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Compliance Inspector (CI) Jessica Ibbotson conducted an investigation regarding the allegation that Child A had been bitten numerous times. After conducting the investigation, CI Ibbotson finds this allegation is substantiated. This conclusion is based on the following evidence of licensing rule violations which occurred at the facility:
5 CSR 25-500.182(1)(D)3. which states: "Caregivers shall be alert to various needs of the child such as thirst, hunger, diaper change, fear of or aggression by other children, and the need for attention."
On April 17, 2023, CI Ibbotson interviewed Manager Osborn, Caregiver Carrillo and Caregiver Lewis. Manager Osborn stated that Child B had been biting other children for approximately five months but had only met with Parent B and Parent C regarding the biting concerns approximately two weeks ago. She stated did not meet with the parents sooner because biting was a normal behavior for children that age and did not think it was a concern. Caregiver Carrillo and Caregiver Lewis stated that Child B often times bit Child A without being provoked. All staff stated that it was age-appropriate for children to bite at that age and did not have any concerns for the excessive amount of times Child B was doing it towards the other children. All staff stated that it was not until meeting with Parent B and Parent C that they started implementing a pacifier and teething toys for Child B, which seemed to resolve the issue since he had not bitten again. Caregiver Carrillo and Caregiver Lewis stated that were no additional resources or individualized plans used to prevent the biting from occurring until approximately two weeks ago, even though the biting had been a concern for the past five months. All staff stated that they believed Child B was biting Child A out of frustration and anger, due to an eyesight issue he was experiencing, but did not alter any changes in their daily routine or implement any lesson plans to help Child B learn that biting others was not appropriate.
5 CSR 25-500.192(5)(A) which states: "In case of accident or injury to a child, the provider shall notify the parent(s) immediately. If the child requires emergency medical care, the provider shall follow the parent's(s') written instructions."
AND
5 CSR 25-500.192(5)(B) which states: "Information regarding the date and circumstance of any accident or injury shall be noted in the child's record."
On April 17, 2023, CI Ibbotson interviewed Manager Osborn who stated that Child A had been bitten for approximately the past five months and that an accident/injury report was documented after each accident. Caregiver Carrillo and Caregiver Lewis both stated that accident/injury reports were created after each accident and parents were notified immediately through the Bright Wheel application. All staff stated they were unsure why there were only two accident/injury reports regarding biting in Child A's file.
CI Ibbotson reviewed Child A's file and only observed two documented accident/injury reports. On March 29, 2023, one accident/injury report stated that at 10:47 a.m., Child A and a friend were playing with a music toy when that friend wanted the toy so he bit Child A on the back, leaving a bite mark.
On March 31, 2023, one accident/injury report stated that at 9:08 a.m., Child A and his friend were playing on the mat while his teachers were changing diapers. During that time, that same friend bit Child A on his back.
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