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Everbrook Academy

Inspection · 2025-10-07

Date
2025-10-07
Complaint Related
No
Licensing Inspector
Cathy Aylor
(540) 222-6352
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.
8VAC20-820 THE LICENSING PROCESS.
8VAC20-820 HEARINGS PROCEDURES.
8VAC20-770 Background Checks
20 Access to minor?s records
22.1 Early Childhood Care and Education
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, on-site monitoring inspection was initiated and completed on 10/7/25.The on-site inspection began at 12 noon and ended at 1:50 pm The inspector reviewed compliance in the areas listed above. There were 51 children present and 8 staff. The inspector reviewed 6 children?s records 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.

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 11/20/2025. A POC submitted after this date will not appear on the public website.

Violations

5
Standard 22.1-289.035-B-1
Provide a sworn statement or affirmation disclosing whether their has ever been a conviction of or is the subject of pending charges for any offense within or outside the Commonwealth and whether he has been the subject of a founded complaint of child abuse or neglect within or outside the Commonwealth.
The sworn disclosure statement form used for staff A was dated in 2014 and not the current 2024 form. The up to date form was overdue by 6 months.
Plan of Correction: The required Sworn Statement or Affirmation was on file; however, it was an outdated version (2017) rather than the current version required by licensing. The staff member signed the current, updated version of the Sworn Statement of Affirmation immediately upon discovery. The correct form has been
placed in her personnel file, replacing the outdated version.

Moving forward, all paperwork for new staff will be printed directly from the VDOE website to ensure it is the most updated version.
Standard 8VAC20-780-270-A
Areas and equipment of the center, inside and outside, shall be maintained in a safe condition.

There were protruding bolts more than 2 threads on the gates and fence throughout the playground. Protruding bolts present impalement and cut hazards.
Plan of Correction: During the licensing inspection, a work order was submitted immediately to have the fence bolts cut to an appropriate length. Maintenance staff completed this work the following day, on 10/08/2025, and all bolts were reduced to a safe length (no more than two visible threads). The playground is now in full compliance.
In the future, before our maintenance team leaves, management will review and verify all completed work to ensure there are no protruding bolts or other safety hazards. This final check will be documented and used to confirm the area is fully compliant.
Standard 8VAC20-780-40-M
Repeat Violation:
The center shall maintain, in a way that is accessible to all staff who work with children, a current written list of all children's allergies, sensitivities, and dietary restrictions documented in the allergy plan required in 8VAC20-780-60 A 8.

Child A has a peanut allergy per their physical however this allergy was not documented on the allergy/sensitivity/dietary restriction list. This was overdue by 2 months
Plan of Correction: Upon discovering the oversight, the center immediately contacted the child's parents to obtain a completed Allergy Care Plan signed by the child's physician. The child's physician-signed care plan has now been received and placed in the child's file. The child's allergy has been added to the center's allergy list, and all staff who interact with the child have been informed and trained on
the child's specific allergy instructions, emergency response procedures, and exposure prevention.

For all updated physicals submitted, staff will carefully review the form to ensure that any newly documented allergies are identified. If a new allergy is listed, parents will be asked to provide a completed allergy action plan from the child's physician to maintain continued enrollment. The new
allergy will be added to the allergy list and all staff who interact with the child will be informed and trained on the child's specific allergy instructions, emergency response procedures, and exposure prevention.
Standard 8VAC20-780-430-C
Play equipment used by children shall not have protrusions.

The basketball hoop had protruding bolts more than 2 threads on the shaft.
Plan of Correction: During the licensing inspection, a work order was submitted immediately to have the bolts on the basketball hoop cut to an appropriate length. Maintenance staff completed this work the following day, on 10/08/2025, and all bolts were reduced to a safe length (no more than two visible threads). The basketball hoop in full compliance.

In the future, before our maintenance team leaves, management will review and verify all completed
work to ensure there are no protruding bolts or other safety hazards. This final check will be
documented and used to confirm the area is fully compliant.
Standard 8VAC20-780-60-A-8
A written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction.

There was no allergy care plan on file for child A's peanut allergy. This was overdue by 2 months.
Plan of Correction: Upon discovering the oversight, the center immediately contacted the child's parents to obtain a completed Allergy Care Plan signed by the child's physician. The child's physician-signed care plan has now been received and placed in the child's file. The child's allergy has been added to the center's allergy list, and all staff who interact with the child have been informed and trained on
the child's specific allergy instructions, emergency response procedures, and exposure prevention.

For all updated physicals submitted, staff will carefully review the form to ensure that any newly documented allergies are identified. If a new allergy is listed, parents will be asked to provide a completed allergy action plan from the child's physician to maintain continued enrollment. The new allergy will be added to the allergy list and all staff who interact with the child will be
informed and trained on the child's specific allergy instructions, emergency response procedures, and exposure prevention.
View original record on Virginia Department of Social Services