G-Ma Luv The Angels Daycare
Inspection history
Source: Ohio Department of Children and YouthRecords held from Sep 12, 2023 onward. Earlier visits may exist in the agency’s own files.
Ohio publishes its inspection findings only as scanned report images. The findings shown here were transcribed from those scans; the archived original report linked on each visit is the authoritative record. Findings the inspector handled as technical assistance are not violations and are not listed.
| Date | Kind | Outcome as recorded | Violations | Official record |
|---|---|---|---|---|
| May 28, 2026 | Compliance | Partially Compliant · Non-Compliance - Not Addressed | 5 | Official report · PDF |
| May 18, 2026 | Attempted | Fully Compliant | 0 | Official report · PDF |
| Dec 18, 2025 | Compliance | Partially Compliant · Non-Compliance - Not Addressed | 8 | Official report · PDF |
| Dec 15, 2025 | Attempted | Fully Compliant | 0 | Official report · PDF |
| Dec 9, 2025 | Attempted | Fully Compliant | 0 | Official report · PDF |
| Jun 23, 2025 | Compliance | Partially Compliant · Non-Compliance - Not Addressed | 4 | Official report · PDF |
| Apr 29, 2024 | Attempted | Fully Compliant | 0 | Official report · PDF |
| Oct 3, 2023 | Compliance | Partially Compliant · Non-Compliance - Partially Addressed | 10 | Official report · PDF |
Violations
Text reproduced verbatim · Ohio Department of Children and YouthNearly every licensed provider accumulates some. A missing signature and an unlocked medicine cabinet are both “violations”, and they are not the same thing. Look at the class, the pattern over time and how quickly it was corrected — not the count alone.
Class is our grouping of the state’s own weights, reviewed per state. The agency’s own label is always shown beside it.
Ohio Department of Children and Youth publishes these findings only as a scanned report. The text below was transcribed from that scan — the archived original is authoritative.
“During the inspection, it was determined the program had not responded to the non-compliances addressed in the inspection report dated 12/18/2025. The rule requires the program complete and submit a Chir Department of i eg Children & Yout! corrective action plan in OCLQS to address non-compliances detailed in written inspection reports within the timeframe outlined in the report. Submit the program’s corrective action plan, which includes a statement that current and future corrective action plans will be submitted timely, to the Department to verify compliance with the requirements of this rule.”
“During the inspection, it was determined that the program did not have a first aid kit [onsite/ on the vehicle/ on a field trip] as required, that included all items listed in the appendix A of the rule. The kit(s) were missing the item(s) or the item(s) were not replaced after use and/or expired listed in number(s) 4,7,9, and 13below: 1. One roll of first-aid tape; 2. Individually wrapped sterile gauze; squares in assorted sizes; 3. Sterile adhesive bandages in assorted sizes; 4.Tweezers; 5. Gauze rolled bandage; 6. Triangular bandage; 7. Rounded end scissors; 8. Tooth preservation system or fresh chilled liquid milk in which to transport a lost permanent tooth, including a written reference indicating location of the refrigerator/freezer where milk is stored if a tooth preservation system is not part of the first aid kit (for programs serving school age children only); 9. A working digital thermometer; 10. Disposable non-latex gloves; 11. A working flashlight; 12. An instant cold pack that has not been activated or ice, including a written reference indicating location of the refrigerator/freezer where the ice is stored if an instant cold pack is not part of the first aid kit; 13. Sealable leak-proof plastic bags in assorted sizes or double bagged plastic bags that can be securely tied for materials soiled with blood or bodily fluids; 14. Pocket mask or face shield, appropriate; for all ages of children in care, for cardiopulmonary resuscitation (CPR) administration; 15. Soap or waterless sanitizer (field trip or transporting away from the program only); 16. Bottled water (field trip or transporting away from the program only). Correct the violation and submit the program's corrective action plan to verify compliance with the requirements of this rule.”
