Little Light House Care R&R

8VAC20-780-270-A

“The center shall ensure that areas and equipment of the center, inside and outside, are maintained in a safe and operable condition. 1. There was a lamp on a table that was approximately two feet high. The cord hung down and was within reach of children in the 2's classroom. 2. There was a bottle warmer sitting on a small refrigerator approximately two feet high. The cord hung down to the floor. There were two mobile infants that could reach the cord. 3. There were multiple cords hanging from a electronic system in the preschool room within reach of children of care. 4. There was a plastic caterpillar tunnel on the outside playground and the entrance arch was broken off, laying on the ground and the second section of the tunnel was detaching along the top of the tunnel.”

8VAC20-780-560-F

“When center chooses to provide meals or snacks, a menu listing foods to be served for the current one-week period shall be dated and posted. The menu posted at the entrance of the center was dated Oct. 14 - 16 which is not the current week.”

8VAC20-780-500-C

“(Repeat violation) Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. Six child toilet chairs were observed in the 2's class bathroom. Two of the toilet chairs had bodily fluids in the bowl.”

8VAC20-780-500-B

“The diapering area shall have a sink with warm water. The diapering areas in the infant room, toddler rooms and 2's room did not have a sink.”

8VAC20-780-280-B

“Hazardous substances must be in a locked place that prevents access by children. In the preschool classroom, two cans of disinfectant spray were on top of the paper towel dispenser, out of reach of children. In the infant classroom, a can of disinfectant spray with warning labels "keep out of reach of children" were unlocked in a cabinet under the diapering table, within reach of children.”

8VAC20-780-570-A

“When a child is placed in an infant seat or high chair, the protective belt shall be fastened securely. An infant was observed in a high chair and the protective belt was not secured around the child.”

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. The screening for Staff #2 and Staff #7 did not document negative results and the staff members have been working for more than a month.”

8VAC20-780-40-M

“Based on observation and interview, facility did not ensure there is a current written list of all children's allergies, sensitivities and dietary restrictions in each room where children are present. The list is to be dated. Evidence: In the toddler classroom, staff reported child #5 (present in the room) had a food allergy. The allergy was not noted on the allergy list in the room. The allergy list was not dated.”

8VAC20-780-450-D

“Based on observation, facility did not ensure when pillows are used they are covered with pillow cases. Evidence: In the rear 2's classroom, a child was observed napping on a square brown pillow and it was not covered with a pillow case.”

8VAC20-780-500-B

“Based on observation, facility did not ensure the diapering surface is non-absorbent. Evidence: In the young infant classroom, the diapering pad had two 1" tears in the cover causing the surface to be absorbent.”

8VAC20-780-570-E

“Based on observation and interview, facility did not ensure prepared infant bottles are labeled with the child's name and date. Evidence: In the young infant room, four bottles were observed in the refrigerator that were not labeled with the child's name and date.”

8VAC20-780-560-J

“Based on observation and interview, facility did not ensure tables and high chairs are sanitized before and after each use for feeding. Evidence: In the 2's classroom, staff was observed spraying the tables with soap and water after children finished eating lunch. Staff reported she sprays tables with bleach/water at the end of each day.”

8VAC20-780-500-C

“Based on observation, facility did not ensure toilet chairs are emptied promptly and cleaned and sanitized after each use. Evidence: In the girls restroom, a child's toilet chair was observed in the sink area with a discolored yellow substance in the bowl.”

8VAC20-780-40-M

“Based on observation and interview, facility did not ensure there is a current written list of all children's allergies, sensitivities and dietary restrictions in each room where children are present. The list is to be dated. Evidence: In the toddler classroom, staff reported child #5 (present in the room) had a food allergy. The allergy was not noted on the allergy list in the room. The allergy list was not dated.”

8VAC20-780-450-D

“Based on observation, facility did not ensure when pillows are used they are covered with pillow cases. Evidence: In the rear 2's classroom, a child was observed napping on a square brown pillow and it was not covered with a pillow case.”

8VAC20-780-500-B

“Based on observation, facility did not ensure the diapering surface is non-absorbent. Evidence: In the young infant classroom, the diapering pad had two 1" tears in the cover causing the surface to be absorbent.”

