La Petite Academy - Dumfries

8VAC20-780-270-A

“(Repeat Violation) The facility shall ensure that all areas inside and outside the center are maintained in a clean, safe and operable condition. The roof is leaking in the preschool room and there has been a tarp on the roof for six weeks; the cabinets in the kitchen are deteriorating and crumbling and debris was observed on the kitchen counter.”

8VAC20-780-550-D

“The center shall implement a monthly practice evacuation drill. There were no documented evacuation drills for the last six months.”

8VAC20-780-530-A

“At least one staff in each classroom or area where children are present shall have current certification in both CPR and first aid. Staff #1, staff #4, and staff #5 were observed alone with a group of children. The CPR and first aid certification for staff #1 expired six months ago; for staff #4 it expired two months ago; and for staff #5 it expired six months ago.”

8VAC20-780-130-A

“The center shall obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Child #2, enrolled for two days, did not have documentation of an immunization record on file.”

8VAC20-780-160-C

“(Repeat Violation) A tuberculosis (TB) screening is required every two years from the last screening. The updated screening for Staff #2 was due nine months ago.”

8VAC20-780-60-A

“(Repeat Violation) Each center shall maintain and keep at the center a separate record for each child enrolled that contains all of the required information. Child #2, enrolled for two days, did not have a record. Child #3, enrolled for seven weeks, was missing proof of birth.”

8VAC20-780-245-J-3

“Any child for whom emergency medications have been prescribed shall always be in the care of a staff member who has been trained to administer the medication. Child #1 has emergency rectal medication on site for seizures but there are no staff trained in administering emergency rectal medication.”

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. There was a bottle of bleach water solution sitting in a basket on the changing table in the toddler room and in an unlocked cabinet above the sink in the preschool room.”

8VAC20-770-70-A

“Documentation of at least 2 references to character, reputation, and competency are to be checked prior to employment. Staff #3, who has been working at the center for six weeks, did not have two completed reference verifications on file.”

8VAC20-780-60-A

“(Repeat Violation) Based on review of two child records, not all records contained all required information. Evidence: the records for child #2, child #5, and child #7 did not contain complete name, address and phone number for two emergency contacts.”

8VAC20-780-40-M

“Based on review of documentation, and staff interview, the facility failed to maintain a current written list of children’s allergies, sensitivities and dietary restrictions in each room or area where children are present. Evidence: not all classrooms had a current allergy list; 1) The early preschool classroom had a list dated: 10/2/2023 2) The preK classroom had a list dated: 3/11/2024 3) The two's classroom had a list dated 12/1/2023 4) The preschool B classroom did not have a list”

8VAC20-780-160-C

“Based on review of five staff records, it was determined that not all staff had documentation of a negative tuberculosis (TB) test/screening completed at least every two years from the date of the initial test or screening. Evidence: the record for staff #3 had a negative TB test/screening dated: 3/12/2022.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a spray bottle of sanitizing solution in a basket on the counter of the two’s classroom and in an unlocked cabinet in the school age classroom.”

8VAC20-780-330-B

“Based on an inspection of the playground, it was determined that the mulch under and around play equipment was not resilient. Evidence: The wood chips surrounding the rocking car on the toddler playground measured less than six inches in depth. The wood chips under and around the composite play structure on the preschool playground measured less than six inches in depth.”

8VAC20-770-60-C-2

“Based on review of five staff records, it was determined that not all staff had Central Registry Search results within 30 days of hire, or documentation that follow up was completed as required. Evidence: the records for staff #2 (date of hire: 1/29/2024), staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not have Central Registry search results or documentation of follow up.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that no out of state child abuse and neglect search was requested within 30 days of hire, and no out of state criminal history name check was conducted prior to hire, for all staff who stated they have lived outside of Virginia in the past five years. Evidence: the records for staff #1, (Date of hire: 5/14/2024) and staff #5, (Date of hire: 4/22/2024), who indicated that they have lived out of the state of Virginia in the past five years, had no documentation of an out of state central registry search request or an out of state criminal history name check.”

8VAC20-780-240-B

“Based on review of five staff records, it was determined that not all staff had documentation of completing orientation training, as required. Evidence: The records for staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not contain documentation of orientation training.”

8VAC20-780-500-A

“(Repeat violation) Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: an infant was fed a bottle and their hands were not washed beforehand. Staff acknowledged that the infant’s hands were not washed first.”

8VAC20-780-270-A

“(Repeat Violation) Based on observation, the facility did not ensure all areas of the center were maintained in a clean, safe and operable condition. Evidence: 1) There were sharp wires coming through the fence and some rusty wires with sharp edges at the top and bottom of the fence between the toddler and preschool playground 2) There were sharp wires at the bottom of the preschool playground fence 3) There were weeds growing through the preschool and school age fences; some with prickers, thorns and berries 4) There was trash on the school age and preschool playground 5) There was a tricycle with a broken handlebar, broken hoola hoop, broken garden box, and a broken plastic bin on the playground 6) There was an orange wire coming through the school age playground fence with an exposed end”

8VAC20-780-60-A

“(Repeat Violation) Based on review of two child records, not all records contained all required information. Evidence: the records for child #2, child #5, and child #7 did not contain complete name, address and phone number for two emergency contacts.”

