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Inspection · 2024-10-24

Date

2024-10-24

Complaint Related

Licensing Inspector

Molly Muscat
(804) 588-2367

Areas Reviewed

8VAC20-780 Administration.
8VAC20-780 Staff Qualifications and Training.
8VAC20-780 Physical Plant.
8VAC20-780 Staffing and Supervision.
8VAC20-780 Programs.
8VAC20-780 Special Care Provisions and Emergencies
8VAC20-820 THE LICENSE.
8VAC20-770 Background Checks (8VAC20-770)
20 Access to minor?s records
63.2 Child Abuse & Neglect

During the inspection, the inspector reviewed the areas listed above to include standards found out of compliance during the previous inspection. Unless otherwise noted as a violation within this inspection report, the provider was in compliance with the standards reviewed. If there were any serious injuries or fatalities related to a violation, the details will be included in the description of the violation.

Inspector Notes

An unannounced monitoring inspection was initiated on 10/24/2024 and completed on 11/14/2024 in response to a self-report received by the licensing office on 10/22/2024 relating to supervision. The Department requested that the provider complete an IPOC as result of the last inspection related to supervision, operational responsibilities, behavioral guidance, and forbidden actions. The inspector reviewed 1 child?s record and 5 staff records on-site. This inspection included document review, tour of the facility, interviews, and observations.

Information gathered during the inspection determined non-compliance with applicable standards or law, and violations are documented on the violation notice issued to the program. Though not a part of the original self report, violations that were not reported were found related to out of state background checks and are documented on the violation notice issued to the program.

Please complete the plan of correction (POC) and date to be corrected sections for each violation cited on the violation notice. Specify how the violation will be or has been corrected. Submit your POC within five (5) business days from today, which will be the close of business on 11/27/2024. A POC submitted after this date will not appear on the public website.

Violations

Standard 22.1-289.035-B-4

The center is required to obtain background checks from any state in which the individual has resided in the preceding five years.

The center did not request a criminal history check from a state that staff #2 lived in the preceding five years. Staff #2 has been employed for 2 weeks.

Plan of Correction: The center had obtained the correct documentation for the Central Registry check for Staff #2, as well as a Criminal History search, and was under the assertion that all checks were complete. Staff #2 was immediately asked to complete the correct Criminal History Check, and was back in compliance. The Director will use a background compliance checklist for all staff prior to scheduling onboarding.

Standard 8VAC20-780-340-A

Repeat Violation
When staff are supervising children, they shall always ensure their care, protection, and guidance.

On 10/18/24, staff #1 and staff #2 transitioned class #1 from the playground to the classroom and were unaware that child #1, age 23 months, was missing from the group. Child #1 was left alone and unsupervised on the playground for approximately 30 minutes. Child #1 was crying when the child was found and brought in from the playground.

Plan of Correction: On 10/18/2024 Staff #1 self-reported the accountability lapse at the time it was discovered. Administration conducted an immediate investigation, resulting in the termination of staff #1. Investigation resulted in school directors determining the child was in a safe and age-appropriate play space, that was fenced in, during the separation from the group. Furthermore, it was established the child had been crying at the time of separation as they did not want to leave the outdoor play area. Upon reunition with the teacher, the child was able to quickly calm down and share stories of what they played with on the playground. No visible injury was noted. Additionally, various witness accounts identified the child's whereabouts and physical safety, as they saw the child on the playground through their classroom windows but did not know the child had been separated from the classroom. The parents of the child were notified on the date of the event.
All staff are required to successfully complete onboarding training with competency check-outs, along with annual retraining. Onboarding and annual training cover operating policies, including accountability. Presently, all staff are completing retraining in the area of accountability. The school Directors will ensure continual enforcement of our operating policies and take action as necessary.

Standard 8VAC20-780-340-F

Repeat Violation
Children under 10 years of age shall always be within actual sight and sound supervision of staff.

Child #1, age 23 months, was left alone and unsupervised on the playground for approximately 30 minutes.

Plan of Correction: On 10/18/2024 Staff #1 self-reported the accountability lapse at the time it was discovered. Administration conducted an immediate investigation, resulting in the termination of staff #1. Investigation resulted in school directors determining the child was in a safe and age-appropriate play space that was fenced in, during the separation from the group. Various witness accounts identified the child's whereabouts and physical safety, as they saw the child on the playground through their classroom windows but did not know the child had been separated from the classroom.
All staff are required to successfully complete onboarding training with competency check-outs, along with annual retraining. Onboarding and annual training cover operating policies, including accountability. Presently, all staff are completing retraining in the area of accountability. The school Directors will ensure continual enforcement of our operating policies and take action as necessary.

Standard 8VAC20-780-40-E

Repeat Violation
The operational responsibilities of the licensee shall include ensuring that the center's activities, services, and facilities are maintained in compliance with the center's own policies and procedures that are required by the standards including, but not limited to procedures for identifying where attending children are at all times.

1. The center's policy titled "child accountability" states that "every time the class or any part of the class moves from one area to another (e.g., classroom to Dining Room...), attendance must be verified by taking roll, matching a name with a face, at the following times: before transitioning from any area, immediately upon arrival at the destination location." It further states that "when more than one teacher is transitioning a group of children, one teacher must lead the group, and one teacher must be immediately behind the group to ensure children remain accounted for."

2. On 10/18/2024 staff #1 and staff #2 transitioned classroom #1 from the playground to the classroom. Staff #1 and staff #2 did not conduct a face to name attendance count upon entering the classroom and were unaware that child #1 was missing from the group.

3. Child #1, age 23 months, was left on the playground for approximately 30 minutes alone and unsupervised.

Plan of Correction: On 10/18/2024 Staff #1 self-reported the accountability lapse at the time it was discovered. Administration conducted an immediate investigation, resulting in the termination of staff #1. All staff are required to successfully complete onboarding training with competency check-outs, along with annual retraining. Onboarding and annual training cover operating policies, including accountability. Presently, all staff are completing retraining in the area of accountability. The school Directors will ensure continual enforcement of our operating policies and take action as necessary.

View original record on Virginia Department of Social Services