Pure at Heart Childcare Center, Phase 2

8VAC20-780-80-A

“Repeat Violation Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: Two out of two of the classrooms did not have attendance list as required. 1.In the infant room 7 infants were observed and only 5 were listed on the attendance. The last two children in the infant room arrived at 8:19am and 8:30am and the attendance list was not updated until 10:08am. 2. In the toddler room 3 children were observed and only two were on the attendance list. The third child arrived at 8:54am and the attendance list was not updated until 10:08am”

8VAC20-780-270-A

“Based on observation, the licensee did not ensure areas and equipment of the center inside was maintained in a clean, safe and operable condition. Evidence In the infant room, next to a crib there was approximately a 2 inch by 2 inch area of peeling plaster type substance. Infant was observed sleeping in the crib.”

8VAC20-780-290-A-3

“Based on observation, electrical outlets shall have protective covers that are of a size that cannot be swallowed by children. Evidence: Ther were 4 uncapped outlets observed in the infant room.”

8VAC20-780-500-A

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure children's and staff hands shall be washed with soap and running water as required. Evidence: Infant staff was observed during a diaper change and did not ensure the infants hands were washed with soap and running water after toileting/diapering.”

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the diaper pad/ surface was cleaned after each use. Evidence: Center staff was observed conducting a diaper change and the diaper surface was not cleaned with a soap and water solution after changing the diaper.”

8VAC20-780-570-A

“Based on observation, when occupied by a child, high chairs were not used according to the manufacturer’s instructions and a safety strap was not used and securely fastened. Evidence: Two infants were observed seated in a high chair without using the high chair safety strap.”

22.1-289.035-A

“Repeat Violation Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a search of the central registry check (SCR). Evidence: Staff #6?s was not updated as the most recent SCR is dated 2-18-2019.”

8VAC20-780-80-A

“Repeat Violation Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: Two out of two of the classrooms did not have attendance list as required. 1.In the infant room 7 infants were observed and only 5 were listed on the attendance. The last two children in the infant room arrived at 8:19am and 8:30am and the attendance list was not updated until 10:08am. 2. In the toddler room 3 children were observed and only two were on the attendance list. The third child arrived at 8:54am and the attendance list was not updated until 10:08am”

8VAC20-780-270-A

“Based on observation, the licensee did not ensure areas and equipment of the center inside was maintained in a clean, safe and operable condition. Evidence In the infant room, next to a crib there was approximately a 2 inch by 2 inch area of peeling plaster type substance. Infant was observed sleeping in the crib.”

8VAC20-780-290-A-3

“Based on observation, electrical outlets shall have protective covers that are of a size that cannot be swallowed by children. Evidence: Ther were 4 uncapped outlets observed in the infant room.”

8VAC20-780-500-A

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure children's and staff hands shall be washed with soap and running water as required. Evidence: Infant staff was observed during a diaper change and did not ensure the infants hands were washed with soap and running water after toileting/diapering.”

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the diaper pad/ surface was cleaned after each use. Evidence: Center staff was observed conducting a diaper change and the diaper surface was not cleaned with a soap and water solution after changing the diaper.”

8VAC20-780-570-A

“Based on observation, when occupied by a child, high chairs were not used according to the manufacturer’s instructions and a safety strap was not used and securely fastened. Evidence: Two infants were observed seated in a high chair without using the high chair safety strap.”

22.1-289.035-A

“Repeat Violation Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a search of the central registry check (SCR). Evidence: Staff #6?s was not updated as the most recent SCR is dated 2-18-2019.”

8VAC20-780-80-A

“Repeat Violation Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: Two out of two of the classrooms did not have attendance list as required. 1.In the infant room 7 infants were observed and only 5 were listed on the attendance. The last two children in the infant room arrived at 8:19am and 8:30am and the attendance list was not updated until 10:08am. 2. In the toddler room 3 children were observed and only two were on the attendance list. The third child arrived at 8:54am and the attendance list was not updated until 10:08am”

8VAC20-780-270-A

“Based on observation, the licensee did not ensure areas and equipment of the center inside was maintained in a clean, safe and operable condition. Evidence In the infant room, next to a crib there was approximately a 2 inch by 2 inch area of peeling plaster type substance. Infant was observed sleeping in the crib.”

