Living Streams Children's Center

AAC R9-5-509.C.20. C. A licensee shall ensure that: 20. Perishable foods, which are foods that become unfit for human consumption if not stored to prevent spoilage, are covered and stored in a refrigerator at a temperature of 41° F or below;

“Findings: Based on the Compliance Officer's observations, both of the thermometers in the infant room refrigerator read 44 degrees F. The refrigerator in the PreK room that contained children's food lacked a thermometer.”

AAC R9-5-502.C.1.lk. C. A licensee shall ensure that: 1. A staff member providing child care services in an infant room: k. Obtains written, current, and dated dietary instructions from a parent or health care provider regarding the method of feeding and types of foods to be prepared or fed to an infant at the facility;

“Findings: Based on the Compliance Officer's review of the written infant feeding instructions and on a discussion with staff, the following was noted: *Child 1- the staff stated the child ate solid foods but the form lacked the amount of food to be fed or the frequency of the feedings; and *Child 2- the staff stated the child ate puréed foods but the form lacked the amount of the purée to be fed to the infant.”

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: Based on the Compliance Officer's observation, a ratio of 2:14 was observed on the playground, with the youngest children in the group being 1-year-olds.”

AAC R9-5-605.B.9. B. A licensee shall ensure that: 9. Fans are mounted and inaccessible to an enrolled child;

“Findings: Based on the Compliance Officer's observation, an unmounted fan was on a shelf in the Preschool room.”

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: Based on the Compliance Officer's observations, 3 packets of puréed food in the infant room were not labeled with the infant’s first and last name.”

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: Based on the Compliance Officer's observation, a plunger was stored on the floor next to one of the toilets in the breezeway bathroom and was accessible to children.”

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's observations, a 6-inch vertical opening was observed at the bottom of the wrought iron fence in 3 separate sections of the fence that is located between the toddler and preschool playgrounds.”

AAC R9-5-516.B.4. B. If prescription or nonprescription medications are administered, a licensee shall ensure that:4. A staff member : a. Administers a prescription medication provided by a parent only from a container dispensed by a pharmacy; b. Administers a nonprescription medication provided by a parent for an enrolled child only from a container prepackaged and labeled for use by the manufacturer and labeled with the enrolled child’s name; c. Does not administer any medication that has been transferred from one container to another; and d. Does not administer a nonprescription medication to an enrolled child inconsistent with the instructions on the nonprescription medication’s label, unless the facility receives written authorization from the enrolled child’s health care provider.

“Findings: Based on the Compliance Officer's observations, a child's over-the-counter medication was not labeled with the child’s first and last name.”

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.

“Findings: Based on the Compliance Officer's observations, the posted Emergency plan was dated 4/25/24 and had not been updated within the last 12 months.”

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: Based on the Compliance Officer's observations, a pungent odor of sewer gas was smelled at the food prep sink in the 2-3 year old room.”

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 the Compliance Officer's observations, the May 2025 AM & PM snack menu listed "Gogurt", "Fruit cup" and "Nutrigrain bar" on various days of the month but did not state the specific components of these items.”

AAC R9-5-502.C.3.a. C. A licensee shall ensure that: 3. When preparing, using, or caring for an infant's feeding bottles, a staff member: a. Labels each bottle received from the parent with the infant's name;

“Findings: Based on the Compliance Officer's observations, 4 bottles in the infant room were not labeled with the child’s first and last name.”

AAC R9-5-502.C.1.l. C. A licensee shall ensure that:1. A staff member providing child care services in an infant room: l. Obtains written, current, and dated dietary instructions from a parent or health care provider regarding the method of feeding and types of foods to be prepared or fed to an infant at the facility;

“Findings: Based on the Compliance Officer's review of the written infant feeding instructions and on a discussion with staff, the following written feedings insructions lacked information: *Child 1- The staff stated the infant was eating puréed food but the written feeding instructions did not state the amount and frequency of the feedings; *Child 2- The staff stated the infant was eating solid foods but the written feeding instructions stated the child was eating only puréed foods and it did not state the amount of solid food to be fed; and *Child #3- The staff stated the infant was eating solid foods but the written feeding instructions stated the child was eating only puréed foods. The form stated it had last been updated in October 2024 and was not current.”

AAC R9-5-203.D. D. A licensee shall ensure that each staff member submits to the licensee a copy of the staff member’s valid fingerprint clearance card each time the fingerprint clearance card is issued or renewed every six years.

