KAMAAINA KIDS JUDD ST INFANT TODDLER PROGRAM

HAR §17-895.1-3 — Background checks according with chapter 17-801 (criminal history, sex offender registry, child abuse/neglect, adult abuse perpetrator, employment history check, and other information)

Please submit satisfactory employment history for the following new staff: XXXXX Employment History Instructions All employees shall complete the form DHS 959A Self Certification of Employment and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 Employment History (EH) form and have the former and/or current employer complete and sign part II. Please complete the following information on the form DHS 959A: the date EH mailed and the date EH returned. Keep copies of all forms mailed out to former employers. If EH forms are not returned after the first try, mail out the again in a few weeks and log the date of the second mailing. If forms are not returned after the second try, we will accept the written self-certification that two mailed attempts were recorded on the DHS 959A. All of the forms can be found on our website here: View official inspection document Correction: Worker received satisfactory employment history for XXXXX: DHS 959A Self-Certification of Employment.

HAR §17-895.1-40 — Written evidence of agreement for health consultation (private physician, non-profit health organization, community health consultation service, or health advisory group

Please submit evidence of a new agreement letter from your school's health consultant. Correction: Worker received a copy of a Health Consultant Agreement Letter from the Public Helath Nursing Office (PHN) dated 2-27-26, expires on 2-28-28. Copy on file.

HAR §17-895.1-12 — Evidence of liability coverage

Please submit a current (not expired) certificate of Liability Insurance (COI) for this site. Correction: Worker received a copy of a Certificate of Liability Insurance (COI) for the period 1-31-26 to 1-31-27. Copy on file.

HAR §17-895.1-43 — One caregiver with current certificates during all operating hours; infant CPR when caring for infant children

Please submit copies of current (not expired) First Aid/Child CPR training certificates for child/infant/adults for your staff members. Correction: Worker visually verified Training Certificates: American Heart Association (AHA) Heartsaver Pediatric First Aid CPR/AED for: XXXXX XXXXX XXXXX XXXXX American Safety & Health Institute (ASHI) Adult/Child/Infant first Aid CPR for : XXXXX

HAR §17-895.1-55 — Physical exam clearance

Please submit evidence of a satisfactory employment physical examination on the DHS 984 Medical Report that was conducted within 1 year of date of hire for the following new staff: XXXXX All of the forms can be found on our website here: View official inspection document Correction: Worker received a copy of a DHS 984 Medical Report showing a satisfactory physical examination dated 2-28-25.

HAR §17-895.1-55 — TB clearance

Please submit evidence of a negative TB test result or TB Risk Assessment that was conducted within one year of date of hire for the following new staff: XXXXX Correction: Worker Received a TB Risk Assessment form showing negative , dated 1-27-25.

HAR §17-895.1-3 — Background checks according with chapter 17-801 (criminal history, sex offender registry, child abuse/neglect, adult abuse perpetrator, employment history check, and other information)

No Action Needed at this time. Worker received completed DHS 948 Annual Clearance Forms for 2 staff that are currently in Received/Pending status. This deficiency will be satisfied when the clearances are completed . XXXXX Correction: All employees have annual current clearances.

HAR §17-895.1-35 — Caregiver staff must complete 16 hours annually after the initial training in at least two of the approved topic areas

Please have the following staff members update PATCH in regard to their Health & Safety Training. XXXXX XXXXX Correction: All staff have updated their Health and Safety Training.

HAR §17-895.1-47 — Annual nutrition review dated: <date>

Please submit a copy of your current Menu Review for your preschool. Correction: Worker received a copy of a satisfactory Menu Review by Hawaii Child Care Nutrition Program (HCCNP) dated 9-25-25 by Nutritionist XXXXX. Copy on file

HAR §17-895.1-71 — Written fire inspection report documenting fire warning device inspected initially and annually by a fire inspector report dated: <date>

Please submit a copy of your current Fire Inspection Report. Correction: Worker received a copy of a satisfactory Fire Inspection Report dated 12-4-25 by XXXXX Copy on file.

HAR §17-895.1-96 — All employees, household members and volunteers complete training in safe sleep practices that is approved by the department, upon 30 days of hire or residency, and on an annual basis

Please update PATCH in regard to staff member XXXXX who is expired in regard to her Safe Sleep Training. Correction: Worker verified on the HANA system that all staff are now current in regard to their Safe Sleep Training at this time.