Young Men's Christian Association of Greater Richmond-Manchester

8VAC20-780-340-A

“When staff are supervising children, they shall always ensure their care, protection, and guidance. On 4/28/2025, Staff #1 transported 42 school-age children from three different schools to the center while under the influence of alcohol and being intoxicated approximately three times the legal limit for operating a motor vehicle.”

8VAC20-780-60-A-8

“A written care plan is required for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Child #5, who has been enrolled for 4 months, has a diagnosed food allergy and did not have a written care plan in their file.”

22.1-289.035-B-4

“The center is required to obtain background checks from any state in which the individual has resided in the preceding five years. Staff #1, employed for more than 1 year and 11 months, did not have documentation of a completed central registry check from one state.”

8VAC20-780-60-A-8

“A written care plan is required for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Child #5, who has been enrolled for 4 months, has a diagnosed food allergy and did not have a written care plan in their file.”

22.1-289.035-B-4

“The center is required to obtain background checks from any state in which the individual has resided in the preceding five years. Staff #1, employed for more than 1 year and 11 months, did not have documentation of a completed central registry check from one state.”

8VAC20-780-240-B

“Staff are required to complete orientation training prior to the staff member working alone with children and no later than seven days of the date of assuming job responsibilities. Staff #2 and staff #5 completed orientation training more than 10 days after their first date of employment.”

22.1-289.011-F

“The license and any other documents required shall be posted in a conspicuous place on the licensed premises. The findings from the most recent inspection, dated 7/24/2024, were not posted on the premises.”

8VAC20-770-60-C-2

“For staff hired before July 1, 2024, providers must obtain the results of a central registry search for an employee, within 30 days of service. Staff #3 had central registry results dated over 30 days after being employed.”

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

“**Repeat Violation** Based on interviews and review of video footage, the center failed to ensure that when staff are supervising children, they shall always ensure their care, protection, and guidance. Evidence: 1. Video recording of the classroom shows child #1 and child #2 starting to touch one another inappropriately under the classroom table at approximately 2:44pm and the children were not separated or addressed until the class left the room at approximately 2:59pm. 2. Staff #2 reported seeing the children touching each other under the classroom table approximately 5 minutes before the children lined up to leave the classroom and stated she did not separate the children or address the behavior. 3. Staff # 1 and staff #3 confirmed staff #2 reported the inappropriate touching behavior between the children to them prior to the class lining up to leave the room. 4. Staff #1, #3 and #4 were present in the classroom and reported they did not directly witness the inappropriate behavior between the children.”

8VAC20-780-400-B Complaint related: No

“Based on interviews and review of video footage, the center failed to ensure when time is used as a behavior guidance technique it shall be used sparingly and shall not exceed one minute for each year of the child’s age. Evidence: 1. Based on interviews and observations, on 7/18/2024 a class consisting of 25 school age children ranging in age from 7 to 9 were instructed to put their heads down and remain quiet for 19 minutes. Video footage from the date and time of the incident shows the children putting their heads down at approximately 2:40pm and getting up from their tables at 2:59pm. 2. Staff #1, #2, #3, and #4 reported that the children were instructed to put their heads down and remain quiet in the classroom for the time period due to the children not following instructions.”

8VAC20-780-40-E

“Based on interviews, the center failed to ensure operational responsibilities that the center’s activities and services are maintained in compliance with the center’s own policies and procedures that are required by the standards. Evidence: 1. The YMCA Counselor Training Manual states that staff must maintain active supervision at all times to include, ?Be able to account for children in your care, always. Staff shall continuously scan the entire environment to know where someone is and what they are doing.? 2. Staff #3 stated they were unaware that child #2 was in the same restroom as child #1 until the children exited the restroom together.”

8VAC20-780-340-A

“Based on interviews, the center failed to ensure that when staff are supervising children, they shall always ensure their care, protection, and guidance. Evidence: 1. Child #1 reported to staff #3 and staff # 4 that child #2 inappropriately touched them while in the restroom. 2. Staff #3 confirmed seeing child #1 enter the restroom. Staff #3 stated they did not see child #2 enter the same restroom as child #1. Staff #3 reported witnessing child #1 and child #2 leaving the same restroom. Staff #3 did not recall exactly how long the children were in the restroom. 3. Staff #4 stated they stopped child #2 from following child #1 into the restroom the week prior to this incident, however, never documented or reported the incident to any other staff.”

