Inspection · 2024-02-02

(Repeat Violation)
Based on a review of 5 staff records (S1 through S5) and interviews with a center representative S6, the center failed to obtain a sex offender registry check and a child abuse and neglect registry search from the state other than Virginia that S2 resided in within the last 5 years.
Evidence:
1) S2 completed a sworn disclosure statement on 6/13/23 documenting that they resided in a state other than Virginia within the last 5 years.
2) There was no documentation in the record of S2 of a sex offender registry check or a child abuse and neglect registry search from that state.
3) CR1 acknowledged that there was no documentation in the file of S2 of a sex offender registry check or a child abuse and neglect registry search from that state.

Based on a review of 5 staff records (S1 through S5) and interviews with a center representative (S6), the center failed to obtain searches of central registry for S1 and S4 before 30 days of employment ended.
Evidence
1) The start date for S1 was documented on the ?Orientation Form? as 1/30/23. The central registry search for S1 was dated 4/28/23.
2) The start date for S4 was documented on the ?Staff File Sheet? as being on 10/09/23. There was no central registry search in the record of S4.
3) S6 acknowledged that the central registry search for S1 was dated outside the 30 day timeframe and that there was no central registry search for S4.

Based on child record review, the provider failed to obtain documentation of additional
immunizations once every six months for children under the age of two years.
Evidence:
The record for C7, under the age of 2, enrolled 12/31/2022 did not contain additional
immunizations due within six months of immunizations in the record dated 03/22/2023.

Based on child record review, the provider failed to assure that each report of immunizations shall be signed by a licensed physician, the physician?s designee, or an official of a local health department.
Evidence:
The immunizations for child, C7 dated 03/22/2023 were not signed by the licensed physician, the physician?s designee, or an official of a local health department.

Based on a review of 5 staff records (S1 through S5) and interviews with a center representative S6, the center failed to obtain documentation that S2 had a negative tuberculosis screening within the last 30 days of employment.
Evidence
1) The most recent TB test completed by S2 in the record was completed in Ohio on 4/28/22.
2) There is no start date in the record of S2; most of the onboarding paperwork is dated in June of 2023.
3) S6 acknowledged that there was no documentation that S2 had a negative tuberculosis screening within the last 30 days of the date of employment.

Based on a review of 5 staff records (S1 through S5) and interviews with a center representative S6, the center failed to ensure that S5 obtained a follow up tuberculosis screening every two years.
Evidence
1) The most recent tuberculosis screening contained in the file of S5 was dated 9/27/21.
2) S6 acknowledged that the tuberculosis screening for S-5 was more than two years old.

Based on a review of 5 staff records (S1 through S5) and interviews with a center representative S6, the center failed to ensure that S1 and S2 completed orientation training that included elements listed under 8VAC20-780-240.C.
Evidence
1) Documentation of the orientation training provided to S1 did not include required elements listed under 8VAC20-780-240.C.10. and 8VAC20-780-240.C.11.
2) There was no documentation of orientation training provided to S2 contained in the record.
3) S6 acknowledged that the orientation documentation for S1 was incomplete and that there was no orientation documentation for S2.

Based on observation, the provider did not ensure that all areas of the center be maintained in a clean, safe, and operable condition.
Evidence:
Discovery Preschool room: laminate top of children?s bookshelf cracked and splintered; and dirt and debris under diaper changing pad.
Toddlers? room: wooden chair rail missing a section exposing raw wood; laminate top of children?s bookshelf cracked and splintered.
Preschool room: missing outlets covers on power strip; child?s tabletop cracked with sharp edges; peeling paint on windowsill; cracked outlet cover and exposed outlet; peeling paint near fire alarm pull; dirt and debris on children?s step stool by exterior door; and stains on area rug.
School age room: multiple areas of peeling paint.
Infant room: window observed open, and the screen torn from the frame; siding outside the window shattered with sharp edges.
Large playground: child?s blue chair with broken plastic bottom; and piles of leaves around the fence base and children?s trikes.
Small playground: sheets of plexiglass on the ground; and rolling trash can surrounded by trash and soiled and wet clothing.

