VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Young Mens Christian Association of the Virginia Peninsulas-R.F.
301 Sentara Circle
Williamsburg, VA 23188
(757) 229-9622

Current Inspector: Christine Mahan (757) 404-0568

Inspection Date: March 10, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-185 ADMINISTRATION. 22VAC40-185 STAFF QUALIFICATIONS AND TRAINING. 22VAC40-185 PHYSICAL PLANT. 22VAC40-185 STAFFING AND SUPERVISION. 22VAC40-185 PROGRAMS. 22VAC40-185 SPECIAL CARE PROVISIONS AND EMERGENCIES. 22VAC40-185 SPECIAL SERVICES. 22VAC40-80 THE LICENSE. 22VAC40-191 Background Checks (22VAC40-191) 63.2(17) License & Registration Procedures

Technical Assistance:

Reviewed and clarified USDA portions as it relates to food offered by the center. Reviewed and clarified requirements for cleaning and sanitizing as it relates to the preventing the spread of disease.

Comments:

An unannounced Renewal Inspection was conducted on March 10, 2020 from approximately 2:20 pm until 6:15 pm. Upon entrance there were 30 children and 2 staff present with children. There were additional staff on site for program and administrative purposes. The record review sample consisted of 6 children's records and 3 staff records. There were no medications on site. Children were observed during their afternoon routine to include during their rest period, reading stories and preparing for snack. The results of the inspection were reviewed and verified with the Program Director during the inspection. The exit interview was conducted with the YMCA Membership Director. Areas of noncompliance are noted on the violation notice. A plan of correction and date of correction for the violations cited must be submitted to the licensing office within 5 days. If you have any questions, contact your licensing inspector at (757) 404-0568. The inspection was amended on March 17, 2020.

Violations:

