CHILD CARE LICENSING UNIT STATE OFFICE PARK SOUTH 129 PLEASANT STREET, BROWN BUILDING, CONCORD, N.H. 03301-3857 TEL. 603-271-9025 OR 1-800-852-3345, EXT. 9025 STATEMENT OF FINDINGS ISSUE DATE: 03/21/2017 VISIT TYPE: Licensed Complaint COMPLAINT NUMBER: 17-035 VISIT DATE(S): 02/28/2017 03/02/2017 CORRECTIVE ACTION PLAN DUE DATE: 04/11/2017 Kristin Ayers, Co-Director Laura Johnson, Co-Director Alpha-Bits Learning Center I 333 Allard Drive Manchester NH 03102

LICENSE NUMBER: CCCB-02369 LICENSING COORDINATOR(S): Erin Fitzgerald Kathleen MacKenzie

In accordance with RSA 170-E, the department finds that the program has violated the following statutes and/or rules: He-C 4002.25(e)(2): CHILD CARE PERSONNEL AND HOUSEHOLD MEMBERS, IF THE PROGRAM IS TO BE LOCATED IN A HOME, SHALL NOT USE CORPORAL PUNISHMENT. He-C 4002.01(o)(15): "CORPORAL PUNISHMENT" MEANS PHYSICAL ACTIONS AGAINST A CHILD, INCLUDING BUT NOT LIMITED TO ROUGH HANDLING. He-C 4002.01(o)(16): "CORPORAL PUNISHMENT" MEANS PHYSICAL ACTIONS AGAINST A CHILD, INCLUDING BUT NOT LIMITED TO FORMS OF AGGRESSIVE CONTACT. THE STATUTE(S) AND/OR RULE(S) WERE NOT MET AS EVIDENCED BY THE FOLLOWING: 1. Staff B's statements that since the beginning of January 2017, she has witnessed Staff A, who works with infants ages 6 weeks to 6 months, handle the infants in an aggressive manner, specifically: a. lifting infants up by just one arm when taking them out of their cribs, bouncy seats and exersaucers. Staff A places one hand under an infant's armpit and quickly lifts them up, without supporting them. Staff B initially stated that the infants are picked up this way multiple times per day, then clarified that this is just how Staff A always picks them up, with the exception of taking them out of a swing because that typically requires both of your hands; b. Staff A's aggression towards the infants has increased over the past two weeks. "Aggression went to now we are kicking the bouncers with babies in them." Staff A kicked bouncy seats several times with infants in them because they were crying, and yelled "shut up" at them. She further clarified that Staff A was not gently kicking the bouncy seats in an attempt to give it some movement to soothe a crying infant, she was kicking it in a hard manner or a "jolt kick" that would "jostle" the infants and yelled at them to "shut up" trying to startle them so they stopped crying;

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Alpha-Bits Learning Center I

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c. Staff A walked up to an infant who was playing in an exersaucer and kicked the exersaucer for no apparent reason and called the child "[expletive] ugly;" and d. Staff B concluded her interview with department staff by stating, "I'm concerned for the babies in that room." 2. The statements by Staff C that Staff A picks up the infants "really quick" and her body language toward them is not nurturing. 3. The statements by Staff E that she has witnessed interactions between Staff A and the infants that concerned her, including: a. Staff A picks up the infants "very abruptly and quickly;" b. Staff A has bounced infants in bouncy seats too hard. Staff A will become frustrated and say to them, "ok, I've had enough of you," then begin kicking the back of the bouncy seat harder. On one occasion, Staff E told Staff A not to bounce the babies so hard. Staff A acknowledged this by stating, "I know, I'm gonna break this thing," meaning the bouncy seat the infant was in; c. Staff A kicked the back of a bouncy seat with so much force the approximately four-month-old's head came forward off the back of the seat and went back; d. Staff A kicked an exersaucer with an infant playing in it to move it away from her because the child was too close; and e. Staff E concluded her interview with the department by stating that things have seemed worse lately. Staff A's aggression toward the infants has increased, while her tolerance for them has decreased. She acknowledged that she has worried about the infants if she is not present in the classroom, when Staff A may be working alone with them. 4. The determination by the department that Staff A's actions and care of the infants, ages 6 months and younger, constituted rough handling when picking them up, and aggressive contact when kicking equipment while the infants were in them, jostling them. CORRECTIVE ACTION PLAN

