Inspection · 2023-04-18

Based on record review, the provider failed to ensure that staff underwent criminal background checks every 5 years.
Evidence:
The record for S8, contained national criminal background checks dated 03/18/2018 and
02/26/2024.

Based on record review, the provider failed to ensure that all applicants for employment shall submit to fingerprinting and undergo a national criminal background check prior to employment.
Evidence:
The record for S1 contained results of the national criminal background check dated 01/25/2024. The provider documented orientation and training for S1 on 01/23 and 24/2024 prior to receipt of background results.
The record for S2 contained results of the national criminal background check dated 01/23/2024. The provider documented orientation and training for S2 on 01/22/2024 prior to receipt of background results.
The record for S3 contained results of the national criminal background check dated 08/17/2023. The provider documented orientation and training for S3 on 08/04/2023 and 08/09/2023 prior to receipt of background results.
The record for S4 contained results of the national criminal background check dated 04/18/2023 and the date of hire 08/02/2023. The results are more than 90 days old.
The record for S5 contained results of the national criminal background check dated 01/18/2024. The provider documented orientation and training for S5 on 01/15/2024 prior to receipt of background results.

(Repeat Violation)
Based on staff record review, the provider failed to ensure that one of eight staff submit
documentation of a negative tuberculosis screening at the time of employment or
documentation completed within the last 30 calendar days of the date of employment.

Evidence:
The record for S4, employed 08/02/2023 did not document a tuberculosis (TB) screening
within the required time frame. The screening was completed 4/18/2023.

Based on staff record review, the provider failed to ensure that one of eight staff shall obtain
and submit the results of a follow-up tuberculosis (TB) screening at least every two
years or more frequently if recommended.
Evidence:
The TB screenings for S8 are dated 08/21/2021 and 01/24/2024.

Based on staff record review and interview, the provider failed to ensure that staff were provided in writing with the center?s information listed in 8VAC20-780-240.D.3 through D.7.

Evidence:
Orientation form used by the center for S1, S2, S3, S4, and S5 failed to document: procedures for identifying where attending children are at all times, including procedures to ensure that all children are accounted for before leaving a field trip site and upon return to the center; procedures for action in case of lost or missing children, ill or injured children, medical emergencies, and general emergencies; policy for any administration of medication; emergency evacuation, relocation, shelter-in-place, and lockdown procedures; and precautions in transporting children, if applicable. S7 reported not being aware the copy of the orientation form was improperly printed and incomplete.

(Repeat Violation)
Based on observation, the provider did not ensure that all areas of the center be maintained in a clean, safe, and operable condition.
Evidence:
The upstairs windows in three children's bathrooms were duct taped shut making them unsafe and inoperable.

Based on observation, interview, and documentation, the center did not ensure compliance with ratios of staff to children as required.

Evidence:
On 3/14/2024, the licensing inspector entered the Infant room at approximately 10:00 a.m.
and observed 17 infants being cared for by 3 staff members. Staff members in the room acknowledged the room was out of ratio when licensing inspector entered the room. The room came into ratio at approximately 10:15 a.m. when a staff returned to the room.

Based on documentation review it was determined that staff used the forbidden action of enclosure in a confined space or any space that the child cannot freely exit.
Evidence:
Licensing inspector reviewed incident reports for C6 dated 02/05/2024 and 02/12/2024 that documented the toddler hitting and scratching other children and staff ?sat (C6) in a highchair? and C6 ?was sat in a highchair and talked to.?.

Based on child record review, the provider failed to document at least annually parent confirmation that the required information in the child?s record is up to date.
Evidence:
The record for child, C4 did not document annual confirmation of required information in the record. C4, enrolled 11/28/2022 and the annual confirmation of information was dated 02/23/2024.

Based on observation and interview, the center failed to assure that medication shall be
labeled with the child?s name, the name of the medication, the dosage amount, and the time
or times to be given.
Evidence:
Licensing inspector observed a plastic bag labeled with the name of child, C8, that
contained an unlabeled prescribed emergency medication. The medication was not labeled
with the child?s name, the name of the medication, the dosage amount, and the time
or times to be given. S7 reported not having the pharmacy labeled box that contained this
information.

Based on review of emergency evacuation, shelter-in-place, and lockdown drills
documentation, the provider failed to ensure the documentation contained all the required
information.
Evidence:
The emergency drill documentation dated January, February, and March 2024 did not
document: the person conducting the drill, the method used for notification of the drill; the number of staff participating; and any special conditions simulated.

Based on observation, the provider failed to ensure food brought from home was clearly
dated.

Evidence:
Licensing inspector observed multiple lunch boxes not dated in the toddler room.

Based on observation, the provider failed to ensure prepared infant formula shall be dated.
Evidence:
Individual infant bottles for three children in the infant room refrigerator were not dated.