St. Francis Of Assisi School

AAC R9-5-305.C. C. A licensee shall attach an enrolled child’s written immunization record or exemption affidavit, required in subsection(A), to the enrolled child’s Emergency, Information, and Immunization Record, required in R9-5 304(B).

“Findings: The Primary Compliance Officer reviewed the immunization records of enrolled children and noted that Child 1 and Child 2 did not have their immunization records with their emergency cards. Facility staff reported that they should be in another binder in the classroom, but when staff looked though both books, the immunization records were not located.”

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: The Primary Compliance Officer observed that there were 16 children, (4 year olds) in the outdoor activity area with Staff 1, while Staff 2 remained in the classroom. When the Compliance Officer informed the classroom staff that they were out of ratio, Staff 2 stepped out of the classroom and into the outdoor activity area.”

AAC R9-5-301.I. I. At least once a month, and at different times of the day, a licensee shall ensure that: 1. An unannounced practice drill that includes evacuation, relocation, shelter-in place, and lock downs are conducted; 2. Each staff member, volunteer, and enrolled child at the facility participates in the practice drill; 3. If applicable, accommodations are made for an enrolled child with a special need or disability according to the enrolled child's individualized plan as specified in R9-5-507(A)(1); 4. If applicable, accommodations are made for an enrolled child or infant who is not yet walking; and 5. Document each practice drill and maintain the documentation on facility premises for 12 months after the date of the practice drill.

“Findings: The Primary Compliance Officer reviewed the facility’s fire drill documentation and noted that there was no fire drill documented in December, 2025. The facility staff confirmed that they had not conducted one in December, 2025.”

AAC R9-5-509.C.17. C. A licensee shall ensure that: 17. 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: The Primary Compliance Officer reviewed the facility’s menu and noted that it listed a mixed fruit cup being served for breakfast on 2/2-2/6/26. The specific fruits were not listed. The menu also listed fruit and yogurt bowls as a lunch option on 2/4/26 but did not list the specific fruits nor the specific flavor of yogurt. On 2/5/26 the menu listed Burritos as being served for lunch but did not list the specific food items in the burrito.”

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 include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, the facility lacked a current violation-free fire inspection. The inspection on file dated 3/22/2024 contained violations.”

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 include: Based on the Compliance Officer's observation, the caulking at the base of the restroom toilets was loose, separating, and was unable to be cleaned and sanitized.”

AAC R9-5-203.A. A. A licensee shall ensure that a staff member completes, signs, dates, and submits to the licensee, before the staff member’s starting date of employment or volunteer service:1. The form required in A.R.S. § 36-883.02(C); and 2. If required by A.R.S. § 8-804, the form in A.R.S. § 8-804(I).

“Findings include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, the files for Staff #1 and Staff #2 lacked Central Registry Affidavits and submission verification. *Reference R9-5-203.G”

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 include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, the file for Staff #1 lacked education documents to qualify as an assistant teacher-caregiver.”

ARS § 36-883.02.A. A. Except as provided in subsection B of this section, child care personnel, including volunteers, shall submit the form prescribed in subsection C of this section to the employer and shall have valid fingerprint clearance cards issued pursuant to section 41-1758.07 before starting employment or volunteer work.

“Findings include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, the files for Staff #1 and Staff #3 lacked Criminal History Affidavits.”

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 include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, the concrete footings of the office patio fence posts were exposed to children on the facility playground.”

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

“Findings include: Based on staff interview and the Compliance Officer's observation, an extension cord was utilized in the classroom. Per staff, there was a recent power outage that prompted the use of the extension cord.”

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 include: Based on facility documentation and the Compliance Officer and Compliance Officer's observations, staff attendance records were not maintained as follows: Staff #1: Lacked arrival and departure times for 2/6/2025, lacked arrival time for 2/7/2025. Staff #3: Lacked arrival and departure times for the week of 2/3/2025 - 2/7/2025.”

AAC R9-5-309.A. A. An applicant shall obtain the following inspections of a facility and make any repairs or corrections stated on an inspection report before a license is issued by the Department: 1. If there are gas pipes that run from a gas meter to an appliance or location on the facility premises, a gas inspection by a licensed plumber or individual authorized by the local jurisdiction that verifies there are no gas leaks in the gas pipes that run from the gas meter to any appliance or location on facility premises; and 2. A fire inspection by a local fire department.

“Compliance Officer observed that the facility did not have a current fire inspection. The last documented fire inspection was dated 6/22/22.”

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.

“Compliance Officer Supervisor observed that Staff 1 only had 4.5 annual training hours for employment year 7/28/22 - 7/28/23.”

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;

“Senior Compliance Officer observed that the menu not specific. The yogurt and cheese did not identify the types/flavors of each food item.”

AAC R9-5-203.A. A. A licensee shall ensure that a staff member completes, signs, dates, and submits to the licensee, before the staff member’s starting date of employment or volunteer service:1. The form required in A.R.S. § 36-883.02(C); and 2. If required by A.R.S. § 8-804, the form in A.R.S. § 8-804(I).

“Compliance Officer Supervisor observed that Staff 1 did not have documentation of a Criminal History Affidavit.”

AAC R9-5-516.G. G. A licensee shall return all unused prescription and nonprescription medications to a parent when the medication prescription date has expired or the medication is no longer being administered to the enrolled child or dispose of the medication if unable to locate the enrolled child's parent after the child's disenrollment

“Senior Compliance Officer observed a medication for Child 5 that expired in January 2025.”

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;

“Senior Compliance Officer observed that the thermometer in the refrigerator is broken.”

AAC R9-5-514. A. A. A licensee shall ensure that there is a first aid kit on facility premises that contains first aid supplies in a quantity sufficient to meet the needs of the enrolled children including the following:1. Sterile bandages including: a. Adhesive bandages of assorted sizes, b. Sterile gauze pads, and c. Sterile gauze rolls; 2. Antiseptic solution or sealed antiseptic wipes; 3. A pair of scissors; 4. Adhesive tape; 5. Single-use, non-porous gloves; and 6. Reclosable plastic bags of at least one-gallon size.

“Senior Compliance Officer observed that the first aid kit did not have gallon size bags.”

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

“Senior Compliance Officer observed that the medication forms for Child 3 and 4 were missing instructions for administration, dosage and route, starting and ending dates, time and frequency. The forms stated to administer "as needed". The reason to administer the medication should be clear and specific.”

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.

“Senior Compliance Officer observed two medications for the same child that were not labeled with their name.”

AAC R9-5-203.G. G. If required by A.R.S. § 8-804, before an individual’s starting date of employment or volunteer service, a licensee shall comply with the submission requirements in A.R.S. § 8-804(C) for the individual.

“Compliance Officer Supervisor observed that Staff 1 did not have documentation that the DCS background check was submitted.”

AAC R9-5-305.B. B. A licensee shall attach an enrolled child’s written immunization record or exemption affidavit, required in subsection(A), to the enrolled child’s Emergency, Information, and Immunization Record card, required in R9-5 304(B).

“Senior Compliance Officer observed that the children's immunizations are not attached their emergency records located in the classroom.”

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.

“Senior Compliance Officer observed that Child 1 was not signed in on the day of the inspection; no time or signature. Child 2 was not signed in on the day of the inspection with a signature; only a time was documented.”