Haygood KinderCare #300940
4621 Crossborough Rd.
Virginia beach, VA 23455
Current Inspector: Heather Harrell (757) 334-4329
Inspection Date: July 10, 2018 and July 13, 2018
Complaint Related: Yes
- Areas Reviewed:
22VAC40-185 STAFF QUALIFICATIONS AND TRAINING.
22VAC40-185 STAFFING AND SUPERVISION.
22VAC40-185 SPECIAL CARE PROVISIONS AND EMERGENCIES.
An investigation was initiated on 6/29/18 in response to a complaint received by the Eastern Regional Office on 6/29/18 regarding medication administration. An unannounced on-site inspection was conducted on 7/10/18 and a follow-up visit was conducted on 7/13/18. Interviews with staff were conducted and medication, as well as other documents pertaining to the complaint, were reviewed. Based on information gathered during the investigation the complaint is determined to be valid. Violations in the areas of administration, staff qualifications and training, staffing and supervision and special care provisions and emergencies are identified on the violation notice and were discussed with the center's director.
Standard #: 22VAC40-185-40-E Complaint related: Yes Description: Based on interviews with staff, review of medication and review of written policies, the center failed to ensure that the center's activities and services are maintained in compliance with the center's own policies and procedures required by these standards. Evidence: 1. Page 6 of the center's Medication Guide Book states that medication will be given at the "right time" and "exactly as authorized." On 6/26/18, 6/28/18 and 6/29/18, child 1's (age 4 years) medication was not administered as the parent authorized based on his asthma symptoms prior to arriving at the center . 2. Page 8 of the center's Medication Guide Book states that if medication is given at the wrong time "the parent or guardian should be contacted". On 6/26/18, the medication was administered 1 hour and 47 minutes late, only after contact was initiated by child 1's parent. 3. Page 9 of the center's Medication Guide Book states that "medications will be reviewed monthly and expired medications returned to parents." a. The asthma inhaler for child 1 expired on 3/18/18. This medication was still on site and being administered during this complaint inspection. Plan of Correction: The center responded with the following: A Health and Safety Coordinator has been assigned to monitor expiring medications, health care plans, and other safety processes throughout the center. The health and safety coordinator has been in place as of 7/16/18. - All MAT trained staff will check the expiration on BOTH the box and the actual prescription itself prior to accepting medication at the facility and administering. A parent is to be contacted immediately if the dates differ. - All communication surrounding medication shall be documented during the dates the center is required to administer.
Standard #: 22VAC40-185-240-D-4 Complaint related: Yes Description: Based on record review and staff interviews, the center failed to ensure that any child for whom emergency medications have been prescribed shall always be in the care of a staff member who meets required medication administration training. Evidence: 1. Child 1, age 4 years, has an asthma action plan on file for emergency administration of albuterol. The inspector confirmed that the emergency medication was in the facility. 2. On 6/26/18, from 10:05am until 11:45am, there were no MAT trained staff on duty at the facility. Child 1 was in care at the center during that time. a. Staff 1 (Center Director), who is MAT certified, confirmed she was out of the building all day on 6/26/18. b. Staff 3 (Assistant Director) confirmed that staff 4 and 5, who were the other staff with current MAT certification, were both out of the building during this time. Plan of Correction: The center responded with the following: Additional staff have been MAT certified; currently (7) staff have certifications as of 8/21/18 - Staff schedules will reflect that a MAT certified staff is in the building at all times and aware at arrival of whom needs medication, plus the times needed to administer.
Standard #: 22VAC40-185-340-A Complaint related: Yes Description: Based on staff interviews and review of medication, the center failed to ensure that when staff are supervising children, they shall always ensure their care and protection. Evidence: The center failed to ensure the care and protection of child 1, age 4 years, as demonstrated by the following: 1. The parent of child 1 told staff 4 upon arrival on 6/26/18 that child 1 needed emergency medication at 10:00am and after nap due to child 1 having some issues with wheezing and coughing that morning. Staff 4 noted this on the Child Supervision Record (CSR). When staff 6 (child's primary teacher) came on duty she did not follow up to ensure that the medication would be administered. 2. Management and staff both stated in interviews that "sometimes it gets crazy and busy" as to the reason why child 1 did not receive his medication on time. 3. Child 1 was administered an expired asthma inhaler on 6/26/18 at 11:47am only after a follow-up call to the center from the child's parent. This was an hour and 47 minutes after the time that the parent requested it to be administered. The parent spoke with staff 3 (Assistant Director) at approximately 11:45am and asked how child 1 was feeling and if he had received his asthma inhaler. Staff 3 informed the parent that she was unaware that child 1 needed his asthma medication and that he had not been administered the inhaler. 4. Child 1's parent stated that she picked him up from the center in the early afternoon on 6/26/18 and took him to Urgent Care due to his coughing and wheezing. The parent stated that child 1 was having an acute asthma attack and required two breathing treatments and additional medication while at Urgent Care. Documentation provided to the licensing inspector confirmed that child 1 was seen at Urgent Care on 6/26/18 for asthma symptoms. Plan of Correction: The center responded with the following: There has been an immediate change in the management team to ensure that emergency procedures and medication protocol are followed to both KCE and State standards - All current staff and management have been retrained on our medication and health care plan procedures - All staff attended a state ?daily health observation? training on August 30, 2018. - District Trainer has spoken to managers and teachers about what a proper communication system looks like when there is a child in a classroom that has an emergency medication that is that is needed at a certain time. Complete acknowledgements have been placed in their files.
