ABC & 123 Small Blessings Center

AAC R9-5-509.C.15. C. A licensee shall ensure that:15. The food served to an enrolled child is consistent with a modified diet prescribed for the child by the child’s parent or health care provider;

“The Compliance Officer observed that Child 6 has a modified diet. Child 6 was served a food item listed on the modified diet documented on the EIIR card.”

AAC R9-5-501.C.5. C. A licensee shall ensure that a staff member:5. Except as provided in subsection (D), prepares and posts a dated lesson plan in each indoor activity area for each calendar week, which is maintained on facility premises for 12 months after the lesson plan date and provides opportunities for each child to: a. Gain a positive self-concept; b. Develop and practice social skills; c. Think, reason, question, and experiment; d. Acquire language skills; e. Develop physical coordination skills; f. Participate in structured large muscle physical activity; g. Develop habits that meet health, safety, and nutritional needs; h. Express creativity; i. Learn to respect cultural diversity of children and staff; j. Learn self-help skills; and k. Develop a sense of responsibility and independence;

“The Compliance Officer observed that the posted lesson plan was not dated in the main activity area.”

AAC R9-5-509.C.14. C. A licensee shall ensure that:14. Each staff member is informed of a modified diet prescribed for an enrolled child by the child’s parent or health care provider, and the modified diet is posted in the kitchen and in the child’s activity area;

“The Compliance Officer observed that Child 6's modified diet was not posted in the activity area.”

AAC R9-5-304.B. B. Except as required in A.R.S. § 36-3009, before an enrolled child receives child care services, a licensee shall require the enrolled child’s parent to complete a Department-provided Emergency, Information, and Immunization Record card that is signed by the enrolled child’s parent containing: 1. The child’s name, home address, city, state, zip code, home telephone number, sex, and date of birth; 2. The date of the child’s enrollment; 3. The name, home address, city, state, zip code, and contact telephone number of each parent of the child; 4. The name and contact telephone number of at least two individuals authorized by the child’s parent to collect the child from the facility in case of emergency, or if the child’s parent cannot be contacted; 5. The name and contact telephone number of the child’s health care provider; 6. The written authorization for emergency medical care of the enrolled child when the parent cannot be contacted at the time of the emergency; 7. The name of the individual to be contacted in case of injury or sudden illness of the child; 8. The written instructions of a child’s parent or health care provider for nutritional and dietary needs of the child including, if applicable, the request in R9-5-509(C)(9); and 9. A written record completed by the child’s parent or health care provider noting the child’s susceptibility to illness, physical conditions of which a staff member should be aware, and any individual requirements for health maintenance.

“The Compliance Officer reviewed 8 EIIR cards and found the following 3 were incomplete: Child 4- no date of enrollment, no physician's name and phone number Child 5 and Child 6- no who to call first in the event of an emergency.”

AAC R9-5-306.A. A. A licensee shall maintain a dated attendance form containing an enrolled child’s name with the time of each admission and release of the enrolled child. 1. Except as provided in subsection (A)(2), a licensee shall ensure that the attendance form is signed with at least a first initial of an individual’s first name and the individual’s last name by each enrolled child’s parent or individual designated by the enrolled child’s parent, each time the enrolled child is admitted or released. 2. An electronic fingerprint verification or an electronic signature may be used in place of a signature of the enrolled child’s parent or designated individual to admit or release the enrolled child. 3. If an electronic signature is used to admit or release the enrolled child, the licensee shall adopt policies and procedures to ensure that the individual whose signature the electronic or digital method of identification represents is accountable for the use of the electronic or digital method; 4. A licensee shall develop, document, and implement policies and procedures to ensure that the identity of an individual is known to the staff member or is verified with picture identification before releasing an enrolled child to the individual. 5. A licensee shall not release the enrolled child to an individual other than the enrolled child’s parent or other individual designated in writing by the enrolled child’s parent except when the enrolled child’s parent is unable to collect the enrolled child and authorizes the licensee by telephone to release the enrolled child to an individual not so designated. a. The licensee shall verify the telephone authorization using a means of verification that has been agreed upon between the licensee and the enrolled child’s parent at the time of enrollment. b. The licensee shall document the means of verification in subsection (A)(5)(a) on the enrolled child’s Emergency, Information, and Immunization Record card. 6. A licensee shall not permit the self-admission or self-release of an enrolled child unless the enrolled child is of school age and the licensee has obtained and verified written permission from the enrolled child’s parent. 7. A licensee shall maintain the attendance form on facility premises for 12 months after the date of attendance.

“The Compliance Officer reviewed 8 sign in and out records. The following children were not signed out: Child 1- not signed out on 10/4, 10/11, and 10/17 Child 2- not signed out on 10/4 and 10/11 Child 3- not signed out on 10/10”

AAC R9-5-506.1. A licensee providing child care services for school-age children shall:1. Ensure that a staff member supervises an enrolled school-age child to and from a bathroom and allows the enrolled child privacy while in the bathroom;

“The Compliance Officer observed that the school age children are mixed with children of all ages in the 1 year old room. The bathroom does not have a door or any means to provide the school age children privacy when using the restroom. Staff 1 and 2 reported that the children use the bathroom located in the room.”

AAC R9-5-502.C.4.a. C. A licensee shall ensure that:4. When feeding an infant, a staff member: a. Provides an infant with food for growth and development that includes: i. Formula provided by the infant’s parent or the licensee or breast milk provided by the infant’s parent following written instructions required by subsection (C)(1)(l); and ii. Cereal as requested by the infant’s parent or health care provider;

“The CO observed that two of three children did not have feeding instructions in the infant room. Child 1 and Child 2 did not have written feeding instructions. Child 3's feeding instructions were not updated. Staff were observed with cucumber slices and cheese cubes, neither food item were listed on the child's instructions.”

AAC R9-5-512.F. F. A licensee shall ensure that: 1. Each toilet room in a facility contains, within easy reach of enrolled children: a. Mounted toilet tissue; and b. Except as provided in subsection (G): i. A sink with running water; ii. Soap contained in a dispenser; and iii. Disposable, single-use paper towels in a mounted dispenser, or a mechanical air hand dryer; 2. Staff members wash their hands with soap and running water after toileting; 3. An enrolled child’s hands are washed with soap and running water after toileting; 4. Except for a cup or receptacle used only for water, food waste is stored in a covered container and the container is clean and lined with a plastic bag; 5. Food waste and other refuse is removed from the facility building at least once every 24 hours or more often as necessary to maintain a clean condition and avoid odors; 6. A staff member or an enrolled child does not draw water for human consumption from a toilet room handwashing sink; 7. Toys, materials, and equipment are maintained in a clean condition; 8. Plumbing fixtures are maintained in a clean and working condition; and 9. Chipped or cracked sinks and toilets are replaced or repaired.

“The Compliance Officer observed that the toilet tissue was not mounted in classroom B or C.”

AAC R9-5-403.B. B. A licensee shall ensure that: 1. Each staff member who provides child care services completes 18 or more actual hours of training every 12 months after the effective date of this Chapter or the staff member’s starting date of employment or volunteer service in at least two topics listed in this subsection: a. Child growth and development, including: i. Infant growth and development, which may include sudden infant death syndrome prevention; ii. Developmental psychology; iii. Language development; iv. Observation and child assessment; v. Developmentally-appropriate activities; vi. Child guidance and methods of discipline which may include training on the appropriate techniques to prevent a child from harm or to prevent the child from harming others; and vii. Developmentally-appropriate activity areas; b. Health and safety issues, including: i. Accident and emergency procedures, including CPR and first aid for infants and children; ii. Recognition of signs of illness and infestation; iii. Nutrition and developmentally-appropriate eating habits; iv. Child abuse detection, reporting, and prevention; v. Safety of indoor and outdoor activity areas; and vi. Sun safety policies and procedures; c. Program administration, planning, development, or management; and d. Availability of community services and resources, including those available to children with special needs; and 2. As part of the required 18 hours of training in subsection (B)(1): a. A staff member who has less than 12 months of child care experience before the staff member’s starting date, completes at least 12 hours in one or more of the topics in subsection (B)(1)(a) in the staff member’s first 12 months at the facility; b. A staff member who has 12 months or more of child care experience, completes at least 6 hours in one or more of the topics in subsection (B)(1)(a) every 12 months after the staff member’s starting date; c. A staff member who provides child care services to an infant completes at least 6 hours in subsection (B)(1)(a)(i) every 12 months after the staff member’s starting date; and d. A facility director completes at least 6 hours in subsection (B)(1)(c) every 12 months after the facility director’s starting date.

