Montessori Room Annex

AAC R9-5-502.C.1.g. C. A licensee shall ensure that: 1. A staff member providing child care services in an infant room: g. Does not allow bumper pads, pillows, comforters, sheepskins, stuffed toys, or other soft products in a crib when an infant is in the crib;

“Findings: Based on the Compliance Officer's observations, in the Infant's Room A, there was an infant sleeping with a lion pacifier soft plush clip holder in the crib.”

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, in the Infant B1 Room, there was an unlabeled can of Similac Alimentom.”

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 the Compliance Officers’ observations, the health, safety or welfare of enrolled children was placed at risk of harm when the fire alarm panel located in the Room 2A 1's room, had the "trouble mode" light flashing and panel read "report fail".”

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. Change diapers until food preparation duties have been completed for the day.

“Findings: Based on staff statements and the Compliance Officer's observations, the following diaper changing sinks were being used to dispose of food and wash eating utensils: Infant Room A classroom- The food prep area was located next to the diaper changing area and lacked a partition. Infant Room B classroom- Contained pieces of food left in the diaper handwashing sink. In Room 2A 1's classroom- Contained a container labeled "dish soap", and staff stated "we use the sink to wash the snack plates and spoons, because we have no other sink in the classroom".”

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, in Room 3A 2's restroom, there was a clear liquid substance on the floor located on the bottom right side of the toilet.”

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 observations, the following hazards where observed in the outdoor playground and were accessible to enrolled children: -There were 5 to 7 inch gaps in areas of the bottom of the northeast side of the chain link fence. -There was an 8x9 inch triangular gap on the bottom portion of the east side of the chain link fence. -3 out of the 4 concrete footings of the shade structure posts were exposed. -There was a broken red and yellow ladybug insert with sharp edges located on the Little Tikes tree house play structure. -There was a small palm tree located on the opposite side of the chain link fence, that had fronds with sharp edges that children could reach. -There was a utility post with black plastic netting at the bottom that was torn and had sharp edges. -There were portions of the bottom of the chain link fence that were not secured to the ground and had sharp edges. -The bottom of the exterior classroom door to Room 2A (1's) had splintered wood where the kick plate was missing.”

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: Based on facility documentation and the Compliance Officer's observations, it was determined that the facility lacked a current fire inspection report. The fire inspection on file expired on 4/30/2026.”

AAC R9-5-501.A.20. A. A licensee shall ensure that: 20. 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: Based on the Compliance Officer’s observations, in the 2A 1’s Room restroom, there was a red mop bucket accessible to enrolled children.”

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 observations, in the 2A 1’s Room restroom, there was a plunger on left side of toilet accessible to enrolled children.”

AAC R9-5-503.A.3.4. A. A licensee shall ensure that each diaper changing area required in R9-5-601(4) contains: 3. At least one waterproof, sanitizable container with a waterproof liner and a tight fitting lid for soiled diapers; and 4. At least one waterproof, sanitizable container with a waterproof liner and a tight fitting lid for soiled clothing.

“Findings: Based on staff statements and the Compliance Officer's observations, in Room 2A 1’s classroom, the diaper changing area lacked a soiled clothing container. Staff stated they "put clothing in a plastic bag and then place it in the child’s backpack to take home".”

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 Officers observations, the water temperatures in the following diaper changing areas were not maintained between 86 and 110 degrees: Infant Room A- The water temperature was 116ºF. Infant Room B- The water temperature was 122ºF. Room 3A 2's- The water temperature was 117.4ºF.”

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 observation, in the Infant's Room B classroom, there was 1 bottle that lacked the enrolled child's last name.”

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, in the 3A 2's Room restroom, there were protruding screws at the base of the toilet.”

AAC R9-5-403.B. B. A licensee shall ensure that: 1. Each staff member who provides child care services completes 24 or more clock 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 below: a. Child growth and development, including: i. Infant growth and development, including sudden infant death syndrome prevention and safe sleeping practices; ii. Brain development; iii. Basic child development, including cognitive, social, emotional, and physical, as well as approaches to learning; iv. Language development; v. Observation and child assessment; vi. Developmentally-appropriate activities; vii. Child guidance and methods of positive discipline which may include techniques to promote healthy social-emotional development and reduce challenging behaviors; or viii. 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; vii. Water safety; viii. Prevention and control of infections diseases, including immunizations; ix: Prevention and response to emergencies due to food and allergic reactions, including anaphylactic shock; x. Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; xi. Emergency preparedness, response, and recovery planning for emergencies resulting from a natural disaster or a human-caused event; xii. Administration of medication, consistent with standards for parental or guardian consent; xiii. Handling and storage of hazardous materials and the appropriate disposal of biocontaminants; xiii. Handling and storage of hazardous materials and the appropriate disposal of biocontaminants; xiiii. Prevention of shaken baby syndrome, pediatric abusive head trauma, and child maltreatment; or xv. Physical restraint techniques. c. Program administration, planning, development, or management; and d. Availability of community services and resources, including those available to children with a special health care need or a disability; and 2. As part of the required 24 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 six hours in subsection (B)(1)(c) every 12 months after the facility director’s starting date. e. A child educator for school-aged children shall complete six of the 24 hours of training within the first three months of hire.