8VAC20-780-40-M

“Based on review of documentation, and staff interview, the facility failed to maintain a current written list of children’s allergies, sensitivities and dietary restrictions in each room or area where children are present. Evidence: not all classrooms had a current allergy list; 1) The early preschool classroom had a list dated: 10/2/2023 2) The preK classroom had a list dated: 3/11/2024 3) The two's classroom had a list dated 12/1/2023 4) The preschool B classroom did not have a list”

8VAC20-780-160-C

“Based on review of five staff records, it was determined that not all staff had documentation of a negative tuberculosis (TB) test/screening completed at least every two years from the date of the initial test or screening. Evidence: the record for staff #3 had a negative TB test/screening dated: 3/12/2022.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a spray bottle of sanitizing solution in a basket on the counter of the two’s classroom and in an unlocked cabinet in the school age classroom.”

8VAC20-780-330-B

“Based on an inspection of the playground, it was determined that the mulch under and around play equipment was not resilient. Evidence: The wood chips surrounding the rocking car on the toddler playground measured less than six inches in depth. The wood chips under and around the composite play structure on the preschool playground measured less than six inches in depth.”

8VAC20-770-60-C-2

“Based on review of five staff records, it was determined that not all staff had Central Registry Search results within 30 days of hire, or documentation that follow up was completed as required. Evidence: the records for staff #2 (date of hire: 1/29/2024), staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not have Central Registry search results or documentation of follow up.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that no out of state child abuse and neglect search was requested within 30 days of hire, and no out of state criminal history name check was conducted prior to hire, for all staff who stated they have lived outside of Virginia in the past five years. Evidence: the records for staff #1, (Date of hire: 5/14/2024) and staff #5, (Date of hire: 4/22/2024), who indicated that they have lived out of the state of Virginia in the past five years, had no documentation of an out of state central registry search request or an out of state criminal history name check.”

8VAC20-780-240-B

“Based on review of five staff records, it was determined that not all staff had documentation of completing orientation training, as required. Evidence: The records for staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not contain documentation of orientation training.”

8VAC20-780-500-A

“(Repeat violation) Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: an infant was fed a bottle and their hands were not washed beforehand. Staff acknowledged that the infant’s hands were not washed first.”

8VAC20-780-270-A

“(Repeat Violation) Based on observation, the facility did not ensure all areas of the center were maintained in a clean, safe and operable condition. Evidence: 1) There were sharp wires coming through the fence and some rusty wires with sharp edges at the top and bottom of the fence between the toddler and preschool playground 2) There were sharp wires at the bottom of the preschool playground fence 3) There were weeds growing through the preschool and school age fences; some with prickers, thorns and berries 4) There was trash on the school age and preschool playground 5) There was a tricycle with a broken handlebar, broken hoola hoop, broken garden box, and a broken plastic bin on the playground 6) There was an orange wire coming through the school age playground fence with an exposed end”

8VAC20-780-60-A

“(Repeat Violation) Based on review of two child records, not all records contained all required information. Evidence: the records for child #2, child #5, and child #7 did not contain complete name, address and phone number for two emergency contacts.”

8VAC20-780-40-M

“Based on review of documentation, and staff interview, the facility failed to maintain a current written list of children’s allergies, sensitivities and dietary restrictions in each room or area where children are present. Evidence: not all classrooms had a current allergy list; 1) The early preschool classroom had a list dated: 10/2/2023 2) The preK classroom had a list dated: 3/11/2024 3) The two's classroom had a list dated 12/1/2023 4) The preschool B classroom did not have a list”

8VAC20-780-160-C

“Based on review of five staff records, it was determined that not all staff had documentation of a negative tuberculosis (TB) test/screening completed at least every two years from the date of the initial test or screening. Evidence: the record for staff #3 had a negative TB test/screening dated: 3/12/2022.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a spray bottle of sanitizing solution in a basket on the counter of the two’s classroom and in an unlocked cabinet in the school age classroom.”

8VAC20-780-330-B

“Based on an inspection of the playground, it was determined that the mulch under and around play equipment was not resilient. Evidence: The wood chips surrounding the rocking car on the toddler playground measured less than six inches in depth. The wood chips under and around the composite play structure on the preschool playground measured less than six inches in depth.”

8VAC20-770-60-C-2

“Based on review of five staff records, it was determined that not all staff had Central Registry Search results within 30 days of hire, or documentation that follow up was completed as required. Evidence: the records for staff #2 (date of hire: 1/29/2024), staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not have Central Registry search results or documentation of follow up.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that no out of state child abuse and neglect search was requested within 30 days of hire, and no out of state criminal history name check was conducted prior to hire, for all staff who stated they have lived outside of Virginia in the past five years. Evidence: the records for staff #1, (Date of hire: 5/14/2024) and staff #5, (Date of hire: 4/22/2024), who indicated that they have lived out of the state of Virginia in the past five years, had no documentation of an out of state central registry search request or an out of state criminal history name check.”

8VAC20-780-240-B

“Based on review of five staff records, it was determined that not all staff had documentation of completing orientation training, as required. Evidence: The records for staff #4 (date of hire: 3/26/2024) and staff #5 (date of hire: 4/22/2024) did not contain documentation of orientation training.”

8VAC20-780-500-A

“(Repeat violation) Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: an infant was fed a bottle and their hands were not washed beforehand. Staff acknowledged that the infant’s hands were not washed first.”

8VAC20-780-270-A

“(Repeat Violation) Based on observation, the facility did not ensure all areas of the center were maintained in a clean, safe and operable condition. Evidence: 1) There were sharp wires coming through the fence and some rusty wires with sharp edges at the top and bottom of the fence between the toddler and preschool playground 2) There were sharp wires at the bottom of the preschool playground fence 3) There were weeds growing through the preschool and school age fences; some with prickers, thorns and berries 4) There was trash on the school age and preschool playground 5) There was a tricycle with a broken handlebar, broken hoola hoop, broken garden box, and a broken plastic bin on the playground 6) There was an orange wire coming through the school age playground fence with an exposed end”

8VAC20-780-510-E

“Based on review of two emergency medications and authorizations, it was determined that the facility failed to follow their medication procedures as required. Long term prescription drug use may be allowed with written authorization from the child’s physician and parent. Evidence: the record for child #1 did not contain written authorization from the physician or parent for long term medication observed on site.”