“Findings: Based on facility documentation and the Compliance Officer's review of Staff #3's file (DOE 9/23/21), the staff's fingerprint clearance card expired on 1/30/24, and a renewal card was issued on 11/4/2024.”

AAC R9-5-603.E. E. A licensee shall ensure that the following is provided and maintained within the fall zones of swings and climbing equipment in an outdoor activity area:1. A shock-absorbing unitary surfacing material manufactured for such use in outdoor activity areas; or 2. A minimum depth of 6 inches of a non-hazardous, resilient material such as fine loose sand or wood chips.

“Findings: Based on the Compliance Officer's observations, the wood chips measured the following depths in the fall zones: *3 inches of the required 6 inches at the base of the toddler slide and the base of the preschool slide; *1 inch of the required 6 inches under the swings; and *4 inches of the required 6 inches under the rock climbing wall.”

AAC R9-5-303.A. A. A licensee shall post in a place that can be conspicuously viewed by individuals entering or leaving the facility or activity area, the:1. Facility’s license; 2. Name of the facility director; 3. Name of the individual designated to act on behalf of the facility director when the facility director is not present in the facility, as prescribed by R9-5-301(B)(1); 4. Schedule of child care services fees and policy for refunding fees as prescribed by A.R.S. § 36-882(P); 5. Breakfast, lunch, dinner, and snack menus for each calendar week at the beginning of the calendar week; 6. Notice of the presence of any communicable disease or infestation listed in 9 A.A.C. 6, Article 2, Table 2, from the date of discovery through the incubation period of the communicable disease or infestation; 7. Notice of the Department’s intent to deny, revoke, or suspend as prescribed by A.R.S. § 36-888 at the expiration of time in the notice for the licensee to respond; 8. Notice of an intermediate sanction imposed as prescribed by A.R.S. § 36-891.01 within 10 calendar days after the licensee received notice of the intermediate sanction; 9. Notice of a legal injunction imposed as prescribed by A.R.S. § 36-886.01 when the licensee receives the legal injunction; and 10. Notice of the availability of facility inspection reports for public viewing at the facility premises.

“Findings: Based on the the Compliance Officer's observation, the main posting area lacked the current license. The posted license expired 7/31/2023.”

AAC R9-5-305.A. A. A licensee shall not permit an enrolled child to attend a facility until the facility receives: 1. An immunization record for the enrolled child with the information required in 9 A.A.C. 6, Article 7, documenting that the enrolled child has received all current, age-appropriate immunizations required under 9 A.A.C. 6, Article 7: a. Provided by a healthcare provider, or b. Generated from the Arizona State Immunization Information System, which is the Department’s child immunization reporting system established in A.R.S. § 36-135; or 2. An exemption affidavit for the enrolled child provided by the enrolled child’s parent that contains: a. A statement, signed by the enrolled child’s health care provider, that the immunizations required by 9 A.A.C. 6, Article 7 would endanger the enrolled child’s health or medical condition; or b. A statement, signed by the enrolled child’s parent, that the enrolled child is being raised in a religion whose teachings are in opposition to immunization.

“Findings: Based on facility documentation and the Compliance Officer's observations, the Emergency, Information and Immunization Record Cards for Child #1 & Child #2 lacked a written immunization record or exemption affidavit.”

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.

“Findings: Based on facility documentation and the Compliance Officer's observations, it was determined that 5 out of 15 enrolled children's attendance forms reviewed lacked the following required information: Child #1: Release time and signature on 5/24/2024. Child #3: Release times and signatures on 5/14/2024 & 5/17/2024. Child #4: Arrival time and signature in the afternoon on 5/15/2024. Child #5: Release signature in the afternoon on 5/14/2024. Child #6: Release times and signatures on 5/15/2024 & 5/17/2024.”

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, in Room C102, there were 5 children present and 4 children were marked on the roster.”

AAC R9-5-401.4. A licensee shall ensure that staff members meet the following qualifications for employment or volunteer service at a facility:4. An assistant teacher-caregiver is 16 years of age or older and provides the licensee with documentation of one of the following: a. Current and continuous enrollment in high school or a high school equivalency class; b. High school or high school equivalency diploma; c. Enrollment in vocational rehabilitation, as defined in A.R.S. § 23-501; d. Employment as a teacher-caregiver aide for 12 months; or e. Service as a volunteer in a child care facility for 12 months;

“Findings: Based on facility documentation, the Compliance Officer's observation and staff statement, Staff #1 was an assistant teacher caregiver. Staff #1 was not qualified as an assistant teacher caregiver as the file lacked documentation of a high school or high school equivalency diploma, or current and continuous enrollment in high school or a high school equivalency class. Staff stated they just graduated last week.”