22.1-289.035-B-1

“Based on review of staff records, the center did not ensure each staff member completed a sworn statement prior to their date of employment. Evidence: 1. The record for staff #3 (DOH: 10/22/2021) contained a sworn statement signed and dated on 10/25/2021.”

22.1-289.035-B-2

“Based on review of staff records, the center did not obtain the results of a national fingerprint-based criminal history record check prior to employment for each staff. Evidence: 1. The record for staff #3 (DOH 10/22/2021) contained a fingerprint background check dated 4/12/2022.”

8VAC20-780-510-G

“Based on observation and documentation review, the center did not ensure medication was labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given. Evidence: A prescription medication for Child #10 was on site at the center. The medication was not labeled with the child's name, the dosage amount and the time or times to be given. Attendance rosters indicated Child #10 is currently attending the center.”

8VAC20-780-510-F

“Based on a review of three medications and documentation review, the center did not ensure two medication authorizations were available to staff during the entire time the medication was effective for two children. Evidence: A prescription medication was observed at the center for Child #10. A medication authorization allowing the center to administer medication was not present at the center. Attendance rosters indicated Child #10 is currently attending the center.”

8VAC20-780-510-G

“Based on observation and documentation review, the center did not ensure medication was labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given. Evidence: A prescription medication for Child #10 was on site at the center. The medication was not labeled with the child's name, the dosage amount and the time or times to be given. Attendance rosters indicated Child #10 is currently attending the center.”

8VAC20-780-510-F

“Based on a review of three medications and documentation review, the center did not ensure two medication authorizations were available to staff during the entire time the medication was effective for two children. Evidence: A prescription medication was observed at the center for Child #10. A medication authorization allowing the center to administer medication was not present at the center. Attendance rosters indicated Child #10 is currently attending the center.”

8VAC20-780-240-A

“Based on review of five staff records, the center did not ensure two staff members completed the Virginia Department of Education-sponsored orientation course within 90 calendar days of employment. Evidence: 1. The record of staff #2, employed 09/20/2022, contained documentation of the completion of the Virginia Department of Education-sponsored orientation dated 03/16/2023, exceeding 90 days from the date of employment. 2. The record of staff #4, employed 03/14/2023, contained documentation of the completion of the Virginia Department of Education-sponsored orientation dated 07/01/2023, exceeding 90 days from the date of employment.”

8VAC20-780-240-A

“Based on review of five staff records, the center did not ensure two staff members completed the Virginia Department of Education-sponsored orientation course within 90 calendar days of employment. Evidence: 1. The record of staff #2, employed 09/20/2022, contained documentation of the completion of the Virginia Department of Education-sponsored orientation dated 03/16/2023, exceeding 90 days from the date of employment. 2. The record of staff #4, employed 03/14/2023, contained documentation of the completion of the Virginia Department of Education-sponsored orientation dated 07/01/2023, exceeding 90 days from the date of employment.”

8VAC20-780-600-B

“Based on review of staff records and interview, the center did not ensure staff obtained in addition to preservice and orientation training, at least 16 hours of training to include the department’s health and safety update course annually. Evidence: 1. The record of staff #2, employed 11/18/2021, did not contained documentation of the department’s annual health and safety update course. 3. A member of management stated staff #2 had not completed the annual health and safety update training.”

22.1-289.035-B-4

“Based on a review of four staff records, the center did not obtain the results of a search of the child abuse and neglect registry and an out of state criminal history name check from any state in which one staff member had resided in the preceding five years within the required time frame. Evidence: 1. The record for Staff #2, employed 11/18/2021, indicated the staff had resided in another state outside of Virginia within the last five years. 2.The record did not contain the results of a search of the child abuse and neglect registry from that state. There was no documentation of a follow up within 45 days requesting the status of the request.”

8VAC20-780-550-F

“Based on review of the drill log and interview, the center did not ensure lockdown procedures were practiced at least annually. Evidence: The drill log did not have documentation of a lockdown drill in the past 12 months. The director stated a lockdown drill had not been conducted in the past 12 months.”

8VAC20-780-550-E

“Based on review of the drill log and interview, the center did not practice a minimum of two shelter in place drill in the past year. Evidence: The drill log did not have documentation of any shelter in place drills in the past 12 months. The director stated that they had not conducted any shelter-in-place drill in the past 12 months.”

8VAC20-780-550-D

“Based on review of the drill log and interview, the center did not implement a monthly practice evacuation drill. Evidence: The drill log did not have any practice evacuation drills documented. The director stated that evacuation drills had not been conducted this school year and that there was no documentation of conducted drill for the past 12 months.”

