Endorsement- O erator• Cf Y� icensed For: Instructions: h lid Number of Children Number of U3 r of Staff "� Under Three(bwks-36m) `r =Compliance Present: 3tPresent: I : l l ( y y) 3 =Not Observed "�' Preschool 3 -5 3 =Not Observed Hours of Operation: Summer Care School Age(5y&up) 4 =Not Applicable vo. ob (n/No ❑ Night Care(6wks&up) Administration 19a-79-29 Health and Safetv.19a-79-6a �l 1.Local Health Inspection Date:)-Q(0' 10 Nh 40.Nutritious Snacks/Meals(Required Food Groups) Administration 19a-79-3a "U 41.Proper Refrigeration 451 2.New Staff/Employee Orientation 42.Kitchen Separated OOq 3.Annual Staff Training 43.Hand Washing Before Eating/Food Handling 4.Documentation o€Beh M.Tech Discussed w/Parents�tV `p 44.First Aid Kits}:Indoor/Outdoor/Field Trip "Na 5.Notification f Change h steal Plant 19a-79-7a O6.Policies:Disc�ine/Superion/Child tection a eral C3 45.License Premise Clean/Good Repair/Safe Operati4olicies/Persb�nel Policies/ losing Time Polic 46-Peeling Paint Observed:l N�Sample Taken:YIN 7.Daily Attendance Records:Children/Sta �CY" 47.Lead Management Plan Reviewed:Y/N Items Posted:Conspicuous/Accessible 48.Sanitary Drinking Fountains/Disposable Cups 'mil 8.License 49.Lead Water Test Date �t11 9.Current Fire Marshal Certificate Date.q•c��'F Within Acceptable Limit _`8 10.DPH Complaint Procedure On Bottled Water Ya `9- 11.Food Service Certificate Date: 1(I 50.Walkways Maintained 12.Menus '-j 51.Designated Staff Toilet/Sink 13.Emergency Plans "V 52.All Openings for Ventilation Screened NQ 14.No Smoking Signs '*-Q 53.Windows Protected to Prevent Falls -Q 15.Radon Test Date:1 '15 Results:1 1 fr-% '*�Ql 54.Glass Protected to 3611 Staffing 19a-79-4a `( El 55.Overhead Doors:Locking Devices/Spring Protectors 16. Staff Health Records '-f 56.Exits/Hallways and Stairs Unobstructed 17. Professional Development '14 57.Individual Storage of Clothing/Bedding 18.Disciplinary Actions '*-Q 58.Smoking Prohibited �l 19.Designated Head Teacher/60% `-Q 59.Matches/Lighters Inaccessible '41) 20.Two Staff Present 'SA 60.Approved Safety Outlets/Covers `-J 21.Ratio: 1 Staff to 10 Children `161 61.Toileting Needs Met '3 22.Group Size:Maximum 20 Children '*0 62.Required Toilets/Sinks/Supplies -1-J 23.Designated Director 4 8 63.Potty Chairs:Nonporous/Emptied/Disinfected s�1 24.CPR Certified Staff 64.Hand Washing After Toileting:Staff/Children 25.First Aid Trained Staff 65.Ventilation in Toilet Room Consultants 19a-79-4a 66.Air Temp 65°,Thermometer Affixed V 26.Agreements/Contracts(Signed Annually) **-Q 67.Water Temperature 60°-115° '%Q 27.Logs/Visits Documented � 68.Portable Space Heaters 16 Early Ch.Educations Health Dental '-Q! 69.Watts/Ceilings/Floors/Rugs:Clean/Good Repair Social Service_ Dietitian '--Q 70.Rugs Secured Swimming 19a-79-4a 1-Ql 71.Hot Water/Steam Pipes Protected 0 28.Norr-Swimmers Identified 1-2 72.Working Phone on Each Level 0 29.Staff/Child Ratios "1073.Emergency Numbers Posted Q 30.CPR Certified Staff(20 years of age) '-a74.Adequate Lighting:50130 Candle Feet Q 31.Lifeguard Certified/Supervision *V 75.Light Fixtures Shielded/Shatter Proof Record Keeping 19a-79-5a '%Q 76.Potentially Hazardous Substances mocked *-Ql 32.Enrollment Information 77.Garbage/Rubbish Disposed Daily NQ 33.Emergency Medical Permission 78.Stairs Protected/Good Repair/Handrails tNQ 34.Authorized Released Permission 79.Pets:Maintained/Care Plan �[ 35.Field Trip Permission 'V 80.Operable CO Detector on Each Level 36.Transportation Permission 1%Q 81.Program Space/Adequate Sq.Ft.Per Child N�l 37.Child Health Records/Immunizations/TB `,a 82.Equipment'Clean/Good Repair/Safe/Non-toxic 38.Individual Care Plan(Signed by