“Findings: Based on facility documentation and the Compliance Officer's observations, it was determined that Staff #1's (D.O.H. 08-18-2022) file lacked 18 of the required 24 hours of training every 12 months.”

AAC R9-5-603.D. D. 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, in the outdoor activity area, the small play structure with a blue slide located under the shade, lacked 2 in a half inches of the required 6 inches of resilient surfacing. The Little Tikes tree house play structure lacked resilient surfacing on all fall zones.”

AAC R9-5-302. A licensee shall prepare a written statement of child care services provided by the licensee that includes the following: 1. A description of the facility’s child care services classifications in R9-5-204; 2. Hours of operation; 3. The facility’s street address, city, state, zip code, mailing address, and telephone number; 4. Child enrollment and disenrollment procedures; 5. Charges, fees, and payment requirements for child care services; 6. Child admission and release requirements; 7. Guidelines for positive discipline reflective of age-appropriate methods for children that include clear, appropriate, consistent expectations; 8. Transportation procedures; 9. Field trip requirements and procedures; 10. Responsibilities and participation of parents in facility activities; 11. A general description of activities and programs; 12. A description of the liability insurance required by R9-5-308 that is carried by the licensee and a statement that documentation of the liability insurance coverage is available for review on the facility premises; 13. Medication administration procedures; 14. Accident and emergency procedures; 15. A notice stating inspection reports are available on-site; 16. A provision stating that the facility is regulated by the Arizona Department of Health Services including the Department’s local street address, city, state, zip code, and local telephone number; 17. The procedures for notifying a parent at least 48 hours before a pesticide is applied on a facility’s premises; 18. A statement that a parent has access to the areas on facility premises where the parent’s enrolled child is receiving child care services; and 19. Policies and procedures for suspension and expulsion of children to include clear, appropriate, consistent expectations, including suspension and expulsion prevention strategies.

“Findings: Based on facility documentation and the Compliance Officer’s observations, it was determined that the Statement of Services lacked the following information: -Guidelines for positive discipline reflective of age-appropriate methods for children that include clear, appropriate, and consistent expectations; -The department's name, address, and phone number and; -Policies and procedures for suspension and expulsion prevention.”

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 facility documentation and the Compliance Officer’s observations, it was determined that 6 of the 11 Emergency, Information, Immunization Record cards lacked the following: Child #1- Date of enrollment and both parent's email address. Child #2- Email address for both parents. Child #3- Email address for both parents and phone number for first parent. Child #4- Email address for both parents, phone number for the two individuals authorized by parent to collect child, name and number of healthcare provider, the back of card noting child's susceptibility to illness, physical conditions of which a staff member should be aware, and any individual requirements for health maintenance, and the parents signature and date. Child #5-Email address for both parents, a second individual authorized by parent to collect child, and name and phone number of healthcare provider. Child #6- Full date of enrollment, email address for both parents, and home address for both parents.”

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 statement, signed by the enrolled child's: a. 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. 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, it was determined that Child #2 lacked a copy of their immunization records.”

AAC R9-5-306.A. A. A licensee shall: 1. Maintain a dated attendance form containing an enrolled child’s name with the time of each admission and release, and the parent or staff member's signature or other unique identifier. 2. If an electronic signature is used to admit or release the enrolled child, 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; 3. 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. 4. 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. 5. 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. 6. 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 3 out of 12 children’s attendance records lacked the following documentation: Child #15 and Child 17: An arrival signarure for 8/4/2026. Child #16: An arrival and release time for 8/3/2026, and an arrival signature for 8/4/2026.”

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 facility documentation and the Compliance Officer observations, it was determined that 11 infant written dietary instructions sheets lacked the following information: Child #1- Type of formula, date, time, foods and amount of feeding schedules and updates. Child #2 and Child #3- Type of formula, and dates and times of feeding schedules and updates. Child #7- Dates for feeding schedule and updates and dates of foods introduced at home. Child #8 and Child #14- Type of formula. Child #9- Dates for feeding schedule and updates. Child #10- Method of feeding and dates for feeding schedules and updates. Child #11- Type of formula and dates for feeding schedule and updates. Child #12- Date of birth, allergies, consistency, method of feeding, dates for feeding schedules and updates and the food list checked with foods and dates introduced at home. Child #13- Type of formula, feeding schedules and updates, and dates for foods introduced at home checked.”

