PENNSYLVANIA DEPARTMENT OF EDUCATION CHILD AND ADULT CARE FOOD PROGRAM CHILD CARE CENTER MONITOR REPORT Date of Visit Name of Center Center Address Type of visit: Announced Unannounced First 4-Week Visit Follow-up Time of Arrival Time of Departure License Expiration Date: Capacity: A. Visit Preparation 1. List problem(s) identified during the last review and determine if effective corrective action has been implemented. Date of Last Monitor Visit Problem(s) Identified Recommended Corrective Action Corrective Action Implemented 2. Are all previous problems corrected? ( ) Yes ( ) No B. Visit/Observation 1. Which meal service was observed? ( ) Breakfast ( ) Lunch ( ) Supper ( ) AM Supplement ( ) PM Supplement ( ) Evening Supplement ( ) Weekday ( ) Saturday ( ) Sunday Approved PEARS Scheduled Time Actual Time of Service 2. Indicate age group and number of infants/children served on day of visit: Infants*: 0-3 months 4-7 months 8-11 months Children: 1-2 years 3-5 years 6-12 years 13+ years *Complete Infant Addendum Form PDE328 (6/11)
3. Complete the following chart for the meal service observed: Meal Size Serving Required Requirements List and Circle Foods Served Requirements Were Met Yes No Breakfast Milk Whole 2% 1% Skim ( ) ( ) Grains/Breads ( ) ( ) Fruit or Vegetable or Full Strength Juice ( ) ( ) Other Foods Lunch or Milk Whole 2% 1% Skim ( ) ( ) Supper Meat or Meat Alternate ( ) ( ) Grains/Breads ( ) ( ) Vegetable or Fruit ( ) ( ) Fruit or Vegetable ( ) ( ) Other Foods Supplement Milk Whole 2% 1% Skim ( ) ( ) (serve 2 of 4 Meat or Meat Alternate ( ) ( ) components) Grains/Breads ( ) ( ) Fruit or Vegetable or Full Strength Juice ( ) ( ) Other Foods 4. Meal Preparation YES a. Are meals served in accordance with the approved meal times? ( ) ( ) b. Are all meals served on the premises? ( ) ( ) c. Are meals ordered or prepared on the basis of providing one meal type per enrolled child at each meal service? ( ) ( ) d. Are the meals prepared on-site? ( ) ( ) If, are meals prepared by a central kitchen, school food authority, or food service company (caterer, management company, restaurant), and delivered to the center? ( ) ( ) e. 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? ( ) ( ) 2
YES f. Is a person responsible for checking to insure that all meals brought from a central kitchen, school, or food service company include the required components for meals? ( ) ( ) [Name of person(s)] g. Has the supplier established a procedure for reporting missing components to the center? ( ) ( ) Describe the procedure: h. Do the number of meals ordered allow for the appropriate quantity of each food item? ( ) ( ) i. Is the number of meals delivered verified with the daily invoice? ( ) ( ) 5. Menus/Meal Count a. Are daily, dated menus maintained in the center for all meals served? ( ) ( ) b. Is each child served the appropriate quantity of each food item? ( ) ( ) c. Are all required components served? ( ) ( ) Is 1% or skim fluid milk served to children two years of age and older? ( ) ( ) d. Is potable drinking water readily available upon request during the hours of care? ( ) ( ) e. Are food substitutions listed on the menu? ( ) ( ) f. Is a food substitution to the menu made for an individual? ( ) ( ) g. Is the substitution documented by a statement from a recognized medical authority which includes recommended alternate foods? ( ) ( ) If YES, list alternate food(s) provided: h. Is a daily meal count taken at the point of service for all meals (by type) served to: Enrolled children? ( ) ( ) Program Adults? ( ) ( ) Non-program Adults? ( ) ( ) Non-program Children? ( ) ( ) 3
i. 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. Date Enrollment Attendance Brkft AM Snack Day of Review: Day 1: Day 2: Day 3: Day 4: Day 5: Total * * Do not include day of review. Lunch PM Snack Supper Evening Snack YES 6. Training Does the meal count for the prior 5 serving days appear reasonable when compared to the day of review s meal count? ( ) ( ) If, obtain and record an explanation; record suggested corrective action. a. Has key staff been trained in CACFP requirements? ( ) ( ) Principals? ( ) ( ) Center Director? ( ) ( ) Bookkeeper/Fiscal Manager? ( ) ( ) Cook? ( ) ( ) Others? ( ) ( ) If YES, name the job positions: b. Has new staff been trained in CACFP requirements prior to performing CACFP tasks? ( ) ( ) c. Are copies of the minimum CACFP meal requirements and additional CACFP materials available to the cook? ( ) ( ) d. Is the present week s menu reviewed with the cook at the monitoring visit? ( ) ( ) e. Is additional help or training needed for food service personnel to ensure CACFP requirements are being met? ( ) ( ) 4
YES f. Is documentation of staff training maintained on file? ( ) ( ) Agenda/Topics? ( ) ( ) Sign-in Sheets? ( ) ( ) Handouts? ( ) ( ) g. Has the annual requirement of training been met? ( ) ( ) 7. Recordkeeping a. Are accurate daily attendance records maintained separately from meal count records? ( ) ( ) b. Are enrollment documents on file for all enrolled children? ( ) ( ) c. Does the Enrollment Form contain: Enrollment Date? ( ) ( ) Child s Name and Age? ( ) ( ) Parent/Guardian Address, Telephone Number? ( ) ( ) Normal Hours of Care? ( ) ( ) Expected Meal Participation? ( ) ( ) Household Contact Information? ( ) ( ) Parent/Guardian Signature? ( ) ( ) Signature of Center Representative? ( ) ( ) 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? ( ) ( ) f. Are written edit check procedures available for review? ( ) ( ) g. Is the facility license available for review? ( ) ( ) h. Is the center in compliance with the authorized licensed or the Head Start Grant Award capacity? ( ) ( ) 8. 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? ( ) ( ) 5
YES d. Are the food service preparation, storage, equipment, and delivery areas clean and maintained properly? ( ) ( ) 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? 9. Others a. List the type(s) of organized activities provided for the children. b. Is supervision adequate for the number of children in attendance each day? ( ) ( ) C. Corrective Action/Follow-up 1. Corrective Action: If your answers to any of these questions 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: 2. 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. Signature of Monitor Signature of Center Representative Date of Visit Date of Visit 6