Grace Lutheran Child Learning Center

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;

“Findings: Based on inspection of the diaper changing areas in the following classrooms the Primary Compliance Officer noted that the transition between the counter top and backsplash in the diapering areas was not seamless due to gaps in the caulk: -Classroom #101 -Classroom #102 -Classroom #105”

AAC R9-5-502.A.1. A. A licensee providing child care services for infants shall: 1. Provide a wall-enclosed room for infants that provides exits required by R9-5-601(1);

“Findings: The Primary Compliance Officer entered Infant Classroom #101 and observed that the shared door that leads to Infant Classroom #102 was open while children were present in both rooms.”

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 an Emergency, Information, and Immunization Record that is no more than a two-page written notice, and is signed by the enrolled child’s parent containing: 1. The child’s name, home address, sex, and date of birth; 2. The date of the child’s enrollment; 3. The name, home address, email address, and 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 the nutritional and dietary needs of the child including, if applicable, the request in R9-5-509(C)(14); 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.

“Findings: Based on review of 20 Emergency, Information and Immunization Record (EIIR) cards, the Secondary Compliance Officer observed the following: -Child 1's card did not document the name and contact telephone number of the child’s health care provider. -Child 2's card did not document the name and contact number of a second emergency contact as required.”

AAC R9-5-501.A.18. A. A licensee shall ensure that: 18. Except as provided in subsection (A)(20), the following are stored separate from food storage areas and are inaccessible to an enrolled child: a. All materials and chemicals labeled as a toxic or flammable substance; b. All substances that have a child warning label and may be a hazard to a child; and c. Lawn mowers, ladders, toilet brushes, plungers, and other facility equipment that may be a hazard to a child;

“Findings: The Primary Compliance Officer observed a toilet plunger that was accessible in the child restroom located off of the Four/Fives Classroom.”

AAC R9-5-510.A.1. A. A staff member shall provide guidance to help children respond to difficult situations. To develop self-regulation, children should receive adult support that is individual to the child and adapts as the child develops internal controls. This process should include: 1. Forming a positive relationship with the child, which occurs when the adult spends time talking to the child, listening to the child, following the child’s lead, playing with the child, and responding to the child’s needs; 2. Base expectations on the child’s developmental level; 3. Establishing and being proactive in teaching and supporting children in learning simple rules; 4. Modifying the learning/play environment to support the child’s appropriate behavior; 5. Creating a predictable daily routine and schedule; 6. Modeling desired behavior; 7. Showing children positive alternatives; 8.Using deliberate redirection, the staff member should encourage the child to use appropriate behavior, and provide positive feedback when the child exhibits the behavior; 9. Individualized positive discipline strategies based on the individual needs of children, such as using a buddy system, individualized schedule, special break, or another applicable positive discipline strategy; and 10. If applicable, a licensee shall develop a written plan with the enrolled child's parent to provide individualized social and emotional intervention supports for the enrolled child that includes methods for understanding the enrolled child's behavior, and developing, adopting, and implementing a team-based positive behavior support plan.

“Findings: Based on staff interviews, the Compliance Officer noted that on occasion: Staff 1 has failed to base expectations on a child's developmental level, and has shown frustration while working with two and three-year-old children in the classroom and the indoor gym. Staff statements included: *Staff 1 wants it to be super structured, not appropriate for their age... *Staff 1 can be gruff toward kids when they take a toy from someone, or crash a ride-on car into the wall... *Staff 1 becomes aggravated and short with children that have certain behaviors (examples: spilling drinking water, toys in mouth)... *Staff 1 wants a structured room, can get frustrated if kids do things wrong...”

AAC R9-5-516.B.3. B. If prescription or nonprescription medications are administered, a licensee shall ensure that: 3. A facility director, or a staff member designated in writing by the facility director, does not administer a medication to an enrolled child unless the facility receives written authorization signed by the enrolled child’s parent or health care provider that includes the: a. Name of the enrolled child; b. Type of the medication; c. Prescription number, if any; d. Instructions for administration specifying the: i. Dosage and route of administration; ii. If indicated, starting and ending dates of the dosage period; and iii. Times and frequency of administration; e. Reason for the medication; and f. Date of authorization; and

“Findings: Based on review of medications stored onsite Compliance Officer 2 noted that Child 5's medication consent form did not document an end date of authorization as required.”

