Inspection · 2026-01-30
Date
2026-01-30
Complaint Related
No
Licensing Inspector
Cathy Aylor
(540) 222-6352
(540) 222-6352
SHSIA monitoring inspection of an approved subsidy vendor to determine compliance with current subsidy requirements regarding the health and safety of children and to promote quality standards for the children in their care.
Yes
Violations
4Standard 22.1-289.035-B-3
The child day center shall obtain a copy of the results of a search of the central registry maintained pursuant to ? 63.2-1515 for any founded complaint of child abuse or neglect against them prior to employment.
There was no documentation to show that staff A had obtained the child abuse and neglect background check prior to employment, This background check was overdue by 3 months.
There was no documentation to show that staff A had obtained the child abuse and neglect background check prior to employment, This background check was overdue by 3 months.
Plan of Correction: The center immediately reviewed staff personnel files upon identification of the missing documentation. It was determined that the child abuse and neglect central registry background check for Staff A had been initiated during the onboarding process; however, the submission did not successfully process and remained in the system hub without final confirmation, resulting in the documentation not being received at that time.
Corrective Actions Implemented:
? The child abuse and neglect central registry background check for Staff A was immediately resubmitted, obtained, and placed in the personnel file.
? A comprehensive audit of all staff personnel files was initiated to confirm that all required background checks are fully submitted, successfully processed, and current before employment.
? Leadership reinforced hiring and onboarding procedures to include verification of successful submission and receipt of background checks before staff begin work.
Date Corrected:
? Background check successfully processed and filed: 2/2/26
? Staff file audit and process reinforcement completed: 2/16/26
Corrective Actions Implemented:
? The child abuse and neglect central registry background check for Staff A was immediately resubmitted, obtained, and placed in the personnel file.
? A comprehensive audit of all staff personnel files was initiated to confirm that all required background checks are fully submitted, successfully processed, and current before employment.
? Leadership reinforced hiring and onboarding procedures to include verification of successful submission and receipt of background checks before staff begin work.
Date Corrected:
? Background check successfully processed and filed: 2/2/26
? Staff file audit and process reinforcement completed: 2/16/26
Standard 8VAC20-780-140-A
Each child shall have a physical examination by or under the direction of a physician within 30 days of enrollment.
There was no physical on file for child A, this was overdue by 6 months.
There was no physical on file for child A, this was overdue by 6 months.
Plan of Correction: Upon review of the children?s records, it was identified that a physical examination for Child A was not present in the child?s file. While leadership believed the documentation had been obtained, the center was not able to provide a copy of the required physical examination to the licenser during the inspection visit.
Corrective Actions Implemented:
? Leadership immediately contacted the family of Child A to request the required physical examination documentation.
? The family was provided a two-week deadline to submit the physical examination, with a required submission date of 2/23/26.
? Enrollment and record-maintenance procedures were reinforced to ensure all required health documentation is received, reviewed, and documented within 30 days of enrollment.
Date Corrected / Anticipated Completion:
? Parent notified, and documentation requested: 2/2/26
? Physical examination due from family: 2/23/26
Corrective Actions Implemented:
? Leadership immediately contacted the family of Child A to request the required physical examination documentation.
? The family was provided a two-week deadline to submit the physical examination, with a required submission date of 2/23/26.
? Enrollment and record-maintenance procedures were reinforced to ensure all required health documentation is received, reviewed, and documented within 30 days of enrollment.
Date Corrected / Anticipated Completion:
? Parent notified, and documentation requested: 2/2/26
? Physical examination due from family: 2/23/26
Standard 8VAC20-780-150-B
Each report shall include the date of the physical examination and dates immunizations were received and shall be signed by a physician, his designee, or an official of a local health department.
The immunization records for child A was not signed by a physician/designee, this was overdue by 7 months.
The immunization records for child B was not signed by a physician/designee, this was overdue by 3 months.
The physical for child C was not signed by a physician/designee, this was overdue by 1 year and 6 months.
The immunization records for child A was not signed by a physician/designee, this was overdue by 7 months.
The immunization records for child B was not signed by a physician/designee, this was overdue by 3 months.
The physical for child C was not signed by a physician/designee, this was overdue by 1 year and 6 months.
Plan of Correction: Leadership identified that the required medical documentation for Child A, Child B, and Child C was incomplete at the time of inspection due to missing physician signatures on required forms.
? For Child A, the immunization record included a physician stamp with the provider?s name and office address; however, the document did not contain a completed physician signature as required.
? For Child B, the immunization record was included as part of the child?s physical examination, which was electronically signed and stamped; however, the immunization section itself did not contain a separate required signature.
? For Child C, the physical examination was not signed; however, the immunization record was included within the physical document, which contained a completed physician signature.
Corrective Actions Implemented:
? Leadership immediately contacted the families of Child A, Child B, and Child C to request fully completed medical documentation with all required physician signatures.
? Families were provided a two-week deadline to submit updated documentation, with a required compliance date of 2/23/26.
? All children?s medical records were reviewed to ensure required documentation includes completed signatures, dates, and provider verification.
? Leadership will continue to monitor child files to ensure ongoing compliance.
Date Corrected / Anticipated Completion:
? Parents notified, and documentation requested: 2/2/26
? Updated, fully signed medical records due: 2/23/26
? For Child A, the immunization record included a physician stamp with the provider?s name and office address; however, the document did not contain a completed physician signature as required.
? For Child B, the immunization record was included as part of the child?s physical examination, which was electronically signed and stamped; however, the immunization section itself did not contain a separate required signature.
? For Child C, the physical examination was not signed; however, the immunization record was included within the physical document, which contained a completed physician signature.
Corrective Actions Implemented:
? Leadership immediately contacted the families of Child A, Child B, and Child C to request fully completed medical documentation with all required physician signatures.
? Families were provided a two-week deadline to submit updated documentation, with a required compliance date of 2/23/26.
? All children?s medical records were reviewed to ensure required documentation includes completed signatures, dates, and provider verification.
? Leadership will continue to monitor child files to ensure ongoing compliance.
Date Corrected / Anticipated Completion:
? Parents notified, and documentation requested: 2/2/26
? Updated, fully signed medical records due: 2/23/26
Standard 8VAC20-780-280-B
Hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children.
The door to the kitchen was unlocked and open and next to the sink was a sanitizing agent and a concentrated detergent. These hazardous agents were sitting on the floor and a shelf a few feet off the floor.
The door to the kitchen was unlocked and open and next to the sink was a sanitizing agent and a concentrated detergent. These hazardous agents were sitting on the floor and a shelf a few feet off the floor.
Plan of Correction: The hazardous materials observed in the kitchen area were immediately secured upon identification to prevent child access. Children do not have routine access to the kitchen area, and children do not use the space; however, additional safeguards were implemented to ensure safety and compliance further.
Corrective Actions Implemented:
? The kitchen door was immediately locked, and a latch was added to provide an additional layer of security.
? Staff were reminded and retrained on proper storage requirements for hazardous materials, including ensuring all items are always stored out of reach and in locked areas.
Date Corrected:
? Hazardous materials secured; kitchen locked, and latch installed: 2/2/26
? Safety expectations and procedures reinforced with staff: 1/30/26
________________________________________
Corrective Actions Implemented:
? The kitchen door was immediately locked, and a latch was added to provide an additional layer of security.
? Staff were reminded and retrained on proper storage requirements for hazardous materials, including ensuring all items are always stored out of reach and in locked areas.
Date Corrected:
? Hazardous materials secured; kitchen locked, and latch installed: 2/2/26
? Safety expectations and procedures reinforced with staff: 1/30/26
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