Little Knights and Ladies CDC

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 facility documentation and the Compliance Officer’s observation, it was determined that the medication form for Child #1 lacked an end date and the times and frequency of administration for the medication.”

AAC R9-5-603.B. B. Except as provided in subsection (D) a licensee shall ensure that an outdoor activity area: 1. Is enclosed by a fence: a. A minimum of 4 feet high; b. Secured to the ground; and c. With either vertical or horizontal open spaces on the fence or gate that do not exceed 4.0 inches; 2. Is maintained free from hazards, such as exposed concrete footings and broken toys; and 3. Has gates that are kept closed while an enrolled child is in the outdoor activity area

“Findings: Based on the Compliance Officer’s observation, in the Outdoor Activity area the following hazard was accessible to enrolled children: *There was a screw on the yellow bus protruding from the ground.”

AAC R9-5-306.B. B. A licensee shall: 1. Develop, document, and implement policies and procedures to ensure that a staff member maintains daily documentation of the presence of an enrolled child in an activity area that includes a method to account for any temporary absences of the enrolled child from the activity area, and 2. Maintain the documentation of the presence of enrolled children in an activity area required in subsection (B)(1) on facility premises for 12 months after the date of the documentation.

“Findings: Based on facility documentation and the Compliance Officer’s observation, it was determined that the roster for the School Age classroom did not reflect the number of children present (9 children present, 8 children listed on the roster). The roster in the 4’s Classroom did not reflect the number of children present (7 children present, 6 children listed on the roster).”

AAC R9-5-309.C. C. A licensee shall maintain on facility premises: 1. A current fire inspection report including documentation of any repairs or corrections required by the fire inspection report; and 2. If there are gas pipes that run from a gas meter to an appliance or location on the facility premises, a current gas inspection report including documentation of any repairs or corrections required by the gas inspection report.

“Findings: The fire inspection had 2 violations and there was no documentation of the corrections.”

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.

“Findings: Based on the Compliance Officer’s observation, in the 3’s Classroom, there were 3 torn sleeping mats with exposed foam. In the 1’s Classroom, there were 7 torn sleeping mats with exposed foam.”

AAC R9-5-306.B. B. A licensee shall: 1. Develop, document, and implement policies and procedures to ensure that a staff member maintains daily documentation of the presence of an enrolled child in an activity area that includes a method to account for any temporary absences of the enrolled child from the activity area, and 2. Maintain the documentation of the presence of enrolled children in an activity area required in subsection (B)(1) on facility premises for 12 months after the date of the documentation.

“Findings: Based on facility documentation and the Compliance Officer and Office Chief’s observations, it was determined that the roster in the 1’s Classroom did not reflect the number of children present (5 children present, 4 children listed on the roster). In the 4’s Classroom the roster did not reflect the number of children present (5 children present, 6 children listed on the roster). In the School-Age Classroom the roster did not reflect the number of children present (8 children present, 7 children listed on the roster).”

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 the Compliance Officer’s observation, in the 1’s Classroom, the diaper changing sink had paint in the base of the sink.”

AAC R9-5-503.A.4. A. A licensee shall ensure that each diaper changing area required in R9-5-601(4) contains:4. At least one waterproof, sanitizable container with a waterproof liner and a tight fitting lid for soiled clothing.

“Findings: Based on the Compliance Officer’s observation, in the 3’s Classroom, the soiled clothing container lacked a tight fitting lid as required.”

AAC R9-5-512.C. C. A licensee shall ensure that floor coverings are:1. Clean; and 2. Free from: a. Dampness, b. Odors, and c. Hazards.

“Findings: Based on the Office Chief’s observation, in the 1’s Classroom, the following flooring hazard was accessible to enrolled children; *There was a large carpet rolled up wedged between a stool and the counter.”