AAC R9-5-501.B.6. B. A licensee shall ensure that a staff member: 6. For enrolled children five-years or younger, and except as provided in subsection (C), prepares, posts, and implements 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;

“Findings: Compliance Officer 1 noted that the lesson plans in the following classrooms were not dated for the current calendar week as required: -Toddlers 103 -Toddlers 104”

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 an Emergency, Information, and Immunization Record that is no more than a two-page written notice, and is signed by the enrolled child’s parent containing: 1. The child’s name, home address, sex, and date of birth; 2. The date of the child’s enrollment; 3. The name, home address, email address, and 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 the nutritional and dietary needs of the child including, if applicable, the request in R9-5-509(C)(14); 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.

“Findings: Based on review of 10 Emergency, Information and Immunization Record (EIIR) cards Compliance Officer 2 noted the following: -Child 1's card was not complete, the back side was blank. -Child 2's card did not document the person to call first in case of injury or illness. -Child 3's card was not complete, question #2 on the back side of the card was not answered. -Child 4's card did not document the contact telephone number of the child’s health care provider.”

AAC R9-5-502.A.11. A. A licensee providing child care services for infants shall: 11. Label each food container received from the parent with the infant's name.

“Findings: Compliance Officer 2 observed the following during the inspection: -Infant food jars that were not labeled in a refrigerator located in the Older Infant Classroom. -A container of oatmeal cereal that was not labeled with the child's name in the Younger Infant Classroom.”

AAC R9-5-501.B.9. B. A licensee shall ensure that a staff member: 9. Does the following when a parent permits or asks a staff member to apply personal products on an enrolled child, such as petroleum jelly, diaper rash ointments, sun screen or sun block preparations, toothpaste, and baby diapering preparations: a. Obtains the enrolled child’s personal products from the enrolled child’s parent or, if the licensee provides the personal products for use by the enrolled child, obtains written approval for use of the products from the enrolled child’s parent; b. Labels the personal products with the enrolled child’s name; and c. Keeps the personal products inaccessible to enrolled children;

“Findings: Compliance Officer 1 observed personal products that were labeled with only a first name in the following classrooms: -Older Infants Classroom -Toddlers 103 Classroom -Two's Classroom”

AAC R9-5-511.A. A. A licensee shall provide each enrolled child who naps or sleeps at the facility with a separate cot or mat or a crib that meets the requirements of R9-5-502(A)(8) and ensure that:1. A cot, mat, or crib used by the enrolled child accommodates the enrolled child’s height and weight; 2. A staff member covers each cot, crib mattress, or mat with a clean sheet that is laundered when soiled, or at least once every seven days and before use by a different enrolled child; 3. A clean blanket or sheet is available for each enrolled child; 4. A rug, carpet, blanket, or towel is not used as a mat; and 5. Each cot, mat, or crib is maintained in a clean and repaired condition.

“THE FOLLOWING WAS SUBSTANTIATED: Findings: Based on interviews, the Compliance Officers determined that Infants are sometimes allowed to continue sleeping in swings or bouncers rather than transferring them to their crib upon falling asleep.”

AAC R9-5-502.C.3.b. C. A licensee shall ensure that:3. When preparing, using, or caring for an infant’s feeding bottles, a staff member: b. Ensures that a bottle is not: i. Heated in a microwave oven; ii. Propped for an infant feeding; or iii. Permitted in an infant’s crib unless the written instructions required by subsection (C)(1)(l) state otherwise;

“THE FOLLOWING WAS SUBSTANTIATED: Findings: Based on interviews the Compliance Officers determined that Infants are sometimes placed in bouncers or swings, with their bottles propped with a receiving blanket, when multiple children need to be fed at the same time.”

AAC R9-5-605.B.6. B. A licensee shall ensure that: 6. Except for a room used only for an enrolled school-age child, each unused electrical outlet is covered with a safety plug cover or insert;

“Findings: Compliance Officer 1 noted that a three-outlet electrical adapter was plugged into a countertop outlet in the Two's Classroom, but the empty outlets in the adapter did not have safety plug covers as required.”

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.

“Findings: Compliance Officer 1 noted that the toilet tissue dispenser in the Two's Classroom was empty. *A staff member refilled the dispenser during the inspection*”

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;

“Findings: The Compliance Officers noted that the transition between the backsplash and the diapering counter in the Younger Infants Classroom was not seamless. Additionally, the Compliance Officers observed the following unrelated items in the following diapering areas: -A figure 8 toy on the diapering sink in the Younger Infants Classroom -An electronic tablet on the diapering surface in the Older Infants Classroom -A portable speaker on the diapering counter in the Toddlers Classroom”

AAC R9-5-501.A.2. A. A licensee shall ensure that: 2. Except for an enrolled school-age child, drinking water is provided sufficient for the needs of and accessible to each enrolled child in both indoor and outdoor activity areas;

“Findings: The Compliance Officers noted that water was not available for the 27 children, ages two and older, that were present in the Gym during the 07/15/24 compliance inspection.”

