Paula Smith C/O Tracy M. Miller 701 5th Ave Suite 3300 Seattle, WA 98104

Provider ID#: 192295

Dear Ms. Smith:

STATE OF WAS.HlNGTON DEPARTMENT OF EARLY LEARNlNG

805 156th Ave NE Bellevue, WA 98007

Must be Certified Mail or Hand Delivered

April 21, 2014

The Department of Early Leaming received your request on March 10, 2014; DEL reviewed your Regional Administrator review request of:

0 Compliance agreement dated regarding . Valid complaint finding(s) from complaint# 439998 received on November 15, 2014.

D No referral status due to mistaken identity received on

During the review process the following materials were provided and taken under consideration: Written statement from you explaining specific reasons/conditions for the review. Relevant materials from your licensing file. Other: RCW 43.215 and WAC 170-295

This review has been concluded and a decision has been made: The licensor's decision has been upheld because:

The letter contesting the Valid complaint finding states that, "the dispute about accommodations o has arisen because (I) the full extent of need for nursing care was not apparent when he was first admitted to the School; and (2) the School does not employ a nurse and cannot, therefore, provide "nursing care," which includes the non-delegable duties of administering medication and piercing the skin."

Point (1) above states that the school was not aware of the full extent of the child's needs. The documentation obtained shows that the family was proactive in notifying the school of the child's needs starting with the admission paperwork, extending themselves to meet and further discuss any questions staff may have and by offering to arrange for training even after the child began attending the program.

· On 01/22/13, the family submitted an essay and enrollment paperwork for their two children. The essay clearly disclosed that the child has type 1 diabetes and requires blood glucose level checks and insulin. When asked to include any other information that the caregiver feels is

10.9. l.3 Supervisory Review Decision Letter Rev. 2/13

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important for the school to know the parent wrote, "As mentioned elsewhere in this application, has type I (juvenile) diabetes that is well controlled and places no limits on his abilities.

However, it is necessary for teachers to be aware of his condition and to know a few basic facts about it." Furthermore, the parents articulated that with basic training the child's previous teachers were able to quickly learn how to assist the child. The children were later accepted into the full-day Early Elementary Program on 03/15/13.

Following the child's acceptance into the program, and prior to the beginning of the school year, the family initiated mutliple attempts to correspond with the school asking how they could help educate and prepare staff to assist their child with his diabetic needs. Included in the correspondence was a PDF document titled, "Helping the Student with Diabetes Succeed: A Guide for School Personnel." Ms. Angie Goodwill acknowledged receipt of this document on 07 /26/13 and informed the family that the school would be touching base with them closer to the start of the school year.

On 08/28/13, Ms. Melissa Chittenden emailed the family to reiterate the messages previously discussed during a 08/27/13 meeting. Ms. Chittenden specifically stated, " ... I'm optimistic that we can work together with you to figure out a way for to get the medical care he needs from someone other than a UCDS employee ... "

In their continued efforts to help educate staff, the family arranged for pediatric endocinologist Dr. Craig Taplin and diabetic educator Amanda Peters to provide a presentation on the basic supervision and monitoring of the child's diabetic needs. During this presentation Ms. Chittenden reportedly stressed to staff that they did not have to assist the child with his diabetic are, but rather the material presented was for informational purposes only.

On 09/23/13, the family completed and signed a Diabetes Medical Management Plan that specified the child's needs.

Point (2) states that the school does not employ a nurse and cannot, therefore, provide "nursing care," which includes the non-delegable duties of administering medication and piercing the skin."

During a meeting held on 10/11/13, you informed the family that the school staff would not directly assist the child with his medical needs.

Federal laws state that child care programs must do an individualized assessment of any child with diabetes and reasonably accommodate their needs. To facilitate appropriate care, staff must have an understanding of diabetes and be trained in its management and emergencies. Based on documentation obtained during the complaint inspection, there was no evidence that the school made any efforts with their staff to assess the child's individual needs and make accommodations to assist him directly.

The US Department of Justice Commonly Asked Questions About Child Care Centers and ADA clearly specifies that programs are generally required to test a child's blood sugar levels. Additionally, it specifies that providers should follow directions for simple diabetes-related care as outlined by the parents and physician. "In most instances they (parents) will authorize the provider to monitor the child's blood sugar- or "blood glucose" - levels before lunch and

10.9. l.3 Supervisory Review Decision Letter Rev. 2/13

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whenever the child appears to be having certain easy-to-recognize symptoms of a low blood sugar incident. While the process may seem uncomfortable or even frightening to those unfamiliar with it, monitoring a child's blood sugar is easy to do with minimal training and takes only a minute or two. The parents are responsible for providing all appropriate testing equipment, training, and special food necessary for the child."

Washington Administrative Code (WAC) 170-295-3050 specifically states, "If a child has a condition where the Americans with Disabilities Act (ADA) would apply you must make reasonable accommodation and give the medication." As mentioned, Federal laws have considered diabetes to be a disability. The family articulated that the child is knowlegable about his condition and has some self care skills, however they also articulated that he requires adult supervision and/or assistance with his daily care.

Based on review of the information obtained during the course of the complaint inspection it is concluded that although the school enrolled the child into the program with knowledge of the child's condition, efforts were not made to make reasonable accommodations to directly help the child. Rather, the program offerred a stipend up to $10,000.00 and placed the responsibility on the family for being at the school and/or hiring a separate person to be at the school each day. This does not meet the intent of the WAC and therefore I am upholding the licensor's decision to conclude the complaint as Valid.

D The licensor's decision has been overturned because:

D Other:

IZI If you are not satisfied with this review, you may request the next level of review by contacting:

Mary Kay Quinlan Statewide Licensing Administrator PO Box40970 Olympia, WA 98504-0970 (360) 407-1972

D This is DEL's final review.

Your request must be received no later than 10 days after the receipt of this letter. If you have any questions, please feel free to call me at:(425) 590-3102

Sincerely,

....

Heather West NW Regional Administrator

10.9 .1.3 Supervisory Review Decision Letter Rev. 2/13

Department of Early Learning

cc: Noy Sivongxay, Child Care Licensor Deanna Sundby, DEL Licensing Analyst Heather West, DEL Regional Administrator

10.9.1.3 Supervisory Review Decision Letter Rev. 2/13

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