Inspection · 2022-06-29
Date
2022-06-29
Complaint Related
No
Licensing Inspector
Lauren Bickford
(540) 280-0742
(540) 280-0742
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
8VAC20-770 Background Checks
20 Access to minor's records
22.1 Early Childhood Care and Education
32.1 Report by person other than physician
63.2 Child Abuse & Neglect
Inspector Notes
An unannounced monitoring inspection was initiated on Wednesday, June 29, 2022 and concluded on Thursday, June 30, 2022. On June 29, 2022, the inspector was on-site from 10:05am to approximately 1:00pm. There were a total of 92 children in care in the direct care of 12 staff members. During the inspection, the children and staff were observed participating in a variety of activities. Staff were observed having positive interactions with the children. All areas of the facility including classrooms, kitchen, hallways, playground, and bathrooms were inspected. The center is equipped with toys and supplies and items were available to the children. The required postings were reviewed. Transportation is provided and two vehicles were inspected. Medication is administered when needed and some were reviewed during the inspection. Eight children's records and eight staff records were also reviewed during the inspection. Additional documentation was submitted to the inspector and was reviewed virtually on June 30, 2022.
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.
Violations
9Standard 8VAC20-770-60-C-2
Based on a review of eight staff records and interview, the center did not ensure that two staff members had a central registry finding within 30 days of employment.
Evidence: 1) The record of Staff #2, employed 05/23/22, did not contain the results of the central registry finding. 2) The record of Staff #6, employed 05/28/21, did not contain the results of the central registry finding. 3) During interview, management acknowledged the central registry finding for Staff #2 and Staff #6 were not on file. The records did not contain documentation of any further contact with the Office of Background Investigations, and the staff members had been continuously employed.
Evidence: 1) The record of Staff #2, employed 05/23/22, did not contain the results of the central registry finding. 2) The record of Staff #6, employed 05/28/21, did not contain the results of the central registry finding. 3) During interview, management acknowledged the central registry finding for Staff #2 and Staff #6 were not on file. The records did not contain documentation of any further contact with the Office of Background Investigations, and the staff members had been continuously employed.
Plan of Correction: The center will follow up with the Office of Background Investigation to inquire about the missing results. New requests will be sent if necessary.
Standard 8VAC20-780-130-A
Based on a review of eight children?s records and interview, the center did not ensure two children had received the immunizations required by the State Board of Health before the child attended the center.
Evidence: 1) The record of Child #2, date of attendance 06/20/22, did not contain immunizations. 2) The record of Child #8, date of attendance 12/03/21, did not contain immunizations. 3) During interview, management acknowledge the immunizations for Child #2 have not been received.
Evidence: 1) The record of Child #2, date of attendance 06/20/22, did not contain immunizations. 2) The record of Child #8, date of attendance 12/03/21, did not contain immunizations. 3) During interview, management acknowledge the immunizations for Child #2 have not been received.
Plan of Correction: The missing immunizations have been requested and will be filed upon receipt. In the future, immunizations will be required prior to a child's first day of attendance.
Standard 8VAC20-780-130-E
Based on a review of eight children?s records and interview, the center did not obtain documentation of additional immunizations once every six months for one child under the age of two years.
Evidence: 1) The most recent immunizations in the record of Child #6 (19-month-old), date of attendance 07/06/21, were dated 05/04/21. 2) During interview, management acknowledged additional immunizations have not been obtained for Child #6.
Evidence: 1) The most recent immunizations in the record of Child #6 (19-month-old), date of attendance 07/06/21, were dated 05/04/21. 2) During interview, management acknowledged additional immunizations have not been obtained for Child #6.
Plan of Correction: The child has a doctor's appointment on in July and will provide updated immunizations at that time. In the future, the center will request immunization updates as required.
Standard 8VAC20-780-140-A
Based on a review of eight children?s records and interview, the center did not ensure one child had a physical examination by or under the direction of a physician before the child?s attendance or within 30 days after the first day of attendance.
Evidence: 1) The record of Child #8, date of attendance 12/03/21, did not contain documentation of a physical examination. 2) During interview, management acknowledged the physical examination for Child #8 was not on file.
Evidence: 1) The record of Child #8, date of attendance 12/03/21, did not contain documentation of a physical examination. 2) During interview, management acknowledged the physical examination for Child #8 was not on file.
Plan of Correction: The physical has been requested and will be filed upon receipt.
Standard 8VAC20-780-160-A
Based on a review of eight staff records, the center did not ensure one staff submitted documentation of a negative tuberculosis (TB) screening within the required timeframe.
Evidence: The TB screening in the record for Staff #1, employed 06/06/22, was dated 4/22/22. The documentation shall have been completed within the last 30 calendar days of the date of employment.
