WILKES-BARRE FAMILY YMCA EARLY LEARNING CENTER

Two written references (3270.192(5))

While at the facility unannounced the inspector observed the file for staff #1 and found that it was missing the two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. Requirement: A facility person's record shall include two written, nonfamily references from individuals attesting to the person's suitability to serve as a facility person. Correction: Two written references were requested form staff #1. Staff #1 resigned shortly after being suspended due to file needs and did not return to the YMCA. Inspection: Unannounced Monitoring. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

12 months prior to service and every 24 months thereafter/Mantoux TB (3270.151(a)/3270.151(c)(2))

While at the facility unannounced the inspector observed the file for staff #1 (see LIS Code Sheet for DOH) and found that this staff was missing a health assessment and TB screening and has been working in direct care with children. Requirement: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department. Correction: Staff member #1 was suspended immediately on 4/16 from work until the required health assessment could be obtained. shortly after staff #2 resigned and no longer was employed by the YMCA. Inspection: Unannounced Monitoring. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Comply with CPSL/CPSL information (3270.32(a)/3270.192(4))

While at the facility unannounced the inspector observed the file for staff #2 (see LIS Code Sheet for DOH) and found that the Pa State Police on file was incomplete. Requirement: Staff Person # 1 may not work in a childcare position at the facility. The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). The CPSL was revised to include a requirement that all clearances be updated and on file at least every 60 months. As of 2/1/25 If staff are going to be hired under the 45-day provisional hire basis, the following conditions must be met; facility received the results of the applicant's PA Child Abuse History Clearance, NSOR Clearance, completed out-of-state clearances (if applicable), a signed disclosure statement, prior to employment and have received the result of the applicant's Pennsylvania State Police OR the FBI finger-print results prior to employment. Proof of submission must be on file for either the FBI or PA State Police Clearance. The employer, administrator, supervisor or other person responsible for employment decisions has no knowledge of information pertaining to the applicant which would disqualify him from employment based on CPSL. Correction: The director will comply with the CPSL. Staff #2 Pa State Police background was re-ran and checked for completion prior to her shift starting. The results were reviewed by the state inspector while present on 4/16/2026. Inspection: Unannounced Monitoring. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Six-months-old held (3270.166(5))

Staff #1 and #2 admitted to the director during an internal investigation that they did not hold infant #1 and #2 (see LIS Code for DOB) while being fed instead staff #1 and #2 propped infant #1 and #2 bottles while the infants were in bounce chairs, cribs, and mats until they fell asleep. Requirement: An infant 6 months of age or younger shall be held while being bottle fed. Correction: Bottle Propping will not occur in the baby room. All infants under the age of 6 months will be held while feeding, all infants under the age of 6 months will be held upright and burped accordingly to support proper digestion. All staff will sign off on safe eating prior to working in the baby room. The sign off sheet recognizes that they have read and will adhere to the policies listed on the posters. Inspection: Complaints- Legal Location. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Infant sleep position (3270.119)

Staff #1 and #2 admitted to the director during an internal investigation that they allowed infants #1 and #2 to sleep in bounce chairs. Bounce chairs are not a recommended sleeping position by the American Academy of Pediatrics and there are no medical reasons documented by a physician on file at the facility recommending a bounce chair sleeping position. Requirement: Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility. Correction: All bouncer chairs, self rockers, baby apparatuses have been removed from the baby room. All infants will be placed in/ on their assigned crib/ mat for sleeping with no blankets. The facility will follow the recommended sleeping position by the American Academy of Pediatrics. Safe sleeping posters were created to help aid as a reminder of safe sleep. Those posters are located near both sleeping sites. Admin staff will frequent the baby room to ensure all proper procedures are met for safe sleep. Inspection: Complaints- Legal Location. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Supervised at all times /Staff assigned to specific children (3270.113(a)/3270.113(a)(1))

Staff #1 and #2 admitted to the director during an internal investigation that they that placed blankets over the heads of infants #1 and #2 while sleeping in bounce chairs, mats, and cribs rendering the infants from being seen, heard, and accessed. Requirement: Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises. TIERED LIS: 1. Children must be supervised at all times. The correction date for this must be immediate. 2 The legal entity must arrange for staff #1 and #2 to receive a minimum of four hours of training specific to supervision and care of infants. The legal entity must receive DHS approval of the training content prior to scheduling the trainings. The operator shall provide a date for when these trainings are completed. 3. The facility will be subject to three unannounced monitoring visits by DHS following the conclusion of the four hours of required staff trainings. These unannounced monitoring visits will be conducted to ensure that both supervision and care of infants are being adhered to and that no further instances of noncompliance are observed. The correction date should reflect a date that allows for at least 6 weeks from the completion of the required trainings for DHS to complete. Correction: Any infant under the age of 12 months and one day will no have a blanket. At no time will a blanket cover a child's face. Children will be supervised at all times while in the classroom. This includes diaper changes, feeding, sleeping, playing and remaining areas while in care. all bouncer chairs have been removed from the infant room. Staff #1 and Staff #2 will both complete a minimum of 6 hours of training on the topics of feeding, daily routines and safe sleep by 5/29. Admin staff will frequent the baby room to ensure all proper procedures are met for supervision, feeding, sleeping and remaining areas. Safe sleeping and safe feeding posters were created to help aid as a reminder of safe sleep and safe feeding. Those posters are located near both feeding sites and both sleeping sites. The director will work with DHS on all unannounced visits ensuring compliance is met and maintained. Inspection: Complaints- Legal Location. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Comply with CPSL/CPSL information (3270.32(a)/3270.192(4))