8VAC20-780-500-A

“(Repeat violation) Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: three infants were placed in high chairs and provided food to eat/drink, and their hands were not washed beforehand. Staff acknowledged that the infant’s hands were not washed first.”

8VAC20-780-130-A

“Based on a review of seven child records, the facility did not obtain documentation that each child has received immunizations prior to the child's first attendance. Evidence: the record for child #6 (date of first attendance: 2/17/2023) did not have documentation of immunizations.”

8VAC20-780-270-A

“Based on observation, the facility did not ensure all areas of the center were maintained in a clean, safe and operable condition. Evidence: There is chipped, peeling paint on the window sills in the two's classroom, the doorway in the toddler classroom and the chair rail in the preschool classroom; there were cracked and broken floor tiles in the two's classroom; there are curling rugs that are a tripping hazard in the preK 2 and school age classrooms.”

8VAC20-780-60-A

“(Repeat Violation) Based on review of two child records, not all records contained all required information. Evidence: the records for child #2, child #3, and child #4 did not contain complete name, address and phone number for two emergency contacts. The records for child #3, child #4, and child #6 did not contain the name and phone number of the child’s physician. The record for child #3 did not contain the work phone number for mom or dad.”

8VAC20-780-140-A

“Based on a review of seven child records, the facility did not obtain documentation that each child has received a physical examination prior to the child's first attendance or within one month after attendance. Evidence: the record for child #6 (date of first attendance: 2/17/2023) did not have documentation of a physical examination.”

8VAC20-780-510-E

“Based on review of two emergency medications and authorizations, it was determined that the facility failed to follow their medication procedures as required. Long term prescription drug use may be allowed with written authorization from the child’s physician and parent. Evidence: the record for child #1 did not contain written authorization from the physician or parent for long term medication observed on site.”

8VAC20-780-500-A

“(Repeat violation) Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: three infants were placed in high chairs and provided food to eat/drink, and their hands were not washed beforehand. Staff acknowledged that the infant’s hands were not washed first.”

8VAC20-780-130-A

“Based on a review of seven child records, the facility did not obtain documentation that each child has received immunizations prior to the child's first attendance. Evidence: the record for child #6 (date of first attendance: 2/17/2023) did not have documentation of immunizations.”

8VAC20-780-270-A

“Based on observation, the facility did not ensure all areas of the center were maintained in a clean, safe and operable condition. Evidence: There is chipped, peeling paint on the window sills in the two's classroom, the doorway in the toddler classroom and the chair rail in the preschool classroom; there were cracked and broken floor tiles in the two's classroom; there are curling rugs that are a tripping hazard in the preK 2 and school age classrooms.”

8VAC20-780-60-A

“(Repeat Violation) Based on review of two child records, not all records contained all required information. Evidence: the records for child #2, child #3, and child #4 did not contain complete name, address and phone number for two emergency contacts. The records for child #3, child #4, and child #6 did not contain the name and phone number of the child’s physician. The record for child #3 did not contain the work phone number for mom or dad.”

8VAC20-780-140-A

“Based on a review of seven child records, the facility did not obtain documentation that each child has received a physical examination prior to the child's first attendance or within one month after attendance. Evidence: the record for child #6 (date of first attendance: 2/17/2023) did not have documentation of a physical examination.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: the record for staff #3 (date of hire: 8/8/2023) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Sex Offender Registry search was completed prior to their first day of employment.”

8VAC20-780-70

“Based on review of five staff records, not all records contained all required information. Evidence: the record for staff #4 (date of hire: 8/7/23) and staff #5 (date of hire: 8/7/2023) did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment.”

8VAC20-780-320-B

“(Repeat violation) Based on observation, the facility failed to ensure that all restrooms were equipped as required. Evidence: The bathroom/sink area utilized by the children in the two's classroom did not contain paper towels that were within reach of children.”

8VAC20-780-350-Q

“(Repeat violation) Based on observation, review of documentation and an interview with staff, the facility casually reassigned children from their regular classroom disrupting their schedule and attachment to their staff members and group. Evidence: 1) on 8/10/23, two toddlers who are assigned to the toddler classroom were moved to the infant room at approximately 9:30 am because the toddler class was over ratio. 2) the two toddlers were moved back to their toddler class at approximately 11:00 am when additional staff arrived. 3) it was reported that there were administrative staff in the building at the time.”

8VAC20-780-500-A

“Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: a child in the toddler class was observed having a diaper change and afterwards staff moved the child to the table for lunch without first washing their hands.”

8VAC20-780-500-B

“(Repeat violation) Based on observation, the facility failed to follow all diapering procedures, including disposal of diapers in a leakproof storage system and sanitizing changing tables, as required. Evidence: 1) Diapers were observed in a trash can in the two's bathroom that was not foot operated. 2) Pullups were observed in a trash can in the preschool bathroom that did not have a lid, therefore was not leakproof 3) Staff in the toddler class and two's class were observed using their hand to lift a trashcan lid to dispose of diapers/wipes/paper towels after diapering children 4) Staff in the toddler and two's class did not sanitize the changing table after diapering, as required. Staff sprayed sanitizing solution on the table but did not allow it to air dry afterwards”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: the record for staff #3 (date of hire: 8/8/2023) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Sex Offender Registry search was completed prior to their first day of employment.”

