MANOA VALLEY CHURCH AFTER SCHOOL CARE

HAR §17-896.1-35 — Health & Safety Training Requirement

Please have the following staff members complete and return their Health & Safety initial assessment to Parents Attentive to Children (PATCH): XXXXX XXXXX Please have the following staff update their expired Health & Safety Training with PATCH. Submit all training certificates to PATCH immediately as their Health and Safety training period has expired or expiring within the next 60 days: XXXXX exp. 2/25/25 XXXXX exp. 6/21/25 XXXXX exp. 10/28/25 XXXXX exp. 10/28/25 XXXXX exp. 11/06/25 XXXXX exp. 5/5/26 Note: If the health and safety training requirements are not met by the deadline date, the above named staff members may be excluded from providing care which may affect your staff-child ratio. This will affect the license. On June 2, 2026 Director reported to the Worker that training certificates were recently mailed to PATCH via USPS. On June 18, 2026 Worker verified with PATCH that NO were received. It is the responsibility of the provider to ensure that PATCH receives the required certificates. Please follow up with PATCH on this immediately. If there are any employees who are no longer employed with the program, please submit a DHS 974A Notification of Changes form to the worker.

HAR §17-896.1-3 — Annual Background Clerance Checks

Please submit DHS 948 AUTHORIZATION FOR BACKGROUND CHECK ANDTO RELEASE FINDINGS Form for the following staff member who has an expired clearance. XXXXX

HAR §17-896.1-66 — Food Establishment Permit

Please submit a copy of a current (not expired) Department of Health (DOH) Food Establishment Permit for your Program. NOTE: On12-2-25 Child Care Licensing (CCL) Worker Robert Miller received a copy of a Food Establishment Invoice verifying that the school paid for an inspection. However, a copy of the actual Food Establishment Permit is required. Correction: Dup Record

HAR §17-896.1-40 — Health Consultant Agreement

Please submit a copy of a new agreement letter from a health care professional agreeing to serve as your program's health consultant and have reviewed the health policies for staff and children. Correction: 2-26-26: Worker Received a copy of a Health Consultant Letter agreement with the Public Health Nursing Branch dated 1-30-26. The letter also states that the agreement expires on 1-30-28. Copy on file.

HAR §17-896.1-66 — Food Establishment Permit

Please submit a copy of a current (not expired) Department of Health (DOH) Food Establishment Permit for your Program. On 12-2-25: Child Care Licensing (CCL) Worker Robert Miller received a copy of a Food Establishment Invoice verifying that the school paid for an inspection. However, a copy of the actual Food Establishment Permit is required. Correction: 2-26-26: Worker received a copy of Food Establishment Permit #PR1023985 expires 1-13-27. Copy on file.

HAR §17-896.1-47 — Menu Review

Please submit a copy of a menu review from a registered/licensed nutritionist to show that snacks served meets nutrition requirements. The department has contracted a menu review service free of charge to the provider with the Department of Health. If you are interested in this service, please contact XXXXX Correction: Worker received a copy of a satisfactory Hawaii Child Care Nutrition Program (HCCNP) Menu review (snacks) dated 12-18-25. Copy on file.

HAR §17-896-3 — Child care abuse/neglect check

Please submit DHS 948 Annual Background Check Forms for the following staff who hold expired annual clearances: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX Please submit a DHS 948 form for XXXXX who has a clearance that is scheduled to expire within the next 60 days. NOTE: The Worker has received DHS 948 Clearance Forms for the following staff, and are currently in Received/Pending status: XXXXX XXXXX Correction: Child Care Licensing (CCL) Worker R. Miller confirmed that all staff hold current (not expired) annual background check clearances at this time except 2 staff who have clearances that are in received/pending status: XXXXX XXXXX

HAR §17-896-3 — Employment history check

Please submit a completed DHS 959A Self Certification of Employment Forms for XXXXX Correction: 12-2-25: Child Care Licensing (CCL) Worker Robert Miller received a copy of a completed, satisfactory DHS 959A Self-Certification of Employment Worksheet for XXXXX. A copy has been placed on file.

HAR §17-896-6 — Insurance coverage policy

Please submit a copy of a current (not expired) Certificate of Liability Insurance for your program. Correction: 12-2-25: Child Care Licensing (CCL) Worker Robert Miller received a copy of an Acord Certificate of Liability Insurance (COI). Period: 1-1-25 to 1-1-26. Policy #048409888 A copy has been placed on file

HAR §17-896-6 — Other policies

§17-896.1-11 Statement of operation policies: Please submit a copy of your written policy that addresses Grievances which shall include the department's information for parents to file a complaint: Department of Human Services (DHS) Childcare Licensing Unit 1, 677 Queen Street #400A, Honolulu, HI (808)-587-5266. Correction: 12-9-25: Child Care Licensing (CCL) R. Miller received a copy of an amended page 9 of their "Manoa Valley Church After School Care Parent Handbook" . Page 9 has a section under "Grievance Policy" which satisfies this requirement.

HAR §17-896-21 — One caregiver with current certificates during operating hours

Please submit certificates of first aid and pediatric CPR training for your staff members. Correction: 12-11-25: Worker received copies of EMS Safety "Emergency Response for Childcare Providers" Training Certificates with expiration date 8-1-27 for the following staff: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX

HAR §17-896-27 — Provisions for substitutes

§17-896.1-55. Staff's health standards. Please submit evidence of satisfactory physical examination (PE), taken within 1 year of date of hire for XXXXX Please submit evidence of a negative TB test result or TB Risk Assessment taken within 1 year of date of hire for XXXXX Correction: 12-19-25: Child Care Licensing (CCL) Worker R. Miller received a copy of a DHS 974A Notification of Change form signed by Director XXXXX and dated 12-19-25 requesting the termination of 2 staff members: XXXXX XXXXX Since Mr. Sirp is no longer employed, this deficiency is satisfied.