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: Based on the Compliance Officer's observation and on a discussion with staff, the door of the Older infant room that leads to the office was open when the Compliance Officer arrived and was entering the office alongside of a parent who was picking up their infant. The staff acknowledged that the door had been opened by the staff prior to the parent's arrival, when the parent had messaged the teacher that they were on their way to pick up the infant.”

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,1 bottle in the Older infant room and 1 bottle in the Younger infant room were not labeled with the infant's first and last name.”

AAC R9-5-512.F.7. F. A licensee shall ensure that: 7. Toys, materials, and equipment are maintained in a clean condition;

“Findings: Based on the Compliance Officer's observations, both shelves of the storage cabinet that is located underneath the diapering table in the 1-year-old room contained storage of various classroom art supplies. Several of the art supplies were stored directly next to the soiled clothing container that is used for soiled clothes related to diapering.”

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 Compliance Officer's observations, the following designated exits were obstructed: *Younger infant room- The exit that leads to the exterior was obstructed by 2 infant feeding chairs; and *One year old room- The exit leading to the parking lot was obstructed by an occupied nap mat.”

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: Based on the Compliance Officer's observations, 4 packages of diapering wipes in the 1 year old room were not labeled with the child's first and last name.”

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

“Per allegation findings: Based on Compliance Officer's observation, the 2 year old classroom was in a staff-to-child ratio of 1:9 instead of the state mandated ratio of 2:9.”

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 Supervisor and the Compliance Officer's observation, the following hazards were accessible to enrolled children in the outdoor activity area: *There were 8 screws protruding up from the cement footings for the shade structure; and *There were 4 exposed concrete footings for the shade structure.”

AAC R9-5-604.B.3. B. A licensee that uses a private pool for an enrolled child shall ensure that the swimming pool and its equipment meet the following requirements: 3. A portable pool that does not meet the requirements of subsection (B)(1) or (2) is prohibited;

“Findings: Based on the Compliance Officer's and the Compliance Officer Supervisor's observations and on staff statements, 2 splash pads with attached wading pools were observed in the outdoor activity area. Staff stated they had been using them for the kids twice a week over the summer and as recently as the last week of July 2024. *Note: Previously cited on 5/30/24.”

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: Based on the Compliance Officer Supervisor's observation and on staff statements, Room 3 lacked a posted lesson plan. The staff stated they had taken it down to work on it, and left it in their car.”

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 Supervisor's observation, in Infant B there was a container of Vaseline with the child's first name, rather than the first and last name, as required. In the Infant B freezer, there were four bags with a white substance labeled with the child's first name and three bags with a white substance labeled with initials, rather than the first and last name of the child.”

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: Based on the facility documentation and the Compliance Officer Supervisor's observations, it was determined that the file for Staff #2 (DOE 8/18/2022) lacked a completed 10-day training. The 10-day training for Staff #1 (DOE 8/18/2022) stated it was completed on 5/18/2022, prior to the starting date of employment.”

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: Based on the Compliance Officer's review of the City of Phoenix's annual fire inspection, the fire inspection had expired in May 2024 and was not current.”

AAC R9-5-301.F. F. A licensee shall ensure that a staff member submits, on or before the starting date of employment or volunteer services, one of the following as evidence of freedom from infectious active tuberculosis: 1. Documentation of a negative Mantoux skin test or other tuberculosis screening test recommended by the U.S. Centers for Disease Control and Prevention, administered within 12 months before the starting date of employment or volunteer service, that includes the date and the type of tuberculosis screening test; or 2. If the staff member has had a positive Mantoux skin test or other tuberculosis screening test, a written statement that the staff member is free from infectious active tuberculosis that is signed and dated by a health care provider within six months before the starting date of employment or volunteer service.

“Findings: Based on the facility documentation and the Compliance Officer Supervisor's observation, it was determined that the file for Staff #1 (DOE 8/18/2022) contained a negative Mantoux skin test that was read on 8/19/2022 after the starting date of employment.”

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 a discussion with the infant room staff, staff stated that Child #1 was eating food and drinking cow's milk. The section of the form that lists the foods that the infant had tried was blank and the parent had not completed it. The feeding schedule lacked the amount and frequency of food and milk to be fed to the child”

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 Supervisor's and Compliance Officer's observations, the temperature in the Infant B diaper changing sink was 120 degrees F, and the temperature in the Toddler room diaper changing sink was 118 degrees F, rather than between 86-110 degrees F, as required.”

