VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Mae's Learning Academy
712 West Broadway
Hopewell, VA 23860
(804) 704-4523

Current Inspector: Sharon Curlee (804) 840-8312

Inspection Date: Feb. 2, 2022

Complaint Related: No

Areas Reviewed:

8VAC20-780 ADMINISTRATION. 8VAC20-780 STAFFQUALIFICATIONS AND TRAINING. 8VAC20-780 PHYSICAL PLANT. 8VAC20-780 STAFFING AND SUPERVISION. 8VAC20-780 PROGRAMS. 8VAC20-780 SPECIAL CARE PROVISIONS AND EMERGENCIES 8VAC20-780 SPECIAL SERVICES. 8VAC20-820 THE LICENSE. 8VAC20-820 THE LICENSING PROCESS. 8VAC20-820 SANCTIONS. 8VAC20-820 HEARINGS PROCEDURES. 8VAC20-770 BACKGROUND CHECKS 22.1 EARLY CHILDHOOD CARE AND EDUCATION

Comments:

A renewal inspection was initiated on February 2, 2022 and concluded on April 21, 2022. The licensing inspector was onsite from on February 2, 2022 and on April 21, 2022. The director assisted with the inspection. There were 45 children present during the inspection on April 21, 2022, ranging in ages from fiv months to five years, with six staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, staffing and supervision, programming, medication, special care and emergencies and nutrition. A total of four child records and eight staff records were reviewed. Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the program.

Violations:

Standard #:	22.1-289.035-B-2
Description:	Based on review of eight staff records and interview, the center did not obtain results of the national fingerprint background check prior to hire for two staff. Evidence: 1. The record of staff #2, hired 11/22/2021, contained a completed national fingerprint background check dated 11/24/2021 exceeding the date of hire. 2. The record of staff #5, hired 12/12/2021, contained a completed national fingerprint background check dated 01/20/2022 exceeding the date of hire.
Plan of Correction:	Per the director: Effectively immediately there is a system in place after the interview if the individual is a candidate for hire the fingerprints is schedule immediately after, and the start date will be after the results are emailed.
Standard #:	22.1-289.035-B-4
Description:	Based on a review of eight staff records, the center did not obtain the results of a criminal history record information check, the results of a sex offender registry check, and a search of the child abuse and neglect registry or equivalent registry from any state in which two staff member had resided in the preceding five years within the required time frame. Evidence: 1). The record for Staff #5, hired on 12/12/2021, indicated the staff had resided in a state outside of Virginia within the last five years. The record did not contain a documentation of a criminal history record information check or a search of the child abuse and neglect registry for that state. 2). The record for Staff #8 (hired 06/09/2021), was reviewed during the initial inspection on 06/04/2021. The sworn statement (dated 05/17/2021) stated staff #8 had not lived outside the state of Virginia in the past five years prior to hire. During record review on April 21, 2022, the record of staff #8 stated on a second sworn statement dated 05/17/2021 that staff #8 had lived outside of Virginia in the past five years. The record for staff #8 did not contain documentation of a criminal history record information check or a search of the child abuse and neglect registry for that state. When asked by the inspector if he had lived outside of Virginia in the past five years, staff #8 would not give a reply. 3. The out-of-state criminal history record information check is required to be obtained prior to hire. The out-of-state search for founded complaints of child abuse or neglect is required to be requested within the first 30 days of being hired. During interview, the director confirmed the required out-of-state checks were not obtained for Staff #8.
Plan of Correction:	Per the director: Since inspection a system has been developed in order to ensure that all background checks are completed before the start date. The week before the inspection there were four employees that quit without the two weeks' notice. If this shall happen again the center will shut down until it can be back fully staffed. Director have researched on the Department of Education website to properly conduct out of state background checks. Employee #5 is no longer with the center. I am currently working on an out of state background check
Standard #:	8VAC20-770-40-D-6
Description:	Based on review of eight staff records, the center did not obtain a completed sworn statement prior to the first day of employment and completed no more than 90 days prior to employment for two staff. Evidence: 1. The record of staff #1, hired 12/09/2021, had a sworn statement dated 08/03/2021 exceeding 90 days prior to employment. 2. The record of staff #6, hired 12/07/2021, had a sworn statement dated 07/12/2021 exceeding 90 days prior to employment.
Plan of Correction:	Per the director: A sworn statement cannot exceed 90 days from the hire date. If the employee return to back to the center fill out entire application process. For instance, if a college student fills out an application on break, they must redo the process if hired on their next break out of school.
Standard #:	8VAC20-770-60-C-2
Description:	Based on review of eight staff records and interview, the center did not obtain a central registry report within 30 days of employment. Evidence: 1. The record of staff #2, hired 11/22/2021, had documentation of a central registry report dated 01/26/2022, exceeding 30 days from employment. The director stated she had not conducted a follow-up at 30 days to check on the status of the request. 2. The record of staff #3, hired 12/09/2021, had documentation of a central registry report dated 01/28/2022, exceeding 30 days from employment. The director stated she had not conducted a follow-up at 30 days to check on the status of the request. 3. The record of staff #7, hired 12/12/2021, did not have documentation of a central registry check on file. The director stated she did not follow-up to check the status at 30 days but did email the agency on 02/07/2022 for the status.
Plan of Correction:	Per the director: All Central registry will be sent off the same day of hire. At the 30th day an email will be sent and followed up with a phone call. If the results are not in at the 45th day, another email will be sent and followed up by a phone call. At this time if there are no results in, an email will be sent, and license inspector will be in the cc line of email.
Standard #:	8VAC20-780-40-E
Description:	Based on observation and interview, the center failed to follow the terms of the current license issued by the department. Evidence: 1. On April 21, 2022, 45 children were present during the inspection. 2. The capacity issued on the license is for 39 children. 3. The director confirmed there were 45 children present exceeding the issued capacity of 39.
Plan of Correction:	Per the director: Director will ensure to not fill slots until the children or child is no longer in the center when a two-week notice is given. Once a two-week notice is given, child will be accepted after the child last day so there will be no overlapping in care.
Standard #:	8VAC20-780-70