8VAC20-780-290-A-3

“Based on observation, electrical outlets shall have protective covers that are of a size that cannot be swallowed by children. Evidence: Ther were 4 uncapped outlets observed in the infant room.”

8VAC20-780-500-A

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure children's and staff hands shall be washed with soap and running water as required. Evidence: Infant staff was observed during a diaper change and did not ensure the infants hands were washed with soap and running water after toileting/diapering.”

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the diaper pad/ surface was cleaned after each use. Evidence: Center staff was observed conducting a diaper change and the diaper surface was not cleaned with a soap and water solution after changing the diaper.”

8VAC20-780-570-A

“Based on observation, when occupied by a child, high chairs were not used according to the manufacturer’s instructions and a safety strap was not used and securely fastened. Evidence: Two infants were observed seated in a high chair without using the high chair safety strap.”

22.1-289.035-A

“Repeat Violation Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a search of the central registry check (SCR). Evidence: Staff #6?s was not updated as the most recent SCR is dated 2-18-2019.”

8VAC20-790-600-F

“Based on a record review and staff interviews, the vendor did not ensure staff shall complete annually the departments health and safety course. Evidence: The most recent course for Staff #4 is dated 2-10-23 and Staff #5?s is dated 3-7-23.”

8VAC20-780-560-F

“Based on observation and staff interviews, the licensee did not ensure to follow the recent, age-appropriate nutritional requirements of the Child and Adult Care Food Program of the United States Department of Agriculture (USDA) when they choose to provide meals and snacks. Evidence: The menu posted was for the week of April 29, 2024”

8VAC20-780-550-F

“Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of lockdown procedures practiced at least annually. Evidence: Center Owner confirmed they did not have documentation of a 2023 lockdown drill.”

8VAC20-780-550-D

“Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of monthly emergency evacuation drills. Evidence: Center owner confirmed they did not have documentation of November and December 2023 evacuation drills.”

8VAC20-780-520-C

“Based on observation and staff interviews, the licensee did not ensure if diaper ointment or cream is used, it shall be in original container and labeled with the child's name and stored in a place inaccessible to children Evidence: Three containers of diaper cream were observed and were not labeled with the children’s names and were stored in a drawer below the handwashing sink and accessible to children”

8VAC20-780-450-A

“Based on observation and staff interview, the licensee did not ensure cots/mats used by children other than infants during the designated rest period shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges. Evidence: Three children out of seven were observed sleeping without a second cover (top or bottom).”

8VAC20-780-350-B-1

“Repeat Based on observation, staff interview and record review, the licensee did not ensure to follow the required ratio of 1 staff for every 4 infants in care. Evidence: At 1:10 PM In the infant room 9 children, youngest age 4 months were observed with only 2 staff. The ratio of 1 staff to every 4 children was not followed.”

8VAC20-780-80-A

“Repeat Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: Two out of two of the classrooms did not have attendance list as required; 1.At approximately 1:10 PM, 9 infants were observed in the infant room and only 8 were on the attendance list 2. There was not an attendance list for the toddler room and 7 children were observed”

8VAC20-780-160-C

“Based on record review and staff interviews, the licensee did not ensure that each staff member had obtained at least every two years from the date of the initial screening or testing, the results of a follow- up tuberculosis screening. Evidence: The records for Staff #3 did not include updated TB screening as the most recent screening was dated 1-17-2021.”

8VAC20-780-150-B

“Repeat Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department Evidence: The physical and immunization documents for Child #5 did not include a physician or designated individual’s signature”

8VAC20-780-130-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Evidence: The record for Child #3, (first date of attendance 5-6-2024) did not include documentation of required immunization.”

22.1-289.035-A

“Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a sworn statement, criminal records check ( CRC ) and search of the central registry check (SCR). Evidence: Staff #3?s most recent CRC is dated 1-25-2019 and the SCR is dated 2-18-2019. Both background checks were not updated every 5 years a required”

22.1-289.011-F

“Based on observation and staff interviews, the licensee did not ensure the license and any other documents required by the Superintendent were posted in a conspicuous place on the licensed premises. Evidence: The most recent inspection results were dated 11-16-2023 were not posted in a conspicuous place.”