Parent/Staff) "Ql 83.Cots Stored/Maintained/Adequate Number 39.Injury/Illness/Accident Reports %Nq 84.Develo mentally Appr.Equipment/Materials Signature of Inspector Written Corrective Action Plan Sig tore of Person in Charge Due to DPH by: Post for 30 Page 2 of 2 Operating Days CHILD CARE CENTER/GROUP INSPECTION FORM Program Name: License Number: Date of - Inspection: 1331 la -cal LO 85.Hot Tubs/Spas/Saunas:Locked Inaccessible Yjl 125.Children's Linens/Clothing/Bedding Stored '-41 86.No Weapons/No Facsimile of a Firearm on Premises Individually Outdoor Space 126.Cribs/Cots Washed/Disinfected - I-Q 87.Outdoor Space Adequate Sq.Ft.Per Child a 127.Under 12 Months Placed on Back for Sleeping .%. 88. Impact Absorbing Material under Equipment Ci.Q 128.Alternate Sleep Position/Equipment -i 89.Playground Free from Hazards Medical Documentation Y/N 90.Peeling Paint Observed:YAD Sample Taken:Y/N q Q 129.Crib/Bed Used for Infant Sleeping E3 91.Lead Management Plan Reviewed:Y/N 0 130.Crib/Bed Free from Observable Hazards 92.Equipment Anchored/Safely Arranged 1 9 131.Infant Toys Separate/Washed/Disinfected Daily �I 93.Outdoor Play Area Protected/Fenced .Q 132.No Toys/Objects Less than 1%11 Diameter `! 94.Drinking Water Available/Accessible -G 133:Plastic Bags/Balloons/Styrofoam Objects Inaccessible \ Z1 134 Health Consultant/Documentation of Visits Educational Reauirements 19a-79-8a C1 135.Infants Held for Bottles/Indiv.Attn/Tummy Time 19 95.Written Plan for Daily Program Available to ❑ 136.Written Statement/Feeding Schedule from Parent Parents/Staff Q 137.Unused Portions of Liquids Discarded %'11 96.Activity Choices Include: 4 a 138.Clean Bottles/Disp.Bottles/Approved Bottle Washing Indoor/Outdoor \ Fine/Gross Motor -Q 139.Food Served from Dish or Whole Jar Served Language Sensory y C•+ 140.Bottles'Individually Identified w/Child's Name Art/Media Dramatic Play Outdoor Play Space-Under Three Music Self Concept -':4b 141.Play Space Fe4ced Health Education Active/Quiet �19 142.Outdoor Equipment Available/ Child/Staff Initiated \ Exploration \\ Developmentally Appropriate Varied Choices -� Indiv/Small Gro Snacks/Meals - Toileting/Clean Up_ School Age Children Endorsement 19a-79-11 ki 143.Approved Endorsement Administration of Medications 19a-79-9a 144.Activity Choices Include: 97.Written Policies/Procedures Free TimeCreative_Homework = 98.Training Outline/Med Training Snacks ! Physical_Special Events Nonprescription Topical Medications ® Small Group_Quiet _Self Concept _ N14b 99.' Administration/Parent Permission/MAR - 145.Ratio:1 Staff to 10 Children %It 100. Labeling/Storage ,1 146.Group Size:Max.20 Children "7 101. Trained Person Present/Written Approval �p 147.Education Consultant Appropriate Oral/TopicaVInhalant/Injectabie Medications - �a 102. Authorized Prescriber/Parent Permission/MAR -NlLyht Care Endorsement 19a49-12 10 m-5am `%'9 103. Labeling/Storage ❑ 148.Approved Endorsement alp 104. Unused/Expired Meds Returned/Disposed IDN ❑ 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/ ti ❑ 106. Labeling/Storage Sleeping Apparel ` ❑ 107.Appvd Petition For Special Medication Authorization El152.