Inspection · 2024-08-26

Based on record review and interview, the provider did not obtain the results of a national fingerprint- based criminal background check for each applicant and household member?s record every 5 years as required.

Evidence:
1. The record of the applicant, caregiver #1, contained documentation of fingerprints dated 09/05/2018 exceeding five years.
2. The record of household member #1, contained documentation of fingerprints dated 09/14/2018 exceeding five years.
3. The provider stated she had not requested updated fingerprints.

Based on interview, the provider did not ensure that the home was equipped with at least one carbon monoxide detector.

Evidence:
1. A carbon monoxide detector could not be located in the home during the inspection.
2. The provider confirmed that they did not have a carbon monoxide detector.

Systemic
Based on review of children?s records and interview, the provider did not obtain documentation of a physical examination by or under the direction of a physician prior to a child's attendance or within 30 days after the first day of attendance.

Evidence:
1. The record of child #1, (enrolled 02/01/2023), did not contain documentation of a physical.
2. The record of child #2, (enrolled 07/01/2023), did not contain documentation of a physical.
3. The record of child #3, (enrolled 06/01/2020), did not contain documentation of a physical.
4. The record of child #4, (enrolled 05/01/2019), did not contain documentation of a physical.
5. The provider stated she did not have documentation of physicals for the four children?s records.

Based on review of records and interview, the provider did not ensure caregivers obtained 16 hours of training annually in areas relevant to their job responsibilities.

Evidence:

1. The record of caregiver #1 contained documentation of 10 hours of training during the period of 01/01/2023 through 12/31/2023 when 16 hours was required.
2. The record of household member #1, identified as a substitute provider, contained documentation of 4 hours of training during the period of 01/01/2023 through 12/31/2023 when 16 hours was required.
3. The provider stated that 16 hours of annual training had not been completed.

Based on record review and interview, the provider did not maintain documentation of each caregiver?s applicable education and programmatic experience, applicable first aid and CPR certification, orientation, annual training, and applicable medication administration training.

Evidence:
The record of household member #1, identified as a substitute provider, did not contain documentation of education, programmatic experience, and orientation.

Repeat
Based on observation and interview, the provider did not ensure that areas and furnishings of the family day home, inside and outside, were maintained in a clean, safe, and operable condition.

Evidence:
1. The plastic elephant slide located on the outdoor play area, was cracked in multiple places. The cracks were at the top of the slide and curved upward creating sharp edges that could snag the skin of a child.
2. The provider acknowledged that the slide was cracked along the top.

Based on documentation review and interview, the provider did not obtain an annual inspection for the wood burning stove and associated chimney by a knowledgeable inspector to verify that the device is properly installed, maintained, and cleaned as needed.

Evidence:
1. The most recent documentation of an inspection for the wood burning stove was dated 10/28/2022.
2. The provider stated that the stove has not been used, and an annual inspection was not conducted.

Systemic
Based on a review of children?s records, the provider did not ensure that each child's record contained all required information.
Evidence:
1. The record for child #1, (enrolled 02/01/2023), did not contain the policy number of the child?s medical insurance.
2. The record of child #2, (enrolled 07/01/2023), did not contain: the telephone number of each custodial parent?s place of employment, the policy number of the child?s medical insurance, and documentation of the annual review of the child's emergency contact information as required by 8VAC20-800-780 B.
3. The record of child #3, (enrolled 06/01/2020), did not contain the policy number of the child?s medical insurance.
4. The record of child #4, (enrolled 05/01/2019), did not contain: the telephone number of each custodial parent?s place of employment, policy number of the child?s medical insurance, written authorization for emergency medical care should an emergency occur, and the parent cannot be located immediately, and documentation of the annual review of the child's emergency contact information as required by 8VAC20-800-780 B. The most recent review was documented 06/01/2022.
5. The record of child #5, (enrolled 04/05/2021), did not contain written authorization for emergency medical care should an emergency occur, and the parent cannot be located immediately, the policy number of the child?s medical insurance, and documentation of the annual review of the child's emergency contact information as required by 8VAC20-800-780 B.
6. The record of child #6, (enrolled 07/01/2022), did not contain the name, address, and phone number for one of the two required emergency contacts, and written authorization for emergency medical care should an emergency occur, and the parent cannot be located immediately.

Systemic
Based on review of children?s records, the provider did not ensure parents were provided required information in writing before the child's first day of attendance.

Evidence:
1. The record of Child #1(enrolled 02/01/2023), child #2 (enrolled 07/01/2023), and child #3 (enrolled 06/01/2020) did not have documentation on file that the provisions of the emergency preparedness and response plan were provided to parents and signed.
2. The record of child #6 (enrolled 07/01/2022) did not have documentation on file whether or not there is liability insurance of at least $100,000 per occurrence and $300,000 aggregate in force on the family day home, and policies for the administration of medications.

Based on observation and interview, the provider did not ensure medication, except for those prescriptions designated otherwise by a written physician's order, including refrigerated medication and medications for caregivers and household members, were kept in a locked place using a safe locking method that prevents access by children.

Evidence:
1. An unlocked plastic bin located in a bedroom contained prescription medication. The bedroom was accessible to children in care.
2. The provider identified the prescription medications as belonging to her and her husband.

Based on observation and interview, the caregiver did not ensure a working portable battery-operate weather band radio was available to caregivers at all times.

Evidence:
The portable battery-operated weather band radio on site was not operational. The provider stated she thought the batteries had gone bad and that she did not have extra batteries to replace the old ones.

Repeat
Based on review of the emergency plan, the provider did not review the plan at least annually and update the plan as needed.

Evidence:
1. The most recent review of the emergency plan was dated 06/02/2022.
2. The provider stated that the annual review had not been done.

Based on review of the emergency drill log and interview, the provider did not ensure shelter-in-place procedures were practiced a minimum of twice per year.

Evidence:
The emergency evacuation log did not contain documentation of any shelter in place drills for the 2023 year, when a minimum of two shelter in place drills is required per year. The provider stated she had not conducted any shelter in place drills.

Systemic
Based on review of children?s records, the provider did not ensure that before a child attended the family day home, the provider obtained documentation that the child had been adequately immunized.

Evidence:
The record of child #3, (enrolled 06/01/2020), did not contain documentation of immunizations.