8VAC20-780-500-B

“Repeat Based on observation and staff interviews, the licensee did not ensure the requirements for diapering were followed. Evidence: 1.The diaper pad/ surface was not sanitized after each use as sanitized is defined as sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes. Staff #4 was observed conducting a diaper changes, and the diaper pad was wiped with disinfectant wipes and was not sprayed with a disinfectant solution as required. 2. The diaper pad in the toddler room had small tears and therefore it was no longer nonabsorbent.”

8VAC20-790-600-F

“Based on a record review and staff interviews, the vendor did not ensure staff shall complete annually the departments health and safety course. Evidence: The most recent course for Staff #4 is dated 2-10-23 and Staff #5?s is dated 3-7-23.”

8VAC20-780-560-F

“Based on observation and staff interviews, the licensee did not ensure to follow the recent, age-appropriate nutritional requirements of the Child and Adult Care Food Program of the United States Department of Agriculture (USDA) when they choose to provide meals and snacks. Evidence: The menu posted was for the week of April 29, 2024”

8VAC20-780-550-F

“Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of lockdown procedures practiced at least annually. Evidence: Center Owner confirmed they did not have documentation of a 2023 lockdown drill.”

8VAC20-780-550-D

“Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of monthly emergency evacuation drills. Evidence: Center owner confirmed they did not have documentation of November and December 2023 evacuation drills.”

8VAC20-780-520-C

“Based on observation and staff interviews, the licensee did not ensure if diaper ointment or cream is used, it shall be in original container and labeled with the child's name and stored in a place inaccessible to children Evidence: Three containers of diaper cream were observed and were not labeled with the children’s names and were stored in a drawer below the handwashing sink and accessible to children”

8VAC20-780-450-A

“Based on observation and staff interview, the licensee did not ensure cots/mats used by children other than infants during the designated rest period shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges. Evidence: Three children out of seven were observed sleeping without a second cover (top or bottom).”

8VAC20-780-350-B-1

“Repeat Based on observation, staff interview and record review, the licensee did not ensure to follow the required ratio of 1 staff for every 4 infants in care. Evidence: At 1:10 PM In the infant room 9 children, youngest age 4 months were observed with only 2 staff. The ratio of 1 staff to every 4 children was not followed.”

8VAC20-780-80-A

“Repeat Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: Two out of two of the classrooms did not have attendance list as required; 1.At approximately 1:10 PM, 9 infants were observed in the infant room and only 8 were on the attendance list 2. There was not an attendance list for the toddler room and 7 children were observed”

8VAC20-780-160-C

“Based on record review and staff interviews, the licensee did not ensure that each staff member had obtained at least every two years from the date of the initial screening or testing, the results of a follow- up tuberculosis screening. Evidence: The records for Staff #3 did not include updated TB screening as the most recent screening was dated 1-17-2021.”

8VAC20-780-150-B

“Repeat Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department Evidence: The physical and immunization documents for Child #5 did not include a physician or designated individual’s signature”

8VAC20-780-130-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Evidence: The record for Child #3, (first date of attendance 5-6-2024) did not include documentation of required immunization.”

22.1-289.035-A

“Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a sworn statement, criminal records check ( CRC ) and search of the central registry check (SCR). Evidence: Staff #3?s most recent CRC is dated 1-25-2019 and the SCR is dated 2-18-2019. Both background checks were not updated every 5 years a required”

22.1-289.011-F

“Based on observation and staff interviews, the licensee did not ensure the license and any other documents required by the Superintendent were posted in a conspicuous place on the licensed premises. Evidence: The most recent inspection results were dated 11-16-2023 were not posted in a conspicuous place.”

8VAC20-780-500-B

“Repeat Based on observation and staff interviews, the licensee did not ensure the requirements for diapering were followed. Evidence: 1.The diaper pad/ surface was not sanitized after each use as sanitized is defined as sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes. Staff #4 was observed conducting a diaper changes, and the diaper pad was wiped with disinfectant wipes and was not sprayed with a disinfectant solution as required. 2. The diaper pad in the toddler room had small tears and therefore it was no longer nonabsorbent.”