AAC R9-5-603.C. C. Except as provided in subsection (D), a licensee shall ensure that an outdoor activity area:1. Is enclosed by a fence: a. A minimum of 4 feet high; b. Secured to the ground; and c. With either vertical or horizontal open spaces on the fence or gate that do not exceed 4.0 inches; 2. Is maintained free from hazards, such as exposed concrete footings and broken toys; and 3. Has gates that are kept closed while an enrolled child is in the outdoor activity area

“Findings: Based on the Compliance Officer and the Office Chief’s observations, in the outdoor activity areas the following hazards were accessible to enrolled children; Back Playground: *There were 2 bolts missing from the spinning bikes causing the equipment to be loose and detached from the ground. *There were 4 bolts pushed up from the ground of the fire truck and the bus climbing equipment causing the equipment to be loose and detached from the ground. Front Playground: *There were bolts missing from the Caboose climbing equipment causing the equipment to be loose and detached from the ground. *There was feces near the bikes and table.”

AAC R9-5-504.5.c. A licensee providing child care services for 1-year-old and 2-year-old children shall: 5. Ensure that: c. If a child is fed with a bottle, a staff member complies with the requirements in R9-5-502(C)(3); and

“Findings: The Compliance Officer observed that there was a child sitting on the floor drinking from a bottle in the 1's and 2's room.”

AAC R9-5-501.A.21. A. A licensee shall ensure that:21. Except when used as part of an activity, the following are stored in an area inaccessible to an enrolled child: a. Garden tools, such as a rake, trowel, and shovel; and b. Cleaning equipment and supplies, such as a mop and mop bucket.

“Findings: The Compliance Officer observed that there was a plunger accessible to children in a toilet room.”

AAC R9-5-306.B. B. A licensee shall: 1. Develop, document, and implement policies and procedures to ensure that a staff member maintains daily documentation of the presence of an enrolled child in an activity area that includes a method to account for any temporary absences of the enrolled child from the activity area, and 2. Maintain the documentation of the presence of enrolled children in an activity area required in subsection (B)(1) on facility premises for 12 months after the date of the documentation.

“Findings: The Compliance Officer observed that the attendance roster in the front 4s - school age room had 11 children listed as present and there were 13 children in the room.”

AAC R9-5-301.H. H. A licensee shall prohibit the use or possession of the following items when an enrolled child is on facility premises, during hours of operation, or in any motor vehicle used for transporting an enrolled child:1. Any beverage containing alcohol; 2. A controlled substance as listed in A.R.S. Title 36, Chapter 27, Article 2, except where used as a prescription medication in the manner prescribed; 3. A dangerous drug as defined in A.R.S. § 13-3401, except where used as a prescription medication in the manner prescribed; 4. A prescription medication as defined in A.R.S. § 32-1901, except where used in the manner prescribed; or 5. A firearm as defined in A.R.S. § 13-105.

“Findings: Per allegation and based on staff statement, a case containing a substance identified as cocaine by the Kingman Police Department was found by a staff member in the facility's toilet room.”

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 and based on staff statement, a case containing a substance identified by the Kingman Police Department as cocaine was found in a toilet room used by staff and children.”

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 and based on staff statements and the CO and OC's observations, the health, safety, and welfare of enrolled children was placed at risk of harm when the facility combined School-age children with 3-year-old children. Staff Statements: *One school-age student is touchy-feely with the littler girls. The student will sit really close to the little girls, try to hold them, hug them and attempts to kiss them. Sometimes the child will refuse to let go. *The student will hug older children too. *The student will try and wrestle with both boys and girls and get them to the ground. *Sometimes the older kids will become aggressive with the littler kids. *There is this one kid that makes me uncomfortable when they are touchy feely with the younger girls. *A school-age student hugs the little girls, get’s in their face, tries to wrestle with the younger children. *This student mainly does this to the girls, but on occasion will try with the boys. *The older kids set off the younger kids, making it hard to control the different ages.”

AAC R9-5-512.B. B. A licensee shall maintain facility premises and furnishings:1. In a clean condition, and 2. Free from odor.

“Findings: Per allegation and based staff statements and the CO and OC's observations, on the playground there were cigarette butts next to the fence accessible to children and there was a cigarette butt next to the picnic table. Staff Statements: *There are cigarette butts on the playground a lot. *We try to clean them all up before the children go out. *It can be hard, but we do try and pick them all up so the kids don’t come in contact with them.”