During the course of the renewal the inspector observed the file for staff #1 and fund that this staff did not update their Pa Child Abuse clearance every 60 months as evidenced by the previous Pa Child Abuse dated 03/26/20 and the most current dated 9/19/25. Requirement: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services). A facility person's record shall include a copy of requests for the criminal history record and child abuse registry clearance information, a copy of the disclosure statement and a copy of the completed clearance information required under the CPSL. Correction: The director's spreadsheet saved the date wrong which resulted in the lapse between updates to the PA Child Abuse clearance. The director conducts manual staff file audits, and this is how the PA Child Abuse clearance was discovered and immediately corrected. The staff was suspended until the updated clearance was on file at the facility. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Supervised at all times /Staff assigned to specific children (3270.113(a)/3270.113(a)(1))

The facility self-reported that on 9/9/25 staff #1 was observed to be sleeping while in a seated position, holding an infant in the infant room. As a result of this staff #1 was terminated from employment on 9/11/25. Requirement: Children on the facility premises and on facility excursions off the premises shall be supervised by a staff person at all times. Outdoor play space used by the facility is considered part of the facility premises. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises. Correction: The Greater Wyoming Valley Area YMCA holds all matters of supervision to the highest level. The childcare director self reported staff #1 for falling asleep in a classroom while holding a child. Staff #1 was immediately suspended, pending further investigation. A meeting was held on 9/10 with the childcare director, the VP of childcare services and the organizations HR manager. The consensus was reached for ultimate termination on 9/11. Inspection: Self-Reported Non Compliance. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

12 months prior to service and every 24 months thereafter/Mantoux TB (3270.151(a)/3270.151(c)(2))

The inspector found that staff #1 was hired with a health assessment and TB screening dated for 9/01/23, both of which were conducted over 12 months prior to providing initial service in a childcare setting. Requirement: A facility person providing direct care who comes into contact with the children or who works with food preparation shall have a health assessment conducted within 12 months prior to providing initial service in a child care setting and every 24 months thereafter. A health assessment is valid for 24 months following the date of signature, if the person does not contract a communicable disease or develop a medical problem. An adult health assessment must include tuberculosis screening by the Mantoux method at initial employment. Subsequent tuberculosis screening is not required unless directed by a physician, physician's assistant, CRNP, the Department of Health or a local health department. Correction: Staff #1 completed a health assessment and TB on 01/22/2025 Inspection: Unannounced Monitoring. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Staff assigned to specific children/Not unattended in vehicle (3270.113(a)(1)/3270.177(a))

On 1/2/25 staff #1 did, in fact, leave child #1, #2, #3, and #4 (see DOB's on LIS Code Sheet) alone and unsupervised, on a facility van, while staff #1 went into another facility to pick up another child. Requirement: Each staff person shall be assigned the responsibility for supervision of specific children. The staff person shall know the names and whereabouts of the children in his assigned group. The staff person shall be physically present with the children in his group on the facility premises and on facility excursions off the facility premises. Children may not be left unattended in a vehicle. Correction: All enrolled children that are transported on YMCA owned vehicles are assigned to a specific vehicle to be sure we know what vehicle each child was on each day. A driver policy has been created stating children are to remain in sight of staff at all times. Staff #1 was written up and removed from driving until further notice. Inspection: Complaints- Legal Location. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Stairs, exits, etc. unobstructed (3270.91(a))

During the annual unannounced inspection on 9/19 and 9/26/24 the inspector observed the exit from the multipurpose room to be housing two large children's strollers. Requirement: Stairways, hallways, exits from rooms, exits from the facility and other means of egress serving as an exit shall be unobstructed. Correction: The strollers were immediately removed and housed in the basement. This room has two means of egress The main door is the door that is the emergency exit outlined in the emergency plan. The director was unaware that the strollers could not be housed outside of the second exit as the strollers could be easily rolled away. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Building Surfaces (3270.76)

During the annual unannounced inspection on 9/19 and 9/26/24 the inspector observed the ceiling tiles in the multipurpose room to be in disrepair. Requirement: Floors, walls, ceilings and other surfaces, including the facility's outdoor play space surfaces shall be kept clean, in good repair and free from visible hazards. Correction: The tiles were immediately replaced. There was a small leak that was immediately repaired. The ceiling tiles had been ordered prior to the leak but were on back order. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).