Tender Care Learning Centers

Regulation: 3270.113(a)

Description: Supervised at all times

Noncompliance Area: A child was able to crawl outside of the infant classroom into the hallway unattended. Another child was in a bouncer seat and out of sight of the one staff member that was present who was changing another child's diaper.

Correction Required: TIERED LIS: 1.) 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 correction date for this portion of the plan will be immediate. 2.) The legal entity will ensure that all facility persons complete the PA Required Health and Safety for Centers-Group Child Care Part 1 and PA Required Health and Safety for Centers-Group Child Care Part 2 trainings found on Penn State Better Kid Care website within 21 calendar days of the acceptance of this plan of correction. All facility persons who have already completed PA Required Health and Safety for Centers-Group Child Care Part 1 and PA Required Health and Safety for Centers-Group Child Care Part 2 trainings will be required to take the trainings again and provide documentation of completion after the date of the acceptance of this plan of correction. Once all facility persons have completed these required trainings, the legal entity will submit the training certificates for all facility persons to the Western Regional Office within 5 business days of the last date of completion. The operator will provide a date by which these trainings will be completed. 3.) The director, assistant director, and representative(s) from executive leadership will participate in a virtual technical assistance session with the senior health management staff at PA Key to conduct a Root Cause Analysis to determine "next steps" for improving systemic issues regarding supervision and risk management. Discussions can include, but are not limited to, the topics of: active supervision, classroom management, anticipating children's movements, response to child injuries, and creating a safe environment for caring for infants. Prior to attending the TA meeting, the director, assistant director, and representative(s) from executive leadership will be required to watch the video of the incident from 3/23/26 and come to the meeting prepared to discuss. The correction date for this portion of the plan will be based on when this technical assistance training is to be scheduled. 4.) Subsequent to the technical assistance (TA) session, a 2-hour supplemental virtual training regarding infant care will be provided by the PA Key, based on the needs identified during the TA session. At minimum, any staff that can be anticipated to work with infants will attend this training. This training can be counted towards the annual regulatory training requirements in 3270.31(e), as long as proper documentation is obtained. The correction date for this portion of the plan will be after the date of the TA session and when this training is to be scheduled.

Regulation: 3270.113(a)(1)

Description: Staff assigned to specific children

Noncompliance Area: A child was able to crawl outside of the infant classroom into the hallway unattended. Another child was in a bouncer seat and out of sight of the one staff member that was present who was changing another child's diaper.

Correction Required: TIERED LIS: 1.) 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. The correction date for this portion of the plan will be immediate. 2.) The facility will participate in an onsite technical assistance consultation with the ELRC #5 coach to assess the infant room layout with the intent to optimize supervision for one or more staff. The correction date for this portion of the plan will be based on when this technical assistance consultation is to be scheduled.

Regulation: 3270.113(b)

Description: No physical punishment

Noncompliance Area: During investigations, Staff #1 was observed roughly handling child#1, this included picking the child up by their clothes and forcefully moving them out into the hallway.

Correction Required: A facility person may not use any form of physical punishment, including spanking a child.

Regulation: 3270.31(e)(4)(i)

Description: Age and Training

Noncompliance Area: Staff person #1 has not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This is evidenced by the previously documented Pediatric first aid and CPR training on file expiring (12/11/25). Documentation of updated Pediatric first aid and CPR training is not on file.

Correction Required: Competence is the completion of training by a professional in the field of first-aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. Until such time as the required training has been completed, staff person #1 must be supervised, when interacting with children at a minimum by, an (AGS) who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #1, staff person #1 may not work in a child-care position at the facility.

Regulation: 3270.103

Description: Small Toys and Objects

Noncompliance Area: Observed multiple colored foam blocks in Room 2 (young toddlers) and Room 4 (older toddlers) that had teeth marks and missing sections. These blocks were accessible to children who are still placing objects in their mouths.

Correction Required: Toys and objects with a diameter of less than 1 inch, objects with removable parts that have a diameter of less than 1 inch, plastic bags and styrofoam objects may not be accessible to children who are still placing objects in their mouths.

Regulation: 3270.123(a)(5)

Description: Designated release persons

Noncompliance Area: The Agreement for Child #2 lacked the persons designated by a parent to whom the child may be released.

Correction Required: An agreement shall specify the persons designated by a parent to whom the child may be released.

