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1255_CTR Insp form_011212

1255_CTR Insp form_011212

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03/26/2015

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MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing

CHILD CARE CENTER INSPECTION REPORT
INSPECTION TYPE Initial Application Conversion Mandatory Review Full Complaint Investigation Monitoring Other ACCREDITED: Y N EXP. DATE: INSPECTION CODES (C) - In Compliance (D) - Discussed (N) – Not in Compliance (X) – Not Inspected (NA) – Not Applicable NURSERY SCHOOL: N TIER_____ Y AGES
6 wks. – 17mos. 18 mos. – 23 mos. 2’s 3’s 4’s 5’s ( pre-school) 5-15 ( school-age)

Approved Capacity__________
Licensed for # Enrolled # Present

ACCREDITING ORGANIZATION: _________________________________________ _______/_______/_______
Mo. Day Year

TOTAL Overnight Head Start

XXXXXXX

XXXXXX

WORKER’S COMPENSATION INSURANCE COVERAGE: OPERATOR NAME: FACILITY NAME: ADDRESS:

Y

N JURISDICTION: LICENSE #:

EXP. DATE: _______/_______/_______
Mo. Day Year

REGION:

INSPECTION DATE/TIME: PERSON(S) INTERVIEWED:

TELEPHONE: E-MAIL: TITLE(S):

PART 1 - MANDATORY REVIEW ITEMS
INSTRUCTIONS: (1) Review each regulation that applies to the inspection being conducted. (2) The compliance status of an item listed under Part 2 may be recorded when deemed necessary. (3) Initial/Resumption/Conversion/Full Inspection - Complete both Part 1 and Part 2. ____.02.01D ____.03.05B ____.03.06A ____.04.01 ____.05.01A ____.05.08B ____.05.11 ____.05.12 ____.06.05C ____.06.09B ____.06.10C ____.06.11C License Conspicuously Displayed Staffing Pattern Posted Notification of New Employee Capacity Building Safety Sanitary Facilities and Supplies General Cleanliness Outdoor Activity Area Director – Continued Training Preschool Teacher – Continued Training School-age Teacher – Continued Training Asst. Teacher – Continued Training ___.07.06 ___.08.01A ___.08.02B ___.08.03 ___.08.07 ___.08.08 ___.09.04F ___.10.01A(4) ___.10.01C ___.10.03 ___.10.04 ___.10.05 ___.12.04A Child Security Child Supervision Qualified Staff in Charge of Groups Group Size and Staffing Playground Supervision Rest Time Supervision No Soft Bedding with Cribs Emergency Escape Route Posted Emergency Contact Information Safe Use of Materials and Equipment Potentially Hazardous Items Rest Time Safety Food Safety

____.06.12A(3)-(4) Aides – Continued Training

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____.07.02 Abuse and Neglect Reporting _______________________________________________________________________________________________________________ MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing

PART 2 – GENERAL COMPLIANCE REVIEW
INSTRUCTIONS: The compliance status of an item listed under Part 1 is excepted (exc.) from recording under this Part 2.

CHAPTER 02 LICENSE APPLICATION & MAINTENANCE ____.03C ____.04B Continuing license Conditional status

CHAPTER 06 STAFF REQUIREMENTS ____.01 ____.02 ____.03 Minimum Staff Age Staff Orientation Suitability for Employment Staff Health Directors of All Child Care Centers [exc. C] Directors – Preschool Centers Directors – School Age Centers Directors – Combined Age Centers Child Care Teachers – Preschool [exc. B] Child Care Teachers – School Age [exc. C] Assistant Child Care Teachers [exc. C] Aides [exc. A(3)-(4)] Substitutes Support Personnel Volunteers

CHAPTER 03 MANAGEMENT & ADMINISTRATION ____.04 ____.01 ____.02 ____.03 ____.04 ____.05 ____.06 ____.07 ____.08 Multi-site facilities ____.05 Admission to care ____.06 Program records ____.07 Child records ____.08 Staff records ____.09 Notifications [exc. A] ____.10 Change of operation ____.11 Variances ____.12 CHAPTER 04 OPERATIONAL REQUIREMENTS ____.01 ____.02 Capacity Enrollment and Attendance ____.13 ____.14 ____.15