8VAC20-780-510-P

“Based on observation and interview, the center did not ensure when a medication authorization expired, the parent was notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. Medications not picked up by the parent within 14 days will be disposed of by the center. Evidence: 1. The medication authorization for child #8 expired on 06/30/2022 and the medication was still on site. The director stated the parent had not been notified that the authorization had expired. 2. The medication authorization for child #11 had a duration date of 09/02/2022 through 09/02/2023. The authorization was only signed by the parent and did not have a physician’s signature; therefore, the authorization was only valid for 10 days. The authorization expired on 09/12/2023 and the medication was still on site exceeding 14 days.”

8VAC20-780-190-A-3

“Based on review of staff records and interview, the center did not ensure the assigned program director met program director qualifications. Evidence: 1. The record of staff #1, identified as the center’s program director, contained documentation of completing 62 college credits of which 11 semester hours were in a child related subject when 48 semester hours of college credits of which 12 semester hours are in a child related subject is required. 2. A member of management acknowledged staff #1 did not have any additional credits hours in a child related subject and did not meet director qualifications.”

8VAC20-780-80-B-2

“Based on interviews and documentation review, the center did not notify the department within two business days of a serious injury to a child that required outside medical attention while under the center's supervision. Evidence: During the 03/09/2023 renewal inspection, interviews and review of an injury report dated 02/20/2023, determined the following: 1. The director stated that on 02/20/2023, child# 9 ran into another child while playing dodgeball receiving a cut above the eye. 2. The director stated the parent of Child# 9 was notified of the incident on 02/20/2023. The child was taken to the doctor on 02/20/2023 by the parent where the child received stiches above the eye for the cut. 3. During the 03/09/2023 inspection, the director confirmed they did not notify the department within two business days that child #9 was seen by the doctor as a result of the 02/20/2023 incident.”

8VAC20-780-60-A-8

“Based on review of children’s records, the center did not obtain a written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: 1. The record of child #1, with a diagnosed food allergy, did not have a written allergy care plan. 2. The record of child #4, with a diagnosed food allergy, did not have a written allergy care plan.”

8VAC20-780-60-A

“Based on review of six children’s records, the center did not obtain all required documentation for four children’s records. Evidence: 1. The record of child #1 did not contain the work phone number for the two parents listed 2. The record for child #2 did not contain the name, address, and phone number for two emergency contacts. The record also did not contain the work phone number for each parent listed. 3. The record for child #4 did not contain the name, address, and phone number for two emergency contacts. The record also did not contain the work phone number and place of employment of the two parents listed. 4. The record of child #5 did not contain the name, address, and phone number for two emergency contacts. 5. The record for child #6 did not contain the work phone number and place of employment of the two parents listed.”

8VAC20-780-140-A

“Based on revied of six children’s records and interview, the center did not obtain documentation of a physical examination for one child’s record before the child’s attendance or within 30 days after the first day of attendance. Evidence: 1. The record of child #6. Enrolled 08/22/2022, did not contain documentation of a physical examination exceeding 30 days from the first day of attendance. 2. The director stated the child’s record did not contain documentation of a physical.”

8VAC20-770-60-C-2

“Based on a review of four staff records and interviews, the center did not ensure that three staff member had a central registry finding within 30 days of employment. Evidence: 1. The record for Staff #1, employed on 06/24/2021, contained the results of a central registry finding dated 08/16/2021 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed. 2. The record for Staff #2, employed on 11/18/2021, contained the results of a central registry finding dated 01/04/2022 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed. 3. The record for Staff #3, employed on 11/02/2021, contained the results of a central registry finding dated 12/15/2021 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed.”

8VAC20-780-130-A

“Based on review of six children’s records and interview, the center did not obtain documentation of immunizations required by the State Board of Health before the child attended the center. Evidence: 1.The record of child #6, enrolled 08/22/2022, did not contain documentation of immunizations exceeding the first day of attendance. 2. The director stated the record did not have documentation of immunizations.”

8VAC20-780-600-B

“Based on review of staff records and interview, the center did not ensure staff obtained in addition to preservice and orientation training, at least 16 hours of training to include the department’s health and safety update course annually. Evidence: 1. The record of staff #2, employed 11/18/2021, did not contained documentation of the department’s annual health and safety update course. 3. A member of management stated staff #2 had not completed the annual health and safety update training.”