8VAC20-780-500-A

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure children's and staff hands shall be washed with soap and running water or disposable wipes when required. Evidence: The following were observed 1) Child #4 and Child #3 did not have their hands washed with soap and running water or disposable wipes before and after eating meals or snacks. 2)Staff #4 was conducting a diaper change for Child #7 and Child #8 and they did not wash their hands in between diaper changes and did not ensure to wash Child #7 and Child #8?s hands after their diaper change. Staff are required to wash their hands with soap and running water after toileting/diapering and ensure that children’s hands are washed with soap and running water after toileting/diapering.”

8VAC20-780-440-B

“Based on observation and staff interviews, the license did not ensure that cribs, cots, rest mats, and beds shall be identified for use by a specific child. Evidence: Child #4 was observed sleeping in a crib that was not labeled for his individual use.”

8VAC20-780-570-A

“Based on observation and staff interviews, the licensee did not ensure when a child is placed in a highchair, the protective belt shall be fastened securely. Evidence: Child #2 was observed sitting in a feeding table and the protective strap was not used”

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the required procedures for diapering were followed. Evidence: The following were observed in the toddler room. 1) The diapering surface is required to be cleaned with soap and at least room temperature water and sanitized after each and this was not followed. Staff #4 was conducting diaper changes for Child #7 and Child #8 and after each diaper change they wiped down the diaper pad with a disinfect wipe and then sprayed it with a disinfectant and immediately changed another child’s diaper. Sanitized is defined as sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes. 2) The requirement that disposable diapers shall be disposed in a leakproof or plastic-lined 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 was not followed. Staff #4 was changing diapers for Child #7 and Child #8 and immediately after each change they placed the soiled diaper in plastic bag that that they had to open with their hands.”

8VAC20-780-280-B

“Repeat Violation Based on observation, the licensee did not ensure hazardous substances shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: In the infant room there were containers of hazardous substances, a spray disinfectant and bottle of hand sanitizer were stored on a shelf in an unlocked manner. These items were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-780-570-E

“Based on observation and provider interviews, the licensee did not ensure that prepared infant formula shall be refrigerated, dated and labeled with the child's name. Evidence: The bottle for Child #6 was not dated as required”

8VAC20-780-80-A

“Based on documentation review and staff interviews, the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: The attendance sheet for Infant Room was not accurate, it did not include Child #1 who was observed in care.”

8VAC20-780-150-B

“Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department Evidence: The immunization and physical documents for Child #5 did not include a physician or designated individual’s signature.”

8VAC20-780-350-B-1

“Based on observation, staff interview and record review, the licensee did not ensure to follow the required staff-to-child ratio for children birth to 16 months is 1:4. Evidence: On 11-15-2023, in the infant room, from approximately 2:15 PM until 2:25 PM, there were 9 infants with 2 staff.”

8VAC20-780-500-A

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure children's and staff hands shall be washed with soap and running water or disposable wipes when required. Evidence: The following were observed 1) Child #4 and Child #3 did not have their hands washed with soap and running water or disposable wipes before and after eating meals or snacks. 2)Staff #4 was conducting a diaper change for Child #7 and Child #8 and they did not wash their hands in between diaper changes and did not ensure to wash Child #7 and Child #8?s hands after their diaper change. Staff are required to wash their hands with soap and running water after toileting/diapering and ensure that children’s hands are washed with soap and running water after toileting/diapering.”

8VAC20-780-440-B

“Based on observation and staff interviews, the license did not ensure that cribs, cots, rest mats, and beds shall be identified for use by a specific child. Evidence: Child #4 was observed sleeping in a crib that was not labeled for his individual use.”