Based on interview, the provider failed to ensure the injury prevention procedures shall be updated at least annually based on documentation of injuries and a review of the
activities and services.
Evidence:
Staff, S6, the administrator on duty during the inspection reported that the injury prevention plan has not been updated.

Based on child record review, the provider failed to document at least annually parent confirmation that the required information in the child?s record is up to date.
Evidence:
The record for child, C1, C6, and C7 did not document annual confirmation of required information in the record. C1, enrolled 12/21/2028 the last annual confirmation of information was dated 11/30/2020; C6, enrolled 08/22/2022, no update noted in record; and C7, enrolled 12/31/2022, no update noted in record.

Based on observation and interview, the center failed to assure that medication shall be labeled with the child?s name, the name of the medication, the dosage amount, and the time or times to be given.

Evidence:
Licensing inspector observed a plastic bag labeled with the name of child, C6, that contained an unlabeled prescribed emergency medication. The medication was not labeled with the child?s name, the name of the medication, the dosage amount, and the time or times to be given. S6 reported not having the pharmacy labeled box that contained this information.

Based on observation and interview, the center administered a prescription medication without written authorization of the parent and that was not maintained in the original labeled container from the pharmacy.

Evidence:
Licensing inspector observed a tube of ointment labeled by the manufacturer as a prescribed medication in the infant classroom. S7 indicated that the ointment was for child, C5 and that it had been administered to the child. Licensing inspector requested the written authorization signed by the parent for the prescribed medication and the original labeled container. S7 reported not knowing the ointment was a prescribed medication, did not have the labeled container, or a written authorization from the parent to administer the prescribed medication.

Based on review of the drill record, the provider failed to implement a monthly practice evacuation drill.
Evidence:
The drill record did not document practice evacuation drills between January ? July 2023.

Based on review of emergency evacuation, shelter-in-place, and lockdown drills documentation, the provider failed to ensure the documentation contained all the required
information.
Evidence:
The emergency drill documentation dated August, October, and November 2023 did not document: the method used for notification of the drill; the number of staff participating; the number of children participating; problems encountered, if any; and weather conditions for emergency evacuation drills.

Based on review of injury reports, the provider failed to document required information.

Evidence:
Licensing inspector reviewed incident reports dated July 2023 ? December 2023.
Six of six injury reports for July 2023, six of six injury reports for August 2023, five of five injury reports for September, two of two in November, and one of one in December failed to document the date and time when parents were notified of the injury.

(Repeat Violation)

Based on child record review, the provider failed to ensure that one of six records contained the required information for each child enrolled.
Evidence:
The record for child, C4, enrolled 09/25/2023 did not document: viewing proof of the child?s identity and age; health information required by 8VAC20-780-130 (immunizations); and health information required by 8VAC20-780-140 (physical examination)

(Repeat Violation)
Based on a review of 5 staff records (S1 through S5) and interviews with a center representative S6, the center failed to obtain and maintain information in 5 staff records (S1, S2, S3, S4, and S5).
Evidence
1) The staff file of S1 did not include documentation that S1 was informed of the center?s information as required under 8VAC20-780-240.D.1. through 7. The staff file of S1 did not include documentation that S1 received orientation training in first aid and CPR. The staff file of S1 did not include documentation that S1 received training regarding precautions and procedures listed under 8VAC20-780-240.F.1. through 7.
2) The staff record for S2 did not include a date of employment, references, or documentation that the staff member has the experience required by the job position of Program Leader.
3) The staff record for S3 did not include information about any health problems that may interfere with job responsibilities.
4) The staff record for S4 did not include the telephone number of a person to be notified in the event of an emergency, information about any health problems that may interfere with job responsibilities or any documentation that the staff member has the experience required by the job position of Program Leader.
5) The staff record for S5 did not include any documentation that the staff member has the experience required by the job position of Program Leader.
6) S6 acknowledged that there was no documentation of the above items in 5 of the staff files.