“The Compliance Officer observed that neither Staff 1 (DOH 9/22/20) nor Staff 2 (DOH 1/31/22) had documentation of the 18 hours of annual training required for 2022-2023 documented in their files.”

AAC R9-5-203.B. B. A licensee shall maintain documentation of a valid fingerprint clearance card issued under A.R.S. § 41-1758.03 and valid background check document issued under in A.R.S. § 46-811.

“The Compliance Officer observed that Staff 2 did not have documentation that a DCS registry background check had been completed.”

AAC R9-5-301.B. B. A licensee shall ensure that a facility director: 1. Designates, in writing, an individual who meets the requirements of R9-5-401(2) to act on behalf of the facility director when the facility director is not present in the facility; 2. Supervises or assigns a teacher-caregiver to supervise each staff member who does not meet the qualifications of R9-5-401(3); 3. Prepares a dated attendance record for each day and ensures that each staff member documents on the attendance record the time of each arrival and departure of the staff member; and 4. Maintains on the facility premises, the dated attendance record required in subsection (B)(3) for 12 months after the date on the attendance record.

“The Compliance Officer observed Staff 2 working alone at the facility, with no qualified staff member to supervise. Staff 2 is not teacher-caregiver qualified.”

AAC R9-5-304.B. B. Except as required in A.R.S. § 36-3009, before an enrolled child receives child care services, a licensee shall require the enrolled child’s parent to complete a Department-provided Emergency, Information, and Immunization Record card that is signed by the enrolled child’s parent containing: 1. The child’s name, home address, city, state, zip code, home telephone number, sex, and date of birth; 2. The date of the child’s enrollment; 3. The name, home address, city, state, zip code, and contact telephone number of each parent of the child; 4. The name and contact telephone number of at least two individuals authorized by the child’s parent to collect the child from the facility in case of emergency, or if the child’s parent cannot be contacted; 5. The name and contact telephone number of the child’s health care provider; 6. The written authorization for emergency medical care of the enrolled child when the parent cannot be contacted at the time of the emergency; 7. The name of the individual to be contacted in case of injury or sudden illness of the child; 8. The written instructions of a child’s parent or health care provider for nutritional and dietary needs of the child including, if applicable, the request in R9-5-509(C)(9); and 9. A written record completed by the child’s parent or health care provider noting the child’s susceptibility to illness, physical conditions of which a staff member should be aware, and any individual requirements for health maintenance.

“The Compliance Officer observed that 4 of 10 Emergency Information and Immunization Record cards were incomplete. Child 1, 2, 3, and 4 did not have a physician's name and phone number documented. Child 4 did not have "who to call first in the event of an emergency" documented.”