8VAC20-780-570-E

“Based on observation and interview, facility did not ensure prepared infant bottles are labeled with the child's name and date. Evidence: In the young infant room, four bottles were observed in the refrigerator that were not labeled with the child's name and date.”

8VAC20-780-560-J

“Based on observation and interview, facility did not ensure tables and high chairs are sanitized before and after each use for feeding. Evidence: In the 2's classroom, staff was observed spraying the tables with soap and water after children finished eating lunch. Staff reported she sprays tables with bleach/water at the end of each day.”

8VAC20-780-500-C

“Based on observation, facility did not ensure toilet chairs are emptied promptly and cleaned and sanitized after each use. Evidence: In the girls restroom, a child's toilet chair was observed in the sink area with a discolored yellow substance in the bowl.”

8VAC20-780-40-M

“Based on observation and interview, facility did not ensure there is a current written list of all children's allergies, sensitivities and dietary restrictions in each room where children are present. The list is to be dated. Evidence: In the toddler classroom, staff reported child #5 (present in the room) had a food allergy. The allergy was not noted on the allergy list in the room. The allergy list was not dated.”

8VAC20-780-450-D

“Based on observation, facility did not ensure when pillows are used they are covered with pillow cases. Evidence: In the rear 2's classroom, a child was observed napping on a square brown pillow and it was not covered with a pillow case.”

8VAC20-780-500-B

“Based on observation, facility did not ensure the diapering surface is non-absorbent. Evidence: In the young infant classroom, the diapering pad had two 1" tears in the cover causing the surface to be absorbent.”

8VAC20-780-570-E

“Based on observation and interview, facility did not ensure prepared infant bottles are labeled with the child's name and date. Evidence: In the young infant room, four bottles were observed in the refrigerator that were not labeled with the child's name and date.”

8VAC20-780-560-J

“Based on observation and interview, facility did not ensure tables and high chairs are sanitized before and after each use for feeding. Evidence: In the 2's classroom, staff was observed spraying the tables with soap and water after children finished eating lunch. Staff reported she sprays tables with bleach/water at the end of each day.”

8VAC20-780-500-C

“Based on observation, facility did not ensure toilet chairs are emptied promptly and cleaned and sanitized after each use. Evidence: In the girls restroom, a child's toilet chair was observed in the sink area with a discolored yellow substance in the bowl.”

8VAC20-780-550-D

“Based on review, facility did not ensure a monthly evacuation drill is conducted. Evidence: An evacuation drill was not conducted September, October and November 2023.”

8VAC20-780-570-E

“Based on observation, facility did not ensure prepared infant bottles are labeled with the child's name and date. Evidence: In the infant room, the following was observed: 1. Child #2 was drinking from a bottle that was not labeled with the name and date. 3. Child #3 was drinking from a bottle that was not labeled with the date.”

8VAC20-780-60-A

“Repeat Violation Based on review, facility did not ensure 2 of 5 children's records have documentation of required information. Evidence: The following was found during record review: 1. The record for child #1 did not have start date and the address for the second emergency contact. 2. The record for child #4 (start date 9/5/2023) did not have father's employment information, mother's employment phone number and a second emergency contact.”

8VAC20-780-550-D

“Based on review, facility did not ensure a monthly evacuation drill is conducted. Evidence: An evacuation drill was not conducted September, October and November 2023.”

8VAC20-780-570-E

“Based on observation, facility did not ensure prepared infant bottles are labeled with the child's name and date. Evidence: In the infant room, the following was observed: 1. Child #2 was drinking from a bottle that was not labeled with the name and date. 3. Child #3 was drinking from a bottle that was not labeled with the date.”

8VAC20-780-60-A

“Repeat Violation Based on review, facility did not ensure 2 of 5 children's records have documentation of required information. Evidence: The following was found during record review: 1. The record for child #1 did not have start date and the address for the second emergency contact. 2. The record for child #4 (start date 9/5/2023) did not have father's employment information, mother's employment phone number and a second emergency contact.”