8VAC20-780-570-A

“Based on observation and staff interviews, the licensee did not ensure when a child is placed in a highchair, the protective belt shall be fastened securely. Evidence: Child #2 was observed sitting in a feeding table and the protective strap was not used”

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the required procedures for diapering were followed. Evidence: The following were observed in the toddler room. 1) The diapering surface is required to be cleaned with soap and at least room temperature water and sanitized after each and this was not followed. Staff #4 was conducting diaper changes for Child #7 and Child #8 and after each diaper change they wiped down the diaper pad with a disinfect wipe and then sprayed it with a disinfectant and immediately changed another child’s diaper. Sanitized is defined as sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes. 2) The requirement that disposable diapers shall be disposed in a leakproof or plastic-lined 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 was not followed. Staff #4 was changing diapers for Child #7 and Child #8 and immediately after each change they placed the soiled diaper in plastic bag that that they had to open with their hands.”

8VAC20-780-280-B

“Repeat Violation Based on observation, the licensee did not ensure hazardous substances shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: In the infant room there were containers of hazardous substances, a spray disinfectant and bottle of hand sanitizer were stored on a shelf in an unlocked manner. These items were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-780-570-E

“Based on observation and provider interviews, the licensee did not ensure that prepared infant formula shall be refrigerated, dated and labeled with the child's name. Evidence: The bottle for Child #6 was not dated as required”

8VAC20-780-80-A

“Based on documentation review and staff interviews, the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs. Evidence: The attendance sheet for Infant Room was not accurate, it did not include Child #1 who was observed in care.”

8VAC20-780-150-B

“Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department Evidence: The immunization and physical documents for Child #5 did not include a physician or designated individual’s signature.”

8VAC20-780-350-B-1

“Based on observation, staff interview and record review, the licensee did not ensure to follow the required staff-to-child ratio for children birth to 16 months is 1:4. Evidence: On 11-15-2023, in the infant room, from approximately 2:15 PM until 2:25 PM, there were 9 infants with 2 staff.”

8VAC20-790-600-D-2

“Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in first aid appropriate to the ages of children in care. Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of First Aid certification.”

8VAC20-790-600-D-1

“Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in- person competency demonstration. Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of CPR certification.”

8VAC20-780-140-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child's attendance; or within 30 days after the first day of attendance. Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical”

8VAC20-780-240-E

“Based on staff record records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Evidence: Staff # 3 (hire date 8-3-2022) did not have documentation of CPR / First Aid orientation”

8VAC20-780-260-A

“Based on documentation review and staff interviews, the licensee did not ensure to obtain an annual fire inspection report from the appropriate fire official having jurisdiction. Evidence: The most recent copy of the fire inspection available for review was dated 1-20-2022.”

8VAC20-780-340-D

“Based on staff record review, observation and staff interviews, the licensee did not ensure that there shall be in each grouping of children at least one staff member who meets the qualifications of a program leader or program director. Evidence: Staff #4, was the designated program leader for the toddler room and was the only staff supervising 5 toddlers during the inspection. Center owner documented in Staff #4?s record that they were promoted to program leader as of 6-20-2021. Center owner indicated they may have gotten rid of the training documents when the records were cleaned out.”

8VAC20-780-500-A

“Based on observation and staff interviews, the licensee did not ensure to wash their hands and did not ensure that children’s hands shall be washed with soap and running water after toileting and any contact with blood, feces, or urine. Evidence: Staff #2 was observed conducting a diaper change for child #6 and the staff did not ensure child #6 had washed their hands after diapering.”

8VAC20-780-500-B

“Based on observation and staff interviews, the licensee did not ensure the diapering surface was cleaned with soap and at least room temperature water and sanitized after each use. Evidence: Staff #2 was observed conducting a diaper change and the diaper pad was not sanitized after. Staff #2 sprayed the diaper pad with a soap and water solution and then wiped it down. The diaper pad was not sanitized as it is required to be sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes.”

8VAC20-780-280-B

“Based on observation and staff interviews, the licensee did not ensure hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: Hazardous chemicals were observed in the toddler room and were stored in an unlocked manner. 1) A container of room deodorizer and a container of disinfectant were observed in a wooden cubby underneath the box of toys. 2) A container of disinfectant was observed on the hooks where `s belongings are placed. These items are hazardous chemicals, and they were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-790-600-D-2

“Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in first aid appropriate to the ages of children in care. Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of First Aid certification.”

8VAC20-790-600-D-1

“Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in- person competency demonstration. Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of CPR certification.”

8VAC20-780-140-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child's attendance; or within 30 days after the first day of attendance. Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical”

8VAC20-780-240-E

“Based on staff record records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Evidence: Staff # 3 (hire date 8-3-2022) did not have documentation of CPR / First Aid orientation”

8VAC20-780-260-A

“Based on documentation review and staff interviews, the licensee did not ensure to obtain an annual fire inspection report from the appropriate fire official having jurisdiction. Evidence: The most recent copy of the fire inspection available for review was dated 1-20-2022.”

8VAC20-780-340-D

“Based on staff record review, observation and staff interviews, the licensee did not ensure that there shall be in each grouping of children at least one staff member who meets the qualifications of a program leader or program director. Evidence: Staff #4, was the designated program leader for the toddler room and was the only staff supervising 5 toddlers during the inspection. Center owner documented in Staff #4?s record that they were promoted to program leader as of 6-20-2021. Center owner indicated they may have gotten rid of the training documents when the records were cleaned out.”

8VAC20-780-500-A

“Based on observation and staff interviews, the licensee did not ensure to wash their hands and did not ensure that children’s hands shall be washed with soap and running water after toileting and any contact with blood, feces, or urine. Evidence: Staff #2 was observed conducting a diaper change for child #6 and the staff did not ensure child #6 had washed their hands after diapering.”

8VAC20-780-500-B

“Based on observation and staff interviews, the licensee did not ensure the diapering surface was cleaned with soap and at least room temperature water and sanitized after each use. Evidence: Staff #2 was observed conducting a diaper change and the diaper pad was not sanitized after. Staff #2 sprayed the diaper pad with a soap and water solution and then wiped it down. The diaper pad was not sanitized as it is required to be sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes.”

8VAC20-780-280-B

“Based on observation and staff interviews, the licensee did not ensure hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: Hazardous chemicals were observed in the toddler room and were stored in an unlocked manner. 1) A container of room deodorizer and a container of disinfectant were observed in a wooden cubby underneath the box of toys. 2) A container of disinfectant was observed on the hooks where `s belongings are placed. These items are hazardous chemicals, and they were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-790-600-F

“Based on a review of 5 staff records and staff interviews, the vendor did not ensure staff completed who work directly with children shall have completed the departments health and safety update course. Evidence: The record for Staff #2 and Staff #4 did not include the required annual 3 hour health and safety update course. The most recent Health and Safety course available for review for Staff #2 was dated 3-1-2020 and for Staff #4 it was dated 11-13-2019.”

8VAC20-780-70

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure the staff records were kept for each staff person with all required information. Evidence: Staff #2, designated as a lead teacher (program leader) does not have documentation to demonstrate they possesses the education and certification required by the job position. Center Director confirmed there was not documentation available.”

8VAC20-780-340-D

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure in each grouping of children there is at least one staff member who meets the qualifications of a program leader or program director. Evidence: Staff #4, the designated lead teacher does not have documentation indicating they meet the qualifications of program leader. Staff #4 was the only staff observed supervising 3 toddlers during the inspection. Center Director confirmed there was not documentation available for review during the inspection.”

8VAC20-780-140-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child's attendance; or within 30 days after the first day of attendance. Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical.”

8VAC20-780-530-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure there was at least one staff in each classroom or area where children are present had obtained a current certification in cardiopulmonary resuscitation (CPR) and First Aid as appropriate to the age of the children in care Evidence: In the toddler classroom Staff #4 was the only staff observed supervising 3 toddlers during the inspection and they have not obtained CPR or First Aid certification.”

8VAC20-780-440-B

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats shall be identified for use by a specific child. Evidence: Child #4 and Child #5 were observed in cribs that were not identified for use by them. Child #4 was in crib that was not labeled for his use and Child #5 was in a crib that was labeled with another child’s name (Child #6).”

