Lilly Grace

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. 1. The record of child #4 contained documentation of immunizations dated four months after the first day of attendance. 2. The record of child #5, enrolled for six months, did not contain documentation of immunizations.”

8VAC20-780-280-B

“Hazardous substances such as cleaning materials shall be kept in a locked place using a safe locking method that prevents access by children. Two cleaning product canisters were unlocked on the kitchen window seal. The gate leading to the kitchen was open.”

8VAC20-780-210-A-4

“Program leaders shall have fulfilled a high school program completion or the equivalent and have met one of the following experience and education requirements. Staff #2, identified as a program leader, was observed alone and supervising a group of children. Staff #2 was promoted to program lead on June 1, 2026, however staff #2 only has four months of supervised programmatic experience when six months of programmatic experience is required.”

8VAC20-780-570-B

“Bottle fed infants who cannot hold their own bottles shall be held when fed. Bottles shall not be propped or used while the child is in his designated sleeping location. Child #4 was observed drinking a bottle while lying in his crib. A second infant was observed on the mat with a bottle propped using a bottle propping pillow.”

22.1-289.035-B-3

“Repeat The center must request a search of the central registry prior to the employee's first day of employment. 1. Staff #1, employed for six months and 28 days, did not have documentation the central registry was requested prior to employment. The results of the central registry had not been obtained as of December 16, 2025. Staff #1 was observed working alongside two staff members.”

8VAC20-780-245-A

“Repeat Staff shall complete annually a minimum of 16 hours of training appropriate to the age of children in care. The record for staff #5 contained documentation of four hours of annual training for the period of 09/04/2024 through 09/03/2025. Staff #5 was missing 12 hours of annual training.”

8VAC20-780-160-C

“Repeat At least every two years from the date of the initial screening or testing, or more frequently if recommended by a licensed physician or the local health department, staff members and individuals from independent contractors shall obtain and submit the results of a follow-up tuberculosis screening. 1. The most recent TB screening for staff #2 was dated 08/26/2023. An updated tuberculosis screen was due three months ago. 2. The most recent TB screening for staff #7 was dated 04/28/2023. An updated tuberculosis screen was due seven months ago.”

8VAC20-780-70

“Repeat Staff records shall be kept for each person and contain documentation to demonstrate that the individual possesses the education, certification, and experience required by the job position, and orientation and training as required. Staff #4, identified as a program lead, did not have documentation of completion of a high school program or the equivalent.”

8VAC20-780-160-C

“Repeat At least every two years from the date of the initial screening or testing, or more frequently if recommended by a licensed physician or the local health department, staff members and individuals from independent contractors shall obtain and submit the results of a follow-up tuberculosis screening. The record of staff #4 contained documentation of a tuberculosis screening that expired 12 days ago. A follow-up tuberculosis screening had not been completed.”

22.1-289.035-B-3

“The center must request a search of the central registry prior to the employee's first day of employment. Staff #1, employed for two months, did not have documentation the central registry was requested prior to employment. The results of the central registry had not been received.”

22.1-289.035-B-1

“The center shall obtain a completed sworn statement prior to the employee's first day of employment. Staff #2, employed for one year, seven months, did not have a completed sworn statement.”

8VAC20-780-245-A

“Repeat Staff shall complete annually a minimum of 16 hours of training appropriate to the age of children in care. The record of staff #2 contained two hours of annual training for the period of 12/21/2023 through 12/20/2024 when 16 hours was required.”

8VAC20-780-245-A

“Repeat Staff shall complete annually a minimum of 16 hours of training appropriate to the age of children in care. The record of staff #2 contained two hours of annual training for the period of 12/21/2023 through 12/20/2024 when 16 hours was required.”

8VAC20-780-160-A

“Repeat Each staff member shall submit documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with the children. 1. The record of staff #2, employed for one year, seven months, did not contain documentation of tuberculosis screening. 2. The record of staff #3, employed for ten months, did not contain documentation of a tuberculosis screening.”

8VAC20-780-540-E

“The center shall maintain one working, battery-operated radio in each building used by children and any camp location without a building. The battery-operated radio did not work.”

8VAC20-780-510-P

“When an authorization for medication expires, the facility shall notify parents that the medication must be picked up within 14 days of the authorization expiring or that a new authorization should be completed. Medication for child #5 was onsite, but the medication authorization had expired over two months ago. The medication had not been administered past the expiration of the authorization. The authorization had not been renewed and the medication was not returned or disposed of as required.”

8VAC20-780-340-F

“Children under 10 years of age shall always be within actual sight and sound supervision of staff. Staff #2 opened the entrance door for the inspector at arrival. The inspector followed staffed #2 across the main classroom past the director’s office where the director was, and into the small classroom where two infants were in their cribs. The door leading into the classroom was closed. Both infants were awake and had been left alone.”