COMPLETION DATE: ___/___/______

FOR DEPT USE ONLY: A*:___ D*:___ He-C 4002.25(e)(3): CHILD CARE PERSONNEL AND HOUSEHOLD MEMBERS, IF THE PROGRAM IS TO BE LOCATED IN A HOME, SHALL NOT ATTEMPT TO CONTROL CHILDREN'S BEHAVIOR BY ACTIONS WHICH ARE HUMILIATING, THREATENING, SHAMING, FRIGHTENING OR OTHERWISE DAMAGING TO CHILDREN, INCLUDING BUT NOT LIMITED TO: (d) RIDICULING CHILDREN; (e) YELLING AT CHILDREN; (f) NAME CALLING.

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Alpha-Bits Learning Center I

Visit Date(s): 02/28/2017

Lic.#: CCCB-02369

03/02/2017

THE STATUTE(S) AND/OR RULE(S) WERE NOT MET AS EVIDENCED BY THE FOLLOWING: 1. The statements by Staff B that she frequently heard Staff A swear and yell at, ridicule, and call infants names, including: a. Staff A has called infants "ugly" and "dumb;" b. Staff A has made statements to infants while frustrated when they were not drinking their bottle, including, "you're a piece of [expletive]," and "you're so [expletive] dumb;" c. As referenced in 1. c. above, Staff A called an infant playing in a stationary activity center, hereafter referred to as an exersaucer, "[expletive] ugly" for no apparent reason; and d. As referenced in 1. b. above, Staff A yelled at infants to "shut up" when they were crying in their bouncy seats, to attempt to startle them so they would stop crying. 2. The statement by Staff E that she has heard Staff A call infants "ugly." She could not recall which infants Staff A said this to, but stated that Staff A favors some babies over others so it was likely one of the infants she does not like. 3. According to Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, 2011: STANDARD 2.1.1.9 Verbal Interaction "The child care facility should assure that a rich environment of spoken language by caregivers/teachers surrounds and includes all children with opportunities to expand their language communication skills. To encourage the development of language, the caregiver/teacher should demonstrate skillful verbal communication and interaction with the child […] For infants, these interactions should include responses to, and encouragement of, soft infant sounds, as well as identifying objects, feelings, and desires by the caregiver/teacher […and] profanity should not be used at any time." 4. The determination by the department that Staff A yelled at, ridiculed, and called infants names, including swearing. As referenced above in #3, "interactions with infants should include responses to, and encouragement of, soft infant sounds, as well as identifying objects, feelings, and desires by the caregiver/teacher and profanity should not be used at any time."

CORRECTIVE ACTION PLAN

COMPLETION DATE: ___/___/______

FOR DEPT USE ONLY: A*:___ D*:___ He-C 4002.25(a): CHILD CARE PERSONNEL SHALL NURTURE AND ENCOURAGE EACH CHILD IN CARE AND PROVIDE EACH CHILD WITH A VARIETY OF DEVELOPMENTALLY APPROPRIATE LEARNING AND SOCIAL EXPERIENCES. He-C 4002.25(e)(4): CHILD CARE PERSONNEL AND HOUSEHOLD MEMBERS, IF THE PROGRAM IS TO BE LOCATED IN A HOME, SHALL NOT WITHHOLD FOOD FROM CHILDREN OR FORCIBLY FEED CHILDREN. Page 3 of 3

