Inspection · 2023-04-12
Date
2023-04-12
Complaint Related
No
Licensing Inspector
Kristy Atanackovic
(804) 629-5032
(804) 629-5032
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)
22.1 Background Checks Code, Carbon Monoxide
63.2 Child Abuse & Neglect
Inspector Notes
A self-reported investigation concerning a child being fed food that contained a known allergen was initiated on 4/12/2023, from a report received by the center on 4/12/2023. The investigation was conducted on 4/12/2023 in concurrence with the center?s renewal inspection, in the morning between 10:45 am and 3:30 pm, and completed on 4/27/2023. The inspection included interviews with the management team and staff. There were 93 children supervised by 12 direct care staff. The physical plant, 6 staff records, 1 child record, medications, injury reports, and policies were inspected. Based on the preponderance of evidence gathered, violations were cited. For violation details, please refer to the Violation Notice. If you have any questions, please e-mail me at Kristy.atanackovic@doe.virginia.gov.
Violations
6Standard 8VAC20-780-240-I
Based on a review of six records and staff interviews, the center did not ensure that documentation of orientation training included all required elements for two staff.
Evidence: Staff #1 and Staff #2?s documentation of orientation training, presented at the time of the inspection, was missing the training delivery method, the entity or individual providing training, and the date of the training.
Evidence: Staff #1 and Staff #2?s documentation of orientation training, presented at the time of the inspection, was missing the training delivery method, the entity or individual providing training, and the date of the training.
Plan of Correction: Orientation given.
Standard 8VAC20-780-340-A
Based on a review of documentation and staff interviews, the center did not ensure their care and protection, when a child with a documented food allergy was served food that contained a known allergen.
1. Child #1 (three-years-old) has a written care plan stating that the child is allergic to eggs.
2. On Monday, April 10, 2023, Staff #2 prepared coleslaw containing mayonnaise (the main ingredient being eggs) and distributed it to the three-year-old classroom for lunch.
3. Staff #2 stated they neglected to provide an alternative food item for Child #1 as they typically would and forgot to remind Staff #1 that Child #1 could not have the coleslaw.
4. Staff #2 confirmed that they were aware of Child #1's egg allergy.
5. Staff #1 reported that on April 10, 2023, at approximately 11:30 am, they placed a small portion of coleslaw containing mayonnaise on Child #1?s plate for lunch.
6. At approximately 11:45 am, Child #1 finished their lunch and went down for a nap. Staff #1 reported that Child #1 began coughing repeatedly during naptime.
7. At approximately 12:30 pm, Staff #1 stated that they realized Child#1's coughing could be due to them eating the coleslaw given to them for lunch and immediately alerted Staff #3.
8. Multiple staff reported that Child #1?s breathing was normal. However, the child was coughing, scratching at their mouth, and started to develop a rash on both cheeks.
9. Multiple staff reported that the emergency medication was administered by Staff#3, at approximately 12:35 pm, in concurrence with Staff #4 calling 911, and Staff #5 calling the parents of Child #1.
10. Child #1 was transported to the nearby hospital and was accompanied by Staff #3 until the parents arrived.
1. Child #1 (three-years-old) has a written care plan stating that the child is allergic to eggs.
2. On Monday, April 10, 2023, Staff #2 prepared coleslaw containing mayonnaise (the main ingredient being eggs) and distributed it to the three-year-old classroom for lunch.
3. Staff #2 stated they neglected to provide an alternative food item for Child #1 as they typically would and forgot to remind Staff #1 that Child #1 could not have the coleslaw.
4. Staff #2 confirmed that they were aware of Child #1's egg allergy.
5. Staff #1 reported that on April 10, 2023, at approximately 11:30 am, they placed a small portion of coleslaw containing mayonnaise on Child #1?s plate for lunch.
6. At approximately 11:45 am, Child #1 finished their lunch and went down for a nap. Staff #1 reported that Child #1 began coughing repeatedly during naptime.
7. At approximately 12:30 pm, Staff #1 stated that they realized Child#1's coughing could be due to them eating the coleslaw given to them for lunch and immediately alerted Staff #3.