8VAC20-780-245-A

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure staff completed 16 hours of annual training. Evidence: The record for Staff #2 only included 1 ? hours of annual training (March 2021 to March 2022)”

8VAC20-780-240-E

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Evidence: Staff # 4 (hire date 1-28-2022) did not have documentation of CPR / First Aid orientation”

8VAC20-780-160-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure that each staff member shall submit documentation of a negative tuberculosis screening and the documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician's designee, or an official of the local health department. Evidence: The record for Staff #5 did not include documentation of a TB screenings/ test conducted. Staff #5 was observed working during the inspection.”

8VAC20-780-280-B

“Based on observation and staff interviews, the licensee did not ensure hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: Hazardous chemicals were observed in the following places and stored in an unlocked manner; 1) In the lobby there was 1 container of hand sanitizer on the window shelf. 2) In the restroom on the diaper pad there was 1 spray container of disinfectant. 3) In toddler room there were 2 containers of hand sanitizer (1 was stored on top of hand soap dispenser and 1 was stored on top of a cabinet), and 1 container of disinfectant wipes was stored on top of a storage cabinet. These items are hazardous chemicals and they were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-780-130-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Evidence: The records for Child #2, (first date of attendance 11-7-2022) did not include documentation of required immunizations.”

8VAC20-780-270-A

“Based on observation and staff interviews, the licensee did not ensure areas and equipment of the center, inside and outside, shall be maintained in a clean, safe and operable condition. Unsafe conditions shall include, but not be limited to, splintered, cracked or otherwise deteriorating wood; chipped or peeling paint; visible cracks, bending or warping, rusting or breakage of any equipment; head entrapment hazards; and protruding nails, bolts or other components that could entangle clothing or snag skin. Evidence: On the playground there was a green metal rocker that has a broken rail that measures approximately 1 inch and is sharp and rusty. There is also a black plastic drain tube that is protruding approximately 1 ? inches from the ground and is a tripping hazard. The plastic tube is broken and has sharp edges.”

8VAC20-780-240-C

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure each staff member had completed orientation training in all required facility specific topics prior to the staff member working alone with children and no later than seven days of the date of assuming job responsibilities. Evidence: The records for Staff #1 (hire date 10-12-2022), Staff # 4 (hire date 1-28-2022) and Staff #3 (hire date 10-17- 22) do not include information indicating orientation related to prevention of shaken baby syndrome, abusive head trauma and procedures to cope with distraught children was conducted.”

8VAC20-780-40-K

“Based on review of center documentation and staff interviews, the licensee did not ensure the center shall develop written procedures for abusive head trauma. Evidence: Center Director, Staff #5 confirmed there was not a policy available for review related to head trauma.”

8VAC20-780-450-A

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats used by children other than infants during the designated rest period or during evening and overnight care shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges. Cribs when being used by infants shall have a bottom cover. Evidence: Child #5 was observed in a crib without a bottom cover.”

8VAC20-790-600-F

“Based on a review of 5 staff records and staff interviews, the vendor did not ensure staff completed who work directly with children shall have completed the departments health and safety update course. Evidence: The record for Staff #2 and Staff #4 did not include the required annual 3 hour health and safety update course. The most recent Health and Safety course available for review for Staff #2 was dated 3-1-2020 and for Staff #4 it was dated 11-13-2019.”

8VAC20-780-70

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure the staff records were kept for each staff person with all required information. Evidence: Staff #2, designated as a lead teacher (program leader) does not have documentation to demonstrate they possesses the education and certification required by the job position. Center Director confirmed there was not documentation available.”

8VAC20-780-340-D

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure in each grouping of children there is at least one staff member who meets the qualifications of a program leader or program director. Evidence: Staff #4, the designated lead teacher does not have documentation indicating they meet the qualifications of program leader. Staff #4 was the only staff observed supervising 3 toddlers during the inspection. Center Director confirmed there was not documentation available for review during the inspection.”

8VAC20-780-140-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child's attendance; or within 30 days after the first day of attendance. Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical.”

8VAC20-780-530-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure there was at least one staff in each classroom or area where children are present had obtained a current certification in cardiopulmonary resuscitation (CPR) and First Aid as appropriate to the age of the children in care Evidence: In the toddler classroom Staff #4 was the only staff observed supervising 3 toddlers during the inspection and they have not obtained CPR or First Aid certification.”

8VAC20-780-440-B

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats shall be identified for use by a specific child. Evidence: Child #4 and Child #5 were observed in cribs that were not identified for use by them. Child #4 was in crib that was not labeled for his use and Child #5 was in a crib that was labeled with another child’s name (Child #6).”

8VAC20-780-245-A

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure staff completed 16 hours of annual training. Evidence: The record for Staff #2 only included 1 ? hours of annual training (March 2021 to March 2022)”

8VAC20-780-240-E

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Evidence: Staff # 4 (hire date 1-28-2022) did not have documentation of CPR / First Aid orientation”

8VAC20-780-160-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure that each staff member shall submit documentation of a negative tuberculosis screening and the documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician's designee, or an official of the local health department. Evidence: The record for Staff #5 did not include documentation of a TB screenings/ test conducted. Staff #5 was observed working during the inspection.”

8VAC20-780-280-B

“Based on observation and staff interviews, the licensee did not ensure hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children. Evidence: Hazardous chemicals were observed in the following places and stored in an unlocked manner; 1) In the lobby there was 1 container of hand sanitizer on the window shelf. 2) In the restroom on the diaper pad there was 1 spray container of disinfectant. 3) In toddler room there were 2 containers of hand sanitizer (1 was stored on top of hand soap dispenser and 1 was stored on top of a cabinet), and 1 container of disinfectant wipes was stored on top of a storage cabinet. These items are hazardous chemicals and they were labeled "keep out of reach of children" and at least one other statement "caution", "flammable" and "warning".”

8VAC20-780-130-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Evidence: The records for Child #2, (first date of attendance 11-7-2022) did not include documentation of required immunizations.”

8VAC20-780-270-A

“Based on observation and staff interviews, the licensee did not ensure areas and equipment of the center, inside and outside, shall be maintained in a clean, safe and operable condition. Unsafe conditions shall include, but not be limited to, splintered, cracked or otherwise deteriorating wood; chipped or peeling paint; visible cracks, bending or warping, rusting or breakage of any equipment; head entrapment hazards; and protruding nails, bolts or other components that could entangle clothing or snag skin. Evidence: On the playground there was a green metal rocker that has a broken rail that measures approximately 1 inch and is sharp and rusty. There is also a black plastic drain tube that is protruding approximately 1 ? inches from the ground and is a tripping hazard. The plastic tube is broken and has sharp edges.”

8VAC20-780-240-C

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure each staff member had completed orientation training in all required facility specific topics prior to the staff member working alone with children and no later than seven days of the date of assuming job responsibilities. Evidence: The records for Staff #1 (hire date 10-12-2022), Staff # 4 (hire date 1-28-2022) and Staff #3 (hire date 10-17- 22) do not include information indicating orientation related to prevention of shaken baby syndrome, abusive head trauma and procedures to cope with distraught children was conducted.”

8VAC20-780-40-K

“Based on review of center documentation and staff interviews, the licensee did not ensure the center shall develop written procedures for abusive head trauma. Evidence: Center Director, Staff #5 confirmed there was not a policy available for review related to head trauma.”

8VAC20-780-450-A

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats used by children other than infants during the designated rest period or during evening and overnight care shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges. Cribs when being used by infants shall have a bottom cover. Evidence: Child #5 was observed in a crib without a bottom cover.”

8VAC20-780-160-A-2

“Based on review of 2 staff records and staff interviews, the licensee did not ensure tuberculosis (TB) documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician's designee, or an official of the local health department. Evidence: The record for staff #2 did not include TB screening dated within 30 day of employment. TB screening was dated 6-17-2021 and date of employment 1-18-2022.”

8VAC20-780-160-A-2

“Based on review of 2 staff records and staff interviews, the licensee did not ensure tuberculosis (TB) documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician's designee, or an official of the local health department. Evidence: The record for staff #2 did not include TB screening dated within 30 day of employment. TB screening was dated 6-17-2021 and date of employment 1-18-2022.”