Inspection · 2023-06-13

Based on a review of two caregivers? records and interview, the provider accepted a required central registry finding from a caregiver that was dated more than 90 days prior to the date of employment.

Evidence: 1) The central registry finding in the record of Caregiver #2, employed on 04/01/23, was completed on 08/02/22.

2) During interview, the Provider reported a new central registry was not requested for Caregiver #2 at the time of employment.

A facility must not accept a required criminal history record report or a central registry finding from an applicant, licensee, registrant, or other person required to obtain background checks that is dated more than 90 days prior to the date of employment, volunteering, residing in the home.

Based on a review of five children?s records and interview, the provider did not obtain documentation of a physical examination by or under the direction of a physician for one child prior to the child?s attendance or within 30 days after the first day of attendance.

Evidence: 1) The record of Child #5, enrolled on 03/07/23, contained a physical examination that was completed on 05/08/23.

2) During interview, the Provider confirmed the physical examination was not provided within the required timeframe.

Based on a review of two caregivers? records and interview, the provider did not obtain from one caregiver a Report of Tuberculosis (TB) Screening within the required timeframe.

Evidence: 1) The record of Caregiver #2, employed on 04/01/23, contained two TB screenings. One TB screening was completed on 06/27/22 and the most recent one was completed on 06/09/23.

2) During interview, the Provider confirmed the TB screenings on file for Caregiver #2 were not obtained within the required timeframe.

The provider shall obtain from each caregiver at the time of hire and prior to coming into contact with children a current Report of Tuberculosis Screening form published by the Virginia Department of Health or a form consistent with it documenting the absence of tuberculosis in a communicable form. The form shall have been completed within the last 30 days and be signed by a physician, physicians' designee, or an official of the local health department.

Based on observations and interview, the provider did not ensure that portable wading pools without integral filter systems shall when not in use during the family day homes? hours of operation, be emptied, sanitized, and stored in a position to keep them clean and dry.

Evidence: 1) During the inspection of the outdoor play area, the inspector observed a portable wading pool in the middle of the yard. The pool contained water, leaves, and dirt.

2) During interview, the Provider reported the pool is not used by the children enrolled and stated she was unaware it had to be emptied, sanitized, and stored away while the children were in care.

Based on observation, the provider did not ensure potentially harmful substances, materials and supplies such as, but not limited to, cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children.

Evidence: During the inspection of the home, the inspector observed bottles of cleaning agents throughout the home. The children were observed waking up from nap time and the cleaning agents were within their reach. On the deck where the children walk by to access the outdoor play area, the inspector observed a bottle of pesticide. There was nothing preventing the children from accessing the bottle of pesticide.

Based on observation and interview, the provider did not ensure children under two years of age and children over two years of age who are not developmentally ready to climb or descend stairs without supervision shall not have access to stairs.

Evidence: 1) During the inspection of the outdoor play area, the inspector observed the staircase that goes from the deck to the front yard where the children play did not have a protective barrier to prevent access by children.

2) During interview, the Provider confirmed the children use the staircase to go outside and play. She confirmed there is no protective barrier that would prevent access by children under two years of age. There were seven children under two years of age present at the time of the inspection.

Based on observation and interview, the provider did not ensure one child was provided with an individual crib, cot, rest mat, or bed for resting or napping.

Evidence: 1) Upon the inspector?s arrival, Child #1 (3-month-old), was observed sleeping in a car seat. 2) Caregiver #2 reported the child fell asleep in a swing and was moved to the car seat. The child was later transferred to a crib but was no longer sleeping and was removed from the crib.

3) The inspector later observed a different child using the same crib and Child #1 was later observed sleeping in a booster feeding seat. 4) At the time of the inspection, there were no other cribs available for Child #1 to rest or nap.

Based on observation and interview, the provider did not ensure cribs when being used by infants shall have a tight-fitting bottom cover.

Evidence: 1) The inspector observed three occupied cribs that did not have a tight-fitting bottom cover. 2) During interview, the Provider acknowledged she did not have bottom covers for the cribs.

Based on observation, the provider did not ensure soft bedding of any kind shall be used under or around infants including, but not limited to, pillows, quilts, comforters, sheepskins, or stuffed toys.

Evidence: The inspector observed a boppy pillow in a crib occupied by Child #5 (7-month-old).

Based on observation and interview, the provider did not ensure infant walkers shall not be used.

Evidence: 1) The inspector observed two infant walkers in the area where children receive care. 2) During interview, Caregiver #2 reported the infant walkers are used by the children in care.

Based on observation and interview, the provider did not ensure that when play pens were used, they were not used as a designated sleeping area and that they did not contain any pillows or filled comforters.

Evidence: 1) During the inspection, Child #10 (16-months-old) and Child #11 (10-months-old) were observed sleeping in play pens. Child #11 was observed sleeping on a boppy pillow in the play pen.

2) During interview, the Provider confirmed the play pens were the designated sleeping areas for Child #10 and Child #11.

Based on a review of documentation and observation, the provider did not ensure that each caregiver did not exceed 16 points.

Evidence: At the time of the inspection, there were eleven children in care for a total of 33 points with two caregivers, exceeding 16 points per caregiver.

The provider shall ensure that a caregiver does not exceed 16 points by using the following point system to determine if an additional caregiver is needed: 1. Children from birth through 15 months of age count as four points each; 2. Children from 16 months through 23 months of age count as three points each; 3. Children from two through four years of age count as two points each; 4. Children from five years through nine years of age count as one point each; and 5. Children who are 10 years of age and older count as zero points.

Based on a review of five children?s records and interview, the provider did not ensure two children?s records contained the required information.

Evidence:
1) The record of Child #2, enrolled on 02/01/23, did not contain proof of the child?s age and identity.

2) The record of Child #4, enrolled on 02/13/23, did not contain the name, address, and telephone number of a second emergency contact. The record did not contain proof of the child?s age and identity.

3) During interview, the Provider confirmed the information was not on file for Child #2 and for Child #4.

Based on observation and interview, the provider did not ensure medication, except for those prescriptions designated otherwise by a written physician's order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place using a safe locking method that prevents access by children.

Evidence: 1) During the inspection of the family day home, the inspector observed non-prescription medication in the area where first aid supplies are kept. The drawers were not locked and there was nothing preventing access by children. 2) On the kitchen countertop, the inspector observed non-prescription medication in a bowl. The Provider reported the medications were household medications and did not belong to any of the children in care. The medications were not locked and there was nothing preventing access by children.

Based on observation and interview, the provider did not ensure that when food is brought from home, the food containers shall be clearly labeled in a way that identifies the owner.

Evidence: 1) During the inspection, the inspector observed several lunch boxes that belonged to the children in care. The lunch boxes were not labeled. 2) During interview, the Provider reported the children bring food from home and acknowledged that not all the lunch boxes are labeled in a way that identifies the owner.

Based on observation, the provider did not ensure infant bottles were labeled with the child?s full name and the date, if more than one infant is in care.

Evidence: 1) The infant bottles observed were not labeled with children?s names or the date. There were four infants present at the time of the inspection. 2) During interview, the Provider acknowledged the bottles were not labeled as required.