Alpha-Bits Learning Center I

Visit Date(s): 02/28/2017

Lic.#: CCCB-02369

03/02/2017

THE STATUTE(S) AND/OR RULE(S) WERE NOT MET AS EVIDENCED BY THE FOLLOWING: 1. The statements by Staff B, that on a daily basis, she has witnessed Staff A forcibly feeding infants as follows: a. Staff A will hold the infants so tightly in her arm while feeding them that they do not have the ability to turn their head away when they no longer want to eat; b. Staff A will continue to insert the nipple of the bottle into their mouths, even as they are screaming. She verbalizes her frustrations by saying things such as, "you're so [expletive] dumb" and "you piece of [expletive]" to the infants; c. Staff B can tell the infants don't want the bottle because, "they are not sucking, they are screaming." Milk flows from the nipple of the bottle while Staff A repeatedly "pushes it" into their mouths, so the infants will begin to make a "gurgling sound" as the milk hits the back of their throat and they continue screaming; and d. Staff B stated that on January 6, 2017, she told Staff F that Staff A was forcefully feeding an infant. 2. Staff F confirmed that Staff B came out of the infant room in early January and told her that Staff A was forcefully trying to get a bottle into a baby's mouth. 3. The statements by Staff E that: a. Staff A will "cup" the head of an infant while bottle feeding so the infant cannot move away from the bottle; b. "[Staff A] gets upset if she's fixed a bottle…and the baby doesn't want it," and becomes upset if "she feeds a baby a bottle and the baby spits up;" and c. If the infant will not eat for Staff A, she will often say, "that's enough out of you, go back to your bed," and will place the baby in their crib. 4. The statement by Staff D that she observed Staff A feeding an infant and verbalizing her frustrations that the child was not eating. Although Staff D could not recall the exact words, she stated that Staff A's statement included a curse word, and was something very similar to, "Dammit, you need to start eating." Staff D stated that it was inappropriate enough that she did a "double take" and said to Staff A that she needed to calm down and should not be getting so upset and speaking that way to an infant. 5. According to Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, 2011: STANDARD 4.3.1.2 Feeding Infants on Cue by a Consistent Caregiver/Teacher "Caregivers/teachers should be gentle, patient, sensitive, and reassuring by responding appropriately to the infant's feeding cues. Cue feeding meets the infant's nutritional and emotional needs and provides an immediate response to the infant, which helps ensure trust and feelings of security. Cues such as turning away from the nipple, increased attention to surroundings, keeping mouth closed, and saying no are all indications of satiation." 6. The determination by the department that Staff A forcibly fed the infants and was not nurturing or developmentally appropriate with them. Staff A was forcefully feeding infants by holding them in a manner that did not allow them to turn away from the nipple, which is an indication they are no longer hungry. As referenced above in #4, "teachers should be gentle, patient, sensitive and reassuring by responding Page 4 of 4

Alpha-Bits Learning Center I

Visit Date(s): 02/28/2017

Lic.#: CCCB-02369

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appropriately to the infant's feeding cues." The manner in which Staff A was feeding the infants was not gentle, patient, sensitive or reassuring, as indicated by statements from staff that the infants were in distress and screaming as she continued forcing the bottle in their mouths. She did not respond to their feeding cues and instead became increasingly frustrated, which does not ensure trust and feelings of security between the caregiver and infant. CORRECTIVE ACTION PLAN