Standard #:	22VAC40-185-140-A
Description:	Based on review of 6 children's records, the licensee did not ensure each child shall have a physical examination by or under the direction of a physician before the child's attendance or within one month after attendance. Evidence: The records for child #1, start date 3-11-19 and child #4, start date 2-3-2020 did not include documentation of a physical examination. A copy of the physical conducted has to be place in the child's record within one month after attendance
Plan of Correction:	Will make sure all records includes a physical examination before child's attendance.
Standard #:	22VAC40-185-150-B
Description:	Based on review of 6 children's records, the licensee did not ensure each report shall include the date of the physical examination and dates immunizations were received and shall be signed by a physician, his designee, or an official of a local health department. Evidence: The record for child #4, start date 2-3-2020 did not include documentation of immunizations received that were signed by a physician, his designee, or an official of a local health department.
Plan of Correction:	Will be sure to include immunization records signed by a physician in child's records.
Standard #:	22VAC40-185-160-A
Description:	Based on review of 3 staff records, the licensee did not ensure each staff member and individual from an independent contractor shall submit documentation of a negative tuberculosis screening. Documentation of the screening shall be submitted no later than 21 days after employment or volunteering and shall have been completed within 12 months prior to or 21 days after employing or volunteering. Evidence: The record for staff #3 date of hire, 11-11-19 did not include documentation of obtaining a TB screening.
Plan of Correction:	Will ensure all staff have a TB testing no later than 21 days of hire.
Standard #:	22VAC40-185-160-C
Description:	Based on record review of 3 staff records, the licnesee did not ensure that all staff had obtained updated tuberculosis (TB) screenings at least every two years from the date of the first initial screening or testing, or more frequently as if recommended by a licensed physician or the local health department, staff members and individuals from independent contractors shall obtain and submit the results of a follow-up tuberculosis screening. Evidence: The record for staff #1 did not include an updated TB screening. The most recent screening is dated 1-26-2018.
Plan of Correction:	Will make sure all staff moving forward will have their TB test done at least every two years.
Standard #:	22VAC40-185-40-J
Description:	Based on documentation review and staff interviews, the licnesee did not ensure injury prevention procedures shall be updated at least annually based on documentation of injuries and a review of the activities and services. Evidence: The Program Director confirmed there was not an annul injury prevention plan.
Plan of Correction:	Will make sure injury prevention procedures is updated annually.
Standard #:	22VAC40-185-60-A
Description:	Based on review of 6 children's records, the licensee did not ensure each center shall maintain and keep at the center a separate record for each child enrolled which shall contain all the required information. Evidence: The record for child #2 did not include documentation of the complete home address for one of two emergency contacts listed (missing the house number, street name and city).
Plan of Correction:	Will make sure moving forward that a separate record for each child will contain all required information.
Standard #:	22VAC40-185-90--A
Description:	Based on record review of 6 children's records the licensee did not ensure that a written agreement between the parent and the center shall be in each child's record by the first day of the child's attendance. The agreement shall be signed by the parent. Evidence: The records for child #4, #5 and #6 did not include the following written agreements. 1) Authorization for emergency medical care should an emergency occur when the parent cannot be located immediately unless the parent states in writing an objection to the provision of such care on religious or other grounds 2) A statement that the center will notify the parent when the child becomes ill and that the parent will arrange to have the child picked up as soon as possible if so requested by the center 3) A statement that the parent will inform the center within 24 hours or the next business day after his child or any member of the immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases which must be reported immediately.
Plan of Correction:	Will make sure all children's records have a written agreement between parent and center.
Standard #:	22VAC40-185-240-A
Description:	Based on review of 3 staff records and staff interviews, the licensee did not ensure all staff had orientation training completed by the end of their first day of assuming job responsibilities. Evidence: The records for staff #2 date of hire 5-21-19 and staff #3 date of hire 11-11-19 did not include documentation of orientation training completed by the end of the first day of assuming job responsibilities. The following information was required training; -The policies and procedures listed in subsection B of this section and 22VAC40-185-420 A that relate to the staff member's responsibilities; -The center's playground safety procedures -Confidential treatment of personal information about children in care and their families; and -The standards which relate to the staff member's responsibilities.
Plan of Correction:	Will be sure to have all staff have an orientation training,
Standard #:	22VAC40-185-240-B
Description:	Based on record review of 3 staff records and staff interviews, the licnesee did not ensure that by the end of the first day of supervising children, staff shall be provided in writing with all required information. Evidence: The records for staff #2 date of hire 5-21-19 and staff #3 date of hire 11-11-19 did not include information indicating the staff had received in writing the following information by the end of their first day of assuming job responsibilities; -Procedures for supervising a child who may arrive after scheduled classes or activities including field trips have begun; - Procedures to confirm absence of a child when the child is scheduled to arrive from another program or from an agency responsible for transporting the child to the center; - Procedures for identifying where attending children are at all times, including procedures to ensure that all children are accounted for before leaving a field trip site and upon return to the center; - Procedures for action in case of lost or missing children, ill or injured children, medical emergencies and general emergencies; - Policy for any administration of medication; - Procedures for response to natural and man-made disasters.
Plan of Correction:	Will be sure to have staff go through the proper training in a timely manner.
Standard #:	22VAC40-185-540-E
Description:	Based on staff interviews, the licnesee did not ensure they had all required emergency supplies. Evidence: There was not a working, battery-operated radio in each building used by children.
Plan of Correction:	The center will get a replacement battery operated radio for the building.
Standard #:	22VAC40-185-550-M
Description:	Based on documentation review and staff interviews, the licnesee did not ensure the center shall maintain a written record of children's serious and minor injuries in which entries are made the day of occurrence. Evidence: Three injury reports were reviewed and all three did not document the date the parent was notified of the injury and three did not include documentation of any future action to prevent recurrence of the injury.
Plan of Correction:	The center will write in the time that a parent is notified of the incident.
Standard #:	22VAC40-185-560-A
Description:	Based on observation and staff interviews, the licensee did not ensure that a menu listing foods to be served for meals and snacks during the current one-week period shall be posted or sent home/given to the parents. Evidence: The most recent menu posted and available to parents was dated for the week of March 6th.
Plan of Correction:	Will make sure the menu is on the correct week for parents to view.