Fillable Certification Inspection Instrument Center Renewal

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Certification Inspection Instrument Center Renewal

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Center Renewal Certification Inspection Instrument rev. 3.2.20
1
Child Care Centers Certification Inspection Instrument (Renewal)
Facility Name:
PCID:
Certification Representative:
Inspection Date:
Key: / = Compliant O = Non-compliant, notes if applicable N/A = Not Applicable EX = Exemption on file UA = Unable to assess
Interview
/ or O
Code
Description
Notes
§ 3270.24
Departmental access, as applicable
• Introduce self and show ID
• Inform Legal Entity (LE /Director) of the reason for inspection
• Verify ID for Director/Responsible Staff Person
Code
Description
Notes
§ 3270.17
Program’s services to children with
special needs
(a) reasonable accommodation
(b) specialized services provided as
specified in IEP, IFSP or behavioral
plan
(c) staff persons and parents aware
of community resources
§ 3270.19
Child abuse reporting
§ 3270.20
Reporting injury, death or fire
§ 3270.26
Compliance with nondiscrimination
statutes
§ 3270.117
Release of children
§ 3270.122
Admission interview
§ 3270.22
Communication with parents
§ 3270.23
Parent access and participation
§ 3270.136
Reporting diseases
§ 3270.137
Children with symptoms of disease
§ 3270.138
Discrimination based on illness
§ 3270.153
Facility persons with symptoms of
disease
§ 3270.154
Facility persons with skin disorders
§ 3270.155
Discrimination based on illness
§ 3270.183
Confidentiality of records (Child)
§ 3270.184
Release of information
§ 3270.185
Record retention
§ 3270.193
Confidentiality of records (Adult)
Exit Interview
✓ Review areas of non-compliance prior to leaving
✓ Address any provider questions
✓ Allow provider the opportunity to locate missing
paperwork
✓ Obtain plans of correction if time permits
✓ Provide technical assistance as needed
✓ Review next steps in process
Center Renewal Certification Inspection Instrument rev. 3.2.20
2
Child Care Centers Certification Inspection Instrument (Renewal)
Posted Notices
/ or O
Code
Description
Notes
§ 3270.25(a)
Certificate of Compliance (a-d)
§ 3270.25(a)
DHS contact information
§ 3270.25(a)
Regulations
§ 3270.27(d)
Emergency plan (reviewed annually) (a-e)
§ 3270.171(c)
Pick-up and drop-off procedures
§ 3270.165
Menu (if applicable)
Required Paperwork on File
/ or O
Code
Description
Notes
§ 3270.18(a)
Liability insurance
§ 3270.94(b)
Fire drill log (a-g)
§ 3270.27(f)
Emergency plan
Emergency plan and subsequent plan
updates sent to the county emergency
management agency
§ 3270.20(e)
§ 3270.182(7)
Reporting injury, death or fire/
Reports of accidents/injuries/illnesses
§ 3270.121
Application
(a) operator reviews general daily
schedule, hours, fees, meals, clothing,
health policies, supervision policies, night
care policies, dismissal policies,
transportation and pick-up arrangements
(b) parent shall receive in writing the
information described in subsection (a)
§ 3270.132
Emergency medical care
§ 3270.118
Pets (a-c)
§ 3270.171
Annual written notification to local traffic
safety authorities of location of facility &
program’s use of pedestrian and vehicular
routes around facility (a)
§ 3270.183
Child records are confidential and stored
in locked cabinet (a)
§ 3270.191
An individual record is required for each
facility person
Transportation / Vehicle Inspection / Excursions (if applicable)
/ or O
Code
Description
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
§ 3270.124
Emergency contact forms (d)
§ 3270.172
Written parental consent to transport, N/A
for transportation of school-age children in
