Inspection · 2023-06-13
Date
2023-06-13
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
X 8VAC20-780 Administration.
X 8VAC20-780 Staff Qualifications and Training.
X 8VAC20-780 Physical Plant.
X 8VAC20-780 Staffing and Supervision.
X 8VAC20-780 Programs.
X 8VAC20-780 Special Care Provisions and Emergencies
X 8VAC20-780 Special Services.
X 8VAC20-820 THE LICENSE.
X 8VAC20-820 THE LICENSING PROCESS.
X 8VAC20-820 HEARINGS PROCEDURES.
X 8VAC20-770 Background Checks
X 22.1 Early Childhood Care and Education
X 63.2 Child Abuse & Neglect
Inspector Notes
A monitoring inspection was conducted on 6/13/2023 with the licensing inspector being on site from approximately 10:45pm to 3:00pm. The center director and center staff were available throughout the inspection to answer any questions. There were 92 children present with 14 staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, staffing, supervision, programming, injury reporting, medication, special care and emergencies and nutrition. Medication is administered. During the inspection, the children and staff were observed participating in a variety of activities. Interviews were conducted with staff and areas of the facility were inspected to include all the classrooms, bathrooms and the playground areas. A total of 9 child records and 9 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.
If you have any questions about this inspection, please contact the Licensing Inspector at 804-929-3771.
Violations
9Standard 8VAC20-770-60-B
Based on record review, the center did not ensure three of nine staff records contained documentation of a completed sworn statement or affirmation prior to employment.
Evidence:
1. The record of staff #1 (employment date: 4/13/2023) did not have documentation of a completed sworn statement or affirmation.
2. The record of staff #3 (employment date: 5/02/2023) did not have documentation of a completed sworn statement or affirmation.
3. The record of staff #7 (employment date: 11/24/2021) had documentation of a completed sworn statement or affirmation dated 11/29/2021.
Evidence:
1. The record of staff #1 (employment date: 4/13/2023) did not have documentation of a completed sworn statement or affirmation.
2. The record of staff #3 (employment date: 5/02/2023) did not have documentation of a completed sworn statement or affirmation.
3. The record of staff #7 (employment date: 11/24/2021) had documentation of a completed sworn statement or affirmation dated 11/29/2021.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-130-A
Based on record review, the center did not ensure four of nine children?s records contained documentation of immunizations required by the State Board of Health before the child can attend the center.
Evidence:
1. The record of child #5 (enrollment date: 4/10/2023) did not have documentation of immunizations required by the State Board of Health.
2. The record of child #6 (enrollment date: 1/4/2023) did not have documentation of immunizations required by the State Board of Health.
3. The record of child #8 (enrollment date: 5/29/2023) did not have documentation of immunizations required by the State Board of Health.
4. The record of child #9 (enrollment date: 6/5/2023) did not have documentation of immunizations required by the State Board of Health.
Evidence:
1. The record of child #5 (enrollment date: 4/10/2023) did not have documentation of immunizations required by the State Board of Health.
2. The record of child #6 (enrollment date: 1/4/2023) did not have documentation of immunizations required by the State Board of Health.
3. The record of child #8 (enrollment date: 5/29/2023) did not have documentation of immunizations required by the State Board of Health.
4. The record of child #9 (enrollment date: 6/5/2023) did not have documentation of immunizations required by the State Board of Health.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-140-A
Based on record review, the center did not ensure three of nine children?s records contained documentation of 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 #1 (enrollment date: 7/6/21) did not have documentation of a physical examination.
2. The record of child #2 (enrollment date: 4/10/23) did not have documentation of a physical examination.
3. The record of child #6 (enrollment date: 1/4/23) did not have documentation of a physical examination.
Evidence:
1. The record of child #1 (enrollment date: 7/6/21) did not have documentation of a physical examination.
2. The record of child #2 (enrollment date: 4/10/23) did not have documentation of a physical examination.
3. The record of child #6 (enrollment date: 1/4/23) did not have documentation of a physical examination.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-350-B-3
Based on observation, the center did not ensure to maintain the required staff-to-child ratio of 1:8 for children ages 2 years old.
Evidence:
1. On the day of the inspection, June 13, 2023, staff #4 revealed to the inspector that she is often out of ratio in the mornings, approximately 3 to 4 times a week and sometimes during the day.
2. When asked, Staff #5 confirmed that the Twoddler classroom is at times out of ratio due to a staffing shortage.
Evidence:
1. On the day of the inspection, June 13, 2023, staff #4 revealed to the inspector that she is often out of ratio in the mornings, approximately 3 to 4 times a week and sometimes during the day.
2. When asked, Staff #5 confirmed that the Twoddler classroom is at times out of ratio due to a staffing shortage.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-350-C
Based on observation, the center did not ensure when children are in ongoing mixed age groups, the staff-to-children ratio applicable to the youngest child in the group shall apply to the entire group.
