Inspection · 2023-03-16
Date
2023-03-16
Complaint Related
No
Licensing Inspector
Sydney Emory
(804) 807-3277
(804) 807-3277
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.
No
Areas Reviewed
22.1 Religious Exempt; Background Checks Code; Carbon Monoxide
32.1 Report by person other than physician
54.1 Must be MAT Certified.
63.2 Child abuse and neglect
8VAC20-770 Background Checks
8VAC20-790 Introduction
8VAC20-790 Administration
8VAC20-790 Staff Qualifications & Training
8VAC20-790 Physical Plant
8VAC20-790 Staffing & Supervision
8VAC20-790 Programs
8VAC20-790 Special Care Provisions & Emergencies
8VAC20-790 Special Services
Inspector Notes
An annual monitoring inspection was initiated on 03/16/2023 and concluded on 03/16/2023. The inspector was on site at the center from 11:15am to 1:20pm. There were 85 children in care with 16 staff supervising. Interviews were held with staff throughout the inspection, and the inspector
interacted with children in each classroom when appropriate. The center?s playground and all classrooms were inspected today. Eight children?s records and eight employee records were reviewed during this inspection. Information gathered during the inspection determined areas of noncompliance with applicable regulations or law, and violations were documented on the violation notice issued to the vendor.
If you have any questions regarding this inspection, please contact the licensing inspector at (804) 929-3771.
Violations
4Standard 22.1-289.031-A-4
Based on record review, the center did not
ensure each person in a supervisory position
has been certified by a practicing physician or
physician assistant to be free from any
disability which would prevent him from caring
for children under his supervision.
Evidence:
1. The record of staff #3 (employment date:
8/8/2022) did not have documentation showing
that they have been certified by a practicing
physician or physician assistant to be free from
any disability which would prevent him from
caring for children under his supervision.
2. The record of staff #6 (employment date:
7/16/2022) did not have documentation showing
that they have been certified by a practicing
physician or physician assistant to be free from
any disability which would prevent him from
caring for children under his supervision.
ensure each person in a supervisory position
has been certified by a practicing physician or
physician assistant to be free from any
disability which would prevent him from caring
for children under his supervision.
Evidence:
1. The record of staff #3 (employment date:
8/8/2022) did not have documentation showing
that they have been certified by a practicing
physician or physician assistant to be free from
any disability which would prevent him from
caring for children under his supervision.
2. The record of staff #6 (employment date:
7/16/2022) did not have documentation showing
that they have been certified by a practicing
physician or physician assistant to be free from
any disability which would prevent him from
caring for children under his supervision.
Plan of Correction: I will have the staff get this taken care of within 10 days.
Standard 22.1-289.035-B-2
Based on record review, the vendor did not
ensure seven of eight staff records contained
documentation of fingerprint based national
criminal history search results prior to
employment.
Evidence:
1. The record of staff #2 (employment date:
2/1/2022) had documentation of
fingerprint based national criminal history
search results dated 7/18/2022.
2. The record of staff #3 (employment date:
8/8/2022) had documentation of
fingerprint based national criminal history
search results dated 9/20/2022.
3. The record of staff #4 (employment date:
7/1/2022) had documentation of
fingerprint based national criminal history
search results dated 7/6/2022.
4. The record of staff #5 (employment date:
7/1/2022) had documentation of
fingerprint based national criminal history
search results dated 8/17/2022.
5. The record of staff #6 (employment date:
7/16/2022) had documentation of
fingerprint based national criminal history
search results dated 8/10/2022.
6. The record of staff #7 (employment date:
7/29/2022) had documentation of
fingerprint based national criminal history
search results dated 8/16/2022.
7. The record of staff #8 (employment date:
8/24/2021) had documentation of
fingerprint based national criminal history
search results dated 9/10/2021.
ensure seven of eight staff records contained
documentation of fingerprint based national
criminal history search results prior to
employment.
Evidence:
1. The record of staff #2 (employment date:
2/1/2022) had documentation of
fingerprint based national criminal history
search results dated 7/18/2022.
2. The record of staff #3 (employment date:
8/8/2022) had documentation of
fingerprint based national criminal history
search results dated 9/20/2022.
3. The record of staff #4 (employment date:
7/1/2022) had documentation of
fingerprint based national criminal history
search results dated 7/6/2022.