8. Multiple staff reported that Child #1?s breathing was normal. However, the child was coughing, scratching at their mouth, and started to develop a rash on both cheeks.
9. Multiple staff reported that the emergency medication was administered by Staff#3, at approximately 12:35 pm, in concurrence with Staff #4 calling 911, and Staff #5 calling the parents of Child #1.
10. Child #1 was transported to the nearby hospital and was accompanied by Staff #3 until the parents arrived.
Plan of Correction: Staff to review allergy list at meal times.
MAT Training updated.
MAT Training updated.
Standard 8VAC20-780-510-I
Based on record review and staff interview, the center did not ensure that prescription medication was administered by a staff member who meets the requirements in 8VAC20-780-245 J related to Medication Administration Training (MAT).
Evidence:
1. Staff #3 confirmed that they administered Child #1's emergency medication to the child on Monday, April 10, 2023, as a result of Child #1's allergic reaction to the coleslaw served for lunch.
2. The most recent MAT certification on file for Staff #3 expired on 3/6/2023.
Evidence:
1. Staff #3 confirmed that they administered Child #1's emergency medication to the child on Monday, April 10, 2023, as a result of Child #1's allergic reaction to the coleslaw served for lunch.
2. The most recent MAT certification on file for Staff #3 expired on 3/6/2023.
Plan of Correction: MAT updated.
Standard 8VAC20-780-510-N
Based on record review and staff interview, the center failed to keep a record of all medications given to a child including the child's name, the amount and type of medication, the date and time of administration, the name of the administering staff member, or any adverse reactions to the medication.
Evidence: Staff #3 confirmed that they administered Child #1's emergency medication on April 10, 2023, in response to an allergic reaction, but did not document the occurrence.
Evidence: Staff #3 confirmed that they administered Child #1's emergency medication on April 10, 2023, in response to an allergic reaction, but did not document the occurrence.
Plan of Correction: Log medication.
Standard 8VAC20-780-550-P
Based on record review and staff interview, the center did not maintain a written record of children's serious injuries in which entries are made the day of the occurrence.
Evidence:
1. There was no documentation of an injury report for Child #1, who suffered an allergic reaction requiring the administration of an emergency medication and EMS being called on Monday, April 10, 2023, after being served a known food allergen.
2. Staff #3 confirmed that there was no injury report on file for Child #1 related to the incident.
Evidence:
1. There was no documentation of an injury report for Child #1, who suffered an allergic reaction requiring the administration of an emergency medication and EMS being called on Monday, April 10, 2023, after being served a known food allergen.
2. Staff #3 confirmed that there was no injury report on file for Child #1 related to the incident.
Plan of Correction: Make a report and will give at time of situation.
Standard 8VAC20-780-560-P
Based on record review and staff interview, the center did not ensure that a child with a diagnosed food allergy was not served any food identified in the required written care plan.
Evidence:
1. Child #1 (three-years-old) has a written care plan stating that the child is allergic to eggs, and the child also has emergency medication on site.
2. On April 10, 2023, at approximately, 11:30 am, Staff #1 placed coleslaw containing mayonnaise (the main ingredient being eggs) on child #1?s plate for lunch.
3. Child #1 was administered the emergency medication by Staff #3 due to an allergic reaction and transported by EMS for medical care.
4. Staff #1, who was caring for the child, and Staff #2, who prepared the food, confirmed that they were aware of Child #1's allergy to eggs.
Evidence:
1. Child #1 (three-years-old) has a written care plan stating that the child is allergic to eggs, and the child also has emergency medication on site.
2. On April 10, 2023, at approximately, 11:30 am, Staff #1 placed coleslaw containing mayonnaise (the main ingredient being eggs) on child #1?s plate for lunch.
3. Child #1 was administered the emergency medication by Staff #3 due to an allergic reaction and transported by EMS for medical care.
4. Staff #1, who was caring for the child, and Staff #2, who prepared the food, confirmed that they were aware of Child #1's allergy to eggs.
Plan of Correction: Children with allergy food will be served with name and alone.