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Four Seasons Learning Center
254 Lakeview Drive
Charlottesville, VA 22901
(434) 975-4455

Current Inspector: Maureen Gallagher-McLeod (540) 430-9259

Inspection Date: Dec. 4, 2018

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.
22VAC40-80 THE LICENSING PROCESS.
22VAC40-191 Background Checks (22VAC40-191)
32.1 Report by person other than physician
63.2 Child Abuse & Neglect
63.2(17) License & Registration Procedures
63.2 Facilities & Programs.

Technical Assistance:
We discussed the requirements for infant care, safe sleep practices, diapering procedures, hand washing, staff records, background checks, staffing, and nutrition. The risk assessments for violations were provided.

We reviewed options for washing infant's hands after they have a diaper change. Also, we talked about the importance of offering a variety of play experiences for infants. When an infant is placed in a crib during awake time for the purpose of play, we talked about toys and books that can be made available. Caregivers assigned to infants need to make sure all children have a variety of experiences and consistency with care during awake time.

Please, submit a copy of the fire inspection report when received. Also, submit the received background checks addressed in the violation notice.

Comments:
Thank you for your assistance during the unannounced renewal inspection conducted from 11:15 AM to 5:45 PM. Today, there were thirty children, ages infancy through four years, with five to seven staff. Two school age children arrived at 2:45 PM for care. I viewed program activities, daily routines, staffing, supervision, interactions with children, equipment, infant care and records, injury records, emergency supplies and drill records, posted information, menu/nutrition, asbestos inspection requirement, policies and procedures, diapering procedures, five records for children, seven staff records, staff qualifications, staff training, indoor and outdoor areas. The children have been provided regular group activities such as stories, music and art/crafts. Outdoor experiences have been offered, weather permitting. We discussed the importance of maintaining compliance with minimum standards for health and safety. During the last monitoring inspection, administrative staff were encouraged to attend another training in licensing standards. Availability of monthly training was discussed again and information is available by contacting the Valley Licensing Office. Let me know if you have any questions or need any assistance. 540/430-9259

Violations:
Standard #: 22VAC40-185-70-A
Description: Based on a review of seven records for staff, and interviews with administrative staff, there was required information missing from records of two staff. Evidence: There were not at least two reference checks documented for staff member 2 who began employment on November 30, 2018. An incorrect date of hire for staff member 1 was written in the record as August 21, 2011 and administrative staff indicated the hire date for August was in 2018. There was no documentation of the date and change of position now held by staff member 1. In addition, there was no documentation of the programmatic group care experience in the record of staff member 1 to demonstrate the minimum amount of experience for meeting lead supervisor qualification requirement. There were only previous employment positions unrelated to supervising children listed on the job application.

Plan of Correction: The administrative staff will obtain and document two objective references for staff member 2. The correct hire date, position title and promotion date will be written in the record of staff member 1. The administrator will make sure all required information is kept in each staff record. The administrator will make sure all programmatic experience, including the type and dates, will be added to the file of staff member 1. The administrator will make sure there is a method for staff to provide written information about all programmatic experience when they apply for a job and to determine qualifications for positions at the center.

Standard #: 22VAC40-185-330-B
Description: Based on measurement of the resilient surfacing at fall zones of equipment, and an interview with administrative staff, there was less than six inches of mulch encompassing sufficient area at the fall zones of all equipment. Evidence: The mulch had disintigrated to dirt consistency and had a depth of two to three inches in some side areas of a pink slide with a height of two feet six inches. Also, there were weeds growing on part of the mulched area three to six feet from the same pink slide. The use zone was six feet from the perimeter of the slide bed.

Plan of Correction: The administrator will arrange to have the weeds removed. New mulch is available to place in the fall zones at a depth of at least six inches. The administrator will have a schedule for checking the condition of the mulch and staff will continue to rake after frequent use of the playground. The staff will be told to report any need to add mulch or do maintenance such as weed removal.

Standard #: 22VAC40-185-350-C
Description: Based on observation after nap time ended, and an interview with staff, the staff-to-children ratio applicable to the youngest child in a mixed age group was not complied with in the preK room. Evidence: At 2:50 PM, two eight year old school age children who were seen after arrival near the front entrance at 2:45 PM were with a group of eleven preschool age children, ages three through four years, who were just up from nap with one teacher. The staffing requirement of one staff per ten children was not met until three children left by 2:58 PM. No additional staff came to assist with the group to meet staffing requirements. Administrative staff had reported that a staff person normally working with preschool age children was off work this date.

Plan of Correction: The administrative staff will make sure staff are scheduled and assigned to meet the staffing requirements after nap time. The administrative staff will communicate with parents of drop-in children about the need to arrange with the center about attendance and availability of staff. The administrative staff will hire additional substitute staff for days staff are absent.

Standard #: 22VAC40-185-370-1
Description: Based on observation of a sