Inspection · 2025-03-13
Date
2025-03-13
Complaint Related
No
Licensing Inspector
Lauren Captain
(571) 835-0599
(571) 835-0599
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
63.2 Child Abuse & Neglect
During the inspection, the inspector reviewed the areas listed above to include standards found out of compliance during the previous inspection. Unless otherwise noted as a violation within this inspection report, the provider was in compliance with the standards reviewed. If there were any serious injuries or fatalities related to a violation, the details will be included in the description of the violation
Inspector Notes
An unannounced, on-site monitoring inspection was initiated on 3/12/25 and completed on 03/13/2025, as a part the licensure period, The on-site inspection began at 12:11 PM and ended at 2:15 PM. The inspector reviewed compliance in the areas listed above. There were 28 children present and 10 staff. The inspector reviewed 3 children?s records, 1 owner record, and 3 staff records on-site.
This inspection included: document review, tour of the facility, interviews and observations.
Information gathered during the inspection determined non-compliance with applicable standards or law, and violations are documented on the violation notice issued to the program.
Please complete the plan of correction (POC) and date to be corrected sections for each violation cited on the violation notice. Specify how the violation will be or has been corrected. Submit your POC within five (5) business days from today, which will be the close of business on 3/24/2025. A POC submitted after this date will not appear on the public website.
Violations
12Standard 22.1-289.035-B-2
Providers must obtain a completed national criminal background check prior to the employee's first day of employment.
Staff B, who had been employed for over 3 weeks, did not have a completed national criminal background check.
Staff B, who had been employed for over 3 weeks, did not have a completed national criminal background check.
Plan of Correction: Staff B now has the completed national criminal background check. Moving forward, we will ensure that all necessary documents are obtained before hiring anyone. WE sincerely apologize for any inconvenience this may have caused.
Standard 8VAC20-780-210-A
Program leaders shall be at least 18 years of age, have fulfilled a high school program completion or the equivalent and meet one of the additional requirements,
There is no documentation on file to demonstrate that Staff B is qualified to be in a lead teacher position.
There is no documentation on file to demonstrate that Staff B is qualified to be in a lead teacher position.
Plan of Correction: Staff B is qualified to be a teacher. She has completed her high school education and graduated in Bolivia with a degree in Social Pedagogy. She is currently in the process of translating her certificates, which have already been sent to the Spanish Group company.
Standard 8VAC20-780-240-A
The Virginia Department of Education-sponsored orientation course shall be completed within 90 calendar days of employment.
Documentation for Staff D of the required VDOE sponsored course was overdue by 2 months when completed.
Documentation for Staff D of the required VDOE sponsored course was overdue by 2 months when completed.
Plan of Correction: The documentation for Staff D has been updated. We will ensure to be more careful and make sure that this documentation is completed within 90 days after employment with new staff members
Standard 8VAC20-780-240-B
Staff shall complete orientation training in subsection C of this section prior to the staff member working alone with children and no later than seven days of the date of assuming job responsibilities.
Documentation of orientation for Staff A was overdue by 3 weeks.
Documentation of orientation for Staff B was overdue by 2 weeks.
Documentation of orientation for Staff D was overdue by 5 months.
Documentation of orientation for Staff A was overdue by 3 weeks.
Documentation of orientation for Staff B was overdue by 2 weeks.
Documentation of orientation for Staff D was overdue by 5 months.
Plan of Correction: The documentation for Staff A has been updated with the correct date. The documentation for Staff B has been dated with the correct date. The orientation documentation for Staff D is now dated with the correct date.
Standard 8VAC20-780-245-J-3
Any child for whom emergency medications such as epinephrine auto injector have been prescribed shall always be in the care of a staff member who meets the requirements to administer the medication.
One child has a specific epinephrine auto injector medication onsite. No staff member has certification of training to administer that medication.
One child has a specific epinephrine auto injector medication onsite. No staff member has certification of training to administer that medication.
Plan of Correction: Staff A now holds the required certification to administer the medication.
Standard 8VAC20-780-280-B
Repeat Violation
Hazardous substances such as cleaning materials shall be kept in a locked place using a safe locking method that prevents access by children.