4. The record of staff #5 (employment date:
7/1/2022) had documentation of
fingerprint based national criminal history
search results dated 8/17/2022.
5. The record of staff #6 (employment date:
7/16/2022) had documentation of
fingerprint based national criminal history
search results dated 8/10/2022.
6. The record of staff #7 (employment date:
7/29/2022) had documentation of
fingerprint based national criminal history
search results dated 8/16/2022.
7. The record of staff #8 (employment date:
8/24/2021) had documentation of
fingerprint based national criminal history
search results dated 9/10/2021.
Plan of Correction: In the future it will be done on time.
Standard 22.1-289.035-B-4
Based on record review and an interview, the
center did not ensure two of eight staff records
contained documentation of criminal history
record results, sex offender registry check
results and a child abuse and neglect search
request from any state in which the individual
has resided in the past five years.
Evidence:
1. The record of staff #3 (employment
date:8/8/2022) did not have documentation of
out of state criminal history record results, sex
offender registry check results and a child
abuse and neglect search request.
2. The record of staff #6 (employment
date:7/16/2022) did not have documentation of
out of state criminal history record results, sex
offender registry check results and a child
abuse and neglect search request.
3. The record of staff #3 and staff #6 indicated that the staff members have lived outside of Virginia within the last 5 years.
center did not ensure two of eight staff records
contained documentation of criminal history
record results, sex offender registry check
results and a child abuse and neglect search
request from any state in which the individual
has resided in the past five years.
Evidence:
1. The record of staff #3 (employment
date:8/8/2022) did not have documentation of
out of state criminal history record results, sex
offender registry check results and a child
abuse and neglect search request.
2. The record of staff #6 (employment
date:7/16/2022) did not have documentation of
out of state criminal history record results, sex
offender registry check results and a child
abuse and neglect search request.
3. The record of staff #3 and staff #6 indicated that the staff members have lived outside of Virginia within the last 5 years.
Plan of Correction: I will start the process today and will provide an update in 10 days.
Standard 8VAC20-770-40-D-2
Based on record review, the provider did not
ensure eight of eight staff records had documentation of central registry results within 30 days of employment and a completed sworn statement or affirmation prior to employment.
Evidence:
1. The record of staff #2 (employment date:
2/1/2022) had documentation of central
registry results dated 11/02/2022 and a completed sworn statement or affirmation dated
6/23/2022.
2. The record of staff #3 (employment date:
8/8/2022) had documentation of central
registry results dated 11/2/2022.
3. The record of staff #4 (employment date:
7/1/2022) had documentation of central
registry results dated 11/02/2022.
4. The record of staff #5 (employment date:
7/1/2022) had documentation of central
registry results dated 3/02/2023 and a completed sworn statement or affirmation dated
8/10/2022.
5. The record of staff #6 (employment date:
7/16/2022) had documentation of central
registry results dated 11/02/2022.
6. The record of staff #7 (employment date:
7/29/2022) had documentation of central
registry results dated 11/02/2022 and a completed sworn statement or affirmation dated
7/31/2022.
7. The record of staff #8 (employment date:
8/24/2021) had documentation of central
registry results dated 11/04/2021 and a completed sworn statement or affirmation dated
6/23/2022.
ensure eight of eight staff records had documentation of central registry results within 30 days of employment and a completed sworn statement or affirmation prior to employment.
Evidence:
1. The record of staff #2 (employment date:
2/1/2022) had documentation of central
registry results dated 11/02/2022 and a completed sworn statement or affirmation dated
6/23/2022.
2. The record of staff #3 (employment date:
8/8/2022) had documentation of central
registry results dated 11/2/2022.
3. The record of staff #4 (employment date:
7/1/2022) had documentation of central
registry results dated 11/02/2022.
4. The record of staff #5 (employment date:
7/1/2022) had documentation of central
registry results dated 3/02/2023 and a completed sworn statement or affirmation dated
8/10/2022.
5. The record of staff #6 (employment date:
7/16/2022) had documentation of central
registry results dated 11/02/2022.
6. The record of staff #7 (employment date:
7/29/2022) had documentation of central
registry results dated 11/02/2022 and a completed sworn statement or affirmation dated
7/31/2022.
7. The record of staff #8 (employment date:
8/24/2021) had documentation of central
registry results dated 11/04/2021 and a completed sworn statement or affirmation dated
6/23/2022.
Plan of Correction: In the future it will be done on time.