-Pertaining to the allegation that “Staff left infant in soiled diaper for extended periods of time”:

This allegation refers to an allegation that an infant (C1) started getting diaper rash and red and bleeding skin only after being enrolled at the Center. C1 attended from July 29-August 21, 2020.

Adult #1 (A1) stated that they had eight photos of the buttocks of C1, but only five photos were provided to LPA. When asked when the photos were taken, A1 stated three were taken on 08/19/21 and five were taken on 08/30/21 (nine days after the child’s last day of attendance). The actual date(s) the five photos provided were taken is unknown, as the photos were not date stamped. Dates aside, the photos provided show the buttocks, thighs and genitals of an infant from different angles. Three photos show a bottom which is very red, whilst the other two photos show a child’s bottom which is peeling. The photos appear to depict a child with inflamed dermatitis (commonly known as diaper rash).

Of the six staff interviewed, one staff was not aware of any concerns raised by any parents; one staff was aware that there was a concern about how many times C1 was getting changed, but wasn’t sure whether the issue was that C1 was getting changed too often or not often enough; one staff spoke in general about parents’ concerns about diaper rashes and about how often they were being changed; while the remaining three staff were aware that the concern raised by A1 was that the Center was going through diapers too quickly, and so the concern was that they were using diapers brought by A1 on other infants.

Three out of four of the parents interviewed expressed no concerns about diaper changing, stating that diaper changes were always logged in the Kindercare app, whilst one parent expressed the same concern as A1 (allegedly)--that they felt as if their supply of diapers was

being depleted too quickly and that their infant was being changed too often because they ran out of diapers quickly, but stated that there has never been a concern about their infant not being changed often enough.

The screen shots and logs from the Kindercare app dated 07/29-08/21 show that C1 was changed between three-seven times each day they were present. (The day C1 was only changed three times was because C1 was not present the entire day that day.)

C1 attended a total of 18 days. The logs show that wipes were requested once, on 08/07; that diapers were requested on both 08/19 and on 08/20; and that diaper cream was requested on 08/20.

Though diaper rash is often related to wet or infrequently changed diapers, it can also be caused by irritation from stool and urine, chafing or rubbing, irritation from a new product, bacterial or yeast (fungal) infection, introduction of new foods, sensitive skin, and the use of antibiotics.

It cannot be disputed that C1 had a diaper rash. However, as the photos provided have no date or time stamp, as three parents expressed no concerns over diaper changes, and three staff stated that A1 had taken issue with the Center using too many diapers (a concern also expressed by one parent), and as logs document that C1 was changed between three to seven times each day they were present at the Center, there was no evidence provided or statements made to corroborate neglect on the Center’s part.

No deficiencies are being cited for the allegation listed above.

-Pertaining to the allegation that “Staff failed to meet child's needs”:

This allegation refers to C1 allegedly not being fed enough because A1 would provide six bottles a day and three to four would come back untouched; C1 would allegedly be so hungry in the car on the way home that A1 would have to feed C1 in the car to stop C1 from crying.

Per A1, the concern was that C1 was consuming only 6 ounces (oz.) of formula the ten hours C1 was present at the Center as opposed to what A1 stated C1 normally consumed, as documented on the “Child’s Preadmission Health History-Parent’s Report,” that C1 consumes 4-6 oz. of formula every two to three hours. Per A1, staff seemed to be documenting on the Kindercare app that C1 was only consuming 1.5-2 oz. every two to three hours. A1 thus felt that the Center was “starving” or depriving C1 by not feeding C1 6 oz. every two to three hours.

According to the screen shots of the log kept on the Kindercare app as provided by both Kindercare and A1, though C1 would consume only 1-5 oz. during each feeding, overall, the total amount would add up to what is recommended for an infant between 3 to 5 months old, which is about 6 to 7 oz. every five to six hours. Of the 18 days C1 was in attendance, C1 would consume between 7.5-17 oz. in the 6-9 hours during which C1 was fed.

Per two of the staff interviewed, A1 would provide bottles which were 6-8 oz. large. Four staff interviewed corroborated that A1 was “adamant” that C1 consume the entire bottle each feeding. As C1 would normally attend approximately ten hours a day, that C1 would consume only two bottles (or 12-16 oz.) is thus an average, normal, healthy amount. Per Johns Hopkins Medical University, “For an infant 3 to 5 months old, they should be drinking 6 to 7 ounces every five to six hours."

A1 stated that C1 gets taken to a gastrointestinal doctor and a neurologist every four days and that both doctors documented that C1 was diagnosed with “dehydration caused by not eating right.” However, though requested, the medical report(s) were not provided nor were any health conditions documented on the “Child’s Preadmission Health History-Parent’s Report.” Further, A1 admitted that C1 has Gastroesophageal reflux disease (aka GERD), which is infant reflux, a condition when “the reflux has enough acid to irritate and damage the lining of the esophagus.”

According to two staff interviewed, however, the concern A1 brought up to them wasn’t the amount C1 was consuming, but that the remaining formula was discarded instead of reheated or re-refrigerated to be consumed. When empty bottles were returned to A1 daily, A1 felt staff was “lying” and trying to make it seem as if C1 was consuming the entire bottle, though telling the “truth” and documenting what C1 actually consumed on the Kindercare app.

As C1 was been fed formula, per Johns Hopkins Medical University, if an infant does not consume the entire bottle, “If it (formula) has been at room temperature for more than 1 hour, throw it away. And if your baby doesn't drink all the formula in the bottle, throw away the unused portion — do not save it for later.”

Per two of the staff, A1 was asked to provide smaller bottles so that C1 could learn to hold the bottle on their own and so that less (if any) formula would be discarded after each feeding if the whole bottle wasn’t consumed. In addition, Center offered A1 formula through their food program so that formula consumed during hours of attendance would be paid for by the food program; per staff, A1 declined the offer. Lastly, after A1 provided tips on how C1 should be fed due to having GERD, staff stated that C1 began consuming more.

None of the four parents interviewed had concerns regarding their infants feeding or drinking enough.

As C1 allegedly has a medical condition, as Kindercare app logs document that C1 was fed every two to three hours and not every five to six hours like at home, as medical reports which allegedly document that C1 was dehydrated were not provided, and as the total amount C1 consumed falls within the recommended amount, there is not enough evidence provided or statements made to corroborate neglect on the Center’s part.

This agency has investigated the complaint alleging that there was a violation of Title 22, Division 12, Chapter 1, Subchapter 2, Section 101427 Infant Care Food Service. The complaint alleged that that “Staff failed to meet child's needs.” Based upon the evidence as presented above, the allegation has been determined to be Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies are being cited for the allegation listed above.

An exit interview has been conducted with Director Maricruz Flores A copy of this report has been signed by LPA Bell. This report and the Appeal Rights will be scanned via e-mail to Director Flores, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature.