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

FAMILY CHILD CARE HOME INSPECTION REPORT
INSPECTION TYPE Initial/Resumption of Service Conversion Mandatory Review Full Complaint Investigation Monitoring Other INSPECTION CODES C D N X NA In Compliance Discussed Not in Compliance Not Inspected Not Applicable AGES 0-23 Months 2’s 3’s 4’s 5’s (pre-school) 5-12 (school-age) TOTAL Overnight Head Start
Registered for # Enrolled # Present Resident Children

XXXXXXX

XXXXXX

XXXXXX XXXXXX

TIER____ ACCREDITED: Y N EXP DATE: ______/______/______ Month Day Year EXP DATE: _____/______/______ Month Day Year JURISDICTION: REGISTRATION #: INSPECTION DATE/TIME: PERSON(S) INTERVIEWED: TITLE(S): REGION:

ACCREDITED BY: __________________________________________ HOMEOWNER’S INSURANCE COVERAGE: N/A Y N

BUSINESS NAME: PROVIDER NAME: CO-PROVIDER NAME: ADDRESS: TELEPHONE: E-MAIL:

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 ____.03.04A ____.03.05C-E ____.04.03 ____.05.03 ____.05.04 ____.05.05 ____.05.06

Certificate Conspicuously Displayed Emergency Forms Notification of Changes Child Capacity Cleanliness and Sanitation Rooms Used for Care Outdoor Activity Area Rest Furnishings

____.06.02 ____.07.01 ____.07.02 ____.07.04 ____.07.07 ____.08.01 ____.08.03 ____.10.02 ____.10.06

Training Requirements Prohibition of Abuse, Neglect, Injurious Treatment Abuse and Neglect Reporting Child Discipline Child Security General Child Supervision Supervision of Resting Children Potentially Hazardous Items Rest Time Safety

1

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 Part 2.
CHAPTER 02 REGISTRATION APPLICATION AND MAINTENANCE ____.03B Continuing Registration ____.04B Conditional Status CHAPTER 03 MANAGEMENT & ADMINISTRATION ____.02 ____.03 ____.04 ____.05 ____.06 Admission to Care Program Records Child Records [exc. A] Notifications [exc. C-E] Variances CHAPTER 10 SAFETY CHAPTER 04 OPERATIONAL REQUIREMENTS ____.01 ____.02 Hours of Care Age Group Enrollment ____.01 ____.03 ____.04 ____.05 CHAPTER 05 HOME ENVIRONMENT & EQUIPMENT ____.01 ____.02 Suitability of the Home Lead-Safe Environment CHAPTER 11 HEALTH ____.01 ____.02 CHAPTER 06 PROVIDER REQUIREMENTS ____.03 ____.03 ____.04 ____.05 Provider Substitute ____.04 Additional Adult ____.05 Volunteers ____.06 CHAPTER 07 CHILD PROTECTION CHAPTER 12 NUTRITION ____.03 ____.05 ____.06 Applicability to Residents ____.01 Parental Access ____.02 Authorized Release CHAPTER 13 INSPECTIONS, COMPLAINTS & ENFORCEMENTS ____.01 Inspections Food Storage/Cleanliness Nutrition/Food Served Consumption of Alcohol/Drugs Smoking Medication Administration/Storage Infectious/Communicable Diseases Child Comfort/Welfare Exclusion for Acute Illness Emergency Safety Outdoor Safety Water Safety Transportation Safety CHAPTER 09 PROGRAM REQUIREMENTS ____.01 ____.02 ____.03 Activities Materials/Equipment Rest Periods CHAPTER 08 CHILD SUPERVISION ____.02 ____.04 ____.05 Off-Site Supervision Water Activity Supervision Overnight Care Supervision

____________________________________________ Signature of Provider

_________________________________________ Signature of Agency Representative

___________________ Date

2

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

STATEMENT OF FINDINGS – PART 1

BUSINESS NAME: PROVIDER NAME: CO-PROVIDER NAME: ADDRESS:

JURISDICTION: REGISTRATION #: 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 registration.

REGULATION NUMBER

REGULATION TEXT

COMMENTS

ADDITIONAL COMMENTS

DATE CORRECTED

_______________________________________________________ Signature of Provider

_______________________________________________________ Signature of Agency Representative

______________________ Date

3

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

STATEMENT OF FINDINGS – PART 2 REGULATION(S) DISCUSSED:
REGULATION NUMBER REGULATION TEXT COMMENTS ADDITIONAL COMMENTS

Remarks:

Total number of regulations not in compliance: _____

Total number of regulations discussed: _____

I request a review of findings. N Y Review requested for the following regulation(s): _________________________________________________________________________________________________

Inspection results have been reviewed with me and will be:

e-mailed to ____________________________________________________________________________ mailed _____________________________________________________ Signature of Agency Representative _____________________________ Date

________________________________________________ Signature of Provider

4

Sign up to vote on this title
UsefulNot useful