“In review of the staff records, it was determined that the medical statements for those individuals listed on the Employee Record Chart did not include the required information listed below in number(s) 1. 1. A medical statement was not on file; 2. The medical statement(s) on file were not dated within 12 months of the individual's first day of employment; 3. Date of examination was missing; 4. Signature, business address, or telephone number of the licensed physician, physician assistant, advanced practice nurse, certified midwife, or certified nurse practitioner who completed the examination was missing; 5. A statement was missing that verifies the individual is: a. Physically fit for employment in a program caring for children; b. Immunized against Tetanus, Diphtheria, Pertussis (Tdap); c. Immunized against Measles, Mumps, and Rubella (MMR); Submit the program’s corrective action plan, which includes a copy of the completed medical statement, to the Department to verify compliance with the requirements of this rule.”
“In review of Hydie's records, it was determined the CCSM or Substitute CCSM was left alone with children and did not have current valid documentation for training(s) listed in number(s) 1 below: 1. First Aid - expired training 2. First Aid - did not have verification of completion of First Aid training 3. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 4. CPR - expired training 5. CPR - had not taken CPR training 6. CPR - did not have verification of the completion of CPR training 7. CPR - training taken did not include all age groups the program serves and developmental levels of all children in care 8. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 9. CPR - audiovisual or electronic media training taken by staff did not include an in-person component of the training 10. Communicable Disease - expired training 11. Communicable Disease - had not taken CD training 12. Communicable Disease - did not have verification of the completion of the CD training Chir Department of i eg Children & Yout! 13. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 14. Child Abuse - expired training 15. Child Abuse - had not taken Child Abuse training 16. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Correct the violation and submit the documentation of current certification with the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of the children's records, it was determined that information had not been secured from the parent/guardian on the JFS 01234 “Child Enrollment and Health Information For Child Care”, as required, for the items in number(s) 10 below: 1. No enrollment form was completed for at least one child 2. The current JFS 01234 was not completed for at least one child 3. Complete child information 4. Complete parent information 5. Complete emergency contact information 6. Complete physician information 7. Information regarding the parent list 8. Health information 9. Additional information for all boxes checked “yes” 10. Emergency transportation information 11. Parent/guardian’s signature 12. Diapering Statement 13. Acknowledgement of Policies and Procedures 14. Enrollment form for at least one child was not updated by either the parent or the administrator 15. Enrollment form for at least one child was not signed by the administrator 16. Other [ ] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule.”
Ohio Department of Children and Youth publishes these findings only as a scanned report. The text below was transcribed from that scan — the archived original is authoritative.
“During the inspection, it was determined that the provider did not have designated storage areas for children's personal belongings, in that there was no personal storage anywhere for children's things. Correct the violation and submit the program's corrective action plan to verify compliance with the requirement of the rule.”
“During the inspection, it was determined that the program did not have a first aid kit [onsite/ on the vehicle/ on a field trip] as required, that included all items listed in the appendix A of the rule. The kit(s) were missing the item(s) or the item(s) were not replaced after use and/or expired listed in number(s) 4 below: 1. One roll of first-aid tape; 2. Individually wrapped sterile gauze; squares in assorted sizes; 3. Sterile adhesive bandages in assorted sizes; 4.Tweezers; 5. Gauze rolled bandage; 6. Triangular bandage; 7. Rounded end scissors; 8. Tooth preservation system or fresh chilled liquid milk in which to transport a lost permanent tooth, including a written reference indicating location of the refrigerator/freezer where milk is stored if a tooth preservation system is not part of the first aid kit (for programs serving school age children only); 9. A working digital thermometer; 10. Disposable non-latex gloves; 11. A working flashlight; 12. An instant cold pack that has not been activated or ice, including a written reference indicating location of the refrigerator/freezer where the ice is stored if an instant cold pack is not part of the first aid kit; 13. Sealable leak-proof plastic bags in assorted sizes or double bagged plastic bags that can be securely tied for materials soiled with blood or bodily fluids; 14. Pocket mask or face shield, appropriate; for all ages of children in care, for cardiopulmonary resuscitation (CPR) administration; 15. Soap or waterless sanitizer (field trip or transporting away from the program only); 16, Bottled water (field trip or transporting away from the program only). Correct the violation and submit the program's corrective action plan to verify compliance with the requirements of this rule.”
