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On May 18, 2023 , the Office of Childhood (OOC) received an allegation that Child A, age 4, ingested Orajel and felt funny and was aspirating. The parent did not authorize Child A to have Orajel and doesn't know how Child A got the Orajel. After conducting an investigation, Compliance Inspector (CI) Liz Hudson has found this allegation to be substantiated based on the following evidence:
5 CSR 25-500.192(3)(E)., which states the following: "All medication shall be stored out of reach of children or in a locked container."
AND
5 CSR 25-500.082(1)(I)., which states the following: "All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children."
On May 25, 2023, CI Hudson conducted an unannounced inspection at Little Bears Learning Center LLC. CI Hudson interviewed Director Emily Miller and Teachers Hailey Rector and Daytona Adams, both from Child A's classroom.
Staff provided consistent accounts of what occurred on May 18, 2023. Staff stated that Child A did ingest adult strength Orajel out of a small tube - Orajel being a topical numbing gel used for oral/tooth pain. Teacher Hailey Rector brought Child A into the front office at 10:40 a.m. along with a small tube of adult strength Orajel which was missing the cap. Child A was coughing and appeared to have ingested the gel. When Director Ms. Emily was informed by Ms. Hailey that Child A put some Orajel in her mouth, Ms. Emily immediately called Parent A to inform her and then Poison Control right after her phone call to Parent A. Child A did not appear to have problems breathing, she maintained normal color and was not vomiting which were the main concerns of Poison Control staff. Poison Control advised her that Child A be directly observed for two hours and if everything appears ok, and Child A
is hungry, Child A can eat. She called Parent A to let her know what was recommended and Parent A gave her permission to supervise Child A closely, one on one, in the office for the few hours following the incident as advised.
Child A appeared to be fine at lunch time and was able to eat without any problems. She continued to keep Parent A informed throughout the day. Staff stated that Child A's behaviors have been challenging at times as she has kicked and punched staff before, most recently a pregnant employee. A Parents as Teachers worker visits the facility and offered Parent A services in the home as well as outside the home at the facility but Parent A declined. Parent A continues to bring Child A to the facility daily. All staff reported that this was an isolated incident and no problems/incidents have ever occurred involving medication or any harmful substances of the kind. Staff acknowledged the importance of a thorough clean-up and walk through prior, during and after the children are present. Director Ms. Emily assured that additional follow-up training would ensue to remind / refresh staff on the rules/regulations involving prescribed and over the counter medication storage, safety and precautions. The staff all stated that they did not know where the Orajel came from or how Child A got it. CI Hudson also observed the facility's storage box and cabinet where the medication is normally stored and out of reach of children. The cabinet is elevated six feet off the ground, in the kitchen where children are not allowed.
CI Hudson noted no further concerns.
On May 25, 2023, CI Hudson conducted an interview via phone with Parent A who was upset about the incident and very worried initially. Parent A stated that she is hopeful that the incident will trigger a heightened state of awareness among workers. Parent A understood that staff was not certain as to where the Orajel came from and that it is possible that a parent could have dropped the tube on the floor, but that either way, the Orajel was not intentionally administered to Child A. Child A still attends the facility. Parent A stated that she was appreciative of how quickly staff reacted and that Ms. Emily handled the incident appropriately.
On May 25, 2023, CI Hudson made contact with the reporter who had no additional concerns to add.
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