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 and based on staff statements, the CO and OC's observations, during the inspection, there were 2 separate occasions where an enrolled child left the 3’s classroom and walked to the 4’s classroom alone and unsupervised. Staff Stated: *Sometimes the children leave the classroom to go to the bathroom in the other classroom if the classroom one is full. *Sometimes the children will leave to grab things out of their backpacks in another classroom. *Sometimes staff will walk out of classroom to the lobby, or the fridge to get something.”

AAC R9-5-605.B.1. B. A licensee shall ensure that:1. All designated exits, corridors, and passageways that provide escape from the building are unobstructed and unlocked during hours of operation;

“Findings: Based on the CO and OC's observations, Classroom 3’s hallway and designated exit that provides escape from the building were obstructed with clutter and classroom furnishings. During nap time, the 4's classrooms designated exit was obstructed with sleeping children on mats.”

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, andthe 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.

“Findings: Per allegation and based on staff statements, photograph evidence, the CO and OC's observations, the facility was not following local ordinances under the food establishment permit issued. Staff Statements: *There has been hair in the food served to enrolled children. *There has been red plastic, like from the food packaging in the children’s food. *The children have been served uncooked food before. *The children have been served expired food and fruit with mold on it. *The food sometimes taste like cigarette smoke. *The cook has picked up a tortoise with gloves and then without changing gloves continued to prepare the food. *The food has tasted like rubber. *There has been stale food served to the children. Photographs observed: *Red plastic in oranges; *Short brown hair on chicken; *Expiration date on pretzels served; *Undercooked French fries and; *Plastic cook wear with red sticky substance.”

AAC R9-5-404.A. A. A licensee shall ensure that at least the following staff-to-children ratios are maintained at all times when providing child care services to enrolled children: Age Group/Staff: Children - Infants/1:5 or 2:11; 1-year-old children/1:6 or 2:13; 2-year-old children/1:8; 3-year-old children/1:13; 4-year-old children/1:15; 5-year-old children not school-age/1:20; School-age children/1:20

“Findings: Per allegation and based on the CO and OC's observations, the ratio in the hallway between the 3’s and 4’s classroom was 0:1 on 2 separate occasions when children left their classroom and walked to the 4’s classroom to get items from their back packs or go to the bathroom.”

AAC R9-5-208.B. B. At least 30 calendar days before the date of an intended change in a facility’s service classification, space utilization, or licensed capacity, a licensee shall submit a written request for approval of the intended change to the Department that includes:1. The licensee’s name; 2. The facility’s name, street address, city, state, zip code, mailing address, and telephone number; 3. The name, telephone number, and fax number of a point of contact for the request; 4. The facility’s license number; 5. The type of change intended: a. Service classification, b. Space utilization, or c. Licensed capacity; 6. A narrative description of the intended change; and 7. The following additional information, as applicable: a. If the intended change affects individual rooms, the following information about each affected activity area, as applicable: i. Identification of the activity area, ii. Current and intended square footage, iii. Current and intended operating hours, iv. Current and intended service classification, v. Current and intended licensed capacity, and vi. Whether the activity area has or will have a diaper changing area; b. If the intended change is to increase licensed capacity, the square footage of the outdoor activity area; and c. If the intended change includes an alteration or addition to the physical plant of a licensed facility, the following, as applicable: i. If the facility is not located in a public school or if providing child care services to infants, one-year-old children, or two-year-old children in a facility located in a public school, the information required in R9-5-201(A)(5)(g) and (A)(5)(h) showing the intended change; or ii. If the facility is located in a public school and provides child care only for three-year-old, four-year-old, or five-year-old, or school-age children, a set of final construction drawings or a school map, including the information required in R9-5-201(5)(j) showing the intended change.