“During the inspection, it was determined that the required drills were not completed for item number(s) 1,2, and 3 below: 1. Monthly fire drills 2. | Monthly weather emergency drills (March through September) 3. Emergency/lockdown drills in each quarter of the calendar year Chior Department of i eg Children & Yout Submit the program’s corrective action plan to verify compliance with the requirements of this rule.”
“In review of the program's records, it was determined that requirements for written permission from the parent/guardian for a field trip or routine trip were not met as listed in number(s) 1 below: 1. Written parental permission was not secured for field trips and/or routine trips off the premises. 2. The written permission was missing the child’s name. 3. The written permission was missing the date(s) of the trip(s) (field trips only). 4. The written permission was missing the destination(s) of the trip(s). 5. The written permission was missing the departure and return time(s) of the trip(s) (field trips only). 6. The written permission was missing the signature of the parent. 7. The written permission was missing the date on which the permission was signed. 8. The written permission was missing a statement notifying parents how their child will be transported. 9. Permission forms for routine trips were not being updated annually. 10. Written parental permission forms for field trips and/or routine trips were not being maintained on file for at least one year from the date of the trip. 11. Other: [ ]. Submit the program’s corrective action plan to verify compliance with the requirements of this rule.”
“In review of the staff records, it was determined that the medical statements for those individuals listed on the Employee Record Chart did not include the required information listed below in number(s) 1. 1. A medical statement was not on file; 2. The medical statement(s) on file were not dated within 12 months of the individual's first day of employment; 3. Date of examination was missing; 4, Signature, business address, or telephone number of the licensed physician, physician assistant, advanced practice nurse, certified midwife, or certified nurse practitioner who completed the examination was missing; 5. A statement was missing that verifies the individual is: a. Physically fit for employment in a program caring for children; Chir Department of i eg Children & Yout! b. Immunized against Tetanus, Diphtheria, Pertussis (Tdap); c. Immunized against Measles, Mumps, and Rubella (MMR); Submit the program’s corrective action plan, which includes a copy of the completed medical statement, to the Department to verify compliance with the requirements of this rule.”
“In review of Jackies records, it was determined the provider did not have current valid documentation for training(s) listed in number(s) 14 below: 1. First Aid - expired training 2. First Aid - did not have verification of the completion of First Aid training 3. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 4. CPR - expired training 5. CPR - had not taken CPR training 6. CPR - did not have verification of the completion of CPR training 7. CPR - training taken did not include all age groups and developmental levels of all children in care 8. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 9, CPR- audiovisual or electronic media training taken did not include an in-person component of the training 10. Communicable Disease - expired training 11. Communicable Disease - had not taken CD training 12. Communicable Disease - did not have verification of the completion of CD training 13. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 14. Child Abuse - expired training 15. Child Abuse - had not taken Child Abuse training 16. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Correct the violation and submit the documentation of current certification with the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of Hydies records, it was determined the CCSM or Substitute CCSM was left alone with children and did not have current valid documentation for training(s) listed in number(s) 1,4,and 14 below: 1. First Aid - expired training 2. First Aid - did not have verification of completion of First Aid training 3. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 4. CPR - expired training 5. CPR - had not taken CPR training 6. CPR - did not have verification of the completion of CPR training 7. CPR - training taken did not include all age groups the program serves and developmental levels of all children in care 8. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 9. CPR - audiovisual or electronic media training taken by staff did not include an in-person component of the training 10. Communicable Disease - expired training 11. Communicable Disease - had not taken CD training 12. Communicable Disease - did not have verification of the completion of the CD training 13. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 14. Child Abuse - expired training 15. Child Abuse - had not taken Child Abuse training 16. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Correct the violation and submit the documentation of current certification with the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of the children's records, it was determined that information had not been secured from the parent/guardian on the JFS 01234 “Child Enrollment and Health Information For Child Care”, as required, for the items in number(s) 4,10,11,12,13, and 15below: 1. No enrollment form was completed for at least one child 2. The current JFS 01234 was not completed for at least one child 3. Complete child information 4. Complete parent information Chior Department of i eg Children & Yout! 5. Complete emergency contact information 6. Complete physician information 7. Information regarding the parent list 8. Health information 9. Additional information for all boxes checked “yes” 10. Emergency transportation information 11. Parent/guardian’s signature 12. Diapering Statement 13. Acknowledgement of Policies and Procedures 14. Enrollment form for at least one child was not updated by either the parent or the administrator 15. Enrollment form for at least one child was not signed by the administrator 16. Other [ ] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule.”