22.1-289.035-B-4

“Based on a review of four staff records, the center did not obtain the results of a search of the child abuse and neglect registry and an out of state criminal history name check from any state in which one staff member had resided in the preceding five years within the required time frame. Evidence: 1. The record for Staff #2, employed 11/18/2021, indicated the staff had resided in another state outside of Virginia within the last five years. 2.The record did not contain the results of a search of the child abuse and neglect registry from that state. There was no documentation of a follow up within 45 days requesting the status of the request.”

8VAC20-780-550-F

“Based on review of the drill log and interview, the center did not ensure lockdown procedures were practiced at least annually. Evidence: The drill log did not have documentation of a lockdown drill in the past 12 months. The director stated a lockdown drill had not been conducted in the past 12 months.”

8VAC20-780-550-E

“Based on review of the drill log and interview, the center did not practice a minimum of two shelter in place drill in the past year. Evidence: The drill log did not have documentation of any shelter in place drills in the past 12 months. The director stated that they had not conducted any shelter-in-place drill in the past 12 months.”

8VAC20-780-550-D

“Based on review of the drill log and interview, the center did not implement a monthly practice evacuation drill. Evidence: The drill log did not have any practice evacuation drills documented. The director stated that evacuation drills had not been conducted this school year and that there was no documentation of conducted drill for the past 12 months.”

8VAC20-780-510-P

“Based on observation and interview, the center did not ensure when a medication authorization expired, the parent was notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. Medications not picked up by the parent within 14 days will be disposed of by the center. Evidence: 1. The medication authorization for child #8 expired on 06/30/2022 and the medication was still on site. The director stated the parent had not been notified that the authorization had expired. 2. The medication authorization for child #11 had a duration date of 09/02/2022 through 09/02/2023. The authorization was only signed by the parent and did not have a physician’s signature; therefore, the authorization was only valid for 10 days. The authorization expired on 09/12/2023 and the medication was still on site exceeding 14 days.”

8VAC20-780-190-A-3

“Based on review of staff records and interview, the center did not ensure the assigned program director met program director qualifications. Evidence: 1. The record of staff #1, identified as the center’s program director, contained documentation of completing 62 college credits of which 11 semester hours were in a child related subject when 48 semester hours of college credits of which 12 semester hours are in a child related subject is required. 2. A member of management acknowledged staff #1 did not have any additional credits hours in a child related subject and did not meet director qualifications.”

8VAC20-780-80-B-2

“Based on interviews and documentation review, the center did not notify the department within two business days of a serious injury to a child that required outside medical attention while under the center's supervision. Evidence: During the 03/09/2023 renewal inspection, interviews and review of an injury report dated 02/20/2023, determined the following: 1. The director stated that on 02/20/2023, child# 9 ran into another child while playing dodgeball receiving a cut above the eye. 2. The director stated the parent of Child# 9 was notified of the incident on 02/20/2023. The child was taken to the doctor on 02/20/2023 by the parent where the child received stiches above the eye for the cut. 3. During the 03/09/2023 inspection, the director confirmed they did not notify the department within two business days that child #9 was seen by the doctor as a result of the 02/20/2023 incident.”

8VAC20-780-60-A-8

“Based on review of children’s records, the center did not obtain a written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: 1. The record of child #1, with a diagnosed food allergy, did not have a written allergy care plan. 2. The record of child #4, with a diagnosed food allergy, did not have a written allergy care plan.”

8VAC20-780-60-A

“Based on review of six children’s records, the center did not obtain all required documentation for four children’s records. Evidence: 1. The record of child #1 did not contain the work phone number for the two parents listed 2. The record for child #2 did not contain the name, address, and phone number for two emergency contacts. The record also did not contain the work phone number for each parent listed. 3. The record for child #4 did not contain the name, address, and phone number for two emergency contacts. The record also did not contain the work phone number and place of employment of the two parents listed. 4. The record of child #5 did not contain the name, address, and phone number for two emergency contacts. 5. The record for child #6 did not contain the work phone number and place of employment of the two parents listed.”

8VAC20-780-140-A

“Based on revied of six children’s records and interview, the center did not obtain documentation of a physical examination for one child’s record before the child’s attendance or within 30 days after the first day of attendance. Evidence: 1. The record of child #6. Enrolled 08/22/2022, did not contain documentation of a physical examination exceeding 30 days from the first day of attendance. 2. The director stated the child’s record did not contain documentation of a physical.”