AAC R9-5-509.C.22. C. A licensee shall ensure that:22. A refrigerator at the child care facility maintains a temperature of 41° F or below, as shown by a thermometer kept in the refrigerator at all times;

“Findings: Based on the Compliance Officer Supervisor's observation, the temperature in the Infant B refrigerator was 48 degrees F.”

AAC R9-5-509.C.23. C. A licensee shall ensure that:23. A freezer at the child care facility maintains a temperature of 0° F or below, as shown by a thermometer kept in the freezer at all times; and

“Findings: Based on the Compliance Officer Supervisor's observation, the temperature in the Infant B freezer was 10 degrees F.”

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 the Compliance Officer Supervisor's observation and discussion with staff, the staff acknowledged that the written permission to administer the medication had not been obtained.”

ARS § 36-883.02.C. C. Applicants, licensees and child care personnel shall attest on forms that are provided by the department that:1. They are not awaiting trial on or have never been convicted of or admitted in open court or pursuant to a plea agreement committing any of the offenses listed in section 41-1758.07, subsection B in this state or similar offenses in another state or jurisdiction. 2. They are not parents or guardians of a child adjudicated to be a dependent child as defined in section 8-201. 3. They have not been denied or had revoked a certificate to operate a child care group home or a license to operate a child care facility in this or any other state or that they have not been denied or had revoked a certification to work in a child care facility or child care group home.

“Findings: Based on facility documentation and the Compliance Officers' observations of 4 staff files, Staff #1's file lacked a completed Criminal History Affidavit.”

AAC R9-5-604.B.3. B. A licensee that uses a private pool for an enrolled child shall ensure that the swimming pool and its equipment meet the following requirements: 3. A portable pool that does not meet the requirements of subsection (B)(1) or (2) is prohibited;

“Findings: Based on the Compliance Officers' observations, on the playground there was a blue portable pool. One of the warning labels on the pool stated "Closely watch children who are in or near this pool".”

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 Officers' observations of the outdoor activity area, the following hazards were observed: *There were sharp metal edges on the bottom of the north chain link fence and a 6" piece of protruding metal on the bottom of the east chain link fence. *The chain link fence was unsecured on the north east side. *There was an unsecured blue slide in the sand. *There was an exposed 10" circular footing with rough concrete surfacing. ***Discussed at Initial inspection on 8/17/2022 & previously cited 1/24/2023, 5/16/2023 & 8/15/2023 *Repeat deficiency 1/29/2024”

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 Officers' observations, in the toilet room in Room 3, there was a fluffy brown substance in the hole in the ceiling where the ceiling vent was missing. ***Previously cited 8/15/2023”

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 Compliance Officers' observations, in Room 3 there were discolored stains on the blue circle rug. ***Previously cited 8/17/2022 ***Repeat deficiency 1/29/2024”

AAC R9-5-503.D. D. A licensee shall ensure that a written diaper changing procedure is posted and implemented in each diaper changing area.

“Findings: Based on the Compliance Officers' observations and staff statement, in Room 3 the diaper area lacked a soap and water solution to clean the diaper table at the completion of a diaper change. Staff stated they use Bioesque to clean the table. ***Repeat deficiency 8/15/2023 (under R9-5-503.E.) & 1/29/2024”

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 Officers' observations, the following diaper changing areas were not seamless and smooth, and clear of unrelated items: Room 2: There were remnants of sand and debris on the diaper surface and on the diaper sink, and there was a green towel below the sink nozzle. There were two 1" openings on both sides of the diaper sink surface. Room 3: There was a pink heart sponge and a container of Dawn dish soap to the left of the diaper sink, and there were cracks with debris along the edges of the diaper surface. ***Previously cited 1/23/2024, 5/16/2023, 8/15/2023, & 1/29/2024”

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, the Compliance Officers' observations and staff statement, the written feeding instructions for Child #2 was not current. The plan was dated 1/8/2024 and did not include all of the foods the child eats. Child #3's form was dated 4/4/2024 and did not list all of the foods the child eats. Staff stated the child eats everything. ***Previously cited 1/29/2024”

AAC R9-5-502.A.8.a. A. A licensee providing child care services for infants shall: 8. Provide a crib for each infant that: a. Has bars or openings spaced no more than 2-3/8 inches apart and a crib mattress measured to fit not more than 1/2 inch from the crib side;

“Findings: Based on the Compliance Officers' observations, the following was observed in 2 Infant rooms: In the South Infant room, the plexiglass additions (located on the ends of some of the cribs) were located 4” from the bottom of the cribs, and the mattress pads were 2.5” high. There was a 1.5-inch gap between the end of the plexiglass and the crib mattress pad. In the North infant room, there was a 2” gap between the end of the plexiglass and the crib mattress pad. *Previously cited 8/17/2022, 1/24/2023, 5/16/2023 & 1/29/2024.”

AAC R9-5-501.A.19. A. A licensee shall ensure that:19. 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 Officers' observations, the following chemicals were accessible to enrolled children: Toilet room in room 3: There was Windex and Febreze on a shelf, and a container of hand sanitizer hanging on the opposite side. Room 3: There were 2 bottles of Botanical disinfectant solution on a low shelf. *** Previously cited 8/17/2022, 1/24/2023, 5/9/2023, 5/16/2023, & 8/15/2023”

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 Officers' observations, in the toilet room in Room 3, the ceiling vent was missing the vent cover. ***Discussed at Initial inspection on 8/17/2022 & previously cited 1/23/2024, 5/9/2023, 8/15/2023 & 1/29/2024”

AAC R9-5-501.A.4. A. A licensee shall ensure that: 4. An enrolled child is placed in an age-appropriate or developmentally-appropriate group;

“Findings: Per allegation and based on the Compliance Officers' observations in Room 3/4, there were one-year-old children mixed with older children (up to the age of 5). The children present were not placed in age-appropriate or developmentally-appropriate groups.”

AAC R9-5-404.E. E. In addition to maintaining the required staff-to-children ratios, a licensee shall ensure that:1. Staff members are present on facility premises to perform facility administration, food preparation, food service, and maintenance responsibilities; and 2. Facility maintenance does not depend on the work of enrolled children.

“Findings: Based on the Compliance Officers' (COs) observation and staff statements, there were 2 staff present at the facility upon the COs arrival. Both staff were in a classroom supervising children. Staff stated they were unaware where the requested items were kept. There was no one present on the facility premises to perform facility administration, until Staff #4 arrived at the facility during the investigation. The 2 staff present did not know where children's Emergency, Information and Immunization Record cards and staff files were kept.”

AAC R9-5-404.C.1. C. A licensee shall ensure that:1. When there are six or more enrolled children present in a facility, the following individuals are present in the facility: a. A facility director or a director’s designee who meets the requirements in R9-5-401 for a director’s designee; and b. One additional staff member;

“Findings: Per allegation and based on the Compliance Officers' observations and staff statement, the Licensee failed to ensure a facility director or a director’s designee who meets the requirements in R9-5-401 for a director’s designee is present in the facility when six or more children are present. The director was not present, and Staff #4 was listed as the designee and was not present at the facility in the beginning of the investigation.”

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 Compliance Officer #1's observations, in Room 3/4 the staff-to-child ratio was 1:10 with one-year-old children present, with a required ratio of 2:10. ***Previously cited 1/29/2024”

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.

“Findings: Based on facility documentation and the Compliance Officers' observations, Staff #3's (start date 2/6/2023) file lacked 18 hours of the required 18 hours of annual training from 2/2023 - 2/2024.”

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: Based on facility documentation and the Compliance Officers' observations, it was determined that the following staff were not qualified as a teacher caregiver and their files lacked the following: *Staff #2's file lacked documentation of a high school diploma or high school equivalency diploma and 5 of the required 6 months of previous child care experience. The document in the file was not translated or evaluated to be equivalent to a high school diploma or high school equivalency diploma from the United States. Staff #3's file lacked documentation of a high school diploma or high school equivalency diploma.”

AAC R9-5-304.C. C. A licensee shall maintain a current Emergency, Information, and Immunization Record card for each enrolled child on facility premises in a place that provides a staff member ready access to the card in event of an emergency at, or evacuation of, the facility.

“Findings: Based on staff statement, no one present knew where the Emergency, Information, and Immunization Record cards were located.”