8VAC20-780-70

“Based on review of five staff records, not all records contained all required information. Evidence: the record for staff #4 (date of hire: 8/7/23) and staff #5 (date of hire: 8/7/2023) did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment.”

8VAC20-780-320-B

“(Repeat violation) Based on observation, the facility failed to ensure that all restrooms were equipped as required. Evidence: The bathroom/sink area utilized by the children in the two's classroom did not contain paper towels that were within reach of children.”

8VAC20-780-350-Q

“(Repeat violation) Based on observation, review of documentation and an interview with staff, the facility casually reassigned children from their regular classroom disrupting their schedule and attachment to their staff members and group. Evidence: 1) on 8/10/23, two toddlers who are assigned to the toddler classroom were moved to the infant room at approximately 9:30 am because the toddler class was over ratio. 2) the two toddlers were moved back to their toddler class at approximately 11:00 am when additional staff arrived. 3) it was reported that there were administrative staff in the building at the time.”

8VAC20-780-500-A

“Based on observation, the facility failed to follow all hand washing procedures, as required. Evidence: a child in the toddler class was observed having a diaper change and afterwards staff moved the child to the table for lunch without first washing their hands.”

8VAC20-780-500-B

“(Repeat violation) Based on observation, the facility failed to follow all diapering procedures, including disposal of diapers in a leakproof storage system and sanitizing changing tables, as required. Evidence: 1) Diapers were observed in a trash can in the two's bathroom that was not foot operated. 2) Pullups were observed in a trash can in the preschool bathroom that did not have a lid, therefore was not leakproof 3) Staff in the toddler class and two's class were observed using their hand to lift a trashcan lid to dispose of diapers/wipes/paper towels after diapering children 4) Staff in the toddler and two's class did not sanitize the changing table after diapering, as required. Staff sprayed sanitizing solution on the table but did not allow it to air dry afterwards”

8VAC20-780-320-B Complaint related: No

“Based on observation, the facility failed to ensure that all restrooms were equipped as required. Evidence: Not all toilets in the bathrooms utilized by the children in the preschool, pre-k and school age classes contained toilet paper that was within reach of children. One of the toilets in each of these bathrooms did not contain any toilet paper.”

8VAC20-780-500-B Complaint related: No

“Based on observation, the facility failed to follow all diapering procedures, as required, including using a nonabsorbent surface for changing diapers. Evidence: Staff were observed changing children standing up in the bathroom in the two's classroom, and not using a nonabsorbent surface (the changing table.)”

8VAC20-780-530-A

“Based on observation, and a review of documentation, the facility failed to ensure that at least one staff in each classroom has current certification in CPR and first aid. Evidence: the records for staff # 1 and staff #4, who were observed alone in a classroom with children, do not contain documentation of current certification in CPR and first aid.”

8VAC20-780-160-A

“Based on review of six staff records, the facility did not have documentation of a negative tuberculosis (TB) test/ screening for all staff at the time of employment and prior to coming into contact with children. Evidence: the record for staff #5 (date of hire: 2/7/2022), who was observed working in a classroom, did not have documentation of a TB test/screening that was dated, demonstrating that it was completed within 30 days prior to employment, or signed by a physician.”

8VAC20-780-160-C

“Based on review of six staff records, the facility did not have documentation of a negative tuberculosis (TB) test/ screening for all staff at least every two years from the date of the initial screening. Evidence: the record for staff #3 had documentation of a TB test/screening dated: 4/25/2019.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current, dated, written list of all children’s allergies, sensitivities and dietary restrictions that is kept confidential in each room or area where children are present. Evidence: The list posted in the infant class was dated: 11/22/22 and not current, per staff. The list in the toddler and two year old classrooms was not posted in a confidential manner.”

8VAC20-780-60-A

“Based on review of seven child records, it was determined that not all records contained all required information. Evidence: the record for child #7, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-80-A

“Based on review of the written attendance record, observation, and an interview with staff, it was determined that the facility did not maintain a written record of daily attendance, for each group of children, that documents the arrival and departure of children in care as it occurs. Evidence: 1) In the infant classroom, there were seven children listed on the attendance record, eight children observed in the classroom, and one additional infant observed in the director’s office. The school age child in the director’s office was not listed on an attendance sheet.”

8VAC20-780-280-B

“Based on observation, not all hazardous substances were kept in a locked place, using a safe locking method that prevents access by children. Evidence: there was a bottle of sanitizing spray sitting in a sink by the changing table in the two's classroom.”

8VAC20-780-320-B

“Based on observation, the facility failed to ensure that all restrooms were equipped as required. Evidence: The bathrooms utilized by the children in the two's and preschool classes did not contain toilet paper that was within reach of children. There was no toilet paper in the school age bathroom within reach of the children and no paper towels in the school age bathroom/sink area.”

8VAC20-780-350-B-1

“Based on observation, and a review of documentation, the facility failed to maintain the staff-to-child ratio of one staff for four children age birth to 16 months. Evidence: in the toddler classroom there were 14 children with 2 staff members. The youngest child in the group was 15 months old.”

8VAC20-780-350-Q

“Based on observation, and an interview with staff, the facility casually reassigned an infant from their regular classroom disrupting their schedule and attachment to their staff members and group. Evidence: 1) infant child #5, age two months, was observed in the director's office sitting in a bouncy chair, in close proximity to a school age child who had been separated from their group because they were sick. 2) There were two administrative staff members sitting in the front office area. 3) Staff acknowledged that there were eight infants already present in the infant classroom with two staff when a ninth infant arrived, but they didn?t go into the class because they had work to do in the office, so when the ninth infant arrived, staff took child #5 out of the infant class and into the office.”

8VAC20-780-500-B

“Based on observation, and an interview with staff, the facility failed to follow all diapering procedures, as required, including using a nonabsorbent surface for changing diapers and disposing of diapers in a leakproof storage system. Evidence: There was no changing table in the early preschool classroom and staff stated that children under three are sometimes changed standing up in the bathroom. Diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

8VAC20-780-530-A

“Based on observation, and a review of documentation, the facility failed to ensure that at least one staff in each classroom has current certification in CPR and first aid. Evidence: the records for staff # 1 and staff #4, who were observed alone in a classroom with children, do not contain documentation of current certification in CPR and first aid.”

8VAC20-780-160-A

“Based on review of six staff records, the facility did not have documentation of a negative tuberculosis (TB) test/ screening for all staff at the time of employment and prior to coming into contact with children. Evidence: the record for staff #5 (date of hire: 2/7/2022), who was observed working in a classroom, did not have documentation of a TB test/screening that was dated, demonstrating that it was completed within 30 days prior to employment, or signed by a physician.”

8VAC20-780-160-C

“Based on review of six staff records, the facility did not have documentation of a negative tuberculosis (TB) test/ screening for all staff at least every two years from the date of the initial screening. Evidence: the record for staff #3 had documentation of a TB test/screening dated: 4/25/2019.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current, dated, written list of all children’s allergies, sensitivities and dietary restrictions that is kept confidential in each room or area where children are present. Evidence: The list posted in the infant class was dated: 11/22/22 and not current, per staff. The list in the toddler and two year old classrooms was not posted in a confidential manner.”

8VAC20-780-60-A

“Based on review of seven child records, it was determined that not all records contained all required information. Evidence: the record for child #7, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-80-A

“Based on review of the written attendance record, observation, and an interview with staff, it was determined that the facility did not maintain a written record of daily attendance, for each group of children, that documents the arrival and departure of children in care as it occurs. Evidence: 1) In the infant classroom, there were seven children listed on the attendance record, eight children observed in the classroom, and one additional infant observed in the director’s office. The school age child in the director’s office was not listed on an attendance sheet.”

8VAC20-780-280-B

“Based on observation, not all hazardous substances were kept in a locked place, using a safe locking method that prevents access by children. Evidence: there was a bottle of sanitizing spray sitting in a sink by the changing table in the two's classroom.”

8VAC20-780-320-B

“Based on observation, the facility failed to ensure that all restrooms were equipped as required. Evidence: The bathrooms utilized by the children in the two's and preschool classes did not contain toilet paper that was within reach of children. There was no toilet paper in the school age bathroom within reach of the children and no paper towels in the school age bathroom/sink area.”

8VAC20-780-350-B-1

“Based on observation, and a review of documentation, the facility failed to maintain the staff-to-child ratio of one staff for four children age birth to 16 months. Evidence: in the toddler classroom there were 14 children with 2 staff members. The youngest child in the group was 15 months old.”

8VAC20-780-350-Q

“Based on observation, and an interview with staff, the facility casually reassigned an infant from their regular classroom disrupting their schedule and attachment to their staff members and group. Evidence: 1) infant child #5, age two months, was observed in the director's office sitting in a bouncy chair, in close proximity to a school age child who had been separated from their group because they were sick. 2) There were two administrative staff members sitting in the front office area. 3) Staff acknowledged that there were eight infants already present in the infant classroom with two staff when a ninth infant arrived, but they didn?t go into the class because they had work to do in the office, so when the ninth infant arrived, staff took child #5 out of the infant class and into the office.”

8VAC20-780-500-B

“Based on observation, and an interview with staff, the facility failed to follow all diapering procedures, as required, including using a nonabsorbent surface for changing diapers and disposing of diapers in a leakproof storage system. Evidence: There was no changing table in the early preschool classroom and staff stated that children under three are sometimes changed standing up in the bathroom. Diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a cannister of disinfecting wipes sitting on the back of the toilet in the two's classroom. There was a bottle of sanitizing solution in an unlocked cabinet in the early preschool and preK-2 room, there were three cans of deodorizer in an unlocked cabinet in the school age classroom that stated, "keep out of reach of children" and "flammable" and there were multiple bottles of sanitizing solution in an unlocked cabinet in the preschool classroom.”

8VAC20-780-60-A-8

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the record for child #5, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-40-L

“8VAC20-780-40L; risk: A1 Based on staff interview, the facility failed to inform all staff who work with children of children’s allergies, sensitivities and dietary restrictions. Evidence: when asked, not all staff could state which children in the group had allergies, sensitivities and/or dietary restrictions.”

8VAC20-780-510-E

“Based on observation, and review of documentation, the facility failed to follow their own medication procedures as required. Evidence: 1) there were two emergency medications on site, and no authorization forms accompanying the medication that were signed by the parent and physician.”

8VAC20-780-500-B

“Based on observation, and an interview, the facility failed to ensure that diapers (and wipes) are disposed of in a leakproof or plastic-lined storage system. Evidence: diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: The records for staff #2, (date of hire: 8/29/2022) and staff #4 (date of hire: 7/18/2022) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Child Abuse and Neglect Search was requested by the end of the 30th day of employment with follow up conducted 45 days after the initial request to search. The record for staff #4 (date of hire: 7/18/2022) had an Out of State Criminal History Name Check (dated: 7/21/2022) that was not conducted prior to employment.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current written list of all children's allergies, sensitivities and dietary restrictions. This list shall be dated and kept confidential in each room or area where children are present. Evidence: The list posted in the infant, toddler and two's classrooms was dated: 9/19/2022 and not current per staff interview. There were two children with food sensitivities/preferences that were not listed, and at least one child listed who no longer attends. Per staff, the list is posted in the classrooms and is not kept in each area where children are in care such as the playground.”

