An unannounced renewal inspection was initiated on 4/20/2022 and concluded on 4/22/2022. The inspector was on site from 9:15 am-10:35 am. There were 20 children present, ranging in ages from 11 months to 5 years, with 4 staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, staffing and supervision, programming, medication, special care and emergencies, nutrition and background checks. A total of 5 child records, 5 staff records, and 9 board member/agent records were reviewed. Staff records were reviewed remotely.
Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the program.
Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to me within 5 business days from today. You will need to specify how the deficient practice will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measures. Please do not use staff names; list staff by positions only.
Based on a review of 5 staff records and interview, the center did not ensure to obtain the results of an out of state child abuse and neglect background check for 1 staff from any state in which the individual had resided in the preceding five years prior to hire as required.
Evidence: 1. The record of staff #4 (DOH:10/30/2019) contained a sworn statement that indicated the staff had resided outside of Virginia within the preceding 5 years. The record did not contain the results of an out of state child abuse and neglect search. 2. Administration acknowledged that the background check had not been obtained.
Plan of Correction:
Email reminders of dates have been set up 60 days prior to expiration date. The staff has completed the final of the 3 out of state background checks and was mailed 4/27/2022.
Standard #:
22.1-289.036-A
Description:
Based on a review of 9 board member/agent records and interview, the center did not ensure to obtain the results of a repeat central registry background check every 5 years for 1 agent as required. Evidence: 1. The record of agent #9 contained a central registry background check dated 11/9/2015. 2. Administration acknowledged that they had not received the results of the repeat background check.
Plan of Correction:
Email reminders of dates have been sent 60 days prior to expiration date- mailed 4/25/2022
Standard #:
22.1-289.036-B-2
Description:
Based on a review of 9 board member/agent records and interview, the center did not ensure that 3 records contained the results of a fingerprint background check by the end of the 30th day of taking office as required. Evidence: 1. The record of board member #3 (DTB:7/1/2020) contained a fingerprint background check dated 3/21/2022. The record of board member #5 (DTB: 1/23/2020) contained a fingerprint background check dated 3/21/2022. The record of board member #6 (DTB:7/1/2021) did not contain the results of a fingerprint background check. 2. Administration acknowledged that the background checks were not completed within the required time frame.
Plan of Correction:
see section 1: All paperwork has been completed for current members.
Standard #:
8VAC20-770-40-D-1-a
Description:
Based on a review of 9 board member/agent records and interview, the center did not ensure that 3 records contained a completed sworn statement and the results of a central registry background check by the end of the 30th day of taking office as required. Evidence: 1. The record of board member #3 (DTB: 7/1/2020) was missing the results of a central registry background check and contained a sworn statement dated 4/11/2022. The record of board member #5 (DTB:1/23/2020) contained a central registry dated 4/18/2022 and a sworn statement dated 3/15/2022. The record of board member #6 (DTB:7/1/2021) was missing the results of a central registry background check and a completed sworn statement. 2. Administration acknowledged that the background checks were not received within the required time frame.
Plan of Correction:
A plan has been created for all new board members where paperwork will be completed at least 30 days prior to coming on the board. All paperwork has been completed for current members.
Standard #:
8VAC20-780-40-M
Description:
Based on observation and interview, the center did not ensure to maintain, in a way that is accessible to all staff who work with children, a current written list of all children's allergies, sensitivities, and dietary restrictions. The list shall be dated and kept confidential in each room or area where children are present.
Evidence: 1. Children's records indicated that there were children enrolled with diagnosed food allergies. A dated list was not observed in each room or area where children were present. 2. Administration acknowledged that the written list was not available in each room.
Plan of Correction:
Records of all allergies is available in all classrooms and buses. This is a confidential area so visitors are not aware.
Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.
Find this content at:
http://www.dss.virginia.gov/facility/search/cc.cgi