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 facility documentation and Compliance Officer #1's observation, it was determined that 1 out of 1 enrolled children's Emergency Information and Immunization Record Card reviewed lacked the following required information: Child #1: Date of enrollment and the health care provider's contact number. ***Discussed at Initial inspection on 8/17/2022 & previously cited 1/24/2023, 8/15/2023, & 1/29/2024”

AAC R9-5-302. A. A licensee shall prepare a written statement of child care services provided by the licensee that includes the following:1. A description of the facility’s child care services classifications in R9-5-204; 2. Hours of operation; 3. The facility’s street address, city, state, zip code, mailing address, and telephone number; 4. Child enrollment and disenrollment procedures; 5. Charges, fees, and payment requirements for child care services; 6. Child admission and release requirements; 7. Age-appropriate discipline guidelines and methods; 8. Transportation procedures; 9. Field trip requirements and procedures; 10. Responsibilities and participation of parents in facility activities; 11. A general description of activities and programs; 12. A description of the liability insurance required by R9-5-308 that is carried by the licensee and a statement that documentation of the liability insurance coverage is available for review on the facility premises; 13. Medication administration procedures; 14. Accident and emergency procedures; 15. A notice stating inspection reports are available on-site; 16. A provision stating that the facility is regulated by the Arizona Department of Health Services including the Department’s local street address, city, state, zip code, and local telephone number; 17. The procedures for notifying a parent at least 48 hours before a pesticide is applied on a facility’s premises; and 18. A statement that a parent has access to the areas on facility premises where the parent’s enrolled child is receiving child care services. B. A licensee shall provide a copy of the written statement of child care services: 1. To the Department: a. Before the facility receives a license, and b. Every 12 months after the date of the license as required by A.R.S. § 36-883.01; and 2. To a parent when the parent requests a copy of the written statement of child care services.

“Findings: Based on facility documentation and Compliance Officer #1's observation and staff statement, the statement of services lacked the following information: 1. A description of the liability insurance that is carried by the Licensee and a statement that documentation of the liability insurance coverage is available for review on the facility premises, and 2.Transportation procedures. Staff stated they were unable to locate them in the printed off version of the statement of services. ***Discussed at Initial inspection on 8/17/2022 & previously cited 8/15/2023 ***Repeat deficiency 1/29/2024”

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 the Compliance Officers' observations and staff statements, the facility lacked an individual designated in writing to act on behalf of the facility director when the facility director is not present in the facility. Staff #4 was listed as the Director Designee and Staff #4 was not present at the beginning of the investigation. The 3 staff present were not listed as a Designee and did not know who was in charge at the beginning of the investigation. Staff stated the following: *I do not know who is in charge. *No one was in charge. Staff #4 was not present and was signed in. Staff #4 stated they were on a lunch break.”

AAC R9-5-204. A. The Department licenses child care facilities using the following service classifications: 1. Full-day care; 2. Part-day care; 3. Evening and nighttime care; 4. Infant care; 5. One-year-old child care; 6. Two-year-old child care; 7. Three-year-old, four-year-old, and five-year-old child care; 8. School-age child care; and 9. Weekend care. B. The Department shall designate on a facility’s license each service classification that the facility is licensed to provide. C. A licensee shall not provide child care services in a service classification for which the licensee is not licensed.

“Findings: Per allegation and based on the Compliance Officers' observations, the Licensee was providing child care services in a service classification for which the Licensee is not licensed. Children ages 3 - 5 were present at the facility, and the facility is only licensed for children ages infants to 2.”

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

“Findings: Based on Compliance Officer (CO) #1's observations, staff failed to supervise enrolled children at all times. When CO #1 entered Room 3/4, there was a trifold mat placed on its side separating one child from the other 9 children present. The one staff seated on the opposite side of the room was unable to observe what the child was doing due to the mat being on its side.”

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: Based on the Compliance Officer's observation, the 1's room lacked a lesson plan. *Discussed at the Initial inspection on 8/17/22, and previously cited 5/9/23 & 8/15/2023.”

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 2's room, there was 1 container of wipes labeled with a child's first name and last initial, and 2 unlabeled packages of wipes, rather than with a child's first and last name as required. *Previously cited 1/24/23, 5/9/23 & 8/15/2023.”

AAC R9-5-503.D. D. A licensee shall ensure that a written diaper changing procedure is posted and implemented in each diaper changing area.

“Findings: Based on the Compliance Officer's observation and staff statement, in the 2's room the diaper area lacked a soap and water solution to clean the diaper table at the completion of a diaper change. Staff stated they use Bioesque to clean the table. *Previously cited 8/15/2023 (under R9-5-503 E.).”

AAC R9-5-502.A.8.a. A. A licensee providing child care services for infants shall: 8. Provide a crib for each infant that: a. Has bars or openings spaced no more than 2-3/8 inches apart and a crib mattress measured to fit not more than 1/2 inch from the crib side;

“Findings: Based on the Compliance Officer's observations, the following was observed in 2 Infant rooms: In the South Infant room, the plexiglass additions (located on the ends of some of the cribs) were located 4” from the bottom of the cribs, and the mattress pads were 2.5” high. There was a 1.5-inch gap between the end of the plexiglass and the crib mattress pad. In the North infant room, there was a 2” gap between the end of the plexiglass and the crib mattress pad. *Previously cited 8/17/22, 1/24/23, & 5/16/2023.”