8VAC20-780-410-1

“Based on multiple interviews, it was determined that staff used a forbidden action - striking a child. Evidence: on 10/19/2022 at approximately 8:30 am, child #1 (age 3) was throwing a tantrum, kicking and throwing items. Staff #1 pulled child #1 into the bathroom, and smacked their hand, causing child #1 to start crying. Staff #2 and staff #3 stated that they heard and saw the smack occur. Staff #1 admitted that they "tapped" the child’s hand.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a cannister of disinfecting wipes sitting on the back of the toilet in the two's classroom. There was a bottle of sanitizing solution in an unlocked cabinet in the early preschool and preK-2 room, there were three cans of deodorizer in an unlocked cabinet in the school age classroom that stated, "keep out of reach of children" and "flammable" and there were multiple bottles of sanitizing solution in an unlocked cabinet in the preschool classroom.”

8VAC20-780-60-A-8

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the record for child #5, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-40-L

“8VAC20-780-40L; risk: A1 Based on staff interview, the facility failed to inform all staff who work with children of children’s allergies, sensitivities and dietary restrictions. Evidence: when asked, not all staff could state which children in the group had allergies, sensitivities and/or dietary restrictions.”

8VAC20-780-510-E

“Based on observation, and review of documentation, the facility failed to follow their own medication procedures as required. Evidence: 1) there were two emergency medications on site, and no authorization forms accompanying the medication that were signed by the parent and physician.”

8VAC20-780-500-B

“Based on observation, and an interview, the facility failed to ensure that diapers (and wipes) are disposed of in a leakproof or plastic-lined storage system. Evidence: diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: The records for staff #2, (date of hire: 8/29/2022) and staff #4 (date of hire: 7/18/2022) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Child Abuse and Neglect Search was requested by the end of the 30th day of employment with follow up conducted 45 days after the initial request to search. The record for staff #4 (date of hire: 7/18/2022) had an Out of State Criminal History Name Check (dated: 7/21/2022) that was not conducted prior to employment.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current written list of all children's allergies, sensitivities and dietary restrictions. This list shall be dated and kept confidential in each room or area where children are present. Evidence: The list posted in the infant, toddler and two's classrooms was dated: 9/19/2022 and not current per staff interview. There were two children with food sensitivities/preferences that were not listed, and at least one child listed who no longer attends. Per staff, the list is posted in the classrooms and is not kept in each area where children are in care such as the playground.”

8VAC20-780-410-1

“Based on multiple interviews, it was determined that staff used a forbidden action - striking a child. Evidence: on 10/19/2022 at approximately 8:30 am, child #1 (age 3) was throwing a tantrum, kicking and throwing items. Staff #1 pulled child #1 into the bathroom, and smacked their hand, causing child #1 to start crying. Staff #2 and staff #3 stated that they heard and saw the smack occur. Staff #1 admitted that they "tapped" the child’s hand.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a cannister of disinfecting wipes sitting on the back of the toilet in the two's classroom. There was a bottle of sanitizing solution in an unlocked cabinet in the early preschool and preK-2 room, there were three cans of deodorizer in an unlocked cabinet in the school age classroom that stated, "keep out of reach of children" and "flammable" and there were multiple bottles of sanitizing solution in an unlocked cabinet in the preschool classroom.”

8VAC20-780-60-A-8

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the record for child #5, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-40-L

“8VAC20-780-40L; risk: A1 Based on staff interview, the facility failed to inform all staff who work with children of children’s allergies, sensitivities and dietary restrictions. Evidence: when asked, not all staff could state which children in the group had allergies, sensitivities and/or dietary restrictions.”

8VAC20-780-510-E

“Based on observation, and review of documentation, the facility failed to follow their own medication procedures as required. Evidence: 1) there were two emergency medications on site, and no authorization forms accompanying the medication that were signed by the parent and physician.”

8VAC20-780-500-B

“Based on observation, and an interview, the facility failed to ensure that diapers (and wipes) are disposed of in a leakproof or plastic-lined storage system. Evidence: diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: The records for staff #2, (date of hire: 8/29/2022) and staff #4 (date of hire: 7/18/2022) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Child Abuse and Neglect Search was requested by the end of the 30th day of employment with follow up conducted 45 days after the initial request to search. The record for staff #4 (date of hire: 7/18/2022) had an Out of State Criminal History Name Check (dated: 7/21/2022) that was not conducted prior to employment.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current written list of all children's allergies, sensitivities and dietary restrictions. This list shall be dated and kept confidential in each room or area where children are present. Evidence: The list posted in the infant, toddler and two's classrooms was dated: 9/19/2022 and not current per staff interview. There were two children with food sensitivities/preferences that were not listed, and at least one child listed who no longer attends. Per staff, the list is posted in the classrooms and is not kept in each area where children are in care such as the playground.”