AAC R9-5-501.A.12. A. A licensee shall ensure that: 12. The facility premises, including the buildings, are maintained free from hazards;

“Findings: Based on the Compliance Officer's observations, the following hazards were accessible to enrolled children: Room 104 toilet room: There was peeling white paint on the bottom right side of the door leading to the outside of the building. Room C102: There was raw wood on the edges of a white table.”

AAC R9-5-501.A.18. A. A licensee shall ensure that:18. Each enrolled child’s pacifier is labeled with an identifier that is specific to the enrolled child and maintained in a clean condition;

“Findings: Based on the Compliance Officer's observation, in the Infant room, there was 1 unlabeled pacifier in an infant’s mouth, rather than labeled with an identifier specific to an enrolled child.”

AAC R9-5-501.C.9. C. 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: Based on the Compliance Officer's observations, in the Infant room, there was healing ointment labeled with a child’s first name only, and a tube of Butt paste labeled with a child’s initials only, rather than with a child’s first and last name as required.”

AAC R9-5-502.A.5.a. A. A licensee providing child care services for infants shall:5. Develop, document, and implement tummy time policies and procedures that: a. Provide an opportunity for a non-crawling infant to experience tummy time each day: i. While the infant is awake, and ii. On the infant’s stomach;

“Findings: Based on staff statement, tummy time is not always documented. Staff stated sometimes they forget to document it.”

AAC R9-5-502.C.1.l. C. A licensee shall ensure that:1. A staff member providing child care services in an infant room: l. Obtains written, current, and dated dietary instructions from a parent or health care provider regarding the method of feeding and types of foods to be prepared or fed to an infant at the facility;

“Findings: Based on facility documentation and the Compliance Officer's observation, the written feeding instructions for Child #7 was not current. The plan was dated 10/8/2023 and did not include the foods to be fed to the child.”

AAC R9-5-502.C.3.a. C. A licensee shall ensure that: 3. When preparing, using, or caring for an infant's feeding bottles, a staff member: a. Labels each bottle received from the parent with the infant's name;

“Findings: Based on the Compliance Officer's observations, in the Infant room, there were 3 bags containing a white substance labeled with a child’s first name only, and an unlabeled pink bottle containing a white substance in the refrigerator.”

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 and staff statement, the diaper changing area in Room C102 was not seamless and smooth. The surfacing was rough. Staff stated it was on the list to be fixed or replaced.”

AAC R9-5-503.A.2. A. A licensee shall ensure that each diaper changing area required in R9-5-601(4) contains:2. A hand-washing sink next to the diaper changing surface for staff use when changing diapers and for washing an enrolled child during or after diapering that provides: a. Running water between 86° F and 110° F, b. Soap from a dispenser, and c. Single-use paper hand towels from a dispenser;

“Findings: Based on the Compliance Officer's observations, the water temperature in the following diaper changing sinks measured below 86 degrees F, rather than between 86 - 110 degrees F as required: C102: 82.9 degrees F. Infant room: 84.2 degrees F.”

AAC R9-5-512.D. D. A licensee shall ensure that toilet bowls, lavatory fixtures, and floors in toilet rooms and kitchens are cleaned and sanitized as often as necessary to maintain them in a clean and sanitized condition or at least once every 24 hours.

“Findings: Based on the Compliance Officer's observation, in Room C208 toilet room, there was a thick layer of a brown fluffy substance on the ceiling vent.”

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's observations, on the Preschool playground, there was 2” of cracked plastic on the top right side of the stairs on the large climber.”

AAC R9-5-603.E. E. A licensee shall ensure that the following is provided and maintained within the fall zones of swings and climbing equipment in an outdoor activity area:1. A shock-absorbing unitary surfacing material manufactured for such use in outdoor activity areas; or 2. A minimum depth of 6 inches of a non-hazardous, resilient material such as fine loose sand or wood chips.

“Findings: Based on the Compliance Officer's observations, the Preschool playground lacked 1” of the required 6” of resilient surface (wood chips) in the fall zones of 4 swings and the stepping stones.”

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 the Compliance Officer’s observations, the posted menu lacked the specific type/flavor of cheese, fruit cup, Nutrigrain bar, and GoGurt to be served to enrolled children.”