CHILD CARE MONITOR REPORT Date of Visit: Type of Visit: (Check All That Apply) Name of Center: Announced Unannounced (as listed in PEARS) First 4-Week Follow-Up Center Address: Program(s) Reviewed: Child Care (CC) Head Start (HS) Pre-K Counts Outside School (PreK) Hours (OSHC) License Expiration Date: License Capacity: Time of Arrival Time of Departure A. Day of Visit Observation 1. Which meal service was observed? Breakfast: Lunch: Supper: AM Snack: PM Snack: Evening Snack: Weekday: Saturday: Sunday: Meal Was Served: Pre-Plated: Family-Style: Approved PEARS Meal Service Time: Begin: End: Actual Time of Meal Service: Begin: End: a. On the day of observation, was the meal served within approved meal times? 2. Indicate age group and number of infants/children served on day of visit: Infants: 0-5 Months 6-11 Months Children: 1-2 Years 3-5 Years 6-12 Years 3. Meal Preparation a. Are all meals served on the premises? b. Are meals ordered or prepared based on providing one meal type per enrolled child at each meal service? c. Are the meals prepared on-site? If no, are meals prepared by a central kitchen, school food authority, or food service company (caterer, management company, restaurant) and delivered to the center? d. If meals are not prepared on site: Are the meals delivered according to contract? Are cold foods delivered and maintained between 35 and 42 degrees F? Are hot foods delivered and maintained between 140 and 160 degrees F? Are all required components delivered? e. Do the number of meals ordered allow for the appropriate quantity of each food item? f. Is the number of meals delivered verified with the daily invoice? PDE328 (12/17) 1 F&B NUT 100 4/18
4. Day of Observation a. Complete the following chart for the meal service observed: Meal Requirements List Foods Served List Quantity Breakfast Milk Grain Fruit, Vegetable, or Portions of Both Meat or Meat Alternate (in place of grain no more than 3 times weekly) Lunch or Supper Supplement (serve 2 of 5 components) Milk Meat or Meat Alternate Grain Vegetable Fruit Other Foods Milk Meat or Meat Alternate Grain Fruit Vegetable b. Did the menu correspond to the meal observed? c. Were all required components served? d. Were required minimum quantities of each food item planned and served to each age group? e. If served family style: Were sufficient amounts of all required components placed on the table so that each participant could receive the full required portions? Is each child initially offered the full portion size? Do the caretakers actively encourage each child to take the full portion during the course of the meal? 5. Food Storage / Food Safety a. Is there a working refrigerator and/or freezer available? Is the cold storage 40 degrees F or below? Is the freezer storage 0 degrees F or below? Are all perishables properly maintained in a refrigerator or freezer? b. Dry storage facilities: Are they adequate? Are foods stored separately from cleaning items? Is there evidence of rodent or insect infestation? Is food storage area properly secured to prevent theft? c. Is the food handled in a sanitary manner before, during, and after preparation? d. Are the food service preparation, storage, equipment, and delivery areas clean and maintained properly? PDE328 (12/17) 2 F&B NUT 100 4/18
e. Are proper garbage disposal methods used in the kitchen, serving areas, and areas for storing garbage until pickup? f. Are dishwashing facilities adequate and properly used? g. Are diaper changing areas located away from food storage, preparation, and service areas? h. Are cleaning supplies stored separately from food and out of reach of children? 6. Menus / Meal Count a. Are daily, dated menus posted and maintained in the center for all meals served? b. Are substitutions, additions, and deletions noted on a working menu? c. Are milk types for each age group recorded on the dated, daily menu? d. Did the review of menus and supporting documentation validate that a minimum of one serving of grains per day is whole grain-rich? e. Did the review of menus and supporting documentation validate that breakfast cereals contain no more than 6 grams of sugar per dry ounce? f. Did the review of menus and supporting documentation validate that yogurt contains no more than 23 grams of sugars per 6 ounce serving? g. Did the review of menus and supporting documentation validate that grain-based desserts are not planned and served as a creditable grain component? h. Did the review of menus and supporting documentation validate pasteurized, 100% juice is served at only one meal or snack per day? i. Did the review of infant menus validate that juice is not served as a meal component to infants? j. Did the review of menus and supporting documentation validate that a meat/meat alternate is served in place of the grain component at breakfast no more than three times per week? k. Did the review of menus and supporting documentation validate that deep fat-fried foods prepared on-site are not served as part of a reimbursable meal? l. Is potable drinking water readily available and offered to children throughout the day? m. Are participants aged 12 months to 24 months served only unflavored whole milk? (One-month transition period is allowable from 24 to 25 months) n. Are participants aged 2 years to 5 years served only unflavored fat free (skim) or low fat (1%) milk? o. Are participants aged 6 years and older served only unflavored or flavored fat free (skim) or low fat (1%) milk? p. Does the center serve milk substitutions to any participants with a non-disabling special dietary need? If yes, are the substitutions nutritionally equivalent to milk? q. Does the center serve participants with special dietary needs related to a disability, that affect the CACFP meal pattern? If yes, is there documentation that contains the participant's name, information about the child's physical or mental impairment, and what must be done to accommodate the child (recommended substitutions) and signature of the state recognized medical authority? PDE328 (12/17) 3 F&B NUT 100 4/18