AAC R9-5-401.3. A licensee shall ensure that staff members meet the following qualifications for employment or volunteer service at a facility: 3. A teacher-caregiver is 18 years of age or older and provides the licensee with documentation of one of the following: a. Six months of child care experience and: i. A high school diploma or high school equivalency diploma; or ii. At least 12 credit hours from an accredited college or university, including at least six credit hours in early childhood, child development, or a closely-related field; b. Associate or bachelor degree from an accredited college or university in early childhood, child development, or a closely-related field; or c. N.A.C., C.D.A., or C.C.P. credential;

“The Compliance Officer reviewed 2 staff files. Staff 2 does not have documentation of a high school diploma or GED certificate. Staff 2 reported that she submitted all of the classes and is waiting on the Department of Education to approve her coursework. Staff 2 was working as a teacher-caregiver during the inspection.”

AAC R9-5-404.C.2. C. A licensee shall ensure that: 2. When five or fewer enrolled children are present in a facility, the facility director or director’s designee who meets the requirements in R9-5-401 is present in the facility, and an additional staff member is available by telephone or other equally expeditious means and able to reach the facility within 15 minutes after notification; and

“The Compliance Officer observed that Staff 2 was the only staff member present at time of inspection. The Director or Director's designee was not present.”

AAC R9-5-502.A.7.b. A. A licensee providing child care services for infants shall: 7. Provide space, materials, and equipment in an infant room that includes the following: b. Toys, materials, and equipment, that are too large for an infant to swallow and free from sharp edges and points, in a quantity sufficient to meet the needs of the infants in attendance that include: i. Toys to enhance physical development such as toys for stacking, pulling, and grasping; ii. Soft toys; iii. Books; iv. Toys to enhance visual development such as crib mobiles and activity mats with an object or objects suspended above the infant’s head; and v. Unbreakable mirrors; and

“The Compliance Officer observed the following equipment in the infant room to not be age appropriate: The Hungry Pelican stuffed toy is rated for nine months and older. The “ugly doll” stuffed toy pillow. Two baby dolls with hard plastic eyes.”

AAC R9-5-503.A.1. A. A licensee shall ensure that each diaper changing area required in R9-5-601(4) contains: 1. A nonabsorbent, sanitizable diaper changing surface that is: a. Seamless and smooth, and b. Kept clear of items not required for diaper changing;

“The Compliance Officer observed that the diapering surface has a chip in the laminate counter leaving the wood exposed in classroom B.”

AAC R9-5-509.A. A. A licensee that prepares food for enrolled children on facility premises shall, if required by 9 A.A.C. 8, Article 1, and the local ordinances of the local health department where the facility is located, obtain a food establishment permit issued under 9 A.A.C. 8, Article 1, and: 1. Provide the Department with a copy of the facility’s food establishment permit before the Department issues a license to the facility, 2. Maintain the facility’s current food establishment permit on the facility’s premises, and 3 Provide a copy of the facility’s current food establishment permit to the Department upon request.

“The Compliance Officer observed that the Sanitation permit expired September 30, 2023.”

AAC R9-5-514. C. C. A licensee shall: 1. Prepare and date a written fire and emergency plan that contains: a. The location of the first aid kit; b. The names of staff members who have the first aid training required by R9-5-403(E); c. The names of staff members who have the CPR training required by R9-5-403(E); d. The directions for: i. Initiating verbal notification of an enrolled child’s parent by telephone or other equally expeditious means within 30 minutes of a fire or emergency; and ii. Providing written notification to the enrolled child’s parent within 24 hours; and e. The facility’s street address and the emergency telephone numbers for the local fire department, police department, ambulance service, and poison control center; 2. Maintain the plan required in subsection (C)(1) in a location on facility premises that has an operable telephone service or two-way voice communication system that connects the facility with an individual who has direct access to an in-and-out operable telephone service; 3. Post the plan required in subsection (C)(1) in any indoor activity area that does not have an operable telephone service or two-way voice communication system that connects the indoor activity area with an individual who has direct access to an in-and-out operable telephone services; and 4. Update the plan in subsection (C)(1) every 12 months after the date of initial preparation of the plan or when any information changes.

“The Compliance Officer observed that the written fire and emergency plan had not been updated since 8/27/2021. Two of three staff listed on the paper had CPR and First Aid certifications that had expired.”