Ohio Department of Children and Youth publishes these findings only as a scanned report. The text below was transcribed from that scan — the archived original is authoritative.
“During the inspection, it was determined the provider's license was not in a location visible to parents, as required. Submit the program’s corrective action plan to verify compliance with the requirements of this rule. Chir Department of i Le Children & Yout!”
“During the inspection, it was determined the program did not meet the requirements for keeping an attendance record as listed in number(s) 8 below: 1. No attendance record was being maintained. 2. The attendance record was not being consistently completed. 3. The record did not include the name of at least one child. 4. The record did not include the birth date of at least one child. 5. The record did not include the assigned group. 6. The record did not include the child’s weekly schedule. 7. The record did not include the time (hours and minutes) of each child’s arrival and departure to the program, including transportation by the program. 8. The original attendance record was not kept at the program for a period of one year, Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule.”
“During the inspection, it was determined that unsanitary conditions, as noted in the following number(s) 3 below, were in the main restroom: 1. There was no liquid soap. 2. There was no toilet tissue. 3. There were no individually assigned towels or disposable towels. 4. The toilet cleaning brush was accessible to the children. 5. The plunger was accessible to the children. 6. The toilet was not flushed. 7. The trash was not emptied from the day before. 8. There was a strong urine odor. 9. Other []. Chir Department of i Le Children & Yout! The restroom(s) must be kept sanitary at all times. Submit the program's corrective action plan to verify compliance with the requirement of the rule.”
“During the inspection, it was determined that employment records in the Ohio Professional Registry (OPR) were not created or maintained as noted in number(s) 1,2, and 5 below: 1. The provider had not created or updated their individual profile in the OPR. 2. The provider had not created or updated the program's organizational dashboard in the OPR. 3. At least one employee, child care staff member, or substitute child care staff member had not created or updated their individual profile in the OPR. 4. At least one employee, child care staff member, or substitute child care staff member had not created an employment record in the OPR for the program on or before the first day of employment, including date of hire. 5. At least one employee, child care staff member, or substitute child care staff member had not updated changes to positions or roles in the OPR within five calendar days of the change. 6. The program's organizational dashboard in the OPR was not updated within five business days when at least one employee, child care staff member, or substitute child care staff member's scheduled days and hours changed. 7. The program's organizational dashboard in the OPR was not updated within five business days when at least one employee, child care staff member, or substitute child care staff member's group assignments changed, if applicable. 8. The program's organizational dashboard in the OPR was not updated with the employment end date within five business days when at least one employee, child care staff member, or substitute child care staff member ended employment. 9, At least one resident over the age of eighteen had not created a profile and employment record for the family child care provider within five days of becoming a resident or turning eighteen. 10. The program's organizational dashboard in the OPR was not updated within five calendar days of a change in residency for at least one resident over the age of eighteen. 11.Other: [] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule.”
Ohio Department of Children and Youth publishes these findings only as a scanned report. The text below was transcribed from that scan — the archived original is authoritative.