“Findings: Based on facility documentation, staff statements, and Compliance Officer and Office Chief's (CO and OC) observations, there were 4 enrolled Infants in the 1's Classroom. The facility is not licensed to provide care to infant children. Staff Statements: *The turf (in the front playground) is uneven for the children in the 1’s classroom that are not walking yet. *We didn’t know to check that children over 1 and not walking yet were still considered infants. *Children are not yet walking. *4 of the children enrolled do not walk yet. Reference R9-5-101. Definition 62. “Infant” means: a. A child 12 months of age or younger, or b. A child 18 months of age or younger who is not yet walking.”

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 CO and OC's observations, in Classroom 4, the surface of the counter next to the diaper changing sink had paper plates, a plastic bucket labeled Dough, a clipboard, a cell phone, and a plastic bottle with blue liquid.”

AAC R9-5-501.A.20. A. A licensee shall ensure that:20. Hand sanitizers: a. When being stored, are stored separate from food storage areas and are inaccessible to enrolled children; and b. When being provided for use, are accessible to enrolled children; and

“Findings: Based on the CO and OC's observations, next to the kitchen and classroom hallway, there was a closet door that was open. It contained Clorox bleach bottles, Clorox bleach tablets, Windex, Clorox toilet bowl cleaner, Odor-B-Gone, and a glass cleaner accessible to enrolled children.”

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: Based on CO and OC's observations, in Classroom 4 and Classroom 3 the health, safety, and welfare of an enrolled child was placed at risk of harm when children were served food items that were not developmentally appropriate items or sizes for the enrolled children’s age. Classroom 4 *Enrolled 1 year old children were served chicken pieces that were 1-1.5 inch in length, while eating an enrolled 1 year old choked while the CO was in the classroom observing. Classroom 3 *Enrolled 2-3 year old children were served whole grapes and chicken pieces that were 2-2.5 inches in length, and children were walking around the room while eating.”

AAC R9-5-603.C. C. Except as provided in subsection (D), a licensee shall ensure that an outdoor activity area:1. Is enclosed by a fence: a. A minimum of 4 feet high; b. Secured to the ground; and c. With either vertical or horizontal open spaces on the fence or gate that do not exceed 4.0 inches; 2. Is maintained free from hazards, such as exposed concrete footings and broken toys; and 3. Has gates that are kept closed while an enrolled child is in the outdoor activity area

“Findings: Per allegation and based on staff statements and the CO and OC's observations, on the playground, the large steel play equipment is not bolted down to the ground, and the equipment slides/moves when used and wobbles when pushed on lightly to the touch. There are broken toys with sharp edges and other plastic items that are broken and jagged with sharp edges. Staff Statements: *Sometime while younger children are on or around the equipment, the school-age children try to pull over the play equipment because they know it is not bolted to the ground. *There is broken equipment, we try and keep the kids off of the broken items, but it is hard. *The school bus and fire truck steering wheels were broken with sharp edges. *We try and fix the broken stuff ourselves, in our off time.”

AAC R9-5-510.B.1. B. A licensee shall ensure that a staff member does not use or permit: 1. A method of discipline that could cause harm to the health, safety, or welfare of an enrolled child;

“Findings: Based on staff statements and the CO and OC's observations, it was determined that a method of discipline that could cause harm to the health, safety or welfare of an enrolled child was used when staff have been observed grabbing children aggressively, yelling at children or using their hands to mock slap children in the face. Staff Statements: *No redirection or conversation with children about not biting, hitting, kicking and spitting on staff by management. *A staff member has been observed grabbing a child by the arm aggressively and tossing them away from the area. *A staff member has been observed placing their hand next to children’s cheeks and slapping their own hand. *A staff member has kicked a toy, it rolled and hit an child. *A staff member grabbed a student and yelled at them.”

AAC R9-5-503.B. B. A licensee shall ensure that a staff member does not:1. Permit a bottle, formula, food, eating utensil, or food preparation in a diaper changing area; 2. Draw water for human consumption from a diaper changing area sink; or 3. Except as provided in subsection (C), if responsible for food preparation, change diapers until food preparation duties have been completed for the day.

“Findings: Based on CO and OC's observations, in Classroom 4, the surface of the counter next to the diaper changing sink had a clear pitcher filled with water, a baby bottle, a plastic container with food items, and a plastic cup of pears.”