8VAC20-770-60-C-2

“Based on a review of four staff records and interviews, the center did not ensure that three staff member had a central registry finding within 30 days of employment. Evidence: 1. The record for Staff #1, employed on 06/24/2021, contained the results of a central registry finding dated 08/16/2021 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed. 2. The record for Staff #2, employed on 11/18/2021, contained the results of a central registry finding dated 01/04/2022 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed. 3. The record for Staff #3, employed on 11/02/2021, contained the results of a central registry finding dated 12/15/2021 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed.”

8VAC20-780-130-A

“Based on review of six children’s records and interview, the center did not obtain documentation of immunizations required by the State Board of Health before the child attended the center. Evidence: 1.The record of child #6, enrolled 08/22/2022, did not contain documentation of immunizations exceeding the first day of attendance. 2. The director stated the record did not have documentation of immunizations.”

8VAC20-780-550-D

“Based on interview, the center did not implement a monthly practice evacuation drill. Evidence: The director stated that evacuation drills had not been conducted and that a drill log could not be located.”

8VAC20-770-60-C-2

“Based on a review of seven staff records and interviews, the center did not ensure that one staff member had a central registry finding within 30 days of employment. Evidence: The record for Staff #7, employed on 09/14/2021, contained the results of a central registry finding dated 05/04/2022 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed.”

8VAC20-780-160-A

“Based on review of seven staff records, the center did not obtain documentation of a negative tuberculosis screening for two staff members at the time of employment and prior to coming into contact with children. Evidence: 1. The record of staff #4, employed 06/02/2022, did not contain documentation of a TB screening. 2. The record of staff #5, employed 06/02/2022, did not contain documentation of a TB screening.”

8VAC20-780-550-F

“Based on interview, the center did not ensure lockdown procedures were practiced at least annually. Evidence: The director stated a lockdown drill had not been conducted and that a drill log could not be located.”

8VAC20-780-60-A-8

“Based on review of children’s records, the center did not obtain a written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: The record of child #8, with a diagnosed food allergy, did not have a written allergy care plan.”

8VAC20-780-550-E

“Based on interview, the center did not practice a minimum of two shelter in place drill in the past year. Evidence: The director stated that they had not conducted any shelter-in-place drill and that a drill log could not be located.”

8VAC20-780-260-A

“Based on review of documentation, the center did not obtain an annual fire inspection report from the appropriate fire official having jurisdiction. Evidence: The most recent fire inspection report was dated 02/26/2021 exceeding the annual requirement.”

8VAC20-780-260-B

“Based on review of documentation, the center did not obtain an annual approval from the health department. Evidence: The most recent health inspection report was dated 02/27/2020 exceeding the annual requirement.”

8VAC20-780-550-D

“Based on interview, the center did not implement a monthly practice evacuation drill. Evidence: The director stated that evacuation drills had not been conducted and that a drill log could not be located.”

8VAC20-770-60-C-2

“Based on a review of seven staff records and interviews, the center did not ensure that one staff member had a central registry finding within 30 days of employment. Evidence: The record for Staff #7, employed on 09/14/2021, contained the results of a central registry finding dated 05/04/2022 exceeding 30 days from the date of employment. The record did not contain documentation of any further contact or follow up as to the status of the request and the staff has been continuously employed.”

8VAC20-780-160-A

“Based on review of seven staff records, the center did not obtain documentation of a negative tuberculosis screening for two staff members at the time of employment and prior to coming into contact with children. Evidence: 1. The record of staff #4, employed 06/02/2022, did not contain documentation of a TB screening. 2. The record of staff #5, employed 06/02/2022, did not contain documentation of a TB screening.”

8VAC20-780-550-F

“Based on interview, the center did not ensure lockdown procedures were practiced at least annually. Evidence: The director stated a lockdown drill had not been conducted and that a drill log could not be located.”

8VAC20-780-60-A-8

“Based on review of children’s records, the center did not obtain a written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: The record of child #8, with a diagnosed food allergy, did not have a written allergy care plan.”

8VAC20-780-550-E

“Based on interview, the center did not practice a minimum of two shelter in place drill in the past year. Evidence: The director stated that they had not conducted any shelter-in-place drill and that a drill log could not be located.”

8VAC20-780-260-A

“Based on review of documentation, the center did not obtain an annual fire inspection report from the appropriate fire official having jurisdiction. Evidence: The most recent fire inspection report was dated 02/26/2021 exceeding the annual requirement.”

8VAC20-780-260-B

“Based on review of documentation, the center did not obtain an annual approval from the health department. Evidence: The most recent health inspection report was dated 02/27/2020 exceeding the annual requirement.”