Evidence: The TB screening in the record for Staff #1, employed 06/06/22, was dated 4/22/22. The documentation shall have been completed within the last 30 calendar days of the date of employment.
Plan of Correction: Staff will provide the missing TB screening. In the future, TB screenings will be obtained prior to employment and they will not be more than 30 days old.
Standard 8VAC20-780-160-C
Based on a review of eight staff records and interview, the center did not ensure one staff member submitted the results of a follow-up tuberculosis (TB) screening at least every two years from the date of the initial screening or testing.
Evidence: 1) The most recent TB screening in the record of Staff #6, employed 05/28/21, was dated 12/19/19. The TB screening expired on 12/19/21. 2) During interview, management reported a new TB screening was not on file for Staff #6.
Evidence: 1) The most recent TB screening in the record of Staff #6, employed 05/28/21, was dated 12/19/19. The TB screening expired on 12/19/21. 2) During interview, management reported a new TB screening was not on file for Staff #6.
Plan of Correction: The staff will get a new TB screening by next week.
Standard 8VAC20-780-280-B
Based on observations at the center, the center did not ensure to keep hazardous substances such as cleaning materials in a locked place using a safe locking method that prevents access by children.
Evidence: 1) In the Toddler classroom, the inspector observed a bottle of bleach/water solution on the counter and in an unlocked cabinet by the refrigerator in the classroom.
2) In the Twaddler classroom, the inspector observed a bottle of bleach/water solution on the changing table and bottles of cleaning supplies in an unlocked cabinet.
3) In the Preppers classroom, the inspector observed cleaning supplies in two unlocked cabinets in the classroom.
Evidence: 1) In the Toddler classroom, the inspector observed a bottle of bleach/water solution on the counter and in an unlocked cabinet by the refrigerator in the classroom.
2) In the Twaddler classroom, the inspector observed a bottle of bleach/water solution on the changing table and bottles of cleaning supplies in an unlocked cabinet.
3) In the Preppers classroom, the inspector observed cleaning supplies in two unlocked cabinets in the classroom.
Plan of Correction: Corrected on site.
Standard 8VAC20-780-280-H
Based on observations at the center and interview, the center did not ensure to keep staff medications or other harmful agents in areas that are inaccessible to children.
Evidence: 1) In the Toddler classroom, the inspector observed a bottle of non-prescription medication next to the sink by the changing table and a bag with cough drops in an unlocked cabinet by the changing table. 2) Management removed the medication and cough drops from the classroom and reported they belonged to a staff member.
Evidence: 1) In the Toddler classroom, the inspector observed a bottle of non-prescription medication next to the sink by the changing table and a bag with cough drops in an unlocked cabinet by the changing table. 2) Management removed the medication and cough drops from the classroom and reported they belonged to a staff member.
Plan of Correction: Corrected on site.
Standard 8VAC20-780-70
Based on a review of eight staff records and interview, the center did not ensure five staff records contained the required information.
Evidence: 1) The following staff records did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment: Staff #1 (employed 06/06/22) and Staff #2 (employed 05/23/22).
2) The following staff records did not contain documentation to demonstrate that the staff completed orientation training: Staff #1; Staff #2, Staff #6 (employed 05/28/21), Staff #7(employed 05/28/21), and Staff #8 (employed 05/28/21). 3) During interview, management reported the staff completed orientation, but the documentation could not be located.
3) The record of Staff #3 (employed 05/28/21) and the record of Staff #5 (employed 05/28/21) did not have documentation of a negative tuberculosis (TB) screening. 4) During interview, management acknowledged the TB results for Staff #3 and Staff #5 were not obtained within 21 days of beginning employment. Staff hired prior to 10/13/2021 were required to obtain TB results within 21 days of beginning employment and such documentation was to be retained in the staff record.
Evidence: 1) The following staff records did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment: Staff #1 (employed 06/06/22) and Staff #2 (employed 05/23/22).
2) The following staff records did not contain documentation to demonstrate that the staff completed orientation training: Staff #1; Staff #2, Staff #6 (employed 05/28/21), Staff #7(employed 05/28/21), and Staff #8 (employed 05/28/21). 3) During interview, management reported the staff completed orientation, but the documentation could not be located.
3) The record of Staff #3 (employed 05/28/21) and the record of Staff #5 (employed 05/28/21) did not have documentation of a negative tuberculosis (TB) screening. 4) During interview, management acknowledged the TB results for Staff #3 and Staff #5 were not obtained within 21 days of beginning employment. Staff hired prior to 10/13/2021 were required to obtain TB results within 21 days of beginning employment and such documentation was to be retained in the staff record.
Plan of Correction: Corrections will be made to each staff record. References will be obtained prior to employment. Documentation will be maintained when orientation is completed.