“During the inspection, it was determined that the program was not maintaining a smoke free environment, as noted in the number(s) 3 below: 1. The program did not provide a smoke free environment for children during the hours of child care in that 2. An individual left the home to smoke, however, this smoking occurred in an area within view of the children. 3. A"No Smoking" sign was not displayed in a conspicuous place at the main entrance. 4. Smoking had occurred in the program or vehicle during hours the program was not in operation; however, parents had not been given written notice of this. 5. Children had access and/or were exposed to smoking paraphernalia in that [cigarettes/cigars/pipe butts/ashes/chewing or smokeless tobacco/electronic cigarettes/vaporizers] was/were observed in view of children. 6. Other [ ]. Submit the program’s corrective action plan to verify compliance with the requirements of this rule.”
“During the inspection, it was determined that unsanitary conditions, as noted in the following number(s) 3,4, and 5 below, were in the downstairs restroom: 1. There was no liquid soap. 2. There was no toilet tissue. 3. There were no individually assigned towels or disposable towels. 4. The toilet cleaning brush was accessible to the children. 5. The plunger was accessible to the children. 6. The toilet was not flushed. 7. The trash was not emptied from the day before. 8. There was a strong urine odor. 9. Other []. The restroom(s) must be kept sanitary at all times. Submit the program's corrective action plan to verify compliance with the requirement of the rule.”
“During the inspection, it was determined the requirements for the JFS 01242 "Medical, Dental and General Emergency Plan" were not followed as the 1st page of the document is missing: 1. The plan was not posted on each level of the home used for child care. 2. The name, address and telephone number of the program were not complete. 3. The location of the first aid kit, fire extinguisher and fire alarm system, fire alarm pull stations and electrical circuit box were not complete. 4. The telephone number for emergency squad, fire department hospital, poison control program, public children services agency, local health department, local emergency management agency and police department were not complete. 5. Location of children's records was not complete. 6. Emergency information including any medications or supplies needed i the event of an evacuation was not complete. 7. The current version of the prescribed form was not used. 8. The plan was not implemented when necessary in that [ ]. Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule.”
“During the inspection, it was determined that the program's weekly menu did not meet the requirement as noted in number(s) 1 below. 1. The menu was not posted. 2. The posted menu was not in a visible place readily accessible to parents. 3. The menu was not currently dated. 4. The entire menu was substituted. 5. At least one item on menu did not match what was served. 6. The meal or snack served did not match the posted menu. Submit the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of the program's records, it was determined that requirements for written permission from the parent/guardian for a field trip or routine trip were not met as listed in number(s) 1-8 below: 1. Written parental permission was not secured for field trips and/or routine trips off the premises. 2. The written permission was missing the child’s name. 3. The written permission was missing the date(s) of the trip(s) (field trips only). 4. The written permission was missing the destination(s) of the trip(s). 5. The written permission was missing the departure and return time(s) of the trip(s) (field trips only). 6. The written permission was missing the signature of the parent. 7. The written permission was missing the date on which the permission was signed. 8. The written permission was missing a statement notifying parents how their child will be transported. 9. Permission forms for routine trips were not being updated annually. 10. Written parental permission forms for field trips and/or routine trips were not being maintained on file for at least one year from the date of the trip. 11. Other: [ ]. Submit the program’s corrective action plan to verify compliance with the requirements of this rule.”