8VAC20-780-410-1

“Based on multiple interviews, it was determined that staff used a forbidden action - striking a child. Evidence: on 10/19/2022 at approximately 8:30 am, child #1 (age 3) was throwing a tantrum, kicking and throwing items. Staff #1 pulled child #1 into the bathroom, and smacked their hand, causing child #1 to start crying. Staff #2 and staff #3 stated that they heard and saw the smack occur. Staff #1 admitted that they "tapped" the child’s hand.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: There was a cannister of disinfecting wipes sitting on the back of the toilet in the two's classroom. There was a bottle of sanitizing solution in an unlocked cabinet in the early preschool and preK-2 room, there were three cans of deodorizer in an unlocked cabinet in the school age classroom that stated, "keep out of reach of children" and "flammable" and there were multiple bottles of sanitizing solution in an unlocked cabinet in the preschool classroom.”

8VAC20-780-60-A-8

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the record for child #5, with a diagnosed food allergy, did not contain a written care plan, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction”

8VAC20-780-40-L

“8VAC20-780-40L; risk: A1 Based on staff interview, the facility failed to inform all staff who work with children of children’s allergies, sensitivities and dietary restrictions. Evidence: when asked, not all staff could state which children in the group had allergies, sensitivities and/or dietary restrictions.”

8VAC20-780-510-E

“Based on observation, and review of documentation, the facility failed to follow their own medication procedures as required. Evidence: 1) there were two emergency medications on site, and no authorization forms accompanying the medication that were signed by the parent and physician.”

8VAC20-780-500-B

“Based on observation, and an interview, the facility failed to ensure that diapers (and wipes) are disposed of in a leakproof or plastic-lined storage system. Evidence: diapers were observed in a trash can in the two's bathroom that was not covered, therefore not leakproof.”

22.1-289.035-B-4

“Based on review of five staff records, it was determined that out of state background checks were not completed as required. Evidence: The records for staff #2, (date of hire: 8/29/2022) and staff #4 (date of hire: 7/18/2022) who indicated they lived out of state in the past five years, did not contain documentation that an Out of State Child Abuse and Neglect Search was requested by the end of the 30th day of employment with follow up conducted 45 days after the initial request to search. The record for staff #4 (date of hire: 7/18/2022) had an Out of State Criminal History Name Check (dated: 7/21/2022) that was not conducted prior to employment.”

8VAC20-780-40-M

“Based on review of documentation, and an interview with staff, the facility failed to maintain a current written list of all children's allergies, sensitivities and dietary restrictions. This list shall be dated and kept confidential in each room or area where children are present. Evidence: The list posted in the infant, toddler and two's classrooms was dated: 9/19/2022 and not current per staff interview. There were two children with food sensitivities/preferences that were not listed, and at least one child listed who no longer attends. Per staff, the list is posted in the classrooms and is not kept in each area where children are in care such as the playground.”

8VAC20-780-410-1

“Based on multiple interviews, it was determined that staff used a forbidden action - striking a child. Evidence: on 10/19/2022 at approximately 8:30 am, child #1 (age 3) was throwing a tantrum, kicking and throwing items. Staff #1 pulled child #1 into the bathroom, and smacked their hand, causing child #1 to start crying. Staff #2 and staff #3 stated that they heard and saw the smack occur. Staff #1 admitted that they "tapped" the child’s hand.”

8VAC20-780-350-B-5 Complaint related: Yes

“Based on observation, the facility failed to maintain the staff-to-children ratio of one staff for 18 children school age eligible up to nine years of age. Evidence: in the kindergarten room, there were 20 children observed with one staff member. The youngest child in the room was reportedly five years old.”

8VAC20-780-330-B

“Based on an inspection of the playground, it was determined that the mulch under and around play equipment was not resilient. Evidence: The depth of the wood chips under and around the composite play structure was approximately one - two inches in depth.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: 1) A spray bottle of sanitizing solution was observed sitting on the changing table next to the sink in both the infant and toddler classrooms. 2) A canister of Clorox wipes was observed in an unlocked cabinet in the school age classroom”

8VAC20-780-270-A

“Based on observation, it was determined that not all areas outside of the center were maintained in a clean and safe condition. Evidence: 1) There was rusty nuts, washers and bolts as well as peeling paint on playground equipment 2) There was rust, exposed sharp edges and gaps on the fence surrounding the playground 3) There was trash and broken items on the playground 4) There were exposed tree roots causing potential tripping hazards and gaps in the fence 5) There was an exposed wire on the school age playground area ? playground is off limits until removed 6) The perimeter of the building had deteriorating and damaged wood”

8VAC20-780-40-M

“Based on observation, and interviews with staff, the facility failed to maintain a current written list of all children’s allergies, sensitivities, and dietary restrictions. Evidence: there was not a written list posted in all rooms; the list that was posted in the toddler and three’s room was dated: 3/23/21; the list in the toddler class was facing forward and was not kept confidential; the list that was posted in the school age class was dated: 4/26/19; staff confirmed that the list was not up to date.”

8VAC20-780-240-B

“Based on review of five staff records, the center did not have documentation that staff received orientation training prior to working alone with children and no later than seven days of the date of assuming job responsibilities, as required. Evidence: The record for staff #1 (date of hire: 9/13/21), staff #2 (date of hire: 10/12/21), staff #3 (date of hire: 4/18/19), and staff #4 (date of hire: 9/15/21) did not contain documentation of orientation training.”

8VAC20-780-60-A

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the records for child #3 and child #4 did not have the name, address and phone number for two emergency contacts or authorization for emergency medical care. The record for child #4 did not have the name, address and phone number for parents, work name and phone number for parents, or doctor name and phone number.”

8VAC20-780-350-B-1

“Based on observation, interview and review of documentation, the facility failed to maintain the ratio of one staff for every 4 children, ages birth through 16 months. Evidence: nine children were observed in the toddler classroom with two staff supervising. The youngest child in the room was 12 months old.”

