AMY BAIR

Designated release persons (3290.123(a)(5))

Agreement form for child #2, #3, and #4 did not list persons to whom the child can be released. Requirement: An agreement shall specify the persons designated by a parent to whom the child may be released. Correction: Child #3 and #4 no longer in care. #2 form corrected to add only parents. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Each child emergency contact person (3290.124(a))

Emergency contact form for child #4 did not list any information for emergency contact persons. Requirement: Emergency contact information is required for each enrolled child. Emergency contact information must reference who shall be contacted in an emergency. Correction: #4 no longer in care Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Information re: disability (3290.124(b)(5))

Emergency contact form for child #1 and #2 did not include information on any disabilities or special needs for the child. Requirement: Emergency contact information must include information on the child's special needs, as specified by the child's parent, physician, physician's assistant of CRNP, which is needed in an emergency situation. Correction: Information corrected on child #1 and #2 emergency contact form Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Bottles labeled (3290.166(4))

Bottles of milk were observed in the fridge and were not labeled with the child's name on them. Requirement: Disposable nursers and bottles shall be labeled with the child's name. Correction: Bottles marked with child's name either with marker or on tape with name. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Signed (3290.123(a))

Agreement for child #1, 2, 3, 4, and 5 was not signed by the operator. Requirement: An agreement shall be signed by the operator and the parent. Correction: Provider printed out agreement form from Dept of Health and had parent sign along with my signature. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Amount of fee (3290.123(a)(1))

Agreement form for child #1 and #3 did not list the fee amount. Requirement: An agreement shall specify the amount of the fee to be charged per day or per week. Correction: Printed DOH agreement form and will use it. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Date fee to be paid (3290.123(a)(2))

Agreement form for child #1, 2, 3, 4, and 5 did not list the date the fee is to be paid. Requirement: An agreement shall specify the date on which the fee is to be paid. Correction: Printed and used DOH agreement listing needed information. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Services provided (3290.123(a)(3))

Agreement form for child #1, 2, 3, 4, and 5 did not list services that are provided. Requirement: An agreement shall specify the services to be provided to the family and the child, including the Department's approved form to provide information to the family about the child's growth and development in the context of the services being provided. the operator shall complete and update the form and provide a copy to the family in accordance with the updates regarding emergency contact information at § 3290.124(e). Correction: Printed DOH agreement form and had it filled out. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Arrival/departure times (3290.123(a)(4))

Agreement form for child #1, #3, and #4 did not list the child's arrival and departure times. Requirement: An agreement shall specify the child's arrival and departure times. Correction: Printed DOH agreement to provide needed information Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Parent home/work address, phone (3290.124(b)(3))

Emergency contact form for child #1 was observed to be missing the work address for both parents. Requirement: Emergency contact information must include the home and work addresses and telephone numbers of the enrolling parent. Correction: Emergency form was updated to included work information Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Insurance coverage information (3290.124(b)(6))

Emergency contact form for child #1 and #2 was missing the child's health insurance policy number. Requirement: Emergency contact information must include health insurance coverage and policy number for a child under a family policy or Medical Assistance benefits, if applicable. Correction: Obtain insurance information for all children Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Name/address/phone release person (3290.124(b)(7))

Emergency contact form for child #5 was missing a complete address for release persons. Address on file contained only the city of the release person. Requirement: Emergency contact information must include the name, address and telephone number of the individual designated by the parent to whom the child may be released. Correction: Make sure all information is filled out correctly. Address was added for emergency contact. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).

Consent for administration of minor first-aid required prior to admission (3290.182(5))

Child #5 was missing signed parental consent for the facility to administer minor first-aid. Requirement: A child's record must contain signed parental consent for administration of minor first-aid procedures by facility staff. Written consent is required prior to admission. Correction: Obtained missing signature for consent of minor first-aid. Inspection: Renewal. Source: PA DHS COMPASS provider search (compass.dhs.pa.gov).