Description:	Based on review of eight staff records, the center did not obtain all required documentation for each staff record. Evidence: The records of staff #1(hired 12/09/2021), staff #2 (hired 11/22/2021), staff #3 (hired 12/09/2021), staff #6 (hired 12/07/2021) and staff #7 (hired 12/12/2021) did not contain two references.
Plan of Correction:	Per the director: All references have been placed in employee files. Future employees will turn in references with resume when file is being completed.
Standard #:	8VAC20-780-90--A
Description:	Based on review of three children?s records, the center did not obtain the parents signed acknowledgement of the written agreement between the parent and the center by the first day of the child?s attendance. Evidence: The record of child #1, enrolled 07/09/2021, did not contain a signed copy of the parent agreement. The child?s record was a licensed family day home enrollment record and did not contain 1. A statement that the center will notify the parent when the child becomes ill and 2. A statement 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.
Plan of Correction:	Per the director: All files have been updated with parent agreement contract; all child records have been updated in each file. All necessary forms directed by Department of Social Service have been added to file.
Standard #:	8VAC20-780-245-L
Description:	Based on interview, the center did not ensure there was always at least one staff member on duty who has obtained within the last three years instruction in performing the daily health observation of children. Evidence: The center director stated no staff had completed the daily health observation training.
Plan of Correction:	Per the director: The Director and another staff member have enrolled to take the daily Health Observation course scheduled for August 1.
Standard #:	8VAC20-780-270-A
Description:	Based on observations, the center did not ensure all areas of the center, inside and outside, were maintained in a safe, clean and operable condition. Evidence: 1. On February 2, 2022, The wooden tabletop of the playhouse was broken off, exposing the two nails. 2. On February 2, 2022, The wooden railing along the platform of the clubhouse climber/slide, approximately 2 feet from the ground, was missing a screw at one end causing the railing to hang down and create an opening a child could fall through. 3. On April 21, 2022, a high chair was observed with a broken foot support beam exposing a wooden edge that could snag the skin of the child. The high chair was occupied by a two year old child whose feet reached the broken beam.
Plan of Correction:	Per the director: Since the inspection the wooden house has been completely removed from the playground. The broken railing for the club house climber screw has been replaced and railing has been remounted. Only stackable highchairs are being used, all other highchairs have been removed from the center.
Standard #:	8VAC20-780-280-B
Description:	Based on observation, the center did not ensure hazardous substances such as cleaning materials were kept in a locked place using a safe locking method that prevents access by children. Evidence: On April 21, 2022; 1. Two supply closets located in the hallway, were unlocked and opened creating access to the cleaning materials that were on the floor and lower shelves of the closet. 2. Cleaning materials were observed on the floor of the kitchen and on the counter. Children were observed walking through the open kitchen to move from one side of the building to the other. 3. A canister of fabric sanitizer was observed on the bookshelf in the occupied preschool classroom accessible to children in care. 4. A canister of air freshener was observed on the sink of the bathroom used by children in care. 5. The wall cabinet containing cleaning products in the toddler classroom was not locked. 6. A bottle of bleach cleaner was observed on the edge of the sink in the Infant class accessible to the children in care.
Plan of Correction:	Per the director; This violation has been rectified by constant training, reinteraction, and follow ups by the Director. A constant rotation by the Director, and reminders of the standards periodically throughout the day. Checks and balances have been put in place to ensure that supplies are secured once they are done cleaning. Closets are checked and reminders are posted on closet doors to close. There are also reminders placed on all cabinets.
Standard #:	8VAC20-780-330-B
Description:	Based on observations made on February 2, 2022, the center did not ensure where playground equipment is provided, resilient surfacing complied with minimum safety standards. Evidence: 1. The clubhouse climber, approximately two feet from the ground was observed on foam puzzle mats less than an inch thick. The puzzle mats were on top of a paved asphalt area. 2. The climbing wall/slide, approximately 3-4 feet from the ground was observed on foam puzzle mats less than an inch thick. The puzzle mats were on top of a paved asphalt area.
Plan of Correction:	per the director: Since the violation rubber mulch have been purchased for the playground. The playground area is scheduled to have an enclosure to keep the mulch in place. Children rakes have been purchased to make it fun for the little ones to put rake the mulch back into place once their recess time is over.
Standard #:	8VAC20-780-340-F