“In review of records, it was determined the provider did not have current valid documentation for training(s) listed in number(s) 1 and 4 below: 1. First Aid - expired training 2. First Aid - did not have verification of the completion of First Aid training 3. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 4. CPR - expired training 5. CPR - had not taken CPR training 6. CPR - did not have verification of the completion of CPR training 7. CPR - training taken did not include all age groups and developmental levels of all children in care 8. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 9. CPR- audiovisual or electronic media training taken did not include an in-person component of the training 10. Communicable Disease - expired training 11. Communicable Disease - had not taken CD training 12. Communicable Disease - did not have verification of the completion of CD training 13. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 14. Child Abuse - expired training 15. Child Abuse - had not taken Child Abuse training 16. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Correct the violation and submit the documentation of current certification with the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of records, it was determined the CCSM or Substitute CCSM was left alone with children and did not have current valid documentation for training(s) listed in number(s) 11 and 14 below: 1. First Aid - expired training 2. First Aid - did not have verification of completion of First Aid training 3. First Aid - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 4. CPR - expired training 5. CPR - had not taken CPR training 6. CPR - did not have verification of the completion of CPR training 7. CPR - training taken did not include all age groups the program serves and developmental levels of all children in care 8. CPR - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 9. CPR - audiovisual or electronic media training taken by staff did not include an in-person component of the training 10. Communicable Disease - expired training 11. Communicable Disease - had not taken CD training 12. Communicable Disease - did not have verification of the completion of the CD training 13. Communicable Disease - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule 14. Child Abuse - expired training 15. Child Abuse - had not taken Child Abuse training 16. Child Abuse - documentation did not demonstrate the person who provided the training met the trainer qualifications as stated in the rule Correct the violation and submit the documentation of current certification with the program's corrective action plan to verify compliance with the requirement of the rule.”
“In review of the staff records, it was determined that verification of a high school education for the child care staff member(s) listed on the Employee Record Chart, did not meet the requirements as listed in number(s) 1 below: 1. Verification of completion of a high school education was not on file. 2. Documentation was not on file to verify that that a high school graduate was at least 16 years of age. 3. Documentation of a high school education was not on file for a person, counted in the staff/child ratio, and therefore was used as a Child Care Staff Member. Submit the program’s corrective action plan, which includes a copy of the education verification, to the Department to verify compliance with the requirements of this rule.”
“In review of the children's records, it was determined that information had not been secured from the parent/guardian on the JFS 01234 “Child Enrollment and Health Information For Child Care”, as required, for the items in number(s) 1, 4, 6, 8, 10, 11,12,13,14, and 15 below: 1. No enrollment form was completed for at least one child 2. The current JFS 01234 was not completed for at least one child 3. Complete child information 4. Complete parent information 5. Complete emergency contact information 6. Complete physician information 7. Information regarding the parent list 8. Health information 9. Additional information for all boxes checked “yes” 10. Emergency transportation information 11. Parent/guardian’s signature 12. Diapering Statement 13. Acknowledgement of Policies and Procedures 14. Enrollment form for at least one child was not updated by either the parent or the administrator 15. Enrollment form for at least one child was not signed by the administrator 16. Other [ ] Submit the program's corrective action plan to the Department to verify compliance with the requirements of this rule.”
“In review of of the children's records, it was determined that completed medical statements were not on file, as required, for children listed on the JFS Children's Record Review For Child Care as indicated in number(s) 6,7, and 8 below: 1. No medical was on file for at least one child 2. Medical(s) on file was not updated every 13 months 3. Medical(s) were missing child's name and date of birth 4, Medical(s) were missing the date of the medical examination 5. The date of the exam was more than 13 months prior to the date the form was signed 6. Medical(s) were missing a statement that the child has been examined and is in suitable condition for participation in group care 7. Medical(s) were missing the signature, business address and telephone number of the physician, physician's assistant(PA), advance practice nurse (APN) or certified nurse practitioner (CNP) who examined the child 8. Medical(s) were missing a record of immunizations the child has had specifying month, day and year 9, Medical(s) were missing a statement from the physician, PA, APN, or CNP that the child has been immunized or is in the process of being immunized against the diseases required by division 5104.014 of the Revised Code and found in appendix A to this rule 10. Medical(s) were missing a statement from the child’s parent or guardian that he or she has declined to have the child immunized against the disease for reasons of conscience, including religious convictions 11. Other [ ] Submit the program’s corrective action plan to the Department to verify compliance with the requirements of this rule.”