r. Do parents/guardians provide no more than one meal component of a reimbursable meal for children with a non-disability dietary need? If yes, is the component creditable? s. Is a daily meal count taken at the point of service for all meals (by type) served to enrolled children? t. Do meal count rosters include the following: First and last name of each participant? Coded eligibility for each participant? u. Are meal count rosters dated? w. Record the enrollment, attendance, and number of meals by meal type for all meals claimed for each of the prior 5 consecutive serving days and compare with day of review: Day of Review: Day 1: Day 2: Day 3: Day 4: Day 5: Total * * Do not include day of review Enrollment Attendance Breakfast AM Snack Lunch PM Snack Supper Evening Snack x. Does the meal count for the prior 5 serving days appear reasonable when compared to the day of review s meal count? If no, obtain and record an explanation: te: If a reasonable explanation is not provided, Household Contacts should be conducted. 7. Training a. Have all key staff been trained annually in CACFP requirements? Record the most recent date of annual CACFP training: b. Has new staff been trained in CACFP requirements prior to performing CACFP tasks? c. Is documentation of staff CACFP training maintained on file? Agenda/Topics? Sign-In Sheets? Handouts? d. Have all key staff been trained annually in Civil Rights requirements? Record the most recent date of annual Civil Rights training: PDE328 (12/17) 4 F&B NUT 100 4/18
e. Has new staff been trained in Civil Rights requirements prior to performing CACFP tasks? f. Is documentation of staff Civil Rights training maintained on file? Agenda/Topics? Sign-In Sheets? Handouts? 8. Recordkeeping a. Are accurate, daily attendance records maintained separately from meal count records? b. Are enrollment documents on file for all enrolled children? (t required for HS or OSHC) c. Does the enrollment form contain: Child s name and age or birthdate? Parent/Guardian address, telephone number? rmal hours of care? Expected meal participation? Parent/Guardian signature and date? Signature of center representative and date? d. Are the enrollment forms completed annually? e. Are the applications for free and reduced-price meals on file for all enrolled children claimed as free or reduced-priced? (t required for HS) f. Are the income eligibility forms completed annually? g. Is a current facility license posted in the facility? h. Is the center in compliance with the authorized license or the Head Start Grant Award capacity? i. Is the required And Justice for All poster prominently displayed in a publicly visible location? j. Does the center ensure that WIC information is distributed annually to participating households? k. Does this center distribute the Building for the Future flyer to parents or guardians at the time of enrollment? PDE328 (12/17) 5 F&B NUT 100 4/18
B. Corrective Action / Follow-Up 1. Were problem(s) identified during the last monitoring visit? If yes, have all problems been corrected? 2. Corrective Action: If your answers to any of the questions on the report indicate any deficiencies in the facility s operation, they must be discussed with the director. Describe below the corrective action proposed or taken for each deficiency: 3. Follow-Up: a. Is a follow-up review necessary due to non-compliance issues? If yes, an unannounced follow-up monitoring visit must be conducted within 30 calendar days. 4. Are Household Contacts required? Signature of Monitor Date of Visit Signature of Center Representative Date of Visit Reviewed by: Signature of Sponsor Representative Title Date PDE328 (12/17) 6 F&B NUT 100 4/18
INFANT ADDENDUM 1. Does the facility provide at least one creditable iron-fortified infant formula? If yes, list the type of formula offered below: 2. Are parents/guardians providing no more than one of the required meal components? a. Is written documentation available indicating parent declined the infant formula offered by the facility? b. If the parent is providing the formula, does it meet the definition of iron-fortified infant formula in the CACFP? If no, is there a medical statement provided by a State recognized medical authority on file? 3. Are separate infant menus recorded and maintained? 4. Do menus include: a. Infant first and last name b. Age or birthdate of the infant 5. Are infant menus dated? 6. Is each infant, by age group, offered the required minimum quantity of each food item? 7. Complete the following chart for the meal service observed. Record food item offered and quantity offered: Meal Components Iron-Fortified Formula/Breast Milk Iron-Fortified Infant Cereal or Meat/Meat Alternate Meat/Meat Alternate Fruit, Vegetable, or Portions of Both Bread, crackers, or Ready-to-Eat Cereal (snack only) Other 0-5 Months 6-11 Months PDE328 Infant Addendum (12/17) 7 F&B NUT 100 4/18