8VAC20-780-270-A Complaint related: No

“Based on observation, facility did not ensure areas and equipment of the center inside and outside are maintained in a clean, safe and operable condition. Evidence: The following was observed: 1. In the preschool room at approximately 7:15 am, children were observed standing and jumping in front of a flat screen tv while watching a video. The television was within reach of children. The television was not secured and could fall if pressure was applied. 2. In the preschool room, there were areas of peeling paint in two window sills. One window had an area of 3? x 10? section and the other window had an area of 5? x 12?. 3. In the infant 2 room, a cabinet door under the sink was disconnected and propped against the cabinet. 4. In the infant 2 room, a door knob to an adjoining classroom was not secured and was hanging loosely from the door. 5. In the infant 2 room, there was an area 11? x 9? of peeling paint on the wall. 6. In the 2?s room, there were stacked cots that were not stacked properly with some propped upright along the side. The cots could fall if pressure was applied. 7. Program Director observed and confirmed all of the above areas and items.”

8VAC20-790-600-D-1

“Based on review and interview, facility did not ensure staff have current certification in cardiopulmonary resuscitation (CPR) within 90 days of employment. Evidence: The records for staff #8 (reported start date 3/6/2023) and staff #10 (reported start date 3/2/2023) did not have current CPR. Program Director stated they that are not currently certified and are scheduled to have the training completed.”

8VAC20-790-600-D-2

“Based on review and interview, facility did not ensure staff have current first aid training within 90 days of employment. Evidence: The records for staff #8 (reported start date 3/6/2023) and staff #10 (reported start date 3/2/2023) did not have current first aid training. Program Director stated they are not currently certified and are scheduled to have the training completed.”

8VAC20-780-440-H

“Based on observation, facility did not ensure cribs meet the requirements in that there shall be no more than one inch between the mattress and the crib. Evidence: In the infant 1 room, the following was observed: 1. Child #7 was observed sleeping in a crib. There was approximately 4.5 inches between the mattress and two corners of the crib. 2. Child #8 was observed sleeping in a crib. There was approximately 2 inches of space between the mattress and the crib.”

8VAC20-770-60-C-2

“Based on review and interview, facility did not ensure 7 of 10 staff records did not have a completed central registry search completed within 30 days of employment. Evidence: The records for staff #3 (reported start date 4/5/23), staff #4 (reported start date 4/5/23), staff #5 (reported start date 4/10/23), staff #6 (start date 5/8/23), staff #7 (reported start date 5/2/23), staff #8 (reported start date 3/6/23) and staff #10 (reported start date 3/2/23) did not have a completed central registry search. Program Director confirmed final central registry search letters had not been received and did not have documentation of follow up to inquire about the delay.”

8VAC20-780-70

“Based on review, facility did not ensure 10 of 10 staff records have documentation of required information. Evidence: The following was found during record review: 1. The records for staff #2, #3, #4, #5, #7, #8, #9 and #10 did not have documentation of start date of employment. 2. The records for staff #1 - #10 did not have documentation of an emergency contact (name, address and phone number) and two reference checks. The records for staff #8 and #10 had documentation of one reference check and did not have a second reference check. 3. The records for staff #2, #9 and #10 did not have documentation of orientation training. Director stated the training was done but could not locate completed paperwork.”

8VAC20-780-280-B

“Based on observation, facility did not ensure hazardous substances such as cleaning materials are kept in a locked place. Evidence: The following was observed: 1. In the young toddler room, hand sanitizer labeled "warning" and "keep out of reach of children" was stored on the diapering table. 2. In the older toddler room, bleach/water was stored in an unlocked cabinet under the diapering table. 3. In the Infant 2 room, disinfectant spray labeled "caution" and "keep out of reach of children" was stored in an unlocked cabinet under the sink.”

8VAC20-780-280-G

“Based on observation and interview, facility did not ensure when hazardous substances are not kept in original containers that the substitute container clearly indicates their contents. Evidence: The following was found: 1. In the young toddler room, a green liquid was observed in a clear spray bottle that was not labeled. Staff stated it was soap water solution. 2. In the older toddler room, a yellow liquid was observed in a clear spray bottle that was not labeled. Staff stated it was soap water solution. 3. In the Infant 2 room, there were 2 clear spray bottles with liquid in each one. Staff stated one was bleach water and the other was soap water solution. The bottles were not labeled.”

8VAC20-780-320-B

“Based on observation, facility did not ensure restrooms have required supplies. Evidence: The men and women's restrooms in the 2's room did not have paper towels.”