COMPLETION DATE: ___/___/______

FOR DEPT USE ONLY: A*:___ D*:___ He-C 4002.25(f): THE APPLICANT, LICENSEE, PERMITTEE, CENTER DIRECTOR OR SITE DIRECTOR AND ALL OTHER CHILD CARE PERSONNEL SHALL TAKE PROMPT ACTION TO PROTECT CHILDREN FROM ABUSE, NEGLECT, CORPORAL PUNISHMENT, OR OTHER MISTREATMENT BY ANY INDIVIDUAL. THE STATUTE(S) AND/OR RULE(S) WERE NOT MET AS EVIDENCED BY THE FOLLOWING: 1. The statements by Staff E that she never reported any information about Staff A's inappropriate conduct and unsafe care of the infants to either center director, or anyone else. She did not consider what she was observing to be abuse, but it made her uncomfortable and she thought it was inappropriate. 2. Staff F confirmed that Staff B told her in early January, that Staff A was forcefully trying to get a bottle into a baby's mouth. Staff F told Staff B to handle it, but did not report the concerns to either center director. Staff F became emotional and acknowledged she made a mistake by not reporting this information. 3. The center directors stated that they never would have tolerated any kind of inappropriate care of the infants at the center as described above, and have fired other staff members for much less. After being notified by department staff of Staff A's behavior, they immediately terminated Staff A and began making arrangements to retrain all staff about recognizing and then reporting abuse or any inappropriate conduct between a staff member and a child. 4. The determination by the department that: a. Staff E frequently witnessed the unsafe care and mistreatment by Staff A with the infants, and did not intervene to protect them or report what she had seen to the center directors or anyone else, allowing it to continue; and b. Staff F was notified by Staff B of Staff A force-feeding an infant, and did not assist Staff B to address the infant's immediate safety, nor report the information to the center co-directors. CORRECTIVE ACTION PLAN

COMPLETION DATE: ___/___/______

FOR DEPT USE ONLY: A*:___ D*:___ Page 5 of 5

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He-C 4002.23(g): TO REDUCE THE RISK OF SUDDEN INFANT DEATH SYNDROME (SIDS), INFANTS SHALL BE PLACED ON THEIR BACKS TO SLEEP, UNLESS THERE ARE WRITTEN MEDICAL ORDERS REQUIRING ALTERNATE POSITIONING. THE STATUTE(S) AND/OR RULE(S) WERE NOT MET AS EVIDENCED BY THE FOLLOWING: 1. The observation by department staff on February 28, 2017, that an infant in the Powder Puff room was sleeping in a swing. Staff in the infant room were advised of safe sleep practices at this time, and were asked to move the infant into a safe sleep position, flat on her back. Later this same day, another infant was observed to be sleeping in a swing and staff were again asked to move the infant out of the swing and place them in a safe sleeping position. 2. The observation by department staff on March 2, 2017, that an infant was sleeping in a swing in the Powder Puff room. Staff were asked to place the infant in a safe sleep position. 3. The program was issued the following reminder following a monitoring visit by the department on December 6, 2016: "Infants should be placed for sleep in safe sleep environments; which include a firm crib mattress covered by a tight-fitting sheet in a safety-approved crib. According to Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, Standard 3.1.4.1: Safe Sleep Practices and Sudden Unexpected Infant Death (SUID)/SIDS Risk Reduction Infants should not nap or sleep in a car safety seat, bean bag chair, bouncy seat, infant seat, swing, jumping chair, play pen or play yard, highchair, chair, futon, sofa/couch, or any other type of furniture/equipment that is not a safety-approved crib (that is in compliance with the CPSC and ASTM safety standards) (3); if an infant arrives at the facility asleep in a car safety seat, the parent/guardian or caregiver/teacher should immediately remove the sleeping infant from this seat and place them in the supine position in a safe sleep environment (i.e., the infant's assigned crib); and if an infant falls asleep in any place that is not a safe sleep environment, staff should immediately move the infant and place them in the supine position in their crib." CORRECTIVE ACTION PLAN

COMPLETION DATE: ___/___/______

FOR DEPT USE ONLY: A*:___ D*:___ By signing below, I agree to maintain future compliance with the statutes and/or rules cited above.

OWNER/APPLICANT SIGNATURE: _______________________________ DATE:

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DIRECTOR/PROVIDER SIGNATURE: _____________________________ DATE:

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FOR DEPARTMENT USE ONLY

*APPROVED (EACH ITEM IN THE CORRECTIVE ACTION PLAN HAS BEEN APPROVED) *DISAPPROVED (A REVISED CORRECTIVE ACTION PLAN WILL BE REQUIRED FOR THE ITEMS MARKED DISAPPROVED IN THE RIGHT HAND COLUMN.) LICENSING COORDINATOR: ________________________________________ DATE: FOLLOW-UP: r:\program support\licensing\ccl\group\_cclu\statements of findings\sof 01 jan - 03 mar 2017\02369_03022017.docx

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