Regulation: 3270.124(b)(2)

Description: Physician name, address, phone

Noncompliance Area: The Emergency Contact Form for Child #3 lacked the telephone number of the child's physician.

Correction Required: Emergency contact information must include the name, address and telephone number of the child's physician or source of medical care.

Regulation: 3270.131(b)(1)/3270.182(1)

Description: Infant: updated health report every 6 months/Initial and subsequent health reports

Noncompliance Area: The file for Child #2, a Young Toddler, contained Health Reports that were updated in an interval greater than 6 months

Correction Required: The operator shall require the parent to provide an updated health report at least every 6 months for an infant or young toddler. A child's record shall contain initial and subsequent health reports.

Regulation: 3270.131(d)(5)/3270.131(e)(1)

Description: Immunization record/Exemption documentation from parent/guardian

Noncompliance Area: The file for Child #1, enrolled for more that 60 days at the facility, did not contain documentation of a 2nd dose of the Rotavirus vaccination, 2nd dose DTAP vaccination, 2nd dose of HIB vaccination, 2nd dose of Pneumococcal vaccination, and 2nd dose of Polio vaccination as required based on the child's age as per the ACIP recommended schedule.

Correction Required: A health report shall include a review of the child's immunized status according to recommendations of the ACIP. The facility shall implement dismissal policies in accordance with the Department of Health regulation in 28 Pa. Code § 27.77 (relating to immunization requirements for children in childcare group settings). Child #1 must be dismissed from care by close of business 10/15/25 and may only return to care when the immunization record is updated or when a parent provides a written, signed exemption letter.

Regulation: 3270.31(e)

Description: Age and Training

Noncompliance Area: The file for Staff #3, lacked documentation of 3 hours of the required 12 annual clock hours of childcare training.

Correction Required: A staff person shall obtain an annual minimum of 12 clock hours of child care training.

Regulation: 3270.31(e)(4)(i)

Description: Age and Training

Noncompliance Area: Staff person #7 has not completed Pediatric first aid and CPR training on or before expiration of the most current certification. This is evidenced by the previously documented Pediatric first aid and CPR training on file expiring (9/2025). Documentation of updated Pediatric first aid and CPR training is not on file.

Correction Required: Competence is the completion of training by a professional in the field of first aid and cardiopulmonary resuscitation (CPR). All staff persons shall renew their certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) on or before the expiration of the most current certification. Until such time as the required training has been completed, staff person #7 must be supervised, when interacting with children at a minimum by, an (AGS) who has completed all preservice trainings and has all qualifications to care for children unsupervised. If there are no staff person(s) available to supervise staff person #7, staff person #7 may not work in a child-care position at the facility.

Regulation: 3270.31(e)(4)(ii)

Description: Fire safety - 1 yr.

Noncompliance Area: The file for Staff #4 contained Fire Safety Trainings that were dated more than 12 months apart.

Correction Required: Staff persons shall participate, at least annually, in fire safety training conducted by a fire protection professional. Staff persons and volunteers shall receive training in maintenance of smoke detectors, the duties of facility persons during a fire drill and during a fire and the use of the facility's fire extinguishers, not including discharge of the fire suppressant agent.

Regulation: 3270.32(a)

Description: Comply with CPSL

Noncompliance Area: The files for Staff #8 and #9 contained mandated reporter training that was not completed within 60 months of the previous training.

Correction Required: The operator shall comply with the CPSL and with Chapter 3490 (relating to protective services).

Regulation: 3270.32(a)/3270.192(4)

Description: Comply with CPSL/CPSL information

Noncompliance Area: Although the files for Staff#1 and #5 contained an NSOR Certificate at the time of Renewal Inspection it was observed that it was obtained after the first day caring for children. The file for Staff #2 contained an incomplete PA State Police Clearance. The file for Staff #6 contained a disclosure statement that lacked a witness. The file for Staff #5 who has lived in Illinois within the last 5 years did not have the required Illinois Clearances.

Correction Required: 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. Facility Person #2, #5, and #6 may not work in a childcare position at the facility.

Regulation: 3270.65

Description: Protective Outlet Covers 5 yrs. or less

Noncompliance Area: Observed an electrical outlet with one plug in Room 6, beside the refrigerator that was missing a protective outlet covers. This outlet was accessible to children 5 years of age and younger.

Correction Required: Protective receptacle covers shall be placed in electrical outlets accessible to children 5 years of age or younger.