Inspection · 2024-03-26
Date
2024-03-26
Complaint Related
No
Licensing Inspector
Sarah Marbert
(703) 479-4678
(703) 479-4678
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 (8VAC20-770)
20 Access to minor?s records
22.1 Background Checks Code, Carbon Monoxide
63.2 Child Abuse & Neglect
Inspector Notes
An unannounced monitoring inspection was conducted today.
All rooms were in ratio during the inspection. The playground was not in use during the inspection.
Children were observed sleeping, during a diaper change, washing hands and eating snack.
4 child and 4 staff records were reviewed.
See Violation notice for non-compliances cited today.
If you have questions regarding this inspection, you may contact me at (703) 479-4678 or at Sarah.Marbert@doe.virginia.gov
LI was present today from 2:00 PM - 4:30 PM.
Violations
11Standard 8VAC20-780-160-C
Based on a review of records, one staff record does not contain documentation of a negative result for a follow up tuberculosis screening result within the allowable two year time frame.
Evidence:
Staff B's record contained a negative screening result dated 1/12/22. (Expired).
Evidence:
Staff B's record contained a negative screening result dated 1/12/22. (Expired).
Plan of Correction: Staff will be asked to obtain a new screening result as soon as possible.
Standard 8VAC20-780-210-A
Based on a review of records, one staff record did not contain documentation of qualifications for a lead teacher.
Evidence:
Staff C's record did not contain documentation to show the person met lead teacher qualifications.
Evidence:
Staff C's record did not contain documentation to show the person met lead teacher qualifications.
Plan of Correction: Staff will be asked to provide transcripts to verify qualifications.
Standard 8VAC20-780-240-A
Based on a review of records, one staff record did not contain documentation of completion for the required Department of Education sponsored orientation course, within 90 days of employment.
Evidence:
Staff C's record had no documentation of completion of the 10 hour orientation course.
(Date of Hire: 11/29/23)
Evidence:
Staff C's record had no documentation of completion of the 10 hour orientation course.
(Date of Hire: 11/29/23)
Plan of Correction: Staff will be reminded to complete the course as soon as possible.
Standard 8VAC20-780-40-E
Repeat Violation
Systemic Deficiency
Based on a review of medication authorizations, the center failed to follow its policy for medication administration, by not receiving an authorization for a prescription medication on site.
Evidence:
There is no authorization available for review for an Epi-pen present at the facility.
(Child 1)
Systemic Deficiency
Based on a review of medication authorizations, the center failed to follow its policy for medication administration, by not receiving an authorization for a prescription medication on site.
Evidence:
There is no authorization available for review for an Epi-pen present at the facility.
(Child 1)
Plan of Correction: Parents will be asked to provide an authorization for the medication.
Standard 8VAC20-780-440-B
Based on observation, cribs were not identified for use by a specific child.
Evidence:
3 infants in the Infant B room were sleeping in cribs that were not identified for use by a specific child.
Evidence:
3 infants in the Infant B room were sleeping in cribs that were not identified for use by a specific child.
Plan of Correction: The infants were moved to a different room to allow for a deep cleaning. Cribs in the Infant A room are labeled. We will make sure cribs in use are labeled.
Standard 8VAC20-780-50-B
Based on a review of records, one staff record was not made available during the inspection.
Evidence:
Staff D's record was not available during the inspection.
Staff stated the file was locked in the Owner's office.
Evidence:
Staff D's record was not available during the inspection.
Staff stated the file was locked in the Owner's office.
Plan of Correction: I will speak to the owner about access to all records.
Standard 8VAC20-780-500-B
Based on observation, the diaper disposal container in use was not foot operated.
Evidence:
The diaper disposal container in the Infant B room had a broken foot pedal. The Staff member was observed using their hand to open the lid, twice, to dispose of a diaper and then a paper towel.
Evidence:
The diaper disposal container in the Infant B room had a broken foot pedal. The Staff member was observed using their hand to open the lid, twice, to dispose of a diaper and then a paper towel.
Plan of Correction: The diaper disposal container will be replaced.
Standard 8VAC20-780-510-I
Based on a review of medications, one medication was not maintained in the original container with the label attached.
Evidence:
Child #4's Albuterol Inhaler was not in the original container with the label attached.
Evidence:
Child #4's Albuterol Inhaler was not in the original container with the label attached.
Plan of Correction: We will ask the parent to provide the container with the label attached.
Standard 8VAC20-780-550-E
Based on a review of documentation, the center did not practice shelter-in-place procedures a minimum of twice a year.
Evidence:
There was only one Shelter-in-place drill conducted for 2023.
Evidence:
There was only one Shelter-in-place drill conducted for 2023.
Plan of Correction: We will conduct 2 Shelter-in-place drills this year. Our form will be changed to make sure there is room to document the second drill.
Standard 8VAC20-780-60-A
Repeat Violation
Systemic Deficiency
Based on a review of records, child records did not contain al required information.
Evidence:
1. Child #1's record did not contain documentation of parent's work and 2 emergency contacts information.
2. Child #1's record was not updated annually. File was dated 7/8/22.
Systemic Deficiency
Based on a review of records, child records did not contain al required information.
Evidence:
1. Child #1's record did not contain documentation of parent's work and 2 emergency contacts information.
2. Child #1's record was not updated annually. File was dated 7/8/22.
Plan of Correction: Parents will be contacted to provide missing information.
All child records will be updated at a near future date.
All child records will be updated at a near future date.
Standard 8VAC20-780-80-A
Based on a review of attendance documentation, the center did not maintain a written record of attendance for each group of children.
Evidence:
1. The Infant room attendance was not accurate. There were 4 infants present in the Infant B room. One infant had not been entered into the "app" system in use, and was not accounted for in attendance.
2. The 3's/4's rooms were combined for rest time. The "app" system showed 13 children present; however, there were 14 children present.
Evidence:
1. The Infant room attendance was not accurate. There were 4 infants present in the Infant B room. One infant had not been entered into the "app" system in use, and was not accounted for in attendance.
2. The 3's/4's rooms were combined for rest time. The "app" system showed 13 children present; however, there were 14 children present.
Plan of Correction: We will begin using paper attendance sheets.