VIRGINIA DEPARTMENT OF SOCIAL SERVICES

PCCA Head Start Refuge Temple #2
205 Clearview Dr.
Martinsville, VA 24112
(434) 432-8911

Current Inspector: Tara K Martin (804) 588-2371

Inspection Date: Aug. 29, 2022 and Aug. 30, 2022

Complaint Related: No

Areas Reviewed:

8VAC20-780 Administration 8VAC20-780 Staff Qualifications and Training 8VAC20-780 Physical Plant 8VAC20-780 Staffing and Supervision 8VAC20-780 Programs 8VAC20-780 Special Care Provision and Emergencies 8VAC20-780 Special Services 8VAC20-770 Background Checks 22.1 Background Checks, Code, Carbon Monoxide

Comments:

A renewal inspection was conducted on 08/29/2022 (announced- staff record review at corporate office) and 08/30/2022 (unannounced on-site inspection). There were 11 children, ages 3 years-4 years, and 2 staff members providing direct supervision present during the inspection. The inspector reviewed compliance in the areas of administration, staff qualifications and trainings, physical plant, staffing and supervision, programs, special care provisions and emergencies and special services. The children were observed during arrival, meal time, teacher initiated activities, free choice activities and outdoor activity. The inspector discussed the following with the provider: outdoor activity. A total of 5 children?s records, 2 staff records, 6 agent/officer records and 1 medication were reviewed. On 08/29/2022, the inspector arrived for the staff record review on 10:00 am and departed at 12:00 pm. On 08/30/2022, then inspector arrived for the on-site inspection at 8:15 am and departed at 11:30 am. Information gathered during the inspection determined non- compliance with applicable standards or law and violations were documented on the violation notice issued to the provider.

Violations:

Standard #:	22.1-289.036-A
Description:	Based on record review and discussion with staff, the center failed to ensure that every applicant for licensure as a child day center shall undergo a background check in accordance with the Code of Virginia prior to issuance of license and every five years thereafter. Evidence: 1. The most recent sworn statement for Agent 1 was dated 8/14/2017. Staff 3 confirmed there was not a sworn statement for 2022 available during the inspection. 2. The most recent sworn statement for Agent 2 was dated 8/14/2017. Staff 3 confirmed there was not a sworn statement for 2022 available during the inspection. 3. The most recent sworn statement for Agent 3 was dated 8/20/2017. Staff 3 confirmed there was not a sworn statement for 2022 available during the inspection. 4. The most recent search of the central registry on record for Agent 6 was dated 08/02/2017. Staff 3 confirmed there was not a central registry for 2022 available during the inspection.
Plan of Correction:	Required information will be obtained by 8/31/2022.
Standard #:	8VAC20-780-510-F
Description:	Based on observation and discussion with staff, the center failed to ensure medication authorization shall be available to staff during the entire time it is effective. Evidence: There was not an authorization form available for medication 1 at the time of inspection. Staff 2 confirmed it was not available.
Plan of Correction:	Staff will seek required information from the parent by 8/31/2022.
Standard #:	8VAC20-780-510-G
Description:	8VAC20-780-510-G Based on observation, the center failed to ensure medication shall be labeled with the child?s name, the name of medication, dosage amount, and the time or times to be given. Evidence: Medication 1 was in a Ziploc bag with the letter ?P? written on it. Neither the bag nor the medication was labeled with the child?s name, the name of medication, dosage amount, and the time or times to be given.
Plan of Correction:	Staff will return the medication to the parent by 8/30/2022.