8VAC20-780-60-A

“Based on review, facility did not ensure 9 of 10 child records have documentation of required information. Evidence: The following was found during record review: 1. The records for child #1, #2, #3, #4, #5, #6, #8 and #10 did not document the first date of attendance. 2. The record for child #2 did not have previous programs attended. 3. The record for child #3 did not have a second emergency contact and physician phone number. 4. The record for child #7 did not have parents' employment phone numbers, second emergency contact, physician information and previous programs attended.”

8VAC20-780-500-B

“Based on observation and interview, facility did not ensure requirements are met when diapering. Evidence: The following was found: 1. In the infant 2 room, the sink was not operable in the diapering area. Staff stated they go into infant 1 room and wash their hands in their classroom. 2. In the young toddler room, staff stated they clean the diapering surface with soap water and the wipe the surface. Staff do not sanitize the surface as required.”

8VAC20-780-510-G

“Based on observation, facility did not ensure medication is labeled with the child's name. Evidence: An over the counter mucus and cold relief medication was stored in facility medication box and it was not labeled with the child's name.”

8VAC20-780-160-A

“Based on review, facility did not ensure staff have a negative tuberculosis screening dated within 30 days and prior to beginning employment. Evidence: The record for staff #6 (start date 5/8/2023) had a TB screening dated 8/18/2022.”

8VAC20-780-270-A

“Based on observation, facility did not ensure areas and equipment of the center, inside and outside, are maintained in a clean, safe and operable condition. Evidence: The following was observed: 1. In the young toddler room, a 2 inch by 3 inch portion was missing at the base on the 3-D brown tree on the rear wall leaving small particles of foam pieces. This was at the floor level and within reach of children. 2. In the men's bathroom used by children, 1 of 2 toilets was not operable and had a sign stating "CLOSED". 3. On the outside playground, the following pieces of equipment had missing pieces leaving exposed cracked plastic with rough edges: pink helicopter riding toy was missing the steering wheel and two plastic rocking horses were missing one of the handles. 4. On the outside playground, one side panel of the fence was leaning. A center ground post of this panel had decaying wood at the ground level. 5. On the outside playground, the paint on the fence was peeling in multiple areas around the bottom of the fence.”

8VAC20-780-510-P

“Based on observation, review and interview, facility did not ensure when an authorization for medication expires that the parent shall be notified to pick up the medication within 14 days or the parent must renew the authorization. Evidence: A cough and cold medication was stored in the medication box for child #11. The parent authorization was signed on 5/7/2023 and had not been updated. There was no signed physician authorization for long term use. Program Director confirmed documentation.”

8VAC20-790-600-D-1

“Based on review and interview, facility did not ensure staff have current certification in cardiopulmonary resuscitation (CPR) within 90 days of employment. Evidence: The records for staff #8 (reported start date 3/6/2023) and staff #10 (reported start date 3/2/2023) did not have current CPR. Program Director stated they that are not currently certified and are scheduled to have the training completed.”

8VAC20-790-600-D-2

“Based on review and interview, facility did not ensure staff have current first aid training within 90 days of employment. Evidence: The records for staff #8 (reported start date 3/6/2023) and staff #10 (reported start date 3/2/2023) did not have current first aid training. Program Director stated they are not currently certified and are scheduled to have the training completed.”

8VAC20-780-440-H

“Based on observation, facility did not ensure cribs meet the requirements in that there shall be no more than one inch between the mattress and the crib. Evidence: In the infant 1 room, the following was observed: 1. Child #7 was observed sleeping in a crib. There was approximately 4.5 inches between the mattress and two corners of the crib. 2. Child #8 was observed sleeping in a crib. There was approximately 2 inches of space between the mattress and the crib.”

8VAC20-770-60-C-2

“Based on review and interview, facility did not ensure 7 of 10 staff records did not have a completed central registry search completed within 30 days of employment. Evidence: The records for staff #3 (reported start date 4/5/23), staff #4 (reported start date 4/5/23), staff #5 (reported start date 4/10/23), staff #6 (start date 5/8/23), staff #7 (reported start date 5/2/23), staff #8 (reported start date 3/6/23) and staff #10 (reported start date 3/2/23) did not have a completed central registry search. Program Director confirmed final central registry search letters had not been received and did not have documentation of follow up to inquire about the delay.”

8VAC20-780-70

“Based on review, facility did not ensure 10 of 10 staff records have documentation of required information. Evidence: The following was found during record review: 1. The records for staff #2, #3, #4, #5, #7, #8, #9 and #10 did not have documentation of start date of employment. 2. The records for staff #1 - #10 did not have documentation of an emergency contact (name, address and phone number) and two reference checks. The records for staff #8 and #10 had documentation of one reference check and did not have a second reference check. 3. The records for staff #2, #9 and #10 did not have documentation of orientation training. Director stated the training was done but could not locate completed paperwork.”

8VAC20-780-280-B

“Based on observation, facility did not ensure hazardous substances such as cleaning materials are kept in a locked place. Evidence: The following was observed: 1. In the young toddler room, hand sanitizer labeled "warning" and "keep out of reach of children" was stored on the diapering table. 2. In the older toddler room, bleach/water was stored in an unlocked cabinet under the diapering table. 3. In the Infant 2 room, disinfectant spray labeled "caution" and "keep out of reach of children" was stored in an unlocked cabinet under the sink.”

8VAC20-780-280-G

“Based on observation and interview, facility did not ensure when hazardous substances are not kept in original containers that the substitute container clearly indicates their contents. Evidence: The following was found: 1. In the young toddler room, a green liquid was observed in a clear spray bottle that was not labeled. Staff stated it was soap water solution. 2. In the older toddler room, a yellow liquid was observed in a clear spray bottle that was not labeled. Staff stated it was soap water solution. 3. In the Infant 2 room, there were 2 clear spray bottles with liquid in each one. Staff stated one was bleach water and the other was soap water solution. The bottles were not labeled.”

8VAC20-780-320-B

“Based on observation, facility did not ensure restrooms have required supplies. Evidence: The men and women's restrooms in the 2's room did not have paper towels.”

8VAC20-780-60-A

“Based on review, facility did not ensure 9 of 10 child records have documentation of required information. Evidence: The following was found during record review: 1. The records for child #1, #2, #3, #4, #5, #6, #8 and #10 did not document the first date of attendance. 2. The record for child #2 did not have previous programs attended. 3. The record for child #3 did not have a second emergency contact and physician phone number. 4. The record for child #7 did not have parents' employment phone numbers, second emergency contact, physician information and previous programs attended.”

8VAC20-780-500-B

“Based on observation and interview, facility did not ensure requirements are met when diapering. Evidence: The following was found: 1. In the infant 2 room, the sink was not operable in the diapering area. Staff stated they go into infant 1 room and wash their hands in their classroom. 2. In the young toddler room, staff stated they clean the diapering surface with soap water and the wipe the surface. Staff do not sanitize the surface as required.”

8VAC20-780-510-G

“Based on observation, facility did not ensure medication is labeled with the child's name. Evidence: An over the counter mucus and cold relief medication was stored in facility medication box and it was not labeled with the child's name.”

8VAC20-780-160-A

“Based on review, facility did not ensure staff have a negative tuberculosis screening dated within 30 days and prior to beginning employment. Evidence: The record for staff #6 (start date 5/8/2023) had a TB screening dated 8/18/2022.”

8VAC20-780-270-A

“Based on observation, facility did not ensure areas and equipment of the center, inside and outside, are maintained in a clean, safe and operable condition. Evidence: The following was observed: 1. In the young toddler room, a 2 inch by 3 inch portion was missing at the base on the 3-D brown tree on the rear wall leaving small particles of foam pieces. This was at the floor level and within reach of children. 2. In the men's bathroom used by children, 1 of 2 toilets was not operable and had a sign stating "CLOSED". 3. On the outside playground, the following pieces of equipment had missing pieces leaving exposed cracked plastic with rough edges: pink helicopter riding toy was missing the steering wheel and two plastic rocking horses were missing one of the handles. 4. On the outside playground, one side panel of the fence was leaning. A center ground post of this panel had decaying wood at the ground level. 5. On the outside playground, the paint on the fence was peeling in multiple areas around the bottom of the fence.”

8VAC20-780-510-P

“Based on observation, review and interview, facility did not ensure when an authorization for medication expires that the parent shall be notified to pick up the medication within 14 days or the parent must renew the authorization. Evidence: A cough and cold medication was stored in the medication box for child #11. The parent authorization was signed on 5/7/2023 and had not been updated. There was no signed physician authorization for long term use. Program Director confirmed documentation.”

8VAC20-780-550-P Complaint related: No

“Based on review, facility did not ensure 3 of 3 injury reports have documentation of required information. Evidence: The following was found during review of injury reports: 1. A report completed for child #1 on 3/2/2023 did not document the plan of preventing recurrence. 2. A report completed for child #2 on 3/7/2023 did not document the parent notification (date, time and method), plan of preventing recurrence and a second signature. 3. A report completed for child #3 on 3/2/2023 did not document the date parent notified, method parent notified, plan of preventing recurrence and a second signature.”

8VAC20-780-500-A

“Based on observation, facility did not ensure staff wash their hands with soap and running water after a diaper change. Evidence: At approximately 10:10 AM, staff was observed changing a child's diaper in the 2's classroom. After the diaper change was complete, the staff member touched a wooden classroom divider and opened a half door in order to leave the classroom to go to the restroom to wash staff and child's hands.”

8VAC20-780-350-B-3 Complaint related: Yes

“Based on observation and interview, facility did not ensure there is at least 1 staff per 8 children in groups that have 2 year old children. Evidence: At approximately 11:00 AM, 3 staff were present with 28 children in the preschool classroom. Staff confirmed child #4 (2 years old) was the youngest in the group.”

8VAC20-780-440-H Complaint related: No

“Based on observation, facility did not ensure when cribs are used there is no more than 1? between the mattress and the crib. Evidence: An infant was observed sleeping in a crib and the mattress curled up on the corners and part of the edges leaving 3? ? 5? of space between the mattress and the crib.”

8VAC20-780-270-A Complaint related: Yes

“Based on observation, facility did not ensure areas and equipment of the center, inside and outside, are maintained in a clean, safe and operable condition. Evidence: The following was observed inside and outside of the facility: 1. In the toddler classroom, there was peeling paint and plaster approximately 14? from the floor with a 1.5? by 2? section of exposed drywall. 2. In the toddler classroom, there was one missing ceiling tile. 3. In the 2?s classroom, there was peeling paint within reach of children on three walls to include an area approximately 8? by 6? section under a front window. Also in this room, a ceiling light cover was disconnected at one corner causing the cover and ceiling camera to hang. 4. In the preschool classroom, one ceiling light cover was disconnected at one corner causing the cover to hang. 5. On the outside playground, one wooden slat was broken from the picket fence and laying on the ground leaving a 8.5? opening in the fence. 6. On the outside playground, a wooden toss ball/bag play set was observed laying on the ground and the approximate 35? by 30? center piece covered by plexiglass was disconnected from the base leaving sharp edges in the circle openings.”

8VAC20-780-350-B-2 Complaint related: Yes

“Based on observation and interview, facility did not ensure there is at least 1 staff per 5 children in groups that have toddler age children (16 months up to 24 months). Evidence: At approximately 10:40 AM, 2 staff were present with 11 children in the toddler classroom. Staff confirmed child # 3 (16 months old) was the youngest in the group.”

8VAC20-780-550-P Complaint related: No

“Based on review, facility did not ensure required information is documented when a child sustains an injury. Evidence: An injury report completed on 10/11/2022 did not document a second signature whether it be a staff or parent.”