8VAC20-780-330-B

“Based on an inspection of the playground, it was determined that the mulch under and around play equipment was not resilient. Evidence: The depth of the wood chips under and around the composite play structure was approximately one - two inches in depth.”

8VAC20-780-280-B

“Based on observation, it was determined that not all hazardous substances were kept in a locked place using a safe locking method that prevents access by children. Evidence: 1) A spray bottle of sanitizing solution was observed sitting on the changing table next to the sink in both the infant and toddler classrooms. 2) A canister of Clorox wipes was observed in an unlocked cabinet in the school age classroom”

8VAC20-780-270-A

“Based on observation, it was determined that not all areas outside of the center were maintained in a clean and safe condition. Evidence: 1) There was rusty nuts, washers and bolts as well as peeling paint on playground equipment 2) There was rust, exposed sharp edges and gaps on the fence surrounding the playground 3) There was trash and broken items on the playground 4) There were exposed tree roots causing potential tripping hazards and gaps in the fence 5) There was an exposed wire on the school age playground area ? playground is off limits until removed 6) The perimeter of the building had deteriorating and damaged wood”

8VAC20-780-40-M

“Based on observation, and interviews with staff, the facility failed to maintain a current written list of all children’s allergies, sensitivities, and dietary restrictions. Evidence: there was not a written list posted in all rooms; the list that was posted in the toddler and three’s room was dated: 3/23/21; the list in the toddler class was facing forward and was not kept confidential; the list that was posted in the school age class was dated: 4/26/19; staff confirmed that the list was not up to date.”

8VAC20-780-240-B

“Based on review of five staff records, the center did not have documentation that staff received orientation training prior to working alone with children and no later than seven days of the date of assuming job responsibilities, as required. Evidence: The record for staff #1 (date of hire: 9/13/21), staff #2 (date of hire: 10/12/21), staff #3 (date of hire: 4/18/19), and staff #4 (date of hire: 9/15/21) did not contain documentation of orientation training.”

8VAC20-780-60-A

“Based on review of five children's records, it was determined that not all records contained all required information. Evidence: the records for child #3 and child #4 did not have the name, address and phone number for two emergency contacts or authorization for emergency medical care. The record for child #4 did not have the name, address and phone number for parents, work name and phone number for parents, or doctor name and phone number.”

8VAC20-780-350-B-1

“Based on observation, interview and review of documentation, the facility failed to maintain the ratio of one staff for every 4 children, ages birth through 16 months. Evidence: nine children were observed in the toddler classroom with two staff supervising. The youngest child in the room was 12 months old.”

22VAC40-665-580-B

“Based on review of three staff records, not all staff members completed the Virginia Preservice Training for Child Care Staff within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of completion of the Virginia Preservice Training for Child Care Staff.”

22VAC40-665-580-E-2

“Based on review of three staff records, not all staff members had certification in first aid within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of first aid certification.”

22VAC40-665-580-E-1

“Based on review of three staff records, not all staff members had certification in cardiopulmonary resuscitation (CPR) within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of CPR certification.”

8VAC20-780-245-J-2

“Based on review of documentation, and an interview with the director, the center has agreed to administer medication but did not have a staff member with current Medication Administration Training (MAT) certification in the building all hours of operation. Evidence: The MAT certification for one staff expired 4/26/2020 leaving the center without a MAT certified staff member from 5:00pm - 6pm daily; The MAT certification for the second staff expired 6/27/2021 leaving the center without a MAT certified staff member from 6:30am - 6:00pm daily.”

22.1-289.035-B-4

“Based on review of three staff records, it was determined that out of state background checks were not completed as required. Evidence: The record for staff #1, (date of hire: 8/27/2021) who indicated they lived out of state in the past five years, did not contain documentation that 1) follow up of an Out of State Child Abuse and Neglect Search request was conducted 45 days after the initial request, 2) an Out Of State Sex Offender Registry check was completed prior to employment, or 3) an Out Of State Criminal History Name Check was completed prior to employment.”

22VAC40-665-580-B

“Based on review of three staff records, not all staff members completed the Virginia Preservice Training for Child Care Staff within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of completion of the Virginia Preservice Training for Child Care Staff.”

22VAC40-665-580-E-2

“Based on review of three staff records, not all staff members had certification in first aid within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of first aid certification.”

22VAC40-665-580-E-1

“Based on review of three staff records, not all staff members had certification in cardiopulmonary resuscitation (CPR) within 90 days of hire. Evidence: The records for staff #1 (date of hire: 8/27/2021), staff #2 (date of hire: 8/10/2021) and staff #3 (date of hire: 6/28/2021 did not contain documentation of CPR certification.”

8VAC20-780-245-J-2

“Based on review of documentation, and an interview with the director, the center has agreed to administer medication but did not have a staff member with current Medication Administration Training (MAT) certification in the building all hours of operation. Evidence: The MAT certification for one staff expired 4/26/2020 leaving the center without a MAT certified staff member from 5:00pm - 6pm daily; The MAT certification for the second staff expired 6/27/2021 leaving the center without a MAT certified staff member from 6:30am - 6:00pm daily.”

22.1-289.035-B-4

“Based on review of three staff records, it was determined that out of state background checks were not completed as required. Evidence: The record for staff #1, (date of hire: 8/27/2021) who indicated they lived out of state in the past five years, did not contain documentation that 1) follow up of an Out of State Child Abuse and Neglect Search request was conducted 45 days after the initial request, 2) an Out Of State Sex Offender Registry check was completed prior to employment, or 3) an Out Of State Criminal History Name Check was completed prior to employment.”