vehicles owned or operated by the school
district (a)
§ 3270.173
Transportation ratios
§ 3270.174
Age of driver; valid operator’s license
§ 3270.175
Safety restraints (a-d)
§ 3270.176
Vehicles (a-f)
§ 3270.177
Children may not be left unattended in
vehicle
§ 3270.178
Transportation first-aid kit
Center Renewal Certification Inspection Instrument rev. 3.2.20
3
Child Care Centers Certification Inspection Instrument (Renewal)
Ratio & Supervision
Regulation
Room # / Name
1
2
3
4
Capacity:
§ 3270.51
Similar age
level ratio
§ 3270.52
Mixed age level
ratio
§3270.53
Children of
operator/staff
§3270.54
Minimum
number of
facility persons
§ 3270.113
Supervision of
children
Indicate time (AM or PM):
Staff Name(s)/Position(s):
# of children and age levels (I, YT,
OT, PS, YSA, OSA) present:
All children present, identified and
supervised?
Y N
Y N
Y N
Y N
Indicate time (AM or PM):
Staff Name(s)/Position(s):
# of children and age levels (I, YT,
OT, PS, YSA, OSA) present:
All children present, identified and
supervised?
Y N
Y N
Y N
Y N
§ 3270.55 Naptime Ratios
Fire Safety
/ or O
Code
Description
Notes
§ 3270.21
Conditions at the facility may not pose a threat to the
health or safety of the children, including missing or
inoperable smoke detectors, fire detection systems,
and fire extinguisher
§ 3270.91
Exits (a-c)
§ 3270.92
Space heaters (a-c)
§ 3270.93
Fireplaces and stoves
§ 3270.94
Fire drills and evacuation plan (b, c)
Physical Site
/ or O
Regulation
Room Number
1
2
3
4
§ 3270.111
Daily activities (a-c)
§ 3270.124
Emergency contact forms (c)
Transportation plan posted (e)
§ 3270.74
Emergency telephone numbers
§ 3270.75
First-aid kit (a-d)
§ 3270.133
Medication (i-viii)
§ 3270.61
Measurement use of indoor space
§ 3270.62
Measurement use of play space
§ 3270.65
Protective outlet covers
§ 3270.66
Toxics (a-e)
§ 3270.67
Sanitation (a-d)
§ 3270.68
Smoking
Child Age
Staff:Child
Max. Group
Size
Nap ratio
Staff:Child
Child Age
Staff:Child
Max. Group
Size
Nap ratio
Staff:Child
Infant – birth to 1yr
1:4
8
1:4
Preschool – 3yrs to K
1:10
20
1:20
YT – 1-2yrs
1:5
10
1:10
School Age – K-4
th
1:12
24
OT – 2-3yrs
1:6
12
1:12
School Age – 4
th
to 15yrs
1:15
30
Center Renewal Certification Inspection Instrument rev. 3.2.20
4
Child Care Centers Certification Inspection Instrument (Renewal)
/ or O
Regulation
Room Number
1
2
3
4
§ 3270.69
Water
§ 3270.70
Indoor temperature
§ 3270.71
Water pipes, other sources of heat
§ 3270.72
Ventilation (a-d)
§ 3270.73
Telephone
§ 3270.76
Building surface
§ 3270.77
Paint / Plaster (a-g)
§ 3270.78
Lighting
§ 3270.80
Stairs (a-d)
§ 3270.81
Glass
§ 3270.101
Type of play equipment (a-c)
§ 3270.102
Condition of play equipment (a-g)
§ 3270.104
Furniture (a-b)
§ 3270.106
Rest equipment (a-j)
§ 3270.103
Small toys, objects, plastic bags,
Styrofoam not accessible to
children who are still placing items
in mouth
§ 3270.119
Infant sleep position
§ 3270.135
Diapering requirements (a-e)
§ 3270.112
Infant and toddler stimulation
§ 3270.166
Meals for infants (1-7)
§ 3270.105
High chairs
§ 3270.82
Toilet areas (a-j)
§ 3270.134
Child hygiene (a-g)
§ 3270.152
Adult hygiene / Handwashing
§ 3270.161
Food / Kitchen (a-g)
§ 3270.162
Meals (a-d)
§ 3270.163
Food groups (a-b)
§ 3270.164
Food servings
§ 3270.107
Refrigerator (45° F or below)
§ 3270.108
Utensils (a-c)
§ 3270.63
Unsafe areas in outdoor space
§ 3270.64
Outside walkways
§ 3270.114
Outdoor activity
§ 3270.115
Water activity / Pool accessibility
§ 3270.116
School-age children / Homework
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Certification Inspection Instrument Center Renewal

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Completed 19 May 2020

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