complaint·July 24, 2025

developed a fungal infection around June 7th and believed C1 was being left in soiled diapers for two hours. A conclusion drawn from BrightWheel app logs. C1 had experienced this rash three times prior. The RP provided a doctor's note on June 10th requesting diaper changes every 30 minutes to an hour. LPA Dunlap also reviewed a medically excused absence letter for C1 dated June 4, 2025, which stated C1 may return to school with restrictions, including checking and changing frequently as needed, and applying topical ointment with each diaper change/check. Interviews with Parents 2-5 corroborated concerns regarding diapering practices, specifically noting instances of wet diapers and rashes when a particular teacher was present and highlighting a need for review of the diaper-changing policy. Interviews with Staff 1-6 revealed varying stated policies: Staff 1 and 3 mentioned a two-hour policy, while Staff 2 claimed every hour. All staff confirmed app/log sheet documentation, but Staff 1, 2, and 3 admitted to instances where app documentation was sometimes missed due to busyness. Staff confirmed they check for and notify parents about rashes. While Staff 1 initially was unaware of a doctor's note for more frequent changes, in a follow up interview they later had a recall of the note. Staff 3 recalled Staff 1 providing a form for applying cream, and Staff 2 acknowledged a form exists for such requests. LPA Dunlap's review of C1's Brightwheel Daily Reports for June 2025 (June 2-13) showed varied timing's for diaper changes that did not consistently occur every two hours. LPA Dunlap also noted a blank dry erase board above the changing station and reviewed a Safe and Healthy Diapering document posted in the classroom. The staff training agenda from April 26, 2024, detailed a diaper changing procedure but did not include a policy for checking or changing diapers every two hours. The parent handbook similarly lacked a policy for the frequency of diaper changes or checks. Based on interviews and record review there is not sufficient evidence to support the allegation that staff are not consistently meeting day care children's diapering needs. Therefore, there is not a preponderance of evidence to support that staff are not consistently meeting day care children's diapering needs. Therefore, this allegation is UNSUBSTANTIATED . Page 2 of 3 No deficiency will be cited today. A notice of site visit was given and must remain posted for 30 days. Appeal Right explained and given to Facility Representative- Shirley Jones. Exit interview was conducted with Facility Representative- Shirley Jones. Page 3 of 3 The Reporting Party (RP) stated that C1, contracted Hand, Foot, and Mouth Disease (HFMD), with symptoms appearing on a Saturday and a diagnosis confirmed the following Sunday. The RP learned of another child, C2, also having HFMD the week of June 2nd, and indicated that the facility did not inform parents of the outbreak until after the RP reported them. The RP expressed significant concerns about the center's hygiene and cleanliness, suggesting it could use a lot of work and noting that many children are frequently sick. Interviews with Parents 2-5 revealed some validation of the HFMD outbreak and concerns from some parents about delayed communication regarding outbreaks and the need for more thorough cleaning protocols, though some parents also expressed satisfaction with the center. Interviews with Staff 1-6 generally confirmed awareness of a Hand, Foot, and Mouth Disease (HFMD) outbreak. Most staff stated that parents were notified via the BrightWheel app and posted letters, typically immediately after becoming aware of multiple cases. However, Staff 1 acknowledged an initial delay in broad parent notification when only one child was diagnosed. Staff consistently reported increased sanitization efforts, including daily cleaning and a professional deep clean by 4M Sanitizing Service on June 16, 2025. LPA Dunlap's review of records included an invoice and video footage confirming 4M Sanitizing Service cleaned the facility on June 16, 2025. A parent letter about Hand, Foot, and Mouth Disease, dated June 16, 2025, was confirmed to have been sent to parents via the BrightWheel app on the same date at 1:13 PM, stating at least two students had contracted the illness. The facility handbook was reviewed and notably did not contain a specific policy for Hand, Foot, and Mouth Disease, though it outlined general sick child policies. Based on interviews and documents reviewed. There is not sufficient evidence to support the allegation that the facility did not consistently take all reasonable precautions to prevent the spread of a communicable disease. The facility followed the necessary physical protocols. Therefore, there is not a preponderance of evidence to substantiate the allegation. Therefore, this allegation is UNSUBSTANTIATED. Page 2 of 3 No deficiency will be cited today. A notice of site visit was given and must remain posted for 30 days. Appeal Rights given and explained to Facility Representative- Shirley Jones. Exit interview was conducted with Facility Representative- Shirley Jones. Page 3 of 3