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Everbrook Academy

Inspection · 2021-11-23

Date
2021-11-23
Complaint Related
No
Licensing Inspector
Stacy Doyle
(571) 835-0386
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

22VAC40-185 ADMINISTRATION.
22VAC40-185 STAFF QUALIFICATIONS AND TRAINING.
22VAC40-185 PHYSICAL PLANT.
22VAC40-185 STAFFING AND SUPERVISION.
22VAC40-185 PROGRAMS.
22VAC40-185 SPECIAL CARE PROVISIONS AND EMERGENCIES.
22VAC40-185 SPECIAL SERVICES.
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
22VAC40-191 Background Checks (22VAC40-191)
63.2 Child Abuse & Neglect
63.2(17) License & Registration Procedures
63.2 Facilities & Programs.

Inspector Notes

This inspection was conducted by licensing staff using an alternate remote protocol, including telephone contacts, documents review, interviews and a virtual tour of the program.

A renewal inspection was initiated and concluded on 11/23/2021. The supervisor was contacted by telephone and a virtual inspection was conducted. There were 63 children present, ranging in ages from 4 months old to 5 years old, with 16 staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, staffing and supervision, programming, medication, special care and emergencies and nutrition. A total of 5 child records and 5 staff records were reviewed.

Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the program. Please contact me if you have any questions at Stacy.Doyle@doe.virginia.gov or 571-835-0386.

Violations

7
Standard 22VAC40-185-130-A
Based on record review, one of five children's records did not have documentation of immunizations for a child prior to the child's first attendance.
Evidence:
1. Child #4 (start date 10/11/2021) did not have documentation of the child's immunization record in the child's file.
Plan of Correction: We have collected the immunizations and will be sure to collect them before the child starts.
Standard 22VAC40-185-140-A
Based on record review, one of five children's records did not have documentation of a physical for a child prior to or within 30 days of attendance.
Evidence:
1. Child #4 (start date 10/11/2021) did not have documentation of the child's physical in the child's file within 30 days.
Plan of Correction: We have collected the Physical and will be sure to collect them before the child starts.
Standard 22VAC40-185-160-A
Based on review of staff records, the center did not have documentation of a tuberculosis (TB) test or screening for staff within 21 days of hire or within 12 months prior to hiring.
Evidence:
1. Staff #1 (Date of hire 8/26/2021) had a TB test or screening dated 10/16/2021.
2. Staff #4 (Date of hire 8/16/2021) had a TB test or screening dated 10/04/2021.
Plan of Correction: We will have all staff complete the TB test within 21 days of hire.
Standard 22VAC40-191-60-B
Based on review of five staff records, the center did not have a completed sworn disclosure statement for each staff prior to hire date.
Evidence:
1. Staff #3 (Date of hire 6/14/2021) had a sworn disclosure statement signed on 6/29/2021.
2. Staff #4 (Date of hire 8/16/2021) had a sworn disclosure statement signed on 10/04/2021.
Plan of Correction: We will be sure to have all New Hires complete on the first day of employment.
Standard 22VAC40-191-60-C-2
Based on review of five staff records, the center did not have the central registry finding within 30 days of employment.
Evidence:
1. Staff #2 (Date of hire 8/26/2021) did not have the central registry findings during the inspection. The center documented it was sent on 8/26/2021.
Plan of Correction: We will have all new hires complete the central registry on their first day.
Standard 22VAC40-80-120-E-2
Based on observation, the center did not have the most recent findings of the most recent inspection posted.
Evidence:
1. The center had the inspection report posted for 4/14/2021, but did not have the most recent report posted for the 8/09/2021 inspection.
Plan of Correction: We will be sure to always keep the most recent inspection posted.
Standard 63.2(17)-1720.1-B-4
Based on record review, the center did not obtain a copy of the results of a criminal history record information check from any state in which the individual has resided in the preceding five years.
Evidence:
1. Staff #1 (Date of hire 5/05/2021) lived in another state (CA) in the last 5 years and did not have the results of a criminal history record check from CA.
Plan of Correction: The staff member is completing the CA background check on 12/03/2021. Going forward we will complete all State background checks on their first day.
View original record on Virginia Department of Social Services