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 'hl 109..Approved Endorsement ❑ 154.Written Policies/Procedures *V 110.Ratio:1 Staff to 4 Children ❑ 155.On Site Staff Trained in First Aid/Glucose Testing *61 111.Group Size no Larger than 8 ❑ 156.Training Current/Documented 'R 112.Physical Barriers/Groups of 8(Indoors/Outdoors) ❑ 157.Supervision of Self Administration %'d 113.Adequate Sinks in Program Space ❑ 158.Equipment/Supplies:Labeled/Inaccessible ❑ 114.Free Standing Cribs ❑ 159.Signed Agreement w/Parent Regarding Equipment � 115.Washable Cots L ❑ 160.Materials to be Discarded:Locked/ 4 5 116.Chairs for Feeding/Stable/Safety Straps/Locking Tray Given to Parent -V 117.Dev.Appropriate Tables/Chairs/Equipment ❑ 161.Authorized Prescriber/Parent Permission '�Q 118.Refrigerators and Food Prep Facilities ❑ 162.Documentation of Test Results/ Diapering Area Action Taken 119.Sturdy/Safety Rail/Nonporous/Exclusive Use ❑ 163.Daily Written Parent Notification 120.Washed/Disinfected �1 121.Disposable Paper Sheets '%Q 122.Covered Waste Receptacle 123.Diaper Changing Policy Posted/Followed 1-3 124.Hand Washing Policy Posted/Followed Signature of Inspector Written Corrective Action Plan Signature of Person in Charge a Due to DPH by: INSPECTION ❑ REINSPECTION ❑ COMPLAINT ❑ INVESTIGATION 0 OTHER SUPPLEMENTAL REPORT OF INSPECTION NAME OF PROGRANUPROVIDE T}h(,t7C�tYl�rY `� C-' DATE:I 40 TIME:Z-1 LOCATION ADDRESS: r�.2_Su l ( Ivan Q yc Lk�W-r�s—�C)r- TELEPHONE#:,(fLl y a I 1 LICENSE NUMBER: EXPIRATION DATE-3 CAPACITYA via- #of CHILDREN PRESENT: 3 I #of STAFF PRESENT: PURPOSE OF VISff O 11 Consent to Inspect I agree to allow the Commissioner's representative to have access to and inspect this facility and all Family Day Care Home child care records as required by Family Day Care Home Regulations. ProviderlApplicant/Substitute's Signature OBSERVATIONS/CORRECTION NEEDED: 400rn6m_V-p5 Q' 2yecn�`rc a m C raid-cam eex�erg 01 e^ ' No Goy rrb 4 A me- 3's low 12, _i�ad { 15p�M5 ebiaR4 CCrn "QuxaL( -(;roM UA -kri3 s CveQbu) Cove o��5ot be•+n� dorw- . in xxi j)C)o� aG h8� m watt b4 Esc Kes S=Substantiated NSW Not Substantiated P=Pending (If applicable) DATE CORRECTIONS DUE: l • t l SIGNED: (Inspector—DPH) SIGNED: erson in Cha ge) s:/Division/Licensure/Family&Center/rield Forms/Report of Inspection 04/06/10 ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT ` .!�:- 4.2 e0r'2 s 0!9 Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 7-/A Zl Date of Inspection INSTRUCTIONS `mil--/ Check=Compliance; Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of Expiration Licensed Capacity r�Z Under 3 End-orsement_ #Children Present_ #Staff Present_ -940 VTW 4,21&(�>sX202 Ccr/c t:c nit�c�•r C Pro ram Na a License# Telephone# 1;13 _'4 1 z . �- Address Operator Licensed for: & nder 3 Yrs Pre-School(3-5 Years) LjPchool Age ❑Night Care ors"' � Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a {y'1 License premises cleantgood repair Refrigeration no more than 45° L�f 1 Equipment clean,in good repair,safe/non-toxic 2 Food prep area clean/good repair V3 Free from observable hazards [113 Food safely stored [�r14 Food prep hand washing E"15 Adequate dishwashing ❑ 4 Water Supply in compliance with all PHC requirements [3`16 Kitchen separated ❑ IT M,ar�s appropriate: �i1 Customer of a Water Company LROanacks served ❑ Cold breakfast Water Company Name: Cjn4j V ❑ Meals served Ego%Teals transported Lead WaWTest Date: ,;Z! y /o ❑ Other Within Limits ❑ Exceeds Limits -or- ❑ Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ 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 Clef Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS„ ii.Bacteriological Analysis Test Bate: ❑ 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 19-13-B51a-m.❑ Yes ❑ No ceealo .� T 1 4 ❑ 4c Other(Please specify) J Required toilets/sinks/supplies [��/f✓ Adequate ventilation in toilet room Sewage disposal adequate Outdoor Space 19a-79-7a y Playground free from observable hazards �y�1D Drinking water available,adequate,safe Si ct ) Date Corrections Due i egI} d(1?erson in Ch S:/Divisio icensure/Group&Center ironmental Inspection Report 10/08/08'(website)