Inspection · 2022-04-26
Date
2022-04-26
Complaint Related
No
Licensing Inspector
Stephanie Salvatori
(571) 389-0980
(571) 389-0980
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 Staffing and Supervision.
8VAC20-780 Programs.
Inspector Notes
An inspection in response to a self-reported incident was initiated on April 26, 2022 and concluded on May 3, 2022. The report received by the department included information of a serious injury sustained by an 18 month old child in care that resulted in the diagnosis of Nursemaid?s elbow.
The Center?s video recordings were observed, staff and parent interviews were conducted, and the center?s staff records, policies and procedures were reviewed in response to the self-reported incident.
The evidence gathered during the investigation supported the self-report of non-compliance with standards or law, and violations were issued. Any violations not related to the self-report but identified during the course of the investigation can also be found on the violation notice.
Violations
3Standard 8VAC20-780-340-A
Based on video observation, staff interview, and review of documentation, staff did not ensure the care, protection and guidance of a child.
Evidence:
1. On 04/22/2022 at approximately 10:45am, the video shows Child #1 (18 months) grabbing at a book held by Child #2 (18 months) and hitting Child #2. Staff #1 was observed calling Child #1?s name from across the classroom and Child #1 stopped hitting at Child #2. Child #1 then took the book from Child #2. Staff #1 walked over to Child #1 and said, ?Really girl?, took the book from Child #1 and gave it back to Child #2. Staff #1 took Child #1 by the left arm under the elbow and pulled them from a seated position on the floor to a standing position. Child #1 began to cry. Staff #1 lifted Child #1 under both arms and placed them to another area of the carpet, and walked over to Child #2 to attend to them. Child #1 continued to cry and sob off and on for the next five minutes of the video.
2. Staff #1 stated that Child #1 cried off and on for 30 minutes after Staff #1 moved Child #1.
3. According to the Injury Report on 04/22/2022, the parents were notified by phone at 11:45 am. The parents picked Child #1 at 1:00 pm.
4. According to discharge papers from a local hospital dated 04/22/2022, Child #1 was treated and diagnosed with Nursemaid's elbow of the upper extremity.
Evidence:
1. On 04/22/2022 at approximately 10:45am, the video shows Child #1 (18 months) grabbing at a book held by Child #2 (18 months) and hitting Child #2. Staff #1 was observed calling Child #1?s name from across the classroom and Child #1 stopped hitting at Child #2. Child #1 then took the book from Child #2. Staff #1 walked over to Child #1 and said, ?Really girl?, took the book from Child #1 and gave it back to Child #2. Staff #1 took Child #1 by the left arm under the elbow and pulled them from a seated position on the floor to a standing position. Child #1 began to cry. Staff #1 lifted Child #1 under both arms and placed them to another area of the carpet, and walked over to Child #2 to attend to them. Child #1 continued to cry and sob off and on for the next five minutes of the video.
2. Staff #1 stated that Child #1 cried off and on for 30 minutes after Staff #1 moved Child #1.
3. According to the Injury Report on 04/22/2022, the parents were notified by phone at 11:45 am. The parents picked Child #1 at 1:00 pm.
4. According to discharge papers from a local hospital dated 04/22/2022, Child #1 was treated and diagnosed with Nursemaid's elbow of the upper extremity.
Plan of Correction: Treating all our students with the utmost care for their physical safety and emotional well-being is our highest priority. To aid in this, we have video coverage of all our classrooms that enables us to review any incidents, accidents, or injuries that may occur on site. In this case, the staff member quickly noticed a physical altercation between two children and interceded in the way she thought best by moving Child #1 to another teacher who provided an alternate toy and attending to the other student. However, in the process, an accident occurred, and Child #1 was injured. When the staff member noticed Child #1 was not calming down in a usual time and manner, Staff #1 tried to figure out what was wrong and called a supervisor for support. The staff member and provider regret any time an accident or injury of any kind occurs. We also believe it is important to note that the state inspector agreed that ?the staff was not taking this action in an angry or punitive way?, as noted by the Department of Education in its response to our First Step Review.
While Staff #1 no longer works at Merritt, we have reminded all our staff of the importance of being observant of a child?s normal behavior and getting support quickly if a student is not behaving in a usual manner or shows signs of an injury or distress. We have reviewed how the injury occurred and created an additional training for all staff members to try to prevent any similar injuries from occurring in the future.
While Staff #1 no longer works at Merritt, we have reminded all our staff of the importance of being observant of a child?s normal behavior and getting support quickly if a student is not behaving in a usual manner or shows signs of an injury or distress. We have reviewed how the injury occurred and created an additional training for all staff members to try to prevent any similar injuries from occurring in the future.
Standard 8VAC20-780-40-E
Based on documentation review and video observation, the licensee did not ensure that staff followed the center?s own policies and procedures as they relate to injury prevention and behavior guidance.
Evidence:
1. The Center?s policies state that staff should move children by lifting them by the trunk and avoid lifting or holding a child by the arm.
2. Staff #1 took Child #1?s left arm under the elbow and pulls them to a standing position.
Evidence:
1. The Center?s policies state that staff should move children by lifting them by the trunk and avoid lifting or holding a child by the arm.
2. Staff #1 took Child #1?s left arm under the elbow and pulls them to a standing position.
Plan of Correction: We would like to note that the staff member took steps to follow the existing training by reaching for the student with both arms, but the student retracted one arm, so the staff member then had to reposition herself and the student so both arms were again under the student?s armpits. The staff member was intending to support the student to a stand, not lift the student. However, we want to make sure no staff member in the future accidentally uses the same motion. Therefore, based on review of this incident, we have created additional training that has been given to all staff to reinforce the importance of caution and hand-position when moving a student or helping students change positions.
Standard 8VAC20-780-400-B
Based on video observation, behavioral guidance was not constructive in nature, age and stage appropriate, and intended to redirect children to appropriate behaviors.
Evidence:
1. On 4/22/2022, at approximately 10:45am, in response to Child #1 (18 months) grabbing a book from and hitting another child, Staff #1 took Child #1 by the left arm under the elbow and pulled them from a seated position on the floor to a standing position. Child #1 began to cry. Staff #1 lifted Child #1 under both arms and placed Child #1 on another area of the carpet. Child #1 cried for the next 5 minutes of the video. Staff #1 walked away from Child #1 without attempting to comfort or talk to them while crying.
Evidence:
1. On 4/22/2022, at approximately 10:45am, in response to Child #1 (18 months) grabbing a book from and hitting another child, Staff #1 took Child #1 by the left arm under the elbow and pulled them from a seated position on the floor to a standing position. Child #1 began to cry. Staff #1 lifted Child #1 under both arms and placed Child #1 on another area of the carpet. Child #1 cried for the next 5 minutes of the video. Staff #1 walked away from Child #1 without attempting to comfort or talk to them while crying.
Plan of Correction: Separating a student from another student is sometimes appropriate and necessary. In this case, the teacher believed removing the student who had just hit another student and redirecting them to another place and object was the right decision. We have reminded our teachers about the different strategies they can use. The teachers in the room did not know Child #1 was injured and therefore consoled the other child who had been hit and attempted to redirect Child #1 with another object. We will continue to provide ongoing training to make sure the teachers are comfortable with many strategies for safe and positive behavior management.