8VAC20-780-240-I

“Documentation of orientation training shall be kept by the center in a manner that allows for identification by individual staff member, is considered part of the staff member's record, and shall include all required elements. Staff #3, employed for four months, did not have documentation of orientation training.”

8VAC20-780-350-B-1

“The center shall maintain the required staff to child children ratio for children birth up to 16 months of age. The required staff-to-children ratio for children birth up to 16 months is one staff for every four children. 1. At the inspector’s arrival, 2:30 pm, staff #3 and staff #4 were observed supervising ten children (youngest child three months old). 2. Two infants, both under 16 months of age, were alone in a classroom when the required ratio was one staff to every four infants.”

8VAC20-780-240-E

“The center shall ensure staff complete orientation training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care within 30 days of the first day of employment. Staff #3, employed for four months, did not have documentation of CPR and first aid training.”

8VAC20-780-70

“The center shall keep a record for each staff that contains all required information. The record of staff #1, identified as a program leader, not contain did not contain documentation to demonstrate that the individual possessed the education required by the job position. The record of staff #3, employed for four months, did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment or volunteering.”

8VAC20-780-160-A

“Each staff member shall submit documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with the children. Staff #1, employed for three years, did not have documentation of a tuberculosis screening. The record of staff #3, employed for four months, did not have documentation of a tuberculosis screening.”

8VAC20-780-160-C

“Based on review of staff records and interview, the center did not obtain the results of a follow-up tuberculosis screening at least every two years from the date of the initial screening or testing. Evidence: The most recent tuberculosis screening for staff #1 was dated 07/10/2022, exceeding two years. The director stated a follow-up tuberculosis screening had not been done.”

8VAC20-780-350-I

“Based on observation and interview, the center did not ensure for children ages 16 months through preschool age, during the designated rest period, when children are resting or in an inactive state, the following rest period ratios are permitted: Children 16 through 24 months of age: one staff per 10 children. Evidence: 1. A total of 12 children ages16 months through two years were observed napping in the toddler classroom with one staff at approximately 2:15 pm. An additional staff was needed to meet the the toddler nap ratio of 1:10. 2. The director confirmed the toddler classroom was over ratio and stated the second staff had gone on break.”

8VAC20-780-245-A

“Repeat Based on review of five staff records, the center did not ensure two staff annually completed a minimum of 16 hours of training appropriate to the age of children in care. Evidence: 1. The record of staff #2, employed 07/07/2007, contained documentation of 14.5 hours of annual training for the period of 07/07/2023 through 07/06/2024, when 16 hours was required. 2. The record of staff #3, employed 06/20/2023, contained documentation of two hours of annual training hours for the period 06/20/2024 through 06/19/2024 when 16 hours was required. 3. The record of staff #4, employed 06/13/2023, contained documentation of two hours of annual training hours for the period 06/13/2024 through 06/12/2024 when 16 hours was required. 4. The director stated she did not have any additional documentation of training for staff #3 and staff #4.”

8VAC20-780-530-A-2

“Based on review of eight records and observation, the center did not ensure at least one staff in each classroom or area where children are present had current certification in first aid from an organization such as the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council. Evidence: 1. The record of staff #3, did not contain documentation of first aid certification. Staff #3 was observed alone, and in charge of a group of children during the inspection on 02/05/2024. The owner stated staff #3 did not have current first aid certification. 2. The record of staff #5, did not contain documentation of first aid certification. Staff #5 was observed alone, and in charge of a group of children during the inspection on 02/05/2024. The owner stated staff #5 did not have current first aid certification.”

8VAC20-780-245-A

“Repeat Based on review of eight staff records, the center did not ensure two staff annually completed a minimum of 16 hours of training appropriate to the age of children in care. Evidence: 1. The record of staff #1, employed 01/05/2015, contained documentation of 11 annual training hours for the period 01/05/2023 through 01/04/2024. Staff #1 was missing five hours of annual training. T2. he record of staff #8, employed 07/07/2007, contained documentation of eight annual training hours for the period 07/07/2022 through 07/06/2023. Staff #8 was missing eight hours of annual training. The owner acknowledged the two staff did not have the required 16 hours of annual training.”

8VAC20-780-270-A

“Repeat Based on observation, the center did not ensure all areas, inside and outside, were maintained in a clean, safe, and operable condition. Evidence: 1. The wood trim around the front door in the toddler room has a piece missing approximately three inches by two inches. The missing piece is located where the trim meets the floor and is accessible to children in care. The missing piece of wood exposes plaster pieces from the wall. 2. The wooden bridge on the playground has a top step that is loose. The steps slides upward creating a tripping hazard.”

8VAC20-780-320-A

“Based on observation and interview, the center did not ensure the center had at least two toilets and two sinks. Evidence: On February 5, 2024, one toilet had a sign stating, ?Do not use?. The owner stated the toilet had been turned off and was not being used.”