Room #1 had cleaning products stored in a cabinet under the sink, not locked.
Room #2 had cleaning products in the diapering area, not locked after use.
Hazardous substances such as cleaning materials shall be kept in a locked place using a safe locking method that prevents access by children.
Room #1 had cleaning products stored in a cabinet under the sink, not locked.
Room #2 had cleaning products in the diapering area, not locked after use.
Plan of Correction: All cleaning products are now locked at all times. Teachers and assistants have been reminded and retrained that all products must remain locked and out of children's reach at all times.
Standard 8VAC20-780-510-F
A medication authorization shall be available to staff during the entire time it is effective.
Child #1, who was present at the center, had a medication on site for which there is no authorization form available.
Child #1, who was present at the center, had a medication on site for which there is no authorization form available.
Plan of Correction: The mother was notified in February 2025 to update the medication form. We will have the updated documents ready by Monday. If the form is not complete by then, the child cannot return to school until it is. The parents have already been informed.
Standard 8VAC20-780-550-G
Documentation shall be maintained of emergency evacuation, shelter-in-place, and lockdown drills.
There was no documentation of an emergency evacuation drill having been conducted in February 2025.
There was no documentation of two shelter-in-place drills having been conducted in 2024.
There was no documentation of an emergency evacuation drill having been conducted in February 2025.
There was no documentation of two shelter-in-place drills having been conducted in 2024.
Plan of Correction: The emergency evacuation drill for February was conducted, but due to an oversight, it was not documented on the form. It has now been updated and registered. The drill for March has also been completed. Additionally, the two shelter-in-place drills have been documented. All drills are now up to date and properly documented.
Standard 8VAC20-780-550-P
center shall maintain a written record of children's serious and minor injuries in which entries are made the day of occurrence. The record shall include the date, time and method of parent notification of the injury.
5 of 7 Injury reports reviewed did not contain the time, method of notification or date when the parent was notified.
5 of 7 Injury reports reviewed did not contain the time, method of notification or date when the parent was notified.
Plan of Correction: The teachers have been trained to ensure that the accident report is fully completed, including all required fields, at the time of notifying parents. The forms have been modified, and now all sections are fully completed.
Standard 8VAC20-780-60-A
Each center shall maintain and keep at the center a separate record for each child enrolled which shall contain the following information; documentation of child updates and confirmation of up-to-date information in the child's record.
The update for the allergy action plan for child #1 was overdue by 7 days.
The update for the allergy action plan for child #1 was overdue by 7 days.
Plan of Correction: The parents have been notified to ensure they provide the correct and updated form. The child will not be allowed to return to the center until we have the completed form.
Standard 8VAC20-780-70
Repeat Violation
The following staff records shall be kept for each staff person; date of employment, background checks, documentation of references checked prior to employment, and if references are conducted over the phone, the date of contact and signature of the person making the call.
Staff D's date of employment was not documented.
Staff A, B's references were not dated.
Staff D had no references documented.
The sworn statement for Staff A, who has been working at the center, for a month, was not dated.
The sworn statement for Staff D, who has been working at the center for over 5 months, was not dated.
The following staff records shall be kept for each staff person; date of employment, background checks, documentation of references checked prior to employment, and if references are conducted over the phone, the date of contact and signature of the person making the call.
Staff D's date of employment was not documented.
Staff A, B's references were not dated.
Staff D had no references documented.
The sworn statement for Staff A, who has been working at the center, for a month, was not dated.
The sworn statement for Staff D, who has been working at the center for over 5 months, was not dated.
Plan of Correction: The date of employment for Staff D has been documented. The references for Staff A have been dated and completed. Staff D's references haven been documented and dated. The sworn statement for Staff A has been dated with the correct date. The sworn statement for Staff D has been updated and dated.
Standard 8VAC20-780-80-A
Repeat Violation
For each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.
Room #1 did not have attendance documented for 3/11/25 or 3/12/25.
For each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.
Room #1 did not have attendance documented for 3/11/25 or 3/12/25.
Plan of Correction: An email was sent ti the parents reminding them that the daily attendance must be recorded every day and that it is important. Teachers and assistants were also reminded about the importance of keeping the attendance documented daily.