8VAC20-780-340-F Complaint related: No

“Based on interviews and review of documentation, facility did not ensure children under 10 years of age always are within sight and sound supervision of staff. Evidence: On 10/25/2022 between approximately 8:00 am ? 8:30 am, child #1 (age 2 years) was found alone outside, without any supervision, in a grassy area behind a neighboring apartment complex. The witness who saw the child, returned the child to the facility. Individuals reported the following: 1. Staff #1 stated that on the morning of 10/25/2022, he was managing the facility front door as children were being dropped off for the day. Staff #1 received a call from staff #2 through the walkie talkie stating that child #1 had ran. Staff #1 began checking areas as he went to the 2?s classroom. Once in the 2?s classroom, staff #2 pointed to the back door of the facility. Staff #1 was walking to the back door when the door opened and a lady come in that door with child #1. Staff #1 met the lady and child by the kitchen at the back door. Staff #1 then took child to staff #4, the Supervisor/Director at the time, where he stayed in her care for the remainder of the day. 2. Staff #2 stated that on the morning of 10/25/2022, she and staff #3 were working in the 2?s classroom with approximately 12 children. Staff #2 stated she contacted staff #1 through the walkie talkie and reported ?(child #1) is not in my classroom.? Staff #2 stated she did not see child #1 leave the classroom. 3. Staff #3 stated that on the morning of 10/25/2022, he and staff #2 were working in the 2?s classroom. They were doing a count of children when they realized they did not see child #1. Staff #3 stated he did not see child #1 leave the classroom. Staff #3 stated everything happened in about 10 minutes from the time they realized he was missing to when he was back in the facility. 4. Staff #4 stated that on the morning of 10/25/2022, she was working in the infant room when she heard over the walkie talkie that child #1 was missing. Staff #4 checked various doors to make sure they were locked. Staff #4 stated it was approximately 10 ? 12 minutes from when they announced the child was missing to when he was back in the facility. 5. Witness stated that on 10/25/2022 between approximately 8:00 am ? 8:30 am, she was sitting on her patio when she saw a young child walk up and stand on the grassy area close to her patio. Witness asked the child questions and then in response to asking where his mom was, the child pointed in the direction of the facility. The witness walked the child to the facility back door and opened the unlocked door. Witness walked the child into a large room when a staff member ?stood up? and stated child’s name in a questioning tone. The staff was sitting on the other side of a partition in a smaller classroom area and not in the large room. The staff member walked over to the child and took him by the hand. Staff did not ask the witness any questions. Witness did not know the name of the staff but described him as a thin male approximately 5? 9? ? 5? 10?. Witness believed the staff did not know the child was missing. The distance from the grassy area to the facility back door is approximately 173?.”

8VAC20-780-340-A Complaint related: No

“Based on interviews and review of documentation, facility did not ensure when staff are supervising children that they always ensure their care, protection, and guidance. Evidence: Child #1 (age 2 years) has been enrolled in the facility since February 9, 2022. Facility stated they were aware child can be difficult to manage and has gotten away from staff/caregivers in the past. They did not ensure a plan was in place to prevent child from leaving the classroom and building unsupervised. 1. Staff #2 stated regarding child #1, ?he’s a runner?. Staff #2 explained they have to watch him closely because he will run out of the classroom. 2. Facility documentation ?Summary of Meetings between (parent), Director and Supervisors? states child #1 ?has opened the classroom doors and tried to leave the building several times.? 3. Staff #4 stated teachers sometimes have difficulty managing child #1?s behaviors. Staff #4 will at times keep him with her as she has known him for a long time and he responds well to her. 4. Collateral stated that child #1 has gotten away from various family members and the facility is aware of that. 5. On 10/25/2022, between approximately 8:00 am ? 8:30 am, child #1 left the building without staff supervision and was found by a stranger outside approximately 173? away from the facility. Staff did not see the child leave the classroom or building. The child crossed a busy parking lot and was standing outside the back patio of an apartment. According to Weather Underground, it was sunny and 57 degrees during this time.”

8VAC20-780-160-A

“Based on review, facility did not ensure 2 of 6 staff records has documentation of a negative tuberculosis screening/test at the time of employment and prior to coming into contact with children. Evidence: The following was observed during staff record review: 1. The record for staff #1 (start date 6-19-2022) had a TB test/screening dated 7-11-2022. 2. The record for staff #2 (start date 6-23-2022) had a TB test/screening dated 7-7-2022.”

8VAC20-780-150-B

“Based on review, facility did not ensure 1 of 5 children’s records has an immunization record that is signed by the physician, designee or an official of a local health department. Evidence: The record for child #4 (start date 6-20-2022) an immunization record that was not signed by the physician, designee or health department official.”

8VAC20-780-560-K

“Based on observation, facility did not ensure children are not allowed to drink or eat while walking around. Evidence: Child #2 (age 19 months) was observed in the tod’s room walking around the classroom while drinking from a bottle.”

8VAC20-780-500-B

“Based on observation, facility did not ensure soiled diapers are disposed of in a storage system that is either foot-operated or used in such a way that neither the staff member’s hand nor the soiled diaper touches an exterior surface of the storage system during disposal. Evidence: The foot-operated diaper pails in the tod’s room and 2?s room were not operable with the foot-operated step. The lid was not secured to the pail and required the lid to be manually lifted with a hand or item. Diapers were observed disposed of in the pail.”