Standard #: 22VAC40-185-510-A Complaint related: Yes Description: Based on interview, medication review and review of written center documents, the center failed to ensure that prescription medication shall be given to a child according to the center's own written policy for administering medication. Evidence: 1. The center's written medication policy states that medication should be administered at the "right time" and "exactly as authorized." 2. Child 1, age 4 years, has an asthma action plan that states he is to be administered two puffs of an asthma inhaler every four hours as needed for coughing and wheezing. a. Child 1's parent informs staff each morning at drop-off if the child is to be administered his medication and what times to administer the medication based upon his symptoms and the time he was administered the medication prior to arrival at the center. This information is written on the Child Supervision Record (CSR) sheet for child 1's class by the opening staff person. 3. On 6/26/18, the CSR sheet states that child 1 was to be administered his inhaler at 10:00am and again when he wakes up from nap (2:30pm). a. The parent called the center at approximately 11:45am to check on child 1. Staff 3 (Assistant Director) told the parent she was unaware the child needed medication. b. According to the medication administration log, child 1 was not administered the medication until 11:47am on 6/26/18. 4. On 6/28/19, the CSR sheet states that child 1 was to be administered his inhaler at 11:00am and 3:00pm. a. There were 2 MAT trained staff on duty at the center at 11:00am. An additional MAT trained person arrived at the center at 11:10am. b. According to the medication administration log, child 1 was not administered the medication until 11:40am. 5. On 6/29/18, the CSR sheet states that child 1 was to be administered his inhaler at 10:00am and 2:30pm. According to the medication administration log, child 1 was not administered the medication until 10:45am. 6. Staff 1 and staff 3 (center management) confirmed the medication for child 1 was not administered at the correct scheduled times on 6/26/18, 6/28/19 and 6/29/18. Plan of Correction: The center responded with the following: Teachers and Center management have been retrained on diligent communication with parents. Despite having spoken to the parents about medication time changes; all instructions must be written down and signed off by parents prior to us administering any medication. - Communication will be going out to all staff and families explaining our medication administering protocol including strict instruction to follow prescription instructions unless we have an updated and signed doctor?s note. (i.e. If the parent says 10 and 230, but the prescription says every 4 hours we have to follow prescription protocol) - Additional staff have been MAT certified; currently (7) staff have certifications as of 8/21/18 - Staff schedules will reflect that a MAT certified staff is in the building at all times and aware at arrival of whom needs medication, plus the times needed to administer.
Standard #: 22VAC40-185-510-C Complaint related: Yes Description: Based on a review of medication, the center failed to ensure that procedures for administering medication shall include methods to prevent use of outdated medication. Evidence: 1. The inhaler for child 1, age 4 years, has an expiration date of 3/18/18. 2. According to the center's medication administration log, the expired inhaler was administered to child 1 a total of twenty-five times between the dates of 4/2/18 and 7/10/18. 3. Staff 1 (Center Director) confirmed that child 1's medication is expired and has not been returned to the parent. Plan of Correction: The center responded with the following: The Health and Safety coordinator along with Center management will be responsible for monitoring expired medications on bi-weekly basis. H/S will initial the monthly Center Safety checklist Twice showing that she has checked medications bi-weekly - All medication expirations will be noted on the center electronic and paper calendars to ensure that they are removed/updated prior to expiration - The district leader will check medication and systems to make sure that everything is being utilized and correct.
Standard #: 22VAC40-185-510-G Complaint related: Yes Description: Based on a review of medication and the medication administration log, the center failed to ensure that prescription medication that would normally be administered by a parent or guardian may be administered to a child by the center provided the medication is administered by a staff member who is trained in medication administration. Evidence: 1. Medication Administration Training (MAT) for staff 2 expired on 3/14/18. Staff 2 administered medication to child 1,age 4 years, on 7/6/18 and 7/9/18 and administered medication to child 2, age 6 years, on 7/2/18. 2. Staff 1 confirmed that MAT training for staff 2 is expired and that staff 2 continued to administer medication after her training expired. Plan of Correction: The center responded with the following: Center Management and Health/Safety Coordinator will ensure that all MAT trainings stay current and there is continuously at least 5 on staff at all times. - Additional staff have been MAT certified; currently (7) staff have certifications as of 8/21/18 - Staff schedules will reflect that a MAT certified staff is in the building at all times and aware at arrival of whom needs medication, plus the times needed to administer.
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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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