CHAPTER 05 PHYSICAL PLANT AND EQUIPMENT ____.01 ____.02 ____.03 ____.04 ____.05 ____.06 ____.07 ____.08 ____.09 ____.10 Building Safety [exc. A] Accessibility Indoor Space Building Repair and Maintenance Lead-Safe Environment

CHAPTER 07 CHILD PROTECTION ____.01 ____.03 ____.04 ____.05 Prohibition of Abuse, Neglect, Injurious Treatment Child Discipline Parental Access Authorized Release

CHAPTER 08 CHILD SUPERVISION Ventilation and Temperature ____.01 Water Supply ____.02 Sanitary Facilities and Supplies [exc. B] ____.04 Lighting ____.05 Telephone and Communication ____.06 Supervision during Transportation Supervision during Water Activities Variations in Group Size Supervision by Qualified Staff [exc. B] Individualized Attention/Care [exc. A]

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____.13

Swimming Facilities

_____________________________________________________________________________________________________________

MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing

PART 2 – GENERAL COMPLIANCE REVIEW (continued) INSTRUCTIONS: The compliance status of an item listed under Part 1 is excepted (exc.) from recording under Part 2.
CHAPTER 09 PROGRAM REQUIREMENTS ____.01 ____.02 ____.03 ____.04 ____.05 ____.06 Schedule of Daily Activities Activity Plans for Infants and Toddlers Activity Materials, Equipment, Furnishings Rest Furnishings [exc. F] Infant and Toddler Equipment Storage CHAPTER 14 ADOLESCENT CENTERS ____.01 Approved Plan CHAPTER 13 CENTERS FOR CHILDREN WITH ACUTE ILLNESS ____.03 ____.04 ____.05 Approved Plan of Operation Director Requirements Use of Health Consultant

CHAPTER 10 SAFETY CHAPTER 15 DROP-IN CENTERS ____.01 ____.02 ____.06 Emergency Safety Requirements [exc. A(4) & C] ____.04 First Aid/CPR ____.06 Transportation CHAPTER 16 EDUCATIONAL PROGRAMS ____.06 ____.07 ____.08 ____.09 Personnel Qualifications Educational Program Child Record Health, Fire Safety, Zoning Admission Requirements Approved Plan

CHAPTER 11 HEALTH ____.01 ____.02 ____.03 ____.04 ____.05 ____.06 Exclusion for Acute Illness Infectious and Communicable Diseases Preventing Spread of Diseases Medication Administration/Storage Smoking Alcohol and Drugs

CHAPTER 17 INSPECTIONS, COMPLAINTS & ENFORCEMENTS ____.02 Inspections

CHAPTER 12 NUTRITION ____.01 ____.02 ____.03 ____.04 ____.05 Food Service Modified Diet Food Sources Food Storage and Preparation [exc. A] Food Preparation Area and Equipment

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____.06 Infant Feeding _______________________________________________________________________________________________________________ TIME OUT: __________ __________________________________________ Signature of Facility Representative _____________________________________ Signature of Agency Representative _____________________ Date

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MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing

PLAN OF IMPROVEMENT – PART 1

OPERATOR NAME: CENTER NAME: ADDRESS:

JURISDICTION: LICENSE #: INSPECTION DATE/TIME: PERSON(S) INTERVIEWED:

REGION:

TELEPHONE: E-MAIL: VISIT TYPE: DURATION:

REGULATION(S) NOT IN COMPLIANCE:
NOTE: Failure to correct violation(s) listed below may result in sanctions being imposed or in the suspension or revocation of your license.
REGULATION NUMBER REGULATION TEXT COMMENTS ADDITIONAL COMMENTS DATE CORRECTED

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_________________________________________________ Signature of Facility Representative

_____________________________________________ Signature of Agency Representative

_________________________ Date

MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing

PLAN OF IMPROVEMENT – PART 2

REGULATION NUMBER

REGULATION TEXT

COMMENTS

ADDITIONAL COMMENTS

DATE CORRECTED

REGULATION(S) DISCUSSED:

Remarks:

Total number of regulations not in compliance: ____ I request a review of findings. N Y Review requested for the following regulation(s):

Total number of regulations discussed: ____

Inspection results have been reviewed with me and will be:

e-mailed to ________________________________________________ mailed

_________________________________________________________ Signature of Facility Representative

______________________________________________ Signature of Agency Representative

__________________ Date

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