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Virginia Commonwealth University Health System Authority -N Deck

Inspection · 2023-03-02

Date
2023-03-02
Complaint Related
No
Licensing Inspector
Lauren Bickford
(540) 280-0742
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

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
8VAC20-780 Special Services.
8VAC20-820 THE LICENSE.
8VAC20-770 Background Checks (8VAC20-770)
20 Access to minor?s records
22.1 Background Checks Code, Carbon Monoxide
63.2 Child Abuse & Neglect

Inspector Notes

An unannounced monitoring inspection was conducted on March 2, 2023 from approximately 11:50 am to 2:00 pm. There were 129 children in attendance and a total of 29 staff present. 10 staff records were viewed electronically and 10 children?s records were viewed on site. All areas of the center were observed including classrooms, bathrooms, and the playgrounds. The children were observed playing in centers, practicing cutting, listening to stories by a guest reader, getting diapers changed, playing outside, and eating lunch, while the licensing inspector was on-site. The center was having pajama day and was celebrating Dr. Seuss.

Violations were cited as a result of this inspection.

Please complete the plan of correction and ?date to be corrected? for each violation cited on the violation notice and return it to me within 5 business days from today, 03/20/2023. Please specify how the deficient practice will be or has been corrected. Your plan of correction should contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again, and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s).

Violations

2
Standard 8VAC20-780-160-C
Based on records review, and interview, the center failed to ensure that all staff submit documentation of a repeat tuberculosis screening at least every two years from the date of the initial screening or testing. Evidence: 1) The record for staff #5, date of employment 5/6/18, contained a tuberculosis screening dated 10/19/18.
2) The record for staff #10, date of employment 06/3/18, contained a tuberculosis screening dated 06/07/18.
3) When interviewed, administrators stated that the most recent tuberculosis screenings could not be located.
Plan of Correction: Per the center "staff #5 and #10 were sent to receive testing after inspection date. All staff members TB screenings will be reviewed each year in April for compliance."
Standard 8VAC20-780-240-A
Based on records review, and interview, the center failed to ensure that the Virginia Department of Education (VDOE) sponsored orientation course is completed within 90 calendar days of employment. Evidence: The record for staff #3, date of employment 05/29/22, did not contain evidence of the VDOE orientation course being completed. When interviewed, Administration acknowledged that staff #3 had not completed the VDOE orientation course within 90 calendar days.
Plan of Correction: Per the center "staff #3 will complete VDOE Preservice training by 3/31/23. All new staff will complete training within their orientation period."
View original record on Virginia Department of Social Services