8VAC20-780-530-A-1

“Based on review of three staff records, observation and interview, the center did not ensure at least one staff in each classroom or area where children are present had current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children in care from an organization such as the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council. Evidence: 1. The record of staff #3, did not contain documentation of CPR certification. Staff #3 was observed alone, and in charge of a group of children during the inspection on 02/05/2024. The owner stated staff #3 did not have current CPR certification. 2. The record of staff #5, did not contain documentation of CPR certification. Staff #5 was observed alone, and in charge of a group of children during the inspection on 02/05/2024. The owner stated staff #5 did not have current CPR certification.”

8VAC20-780-350-B-1

“Based on observation and interview, the center did not maintain the required staff to child children ratio for children birth up to 16 months of age. Evidence: 1. The required staff-to-children ratio for children birth up to 16 months is one staff for every four children. At the time of the inspector’s arrival, approximately 11:00 am, there were seven Infants combined with nine toddler age children and three staff supervising. 2. A staff member stated the infants and toddlers had been combined for approximately 10 to 20 minutes. The director acknowledged the class was out of ratio. The staff to child ratio is applicable to the youngest child in the group and shall apply to the entire group.”

8VAC20-780-40-E

“Based on observation and review of the license, the licensee did not ensure operational responsibilities, including compliance with the terms of the current license issued by the department. Evidence: 1. Upon the arrival of the licensing inspector on 01/24/2024, Nine toddler age children and seven children under the age of 16 months were observed in classroom #4. The current license stipulates: ?When infants are in room 4, a maximum of seven children may be present?. 2. During the inspection on 01/24/2024, the licensing inspector observed 16 infants playing on the floor in classroom #8. The current license stipulates: ?Room 8- (formerly rooms 2 & 3) - A maximum of 13 infants may be in care at any one time?.”

8VAC20-780-245-C

“Based on review of eight staff records, the center did not ensure one staff completed a minimum of 16 hours of training appropriate to the age of the children in care annually. Evidence: The record of staff #7, did not contain documentation of 16 hours of training for the period of 01/05/2022 through 01/04/2023. The director stated staff #7 had not completed any training during the annual period”

8VAC20-780-40-E

“Based on observation and review of the license, the licensee did not ensure operational responsibilities, including compliance with the terms of the current license issued by the department. Evidence: During the inspection on 07/27/2023, the licensing inspector observed four infants sleeping in cribs in classroom #1. The current license stipulates: ?Room 1- A maximum of three cribs/3 children at any one time?.”

22.1-289.035-A

“Based on review of eight staff records and interview, the center did not ensure one staff obtained up-dated background checks every five years. Evidence: 1. The record for staff #4 (employed 02/19/2013) contained the results of a fingerprint national criminal record check dated 05/31/2018, exceeding five years. 2. The director confirmed the fingerprint national criminal record check for staff #4 had not yet been obtained”

8VAC20-770-60-C-2

“Based on review of eight staff records and interview, the center did not obtain the results of the central registry background report within 30 days of employment. Evidence: 1. The record of staff #1, employed 04/05/2022, contained the results of a central registry report dated 06/07/2023, exceeding 30 days from employment. 2. The director stated an original central registry check could not be located.”

8VAC20-770-70-A

“Based on review of staff records, the center did not obtain all required documentation for each staff record. Evidence: The record of staff #1 (employed 04/05/2022), did not contain documentation to demonstrate the individual possesses the education required by the job position. The director stated staff #1 is a program leader.”

8VAC20-780-270-A

“Based on observations, the center did not maintain all areas and equipment in a clean, safe, and operable condition. Evidence: 1. The metal lattice seats of two adult size chairs on the playground have pieces that are broken exposing a sharp edge that could snag the skin of a child in care. 2. A child size plastic picnic table on the playground has multiple holes on the top where small fingers could enter. The holes have rough edges that could snag the skin of a child in care.”

8VAC20-780-350-B-1

“Based on observation and interview, the center did not maintain the required staff to children ratio for children birth up to 16 months of age. Evidence: 1. The required staff-to-children ratio for children birth up to 16 months is one staff for every four children. At approximately 8:45 am on July 27, 2023, nine children ages5 months through 16 months were observed in care with two staff member supervising. 2. The director stated additional staff would be arriving soon. The third staff arrived at 9:25 am. The director acknowledged the infant class was out of ratio.”

8VAC20-780-160-A

“Based on review of eight staff records, the center did not obtain documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with children for three staff. The documentation must have been completed within the last 30 calendar days prior to employment. Evidence: 1. The record of staff #1, employed 04/05/2022, contained documentation of a negative tuberculosis screening dated 04/27/2022, exceeding the date of employment. 2. The record of staff #2, employed 06/20/2023, contained documentation of a negative tuberculosis screening dated 07/11/2023, exceeding the date of employment. 3. The record of staff #3 employed 06/13/2023, contained documentation of a negative tuberculosis screening dated 06/27/2023, exceeding the date of employment.”