AAC R9-5-302. A. A licensee shall prepare a written statement of child care services provided by the licensee that includes the following:1. A description of the facility’s child care services classifications in R9-5-204; 2. Hours of operation; 3. The facility’s street address, city, state, zip code, mailing address, and telephone number; 4. Child enrollment and disenrollment procedures; 5. Charges, fees, and payment requirements for child care services; 6. Child admission and release requirements; 7. Age-appropriate discipline guidelines and methods; 8. Transportation procedures; 9. Field trip requirements and procedures; 10. Responsibilities and participation of parents in facility activities; 11. A general description of activities and programs; 12. A description of the liability insurance required by R9-5-308 that is carried by the licensee and a statement that documentation of the liability insurance coverage is available for review on the facility premises; 13. Medication administration procedures; 14. Accident and emergency procedures; 15. A notice stating inspection reports are available on-site; 16. A provision stating that the facility is regulated by the Arizona Department of Health Services including the Department’s local street address, city, state, zip code, and local telephone number; 17. The procedures for notifying a parent at least 48 hours before a pesticide is applied on a facility’s premises; and 18. A statement that a parent has access to the areas on facility premises where the parent’s enrolled child is receiving child care services. B. A licensee shall provide a copy of the written statement of child care services: 1. To the Department: a. Before the facility receives a license, and b. Every 12 months after the date of the license as required by A.R.S. § 36-883.01; and 2. To a parent when the parent requests a copy of the written statement of child care services.

“Findings: Based on the facility documentation and the Compliance Officer's observations, the statement of services lacked the following information: 1.Transportation procedures, and 2. A description of the liability insurance that is carried by the Licensee. *Discussed at the Initial inspection on 8/17/22, and previously cited 8/15/2023.”

AAC R9-5-502.C.1.c. C. A licensee shall ensure that: 1. A staff member providing child care services in an infant room: c. Responds immediately to each infant's distress signals;

“Findings: Based on the Compliance Officer's (CO) observations and staff statement, in the North Infant room, there were 10 infants present and 2 staff. Some of the infants were crying and were not being responded to. Staff were feeding an infant and holding another infant and unable to respond immediately to each infant's distress signals. The Director and the CO stepped in to the room to assist the staff with the crying infants. A staff stated the parent of one of the infants requested that the infant not take more than one nap a day, and the infant was crying for 40 minutes.”

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 observation, in the 2's room there was a brown fluffy substance on the ceiling vent. *Discussed at the Initial inspection on 8/17/22, and previously cited 1/24/23 & 8/15/2023.”

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 observations and staff statement, the following written feeding instructions were not current and did not list the current foods fed to the infants: Child #10: Date of birth 3.29.23, and the plan was updated 6.30.23 Child #11: Date of birth 12.21.22, and the plan was dated 8.7.23. Staff was observed feeding the infant puffs, and stated the infant eats peaches and meats which were not listed on the plan. Child #12: Date of birth 1.30.23, and the plan was dated 3.1.2023. 2 infants present lacked feeding plans. *Previously cited 1/24/23 & 8/15/2023.”

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 Compliance Officer's observations, the following areas were not maintained in a clean condition: Room 3: There were discolored stains on the blue number rug. Room 4: There were discolored stains on a blue circle rug. *Previously cited 8/17/2022.”

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 the Compliance Officer's observation, Child #13's medication form lacked the starting and ending dates of the dosage period. *Previously cited 8/15/2023.”

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 observation, the medication form for Child #13 lacked a doctor's note to administer the medication. The medication stated "do not use unless directed by a doctor" for children ages 2 - 5 years old. Child #13 was 2 years old. *Previously cited 8/15/2023.”

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 the Compliance Officer's observation and staff statements, the following hazards were observed on the playground: *There were sharp metal edges on the chain link fence. *The chain link fence was unsecured on the northeast the side of the fence. *The barbed wire was accessible to children through the fence near the northeast side. *There were sharp edges on the black netting around a post. *There were eight 10” circular concrete footings with rough concrete surfacing, and some had sharp metal edges on the top metal cover. Staff stated the following: *The patio cover was removed over winter break. *The patio cover has been gone since January 6, 2024. *Discussed at the Initial inspection on 8/17/22, and previously cited 1/24/23, 5/16/23 & 8/15/2023.”