Evidence:
1. The center did not ensure to maintain the required staff-to-child ratio of 1:8 for children in a combined group, ages 2 years old to 4 years old.
2. On the day of the inspection, June 13, 2023, the Pre K classroom had one staff member supervising 23 children 2 years old to 4 years old after naptime. When asked by a center representative regarding the number of children being supervised, staff number #7 stated, 23 children. At the time of the observation, most of the children were sitting against the wall while the teacher was waking up and putting away cots for the remaining children who were waking up from nap.
3. The center representative stated that the two year old teacher had not been present and the two year old classroom was split between the Twoddlers and Preschool classrooms. Staff #7 also stated that the Preschool and Pre K classrooms combine during and after naptime.
Evidence:
1. The center did not ensure to maintain the required staff-to-child ratio of 1:8 for children in a combined group, ages 2 years old to 4 years old.
2. On the day of the inspection, June 13, 2023, the Pre K classroom had one staff member supervising 23 children 2 years old to 4 years old after naptime. When asked by a center representative regarding the number of children being supervised, staff number #7 stated, 23 children. At the time of the observation, most of the children were sitting against the wall while the teacher was waking up and putting away cots for the remaining children who were waking up from nap.
3. The center representative stated that the two year old teacher had not been present and the two year old classroom was split between the Twoddlers and Preschool classrooms. Staff #7 also stated that the Preschool and Pre K classrooms combine during and after naptime.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-530-A-1
Based on record review, the center did not ensure at least one staff in each classroom or area where children are present have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children.
Evidence:
1. The record of staff # 6 did not have documentation showing that the staff has a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #6 was observed supervising four infant children alone.
2. The record of staff #2 and staff #4 did not have documentation showing that the staff members have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #2 and staff #4 was observed supervising twelve 2 year old children on the day of the inspection in the Twoddler classroom.
3. The record of staff # 7 did not have documentation showing that the staff has a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #7 was observed supervising 23 Preschool children alone after nap time. Staff #7 stated that she supervises the Preschool children alone in a school age classroom in the mornings and combines with the preschool classroom during and after nap time.
4. The record of staff #8 and staff #9 did not have documentation showing that the staff members have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #8 and staff #9 was observed supervising 16 preschool children on the day of the inspection on the playground.
Evidence:
1. The record of staff # 6 did not have documentation showing that the staff has a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #6 was observed supervising four infant children alone.
2. The record of staff #2 and staff #4 did not have documentation showing that the staff members have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #2 and staff #4 was observed supervising twelve 2 year old children on the day of the inspection in the Twoddler classroom.
3. The record of staff # 7 did not have documentation showing that the staff has a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #7 was observed supervising 23 Preschool children alone after nap time. Staff #7 stated that she supervises the Preschool children alone in a school age classroom in the mornings and combines with the preschool classroom during and after nap time.
4. The record of staff #8 and staff #9 did not have documentation showing that the staff members have a current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children. Staff #8 and staff #9 was observed supervising 16 preschool children on the day of the inspection on the playground.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-530-A-2
Based on record review, the center did not ensure at least one staff in each classroom or area where children are present have a current certification in first aid.
Evidence:
1. The record of staff # 6 did not have documentation showing that the staff has current certification in first aid. Staff #6 was observed supervising four infant children alone.
2. The record of staff #2 and staff #4 did not have documentation showing that the staff members have current certification in first aid. Staff #2 and staff #4 was observed supervising twelve 2-year-old children on the day of the inspection, in the Twoddler classroom.
3. The record of staff # 7 did not have documentation showing that the staff has current certification in first aid. Staff #7 was observed supervising 23 Preschool children alone after nap time. Staff #7 stated that she supervises the Preschool children alone in a school age classroom in the mornings and combines with the preschool classroom during and after nap time.
4. The record of staff #8 and staff #9 did not have documentation showing that the staff members have current certification in first aid. Staff #8 and staff #9 was observed supervising 16 preschool children on the day of the inspection, on the playground.
Evidence:
1. The record of staff # 6 did not have documentation showing that the staff has current certification in first aid. Staff #6 was observed supervising four infant children alone.
2. The record of staff #2 and staff #4 did not have documentation showing that the staff members have current certification in first aid. Staff #2 and staff #4 was observed supervising twelve 2-year-old children on the day of the inspection, in the Twoddler classroom.
3. The record of staff # 7 did not have documentation showing that the staff has current certification in first aid. Staff #7 was observed supervising 23 Preschool children alone after nap time. Staff #7 stated that she supervises the Preschool children alone in a school age classroom in the mornings and combines with the preschool classroom during and after nap time.