8VAC20-780-160-A

“Based on review, facility did not ensure 2 of 6 staff records has documentation of a negative tuberculosis screening/test at the time of employment and prior to coming into contact with children. Evidence: The following was observed during staff record review: 1. The record for staff #1 (start date 6-19-2022) had a TB test/screening dated 7-11-2022. 2. The record for staff #2 (start date 6-23-2022) had a TB test/screening dated 7-7-2022.”

8VAC20-780-150-B

“Based on review, facility did not ensure 1 of 5 children’s records has an immunization record that is signed by the physician, designee or an official of a local health department. Evidence: The record for child #4 (start date 6-20-2022) an immunization record that was not signed by the physician, designee or health department official.”

8VAC20-780-560-K

“Based on observation, facility did not ensure children are not allowed to drink or eat while walking around. Evidence: Child #2 (age 19 months) was observed in the tod’s room walking around the classroom while drinking from a bottle.”

8VAC20-780-500-B

“Based on observation, facility did not ensure soiled diapers are disposed of in a storage system that is either foot-operated or used in such a way that neither the staff member’s hand nor the soiled diaper touches an exterior surface of the storage system during disposal. Evidence: The foot-operated diaper pails in the tod’s room and 2?s room were not operable with the foot-operated step. The lid was not secured to the pail and required the lid to be manually lifted with a hand or item. Diapers were observed disposed of in the pail.”

8VAC20-780-560-F Complaint related: Yes

“Based on observation and interview, facility did not ensure when meals or snacks are provided that there is a posted daily menu or one provided to parents, showing foods served for the current week. Evidence: The menu was not posted for the current week. Program Director stated a copy for the current week was not provided to the parents.”

8VAC20-780-450-D

“Based on observation and interview, facility did not ensure when pillows are used that they are assigned for individual use and covered with pillow cases. Evidence: On March 29, 2022, 7 of 12 children in the preschool room were observed napping with pillows that were not assigned for individual use and not covered in pillow cases. Staff reported 6 of the pillows were supposed to be used on the classroom couches.”

8VAC20-780-430-K

“Based on observation, facility did not ensure there was a provision for an individual place for each child's personal belongings. Evidence: Three backpacks were observed on the floor in the 2's classroom.”

8VAC20-780-500-B

“Based on observation, facility did not ensure diapers are disposed of in a diapering system that is not hand operated or requiring the diaper to touch the exterior surface of the system. Evidence: The diaper pail in the infants 2 room did not operate with the step therefore someone would have to manually lift the lid with their hand in order to dispose of a diaper.”

8VAC20-780-160-A-1

“Based on review, facility did not ensure 1 of 3 staff have a completed TB test or screening prior to coming into contact with children. Evidence: The record for staff #3 (start date March 21, 2022) did not have a TB test or screening.”

8VAC20-780-350-B Complaint related: No

“Based on observations of classrooms and review of children records, facility did not ensure the required staff-to-children ratio is met when children are in care. Evidence: The following was found during inspection on March 3, 2022: 1. At approximately 8:15 AM, two staff were observed with eleven children in the infant room. Child # 1 (age 2 months) was the youngest in the group. 2. At approximately 8:25 AM, one staff was observed with eight children in the classroom referred by staff as the "toddler" room. Child #2 (age 14 months) was the youngest in the group. 3. Child #1 (age 2 months) and child #2 (age 14 months) are infant age children therefore one staff is required for every four children.”

8VAC20-780-80-A Complaint related: No

“Based on observations of classrooms, review of facility attendance records and interviews with staff, facility did not ensure for each group of children that there is a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: The following was found during inspection on March 3, 2022: 1. Ten children were observed in the classroom identified by staff as the "Toddler" room however seven children were signed in for attendance in that room. 2. Seven children were observed in the 2's classroom however four children were signed in for attendance in that room. 3. Staff #1 stated that parents are responsible for signing in their child(ren) and that sometimes they do not follow through as requested. 4. Staff #1 confirmed attendance roster was not consistent with the number of children present and told classroom staff they needed to sign in those children.”