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Callahan Learning Center LLC

Inspection · 2023-11-15

Date
2023-11-15
Complaint Related
No
Licensing Inspector
Kelly Adriazola
(804) 840-8245
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.
8VAC20-770 Background Checks (8VAC20-770)
22.1 Background Checks Code, Carbon Monoxide

Inspector Notes

An unannounced monitoring inspection was conducted on-site November 15, 2023. There was no director was available during the inspection but there was a person in charge. There were 62 children present, ranging in ages from 16 months to 4 years, with 10 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 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. 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 measures. Please do not use staff names; list staff by positions only.

Violations

5
Standard 8VAC20-780-200-A
Based on review of records and interview, the center failed to have a qualified program director or qualified back-up program director on site at least 50% of the center's hours of operations.
Evidence: 1. Staff #1 stated that she is the program director. Staff #1 stated she was promoted to program director on July 1, 2023.
2. Documentation provided by Staff #1 showed that Staff #1 does not qualify as a director or back up director.
Plan of Correction: A fully qualified employee with verified documentation has been placed in the position of program director at the center effective December 6, 2023 and will be on-site at least 50% of the time. If we appoint a back-up program director we will include documentation of date, title, and duties in their file.
Standard 8VAC20-780-260-B
Based on a review of records, the center failed to ensure annual approval from the health department shall be provided, or approvals of a plan of correction, for meeting requirements for: water supply, sewage disposal system, and food service, if applicable.
Evidence: Documentation of the most recent health inspection is dated 05/23/2022.
Plan of Correction: As of November 16th, VDH was contacted and asked to come out ASAP. Inspectin held on 11/29/23.
Standard 8VAC20-780-510-I
Based on observation, the center failed to ensure that prescription medicine is maintained in the original, labeled container and the label on the medication identifies the child's name, prescriber's instructions pertaining to dosage, frequency, and manner of administration.
Evidence: Albuterol medication for child #6 was not in the original container. The label from the pharmacy with the child's name, the name of the medication, the dosage amount, and the time or times to be given was not available for review.
Plan of Correction: As of November 15th, unlabeled medication was sent home and parents were notified of requirements. Going forward, all medicine will be checked for original labeled container prior to accepting the medication.
Standard 8VAC20-780-510-L
Based on observation and interview, the center failed to ensure that medication is kept in a locked place using a safe locking method that prevents access by children.
Evidence: 1. Medication is kept in an unlocked box.
2. Staff #1 confirmed the medications were not kept locked.
Plan of Correction: As of November 16th, 2023, the medication box now has a lock placed.
Standard 8VAC20-780-70
Based on a review of staff records and interview, the center failed to obtain documentation that the individual possesses the education, certification, and experience required by the job position. Evidence: 1. Staff #1 stated she was promoted to director on July 1, 2023.
2. The record of staff #1, promoted July 1, 2023, does not contain documentation that the staff possesses the education and certification required by the job position.
Plan of Correction: A fully qualified employee with verified documentation has been placed in the position of program director at the center effective December 6, 2023. We will clearly label positions held in staff files moving forward using a more clear cover sheet.
View original record on Virginia Department of Social Services