Inspection · 2022-11-01

Based on staff record review, the provider failed to ensure that 2 of 6 employees underwent
background checks every five years.
Evidence:
1. The record for S1, contains searches of the central registry dated 09/09/2016 and
10/27/2022.
2. The record for S2, contains searches of the central registry dated 04/22/2016 and 10/27/2022.

Based on review of a child record, the provider failed to ensure that pursuant to subsection C of 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any
child whose: parent submit an affidavit to the center on the current form approved by the
Virginia Department of Health stating that the administration of immunizing agents conflicts
with the parent?s or child?s religious tenets or practices.
Evidence:
The record contained a letter from the family?s church leader. The record for C4 did not
contain an affidavit on the current form approved by the Virginia Department of Health stating
that the administration of immunizing agents conflicts with the parent?s or child?s religious
tenets or practices.

8VAC20-780-210.A
Based on staff record review, the provider failed to ensure program leader qualifications for 2
staff designated as program leaders.
Evidence:
Records for S3 and S4 did not contain documentation showing possession of Program Leader
qualifications by either: meeting endorsement or bachelor?s degree requirement; educational
requirements and programmatic experience; or supervised programmatic experience.

Based on record review, the provider failed to ensure that the emergency preparedness plan
was reviewed annually.
Evidence:
Provider records did not document an annual review of the center?s emergency preparedness
plan.

Based on observation, the provider failed to provide annual approval from
the health department.
Evidence:
At the renewal inspection on 11/01/2022 the health inspection available for inspection was dated 10/13/2021. The annual inspection should have been completed by 10/13/2022.

Based on observation, agency failed to assure that all areas and equipment inside the center
was maintained in a clean, safe, and operable condition.
Evidence:
1. There was a large patch of peeling paint within reach of children in the preschool
classroom.

Based on observation, the provider failed to ensure that sinks are supplied with running
warm water that does not exceed 120 degrees Fahrenheit (?F).
Evidence:
The water temperature in the bathroom sink used by the toddlers check by a thermometer registered
120.4?F.

Based on observation, the provider failed to assure that in each grouping at least one staff
member who meets the qualifications of a program leader or program director shall be
regularly present.
Evidence:
S6, hired as an aide was observed supervising 5 children in the pre-school classroom without a program leader or program director being regularly present while staff left the program to transport school age children to the center.

Based on review of child injury reports and interview, the provider administered
nonprescription medication without written permission from parents.
Evidence:
Child injury reports dated 09/02/2022, 07/14/2022, and 02/21/22 documented staff
administering Neosporin and antibacterial cream for minor injuries sustained by children in care without written permission of parents. Program Director acknowledged the center did not
have parental permission to administer the ointments.

Based on review of emergency evacuation drills documentation, the provider failed to ensure the documentation contained all of the required information.
Evidence:
The emergency drill documentation dated January 2022 ? October 2022 did not document any special conditions simulated and weather conditions.

Based on observation, provider failed to ensure all food and bottles brought from home and
stored in the refrigerator were clearly dated and labeled in a way that identifies the owner.
Evidence:
1. One Apple and Berry squeeze container was not dated or labeled.
2. Multiple bottes in the refrigerator were not labeled with a date or labeled in a way that
identified the owner.

Based on observation, provider failed to assure when children are placed in an infant seat, the protective belts shall be fastened securely.
Evidence:
Four children seated in infant seats at the feeding table did not have protective belts fastened
securely.

Based on child record review, the provider failed to ensure that two of five records contained
all the required information.
Evidence:
The record for C2, enrolled 09/28/20 failed to contain documentation of annual parent
confirmation of up-to-date information in the record as required by 8VAC20-780-420.E.3 since
enrollment.
The record for C5, enrolled 01/13/2020 failed to contain documentation of annual parent
confirmation of up-to-date information in the record as required by 8VAC20-780-420.E.3 since
08/04/2021.

Based on staff record review, the provider failed to ensure that health information was kept for
one of six staff.
Evidence:
Record for S6 employed 10/31/2022 did not contain health
information required by 8VAC20-780-160.C within the required time frame.

Based on staff record review, the provider failed to keep documentation to demonstrate that
the individual possesses training as required in 8VAC20-780.240 1of 6 staff
Evidence:
Record for S6 did not contain documentation of orientation required by 8VAC20-780-240
regarding sudden infant death syndrome and use of safe sleep practices, prevention of shaken baby syndrome and abusive head trauma, prevention and response to emergencies due to food or other allergic restrictions, and the prevention and control of disease.