4. The record of staff #8 and staff #9 did not have documentation showing that the staff members have current certification in first aid. Staff #8 and staff #9 was observed supervising 16 preschool children on the day of the inspection, on the playground.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-60-A
Based on record review and interviews, the center did not ensure five of nine children?s records contained all of the required information.
Evidence:
1. The record of child #1 (enrollment date: 7/6/21) did not contain documentation of child updates and confirmation of up-to-date information in the child's record as required by 8VAC20-780-420 E 3.
2. The record of child #2 (enrollment date: 8/23/21) did not contain documentation of child updates and confirmation of up-to-date information in the child's record as required by 8VAC20-780-420 E 3.
3. The center did not have a record for child #4. Child #4 was being cared for in the infant room. The infant staff supervising child #4 stated that the child was the youngest child in the room and recently enrolled. Both center representatives confirmed that the child?s record was not able to be found in the center.
4. The record of child #6 (enrollment date: 1/4/2023) did not have documentation showing that the center has viewed the child?s proof of age and identification.
5. The record of child #9 (enrollment date: 6/5/2023) did not have documentation showing that the center has viewed the child?s proof of age and identification.
Evidence:
1. The record of child #1 (enrollment date: 7/6/21) did not contain documentation of child updates and confirmation of up-to-date information in the child's record as required by 8VAC20-780-420 E 3.
2. The record of child #2 (enrollment date: 8/23/21) did not contain documentation of child updates and confirmation of up-to-date information in the child's record as required by 8VAC20-780-420 E 3.
3. The center did not have a record for child #4. Child #4 was being cared for in the infant room. The infant staff supervising child #4 stated that the child was the youngest child in the room and recently enrolled. Both center representatives confirmed that the child?s record was not able to be found in the center.
4. The record of child #6 (enrollment date: 1/4/2023) did not have documentation showing that the center has viewed the child?s proof of age and identification.
5. The record of child #9 (enrollment date: 6/5/2023) did not have documentation showing that the center has viewed the child?s proof of age and identification.
Plan of Correction: Not available online. Contact Inspector for more information.
Standard 8VAC20-780-70
Based on record review, the center did not ensure six of nine staff records had documentation of all required information.
Evidence:
1. The record of staff #1 (employment date: 4/13/2023) did not have documentation of two or more references prior to employment.
2. The record of staff #2 (employment date: 3/18/2022) did not have documentation of two or more references prior to employment.
3. The record of staff #4 (employment date: 11/17/2022) did not have documentation to demonstrate that the individual possesses the education as required by the job position. Staff #3 is the program lead designated for the Twoddler classroom.
4. The record of staff #7 (employment date: 11/24/2021) did not have documentation to demonstrate that the individual possesses the education, orientation and training as required by the job position. Staff #4 is the program lead designated for the Pre K classroom.
5. The record of staff #8 (employment date: 10/24/2022) did not have documentation of the following: name, address, and telephone number of a person to be notified in an emergency; any health problems that may interfere with fulfilling the job responsibilities; and documentation to demonstrate that the individual possesses the orientation training as required by the job position. According to the center representative, Staff #8 is a Program Lead.
6. The record of staff #9 (employment date: 7/8/2022) did not have documentation to demonstrate that the individual possesses the education and training as required by the job position. Staff #9 is the program lead designated for the Preschool classroom.
7. The record of staff #6 (employment date: 12/13/2022) did not have documentation to demonstrate that the individual possesses the orientation training as required by the job position.
Evidence:
1. The record of staff #1 (employment date: 4/13/2023) did not have documentation of two or more references prior to employment.
2. The record of staff #2 (employment date: 3/18/2022) did not have documentation of two or more references prior to employment.
3. The record of staff #4 (employment date: 11/17/2022) did not have documentation to demonstrate that the individual possesses the education as required by the job position. Staff #3 is the program lead designated for the Twoddler classroom.
4. The record of staff #7 (employment date: 11/24/2021) did not have documentation to demonstrate that the individual possesses the education, orientation and training as required by the job position. Staff #4 is the program lead designated for the Pre K classroom.
5. The record of staff #8 (employment date: 10/24/2022) did not have documentation of the following: name, address, and telephone number of a person to be notified in an emergency; any health problems that may interfere with fulfilling the job responsibilities; and documentation to demonstrate that the individual possesses the orientation training as required by the job position. According to the center representative, Staff #8 is a Program Lead.
6. The record of staff #9 (employment date: 7/8/2022) did not have documentation to demonstrate that the individual possesses the education and training as required by the job position. Staff #9 is the program lead designated for the Preschool classroom.
7. The record of staff #6 (employment date: 12/13/2022) did not have documentation to demonstrate that the individual possesses the orientation training as required by the job position.
Plan of Correction: Not available online. Contact Inspector for more information.