Description:	Based on observation, the center did not ensure that children under 10 years of age were always within actual sight and sound supervision. Evidence: 1. On April 21, 2022, at approximately 10:10 am, six children (four to five years in age) were Observed alone in a classroom watching TV. The director stated she had moved staff #1 from the classroom to cover the toddler room at the licensing inspector?s arrival so that she could leave the toddler classroom. The inspector arrived at 10:00 am. 2. On April 21, 2022, at approximately 12:10 pm, ten children age 3 years, were observed alone as Staff #2 was in the main lobby preparing plates for lunch. Staff #2 left the room two additional times to retrieve food. Each time was approximately one to four minutes. 3. Child #4, age 22 months, was observed leaving the toddler classroom undetected for approximately a minute to a minute and a half and was returned to the class by the inspector. Child #4 exited the toddler classroom a second time. Child #4 reached the hall way, before the director came out of the classroom to retrieve her, approximately one minute.
Plan of Correction:	Per the director: Doors will be closed while class is in session to prevent children from running. A constant reminder will be informed to the children on the importance of staying in the classroom
Standard #:	8VAC20-780-430-M
Description:	Based on interview and observation, the center did not ensure play yards were not used for the designated sleeping area. Evidence: 1. A staff member stated that children in the toddler room slept in the play yards on a regular basis for nap time. The staff member stated the play yards were kept in the hall closet. 2. Six pack and plays were observed in the closet alongside 23 cots.
Plan of Correction:	Per the director: Since inspection date play yards are no longer used in the center. They have been removed due to the lack understanding by staff members that they cannot be used for sleeping. A total of 25 mats were purchased with cots with the addition of mats that was already in inventory.
Standard #:	8VAC20-780-440-A
Description:	Based on observation and interview, the center did not ensure cribs, cots, rest mats or beds were provided for children during the designated rest period. Evidence: Child #5 (17 months in age) was observed sleeping in a bouncy chair in the infant room. Staff #7 stated child #5 slept in the bouncy chair on a regular basis.
Plan of Correction:	Per the Director: The plan of action for this violation is that there have been more cribs placed in the infant room. One of teacher that was present is no longer is employed with the center, but before the responsibility of the infant room is assumed by a new hire training on each baby item will be administered. We are conducting training for staff on the 2nd Saturday of each month. This will allow others to understand how important it is to follow the standards.
Standard #:	8VAC20-780-440-G
Description:	Based on observation and interview, the center did not ensure cribs were used for children under 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Evidence: On April 21, 2022, One child was observed sleeping in bouncy chairs. Staff #7 stated the child, child #6 (5 months) usually slept in the bouncy chair as there were not enough cribs. Ten children were present in the infant room with six cribs.
Plan of Correction:	Per the director: Since date of violation extra cribs have been purchased. Staffed is being trained on standards policies and procedures. Infant room staff will be familiar with each piece of equipment according to what it was manufactured for.
Standard #:	8VAC20-780-560-F
Description:	Based on observation and interview, the center did not post a menu listing foods to be served for meals and snacks during the current one-week period. Evidence: 1. There was no menu posted. 2. . The director stated the menu had not been complete for the week of 04/18/2022.
Plan of Correction:	Per the director: A checklist has been created for monthly posting in the center. The menu will be posted on first business of day of the month.
Standard #:	8VAC20-780-560-M
Description:	Based on observation, the center did not ensure children were not permitted to drink or eat while walking around. Evidence: On April 21, 2022, a child was observed walking around the infant room with a bottle.
Plan of Correction:	Per the director: Bottles and sippy cups are off limits to children while they are not seated. No child will drink while walking. Signs have been posted stating no drinking while walking
Standard #:	8VAC20-780-570-A
Description:	Based on observation on February 2, 2022, the center did not ensure when a child is placed in an infant seat or high chair, the protective belt was fastened securely. Evidence: Four infants were observed sitting in bucket seats at the feeding table. The four infants were not fastened with the protective belts.
Plan of Correction:	Per the director: All staff have been briefed on the importance of always fastened the seatbelt in the circle table with inserted chairs. There will be frequent checks and follow ups to ensure the staff are in compliance with the training that has been given to them. At know time will a child be put in a chair or the table without fastening the seatbelts. Checks will frequently be conducted, and constant reminders will be made periodically through the day.
Standard #:	8VAC20-780-570-C
Description:	Based on interview, the center did not maintain a record of each child on formula that contained the brand of formula and the child's feeding schedule. Evidence: Staff #7 stated they did not have a record of the brand of formula or the feeding schedule for the children on formula. In care.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	8VAC20-780-570-E
Description:	Based on observation, the center did not ensure prepared infant formula was dated and labeled with the child's name. Evidence: 1. Two prepared bottles in the infant room refrigerator did not have a date. 2. Two bottles on the counter were not labeled with a name or date. Staff stated they had run out of labels.
Plan of Correction:	Per the director: Since inspection all bottles are labeled in the morning before they are carried into the infant room. Parents that bring bottles in the morning are labeled immediately upon arrival. Systems are being set in place to ensure that dates are placed on bottles. We used tape and a permanent marker for labeling purposes.