Inspection · 2024-05-15
Date
2024-05-15
Complaint Related
No
Licensing Inspector
Emily Walsh
(757) 404-2575
(757) 404-2575
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 (8VAC20-770)
20 Access to minor?s records
22.1 Background Checks Code, Carbon Monoxide
63.2 Child Abuse & Neglect
Inspector Notes
A monitoring inspection was initiated and concluded on 5/15/2024. The inspector arrived at 1:00 PM and departed at 2:45 PM. There were 34 children present, ranging in ages from toddlers to school age, with 6 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 3 child records and 3 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 and discussed with the program director during the exit interview.
Violations
10Standard 8VAC20-780-160-C
Repeat violation
Based upon review of staff tuberculosis screening, the facility has not ensured that staff obtain and submit results of follow-up tuberculosis screenings at least every two years.
Evidence:
The most recent tuberculosis screening in the record provided for staff 1 was obtained on 10/15/2021.
Based upon review of staff tuberculosis screening, the facility has not ensured that staff obtain and submit results of follow-up tuberculosis screenings at least every two years.
Evidence:
The most recent tuberculosis screening in the record provided for staff 1 was obtained on 10/15/2021.
Plan of Correction: The facility responded with the following:
TB appointment scheduled
TB appointment scheduled
Standard 8VAC20-780-245-A
Repeat violation
Based upon review of staff records, the facility has not ensured that staff complete annually a minimum of 16 hours of training.
Evidence:
Repeat violation
The records provided for staff 1 and staff 3 did not include documentation of 16 hours of training in the past year.
Based upon review of staff records, the facility has not ensured that staff complete annually a minimum of 16 hours of training.
Evidence:
Repeat violation
The records provided for staff 1 and staff 3 did not include documentation of 16 hours of training in the past year.
Plan of Correction: The facility responded with the following:
redo filing system for PD hours and posting hours log
redo filing system for PD hours and posting hours log
Standard 8VAC20-780-270-A
Based upon observation, the facility has not ensured that areas are maintained to be safe.
Evidence:
There were numerous sharp steak knives with serrated edges stored in an unlocked drawer under the counter in the kitchen area in the large classroom, accessible to the children.
Evidence:
There were numerous sharp steak knives with serrated edges stored in an unlocked drawer under the counter in the kitchen area in the large classroom, accessible to the children.
Plan of Correction: The facility responded with the following:
lock up sharp utensils in child proof cabinet
lock up sharp utensils in child proof cabinet
Standard 8VAC20-780-280-B
Based upon observation, the facility has not ensured that hazardous substances are kept in locked places using safe locking methods that prevent access by children.
Evidence:
There was a container of hair texture spray labeled "warning" and "flammable", liquid hand sanitizer with a warning label and hemp seed oil with a warning label in an open plastic bin on the floor of the school age classroom near the water heater closet.
Evidence:
There was a container of hair texture spray labeled "warning" and "flammable", liquid hand sanitizer with a warning label and hemp seed oil with a warning label in an open plastic bin on the floor of the school age classroom near the water heater closet.
Plan of Correction: The facility responded with the following:
hazardous substances stored in locked closet
hazardous substances stored in locked closet
Standard 8VAC20-780-40-M
Based upon observation, the facility has not ensured that they maintain a current written list of all children's allergies, sensitivities and dietary restrictions that is dated.
Evidence:
The list of children's allergies, sensitivities and restrictions was not date.
Evidence:
The list of children's allergies, sensitivities and restrictions was not date.
Plan of Correction: The facility responded with the following:
dated
dated
Standard 8VAC20-780-50-A
Based upon observation, the facility has not ensured that staff and children's records are treated confidentially.
Evidence:
The Supplemental Information Sheet from the most recent VDOE inspection was posted on the parent information board. This information sheet includes confidential information and a statement that it is not to be posted in the facility.
Evidence:
The Supplemental Information Sheet from the most recent VDOE inspection was posted on the parent information board. This information sheet includes confidential information and a statement that it is not to be posted in the facility.
Plan of Correction: The facility responded with the following:
removed from bulletin board
removed from bulletin board
Standard 8VAC20-780-560-F
Repeat violation
Based upon review of the posted menu and observation, the facility has not ensured that when the facility provides snacks, there is a menu listing foods to be served during the one week period.
Evidence:
The posted menu indicated that melon, cheese and crackers were to be served for snacks, however the children in the toddler grouping were observed being served apple slices for afternoon snack. This substitution was not indicated on the posted menu.
Based upon review of the posted menu and observation, the facility has not ensured that when the facility provides snacks, there is a menu listing foods to be served during the one week period.
Evidence:
The posted menu indicated that melon, cheese and crackers were to be served for snacks, however the children in the toddler grouping were observed being served apple slices for afternoon snack. This substitution was not indicated on the posted menu.
Plan of Correction: The facility responded with the following:
post daily snack menu
post daily snack menu
Standard 8VAC20-780-560-G
Based upon observation, the facility has not ensured that when food is brought from home, the food container is clearly dated.
Evidence:
1. Several lunch boxes brought in from home were observed that were not dated.
2. The program director confirmed that not all lunch boxes were dated.
Evidence:
1. Several lunch boxes brought in from home were observed that were not dated.
2. The program director confirmed that not all lunch boxes were dated.
Plan of Correction: The facility responded with the following:
date lunch boxes with labels
(if parents haven't)
date lunch boxes with labels
(if parents haven't)
Standard 8VAC20-780-60-A
Repeat violation
Based upon review of children's records, the facility has not ensured that each child's record includes all required information.
Evidence:
The record provided for child 2 did not include the business phone numbers for the mother and father.
Based upon review of children's records, the facility has not ensured that each child's record includes all required information.
Evidence:
The record provided for child 2 did not include the business phone numbers for the mother and father.
Plan of Correction: The facility responded with the following:
go though children's files
go though children's files
Standard 8VAC20-780-70
Repeat violation
Based upon review of staff records, the facility has not ensured that staff records include all required information.
Evidence:
1. The record provided for staff indicated that staff 1 is an assistant, however the program director stated that staff 1 is a substitute staff.
2. There is no documentation in the record of staff 1 that staff 1 received the required orientation training before assuming job responsibilities.
3. The records provided for staff 1 and staff 2 did not include documentation that at least two references as to character and qualifications were obtained prior to employ of either staff.
Based upon review of staff records, the facility has not ensured that staff records include all required information.
Evidence:
1. The record provided for staff indicated that staff 1 is an assistant, however the program director stated that staff 1 is a substitute staff.
2. There is no documentation in the record of staff 1 that staff 1 received the required orientation training before assuming job responsibilities.
3. The records provided for staff 1 and staff 2 did not include documentation that at least two references as to character and qualifications were obtained prior to employ of either staff.
Plan of Correction: The facility responded with the following:
redo filing system with updated checklist
email references for records purposes
redo filing system with updated checklist
email references for records purposes