Child Care Center/group Inspection Form Page 2

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Operating
Days
CHILD CARE CENTER/GROUP INSPECTION FORM
Program Name:
License Number:
Date of
Inspection:
85. Hot Tubs/Spas/Saunas: Locked/Inaccessible
125. Children’s Linens/Clothing/Bedding Stored
86. No Weapons/No Facsimile of a Firearm on Premises
Individually
Outdoor Space
126. Cribs/Cots Washed/Disinfected
87. Outdoor Space Adequate Sq. Ft. Per Child
127. Under 12 Months Placed on Back for Sleeping
88. Impact Absorbing Material under Equipment
128. Alternate Sleep Position/Equipment
89. Playground Free from Hazards
Medical Documentation Y/N
90. Peeling Paint Observed: Y/N, Sample Taken: Y/N
129. Crib/Bed Used for Infant Sleeping
91. Lead Management Plan Reviewed: Y/N
130. Crib/Bed Free from Observable Hazards
92. Equipment Anchored/Safely Arranged
131. Infant Toys Separate/Washed/Disinfected Daily
93. Outdoor Play Area Protected/Fenced
132. No Toys/Objects Less than 1 ¼” Diameter
94. Drinking Water Available/Accessible
133. Plastic Bags/Balloons/Styrofoam Objects Inaccessible
134. Health Consultant/Documentation of Visits
Educational Requirements 19a-79-8a
135. Infants Held for Bottles/Indiv. Attn/Tummy Time
95. Written Plan for Daily Program Available to
136. Written Statement/Feeding Schedule from Parent
Parents/Staff
137. Unused Portions of Liquids Discarded
96. Activity Choices Include:
138. Clean Bottles/Disp. Bottles/Approved Bottle Washing
Indoor/Outdoor
____
Fine/Gross Motor ____
139. Food Served from Dish or Whole Jar Served
Language
____
Sensory
____
140. Bottles Individually Identified w/Child’s Name
Art/Media
____
Dramatic Play
____
Outdoor Play Space-Under Three
Music
____
Self Concept
____
141. Play Space Fenced
Health Education ____
Active/Quiet
____
142.Outdoor Equipment Available/
Child/Staff Initiated ____ Exploration
____
Developmentally Appropriate
Varied Choices
____
Indiv/Small Group____
Snacks/Meals
____ Toileting/Clean Up ____
School Age Children Endorsement 19a-79-11
143. Approved Endorsement
Administration of Medications 19a-79-9a
144. Activity Choices Include:
97. Written Policies/Procedures
Free Time ____ Creative ____ Homework
____
98. Training Outline/Med Training
Snacks
____ Physical____ Special Events ____
Nonprescription Topical Medications
Small Group____ Quiet
____ Self Concept ____
99. Administration/Parent Permission/MAR
145. Ratio: 1 Staff to 10 Children
100. Labeling/Storage
146. Group Size: Max. 20 Children
101. Written Approval
147. Education Consultant Appropriate
Oral/Topical/Inhalant/Injectable Medications
102. Authorized Prescriber/Parent Permission/MAR
Night Care Endorsement 19a-79-12 (10pm-5am)
103. Labeling/Storage
148. Approved Endorsement
104. Unused/Expired Meds Returned/Disposed Y/N
149. Written Plan: Program Activities/Supervision
Self Administration
150. All Staff Awake/Available
105. Authorized Prescriber/Parent Permission/MAR
151. Individual Cot/Crib/Bedding/Toiletries/
106. Labeling/Storage
Sleeping Apparel
107. Appvd Petition For Special Medication Authorization
152. Sleeping Apparel/Toiletries Individually
Emergency Distribution of Potassium Iodide
Labeled/Stored
108.
Parent Permission/Storage
153. Bedding/Sleeping Apparel Laundered Weekly
Under Three Endorsement 19a-79-10
Monitoring of Diabetes 19a-79-13
109. Approved Endorsement
154. Written Policies/Procedures
110. Ratio: 1 Staff to 4 Children
155. On Site Staff Trained in First Aid/Glucose Testing
111. Group Size no Larger than 8
156. Training Current/Documented
112. Physical Barriers/Groups of 8 (Indoors/Outdoors)
157. Supervision of Self Administration
113. Adequate Sinks in Program Space
158. Equipment/Supplies: Labeled/Inaccessible
114. Free Standing Cribs
159. Signed Agreement w/Parent Regarding Equipment
115. Washable Cots
160. Materials to be Discarded: Locked/
116. Chairs for Feeding/Stable/Safety Straps/Locking Tray
Given to Parent
117. Dev. Appropriate Tables/Chairs/Equipment
161. Authorized Prescriber/Parent Permission
118. Refrigerators and Food Prep Facilities
162. Documentation of Test Results/
Diapering Area
Action Taken
119. Sturdy/Safety Rail/Nonporous/Exclusive Use
163. Daily Written Parent Notification
120. Washed/Disinfected
121. Disposable Paper Sheets
122. Covered Waste Receptacle
123. Diaper Changing Policy Posted/Followed
124. Hand Washing Policy Posted/Followed
Signature of Inspector
Written Corrective Action Plan
Signature of Person in Charge
Due to DPH by:

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