AAC R9-5-502.C.4.h. C. A licensee shall ensure that:4. When feeding an infant, a staff member: h. If an infant is no longer being held for feeding, seats the infant in a feeding chair or at a table with a chair that allows the infant to reach the food while sitting.

“Findings: Based on the Compliance Officer's observation, in the North Infant room, a staff was observed holding a bottle and feeding a 6 month old infant laying flat on the floor, rather than in a feeding chair or a table as required.”

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 facility documentation and the Compliance Officer's observations, it was determined that 7 out of 7 enrolled children's Emergency Information and Immunization Record Cards reviewed lacked the following required information: Child #1, Child #2, & Child #7: Dates of disenrollment. Child #3: The name of the person to contact in case of sudden injury/illness. Child #4: Date of enrollment. Child #5 & Child #6: Record cards were unavailable to review. *Discussed at the Initial inspection on 8/17/22, and previously cited 1/24/23 & 8/15/2023.”

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 2 out of 3 enrolled children's attendance forms reviewed lacked the following required information: Child #8: Release and arrival signatures at 11:35 & 11:38 on 1/11/2024. Child #9: Arrival signature on 1/8/2024. *Discussed at the Initial inspection on 8/17/22, and previously cited 1/24/23, 5/16/23 & 8/15/2023.”

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, in the North Infant room, the staff to child ratio was 1:10, with a required ratio of 2:10. A staff member left the room two separate times to put something in a cubby in the front office area, leaving the other staff in the room alone with 10 infants.”

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: 1's room: There was peeling paint and exposed drywall on the wall behind the diaper table. 2's room: There was an unsecured ceiling vent. *Discussed at the Initial inspection on 8/17/22, and previously cited 1/24/23, 5/9/23 & 8/15/2023.”

AAC R9-5-501.A.14. A. A licensee shall ensure that: 14. Temperatures are maintained between 68° F and 82° F in each room used by enrolled children;

“Findings: Based on the Compliance Officer's observation, in the 2's room, the temperature was 65 degrees F and there were 8 children present in the room.”

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 observations, the following diaper changing areas were not seamless, smooth and sanitizable: 1's room: There was a gap between the diaper surface and the sink, and there was debris along the edges of the diaper surface. 2's room: There was debris along the edges of the diaper surface. *Previously cited 1/24/23, 5/16/23 & 8/15/2023.”

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 North Infant room there was an unlabeled white pacifier. *Previously cited 1/24/2023”

AAC R9-5-605.B.5. B. A licensee shall ensure that: 5. Electrical extension cords are not used;

“Findings: Based on staff statement, in Room 3 staff stated they use an extension cord to plug in the water heater plug and run it across the top of a door to the outlet below between a door and the 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: Based on the Compliance Officer's ("CO") & the Compliance Officer Supervisor ("COS")'s observations, the the health, safety and welfare of enrolled children was placed at risk of harm. In Room 2, the diaper surface measured 24" in length and was not long enough to accommodate a child’s length. On the Playground, there was water dripping from the bottom of the water fountain onto an electrical outlet. (The water dripped when the 1's room toilet room sink was turned on.)”

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 CO & the COS's observations, the following diaper changing areas were not seamless and smooth, and kept clear of unrelated items: Infant Room 1: There was a nick on the diaper surface. Room 3: There was a green rag and a paint palette next to the diaper sink, and there was sand along the edges of the diaper surface.”

AAC R9-5-502.A.10. A. A licensee providing child care services for infants shall: 10. Ensure that an occupied crib with a crib side that does not have a non-porous barrier is placed at least 2 feet from another occupied crib side that does not have a non porous barrier; and

“Findings: Based on the CO & the COS's observations, in Room 2 there were cribs that had plexiglass dividers installed on the ends of the cribs from a company other than the crib manufacturer. The facility lacked the manufacturer's approval for the altered cribs.”

AAC R9-5-502.A.8.c. A. A licensee providing child care services for infants shall: 8. Provide a crib for each infant that: c. Is furnished with clean, sanitized, crib-size bedding, including a fitted sheet and top sheet or a blanket;

“Findings: Based on the CO & the COS's observations, in Rooms 1 & 2 there were loose crib sheets on multiple cribs, rather than tight-fitted sheets as required.”

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 CO's observations, in Room 3 there was a 2" x 4” hole in the wall to the right of the diaper surface.”

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 & the COS's observations, in Room 1 the south exit door was blocked by an adult chair, 2 blocks and a wooden hanging mobile.”

AAC R9-5-503.A.2.a. 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 CO & the COS's observations, in Room 3 the water temperature in the diaper changing sink measured 73.7 degrees F, rather than between 86 - 110 degrees F as required.”