AAC R9-5-509.C.18. C. A licensee shall ensure that:18. A staff member: a. Prepares a weekly menu at least one week in advance, b. Includes on the menu the specific foods to be served on each day, c. Dates each menu, d. Posts each menu at least one day before the first meal on the menu will be served, and e. Writes food substitutions on a posted menu no later than the morning of the day of meal service;

“Findings: Based on facility documentation and the CO and OC's observations, the posted menu documented fruit cocktail and fruit of the day but lacked the specific type of fruit in the fruit cocktail and the fruit of the day served to enrolled children.”

AAC R9-5-510.A.2. A. A licensee shall ensure that a staff member: 2. Teaches, models, and encourages orderly conduct, personal control, and age-appropriate behavior;

“Findings: Based on staff statements and the CO and OC's observations, it was determined that staff were not teaching, modeling and encouraging orderly conduct, personal control and age appropriate behavior with enrolled children who are misbehaving. Staff Statements: *The children are removed from the classroom, taken to the office for a couple minutes and brought back with a reward. *If management comes and helps, kids will receive rewards and return back to class, only sometimes are they switched to other classes. *There is no redirection or conversation with children about not biting, hitting, kicking and spitting on staff by management. *Management will not always come to help when the children are hitting, kicking and biting. *A staff member has been observed grabbing a child by the arm aggressively and tossing them away from the area. *A staff member has been observed placing their hand next to child’s cheeks and slapping their own hand. *A staff member has kicked a toy, it rolled and hit a child. *A staff member grabbed a student and yelled at them. *A staff member has yelled NO KNOCK IT OFF and GET DOWN, GET AWAY”.”

AAC R9-5-402.A. A. A licensee shall maintain a file for each staff member containing:1. The staff member’s name, date of birth, home address, and telephone number; 2. The staff member’s starting date of employment or volunteer service; 3. The staff member’s ending date of employment or volunteer service, if applicable; 4. The name and telephone number of an individual to be notified in case of an emergency; 5. The staff member’s written statement attesting to current immunity against measles, rubella, diphtheria, mumps, and pertussis; 6. The form required in A.R.S. § 36-883.02(C); 7. Documents required by R9-5-203; 8. Documents required by R9-5-301; 9. Documents required by R9-5-401, if applicable; 10. If applicable: a. The form required in A.R.S. § 8-804(I), b. Documentation of the submission required in A.R.S. § 8-804 and the information received as a result of the submission, and c. Documentation of training provided by a licensee as required by R9-5-403, if applicable; 11. A copy of any current license or certification required by A.R.S. Title 36, Chapter 7.1, Article 1. or this Chapter; and 12. Documentation of the requirements in A.R.S. § 36-883.02(D).

“Findings: The Compliance Officer reviewed staff files. The file for staff 1 lacked the form required in ARS 36-883.02(C) - criminal history affidavit and documentation of completing the required new staff training. The file for staff 2 lacked the name and telephone number of an individual to be notified in case of an emergency and the staff member's written statement attesting to current immunity. The file for staff 3 lacked documents required by R9-5-401 - documentation of education.”

AAC R9-5-306.B. B. A licensee shall: 1. Develop, document, and implement policies and procedures to ensure that a staff member maintains daily documentation of the presence of an enrolled child in an activity area that includes a method to account for any temporary absences of the enrolled child from the activity area, and 2. Maintain the documentation of the presence of enrolled children in an activity area required in subsection (B)(1) on facility premises for 12 months after the date of the documentation.

“Findings: The Compliance Officer observed that the attendance roster in the 3- school age classroom had 6 children physically present in the room and the roster had 4 children marked as present.”

AAC R9-5-503.A.4. A. A licensee shall ensure that each diaper changing area required in R9-5-601(4) contains:4. At least one waterproof, sanitizable container with a waterproof liner and a tight fitting lid for soiled clothing.

“Findings: The Compliance Officer observed that the 1's diaper changing area lacked a lined container with a lid for soiled clothing.”

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;

“Findings: The Compliance Officer observed that the posted lesson plans in each classroom were not dated.”