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;

“Findings: Compliance Officer 2 reviewed Staff 1's file and noted that it contained a foreign education document that had not been evaluated as being equivalent to a high school diploma or GED in the United States.”

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.

“Findings: Based on documentation and interview it was determined that Staff 1 had worked alone with children, but their staff file contained a foreign education document that had not been evaluated.”

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.

“Findings: Based on review of Emergency, Information and Immunization Record (EIIR) cards Compliance Officer 2 noted the following: -Child 1's card was not signed or dated by the parent as required. -Child 2 and Child 5's cards did not document their date of enrollment, their physician's contact information, or the person to call first in an emergency. -Child 3, Child 4, and Child 6 did not have their dates of enrollment documented.”

AAC R9-5-502.C.3.b. C. A licensee shall ensure that:3. When preparing, using, or caring for an infant’s feeding bottles, a staff member: b. Ensures that a bottle is not: i. Heated in a microwave oven; ii. Propped for an infant feeding; or iii. Permitted in an infant’s crib unless the written instructions required by subsection (C)(1)(l) state otherwise;

“FINDINGS: The Compliance Officer Supervisor inspected the 101 Infant Classroom and observed 5 children asleep in their cribs and a bottle of milk was in each of their cribs. It was confirmed that staff were allowing the children to go to sleep with their bottles while lying in their cribs.”

AAC R9-5-403.A. A. Within 10 calendar days of the starting date of employment or volunteer service, a licensee shall provide, and each staff member who provides child care services shall complete, training for new staff members that includes all of the following:1. Facility philosophy and goals; 2. Names and ages of and developmental expectations for enrolled children for whom the staff member will provide child care services; 3. Health needs, nutritional requirements, any known allergies, and information about adaptive devices of enrolled children for whom the staff member will provide child care services; 4. Lesson plans; 5. Child guidance and methods of discipline; 6. Hand washing techniques; 7. Diapering techniques and toileting, if assigned to diaper changing duties; 8. Food preparation, service, sanitation, and storage, if assigned to food preparation; 9. If a staff member is assigned to feeding infants, the preparation, handling, and storage of infant formula and breast milk; 10. Recognition of signs of illness and infestation; 11. Child abuse or neglect detection, prevention, and reporting; 12. Accident and emergency procedures; 13. Staff responsibilities as required by A.R.S. Title 36, Chapter 7.1, Article 1 and this Chapter; 14. Sun safety policies and procedures; 15. Safety in outdoor activity areas; 16. Transportation procedures, if applicable; and 17. Field trip procedures, if applicable.

“FINDINGS: The Compliance Officer Supervisor reviewed the file for Staff 2 and observed that it lacked their New Employee 10-day Training Checklist.”

AAC R9-5-501.A.1. A. A licensee shall ensure that:1. In addition to complying with the requirements in this Chapter, the health, safety, or welfare of an enrolled child is not placed at risk of harm;

“FINDINGS: Per allegation Per Staff interview and findings on the police report, Child 1, Child 2 and Child 3 "dared" each other and then participated in licking each others' private parts while being cared for on the playground of the facility. The health, safety, and welfare of these enrolled children was placed at risk of harm when they were able to perform this act while at the facility. The Compliance Officer Supervisor inspected the 101 Infant Classroom and observed a child was asleep in their crib and wearing a bib. Compliance Officer 1 inspected the 102 Infant Classroom and observed that a child was lying in their crib with their pacifier strapped onto their clothing. The same child’s head was resting on a folded, thick blanket in their crib.”

AAC R9-5-501.C.1. C. A licensee shall ensure that a staff member: 1. Supervises each enrolled child at all times;

“FINDINGS: Per allegation Per Staff interview and findings on the police report, Staff 1 and Staff 2 failed to supervise Child 1, Child 2 and Child 3 as they each participated in licking each others' private parts while being cared for on the playground of the facility. According to the Director, Staff 1 admitted that on the day of the incident, she was on her personal phone while supervising on the playground. Neither Staff 1 or Staff 2 had knowledge that the children participated in licking each other's private parts while on the playground.”