ARIZONA DEPARTMENT Statememolne'

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OF HEALTH SERVICES Survey Daler1/23/2019
.I LICENSING

 

 

CHILD CRISIS ARIZONA EARLY EDUCATION SERVICES-MESA
Facility ID: CD017344

License: CDC47844

The following deficiencies were observed oi ihe iime or the compliance on 1/23/2019 and are someoi Io
changes pending piogrammalic Teview.

Surveyor i: 1: Ann Ramirez
The Wrinen Dooumemeiion oi Coireciions was during ihe exii inierview.
a of 3 iingerprini cards were Io be valid via ihe DPS webshe during ihe lime oi ihe 

The Empower Survey was oompieied oi ihe lime or ihe 

 

PM Page1of2

Statement of Deficiencies
Survey Date - 1/23/2019

Findings Report Summary
Findings for:
Citation 1
Corrected Date:
01/25/2019

Rule/Statute:
article 3
Rule Text:
R9-5-304. Enrollment of Children B. Except as required in
A.R.S. § 36-3009, before an enrolled child receives child
care services, a licensee shall require the enrolled child 's
parent to complete a Department-provided Emergency,
Information, and Immunization Record card that is signed
by the enrolled child 's parent containing: 1. The child 's
name, home address, city, state, zip code, home
telephone number, sex, and date of birth; 2. The date of
the child ' s enrollment; 3. The name, home address, city,
state, zip code, and contact telephone number of each
parent of the child; 4. The name and contact telephone
number of at least two individuals authorized by the child
's parent to collect the child from the facility in case of
emergency, or if the child 's parent cannot be contacted; 5.
The name and contact telephone number of the child 's
health care provider; 6. The written authorization for
emergency medical care of the enrolled child when the
parent cannot be contacted at the time of the emergency;
7. The name of the individual to be contacted in case of
injury or sudden illness of the child; 8. The written
instructions of a child 's parent or health care provider for
nutritional and dietary needs of the child including, if
applicable, the request in R9-5-509(C)(9); and 9. A written
record completed by the child 's parent or health care
provider noting the child ' s susceptibility to illness,
physical conditions of which a staff member should be
aware, and any individual requirements for health
maintenance.

Survey Text:
R9-5-304.B.1-9.~
Based on the facility documentation, three of
the fifteen Emergency, Information, and
Immunization Record cards reviewed lacked
the following: * Child #1 - lacked the father's
information. * Child #2 - lacked the health
care provider's phone number. * Child #3 lacked the father's information.

Findings for:
Citation 2
Corrected Date:
01/25/2019

Rule/Statute:
article 5
Rule Text:
R9-5-503. Standards for Diaper Changing A. A licensee
shall ensure that each diaper changing area required in
R9-5-601(4) contains: 2. A hand-washing sink next to the
diaper changing surface for staff use when changing
diapers and for washing an enrolled child during or after
diapering that provides: a. Running water between 86° F
and 110° F, b. Soap from a dispenser, and c. Single-use
paper hand towels from a dispenser;

Survey Text:
R9-5-503.A.2.a-c.~
Based on the Surveyor's observation, the
water in the diaper changing sink in the
Plum's room measured at 70° F.

7/11/2019 8:49:19 PM

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