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Heritage Child Development Center
224 Mosby Blvd.
Berryville, VA 22611
(540) 955-4194

Current Inspector: Barbara Workman

Inspection Date: July 8, 2016 and July 28, 2016

Complaint Related: No

Areas Reviewed:
22VAC40-185 STAFF QUALIFICATIONS AND TRAINING.
22VAC40-185 SPECIAL CARE PROVISIONS AND EMERGENCIES.

Comments:
An unannounced investigation was conducted on July 8, 2016 and today due to the facility self-reporting an overdose in the administration of two prescribed medications on July 6, 2016. Interviews were conducted and documentation reviewed. There was a preponderance of evidence found that a staff person administered an incorrect dosage of two medications to a child in care. The self-reported incident is valid. Areas of non-compliance are identified on the violation notice. Should you have any questions please telephone your licensing inspector at (540) 430-9257.

Violations:
Standard #: 22VAC40-185-240-D-1-b
Description: Based on interviews and documentation medications were administered on July 6, 2016 by a staff person who had not received updated Medication Administration Training within the last three years. Evidence: 1. On July 22, 2016 the licensing inspector requested a copy of the most recent Medication Administration Training for staff #1. The most current training for staff #1 had been completed on February 16, 2013. 2. On July 22, 2016 staff #3 confirmed with staff #1 that she had not taken Medication Administration Training this year and that February 16, 2103 was the most current medication administration training she had received.

Plan of Correction: There was a change in management the end of March, 2016. The inherited tickler file unfortunately did not have the dates for updating expiring MAT training. We do currently have adequate MAT trained staff to cover any needed medication administration needs. Dates for staff to have updated training is now checked daily to prevent this from happening again. Every staff has received our medication administration checklist and guidelines.

Standard #: 22VAC40-185-510-A
Description: Based on interviews and documentation the facility failed to administer two prescription medications according to the center's written medication procedures. Evidence: 1. The procedure states, "Read Medication Instructions - Confirm the name of the student & the dosage needing to be administer to the child on the student's medication." On July 8, 2016, staff #1 reported, "I do not know why I did not follow MAT protocol but I did not take the signed permission to give the medicine with me. When I dispensed the medicine I for some reason had the number 5 ml in my head. It was not the correct amount to be given. When I returned to where the medicine papers were and signed the papers I looked at the front and immediately realized I had made a mistake." 2. The center's written medication procedure states, "Administer medication in front of a witness. The witness must confirm the amount of medication that is prescribed by the doctor on the student's medication." On July 6, 2016, staff #3 reported, "The error was caught right away by staff #1, she told the witness in the room staff #2 what she had done. Staff #2 confirms that staff #1 did give 5 ml of each medication to child #1." On July 27, 2016 staff #2 stated she was the witness on July 6, 2016 and that she did not confirm the dosage amount for the medications that were prescribed by the doctor for child #1 prior to staff #1 administering the medications.

Plan of Correction: Prior to this incident only MAT trained staff had our medication administration checklist however understanding that all staff might act in the role of witness all staff have been given the checklist and notified of the procedure.

Standard #: 22VAC40-185-510-C
Description: Based on review of written documentation provided by the facility, the facility failed to ensure required procedures were in place for administering medication. Evidence: 1. The written medication administration documentation provided by the facility did not include procedures for nonprescription medication to be administered in accordance with manufacturer's instructions for duration and dosage and methods to prevent use of outdated medication.

Plan of Correction: Our policy will be reviewed and revised to provide written notice for nonprescription medication to be administered in accordance with the manufacturer's instruction for duration and dosage. We will add written notice as to our policy/methods to prevent use of outdated medication. The board has to approve any changes or revisions to the staff and parent handbook.

Standard #: 22VAC40-185-510-G
Description: Based on self-report by the facility, documentation and interviews the facility failed to administer two prescription medications to a child in accordance with the prescriber's instructions pertaining to dosage.

Evidence:

1. On July 8, 2016 the licensing inspector interviewed staff #1 who stated she didn't know why she did not follow protocol when she gave child #1 the wrong dose of two medications but the 5 ml was what stood out in her mind and this was the wrong dosage of medication for both prescribed medications that she administered to child #1 on July 6, 2016.

2. July 8, 2016 staff #1 provided a written statement that acknowledged that once she returned to where the medication consent forms were and signed the medication administration record, she looked at the front of the consent form and immediately realized the mistake in dosage of the two medications.

3. On July 8, 2016 staff #2 stated that she was present when staff #1 gave the 5 ml in error of antibiotics and steroids to child #1 and that staff #1 immediately told her of the error she had made.

4. On July 6, 2016, child #1, a 4 month old infant, was taken to the emergency room and diagnosed with an accidental or unintentional overdose.

Plan of Correction: With everyone being aware of the steps and the need to follow-through on both staff clarifying the right medication, the right child and right dosage for the right child there should be no mistakes.

Disclaimer:
A compliance history is in no way a rating for a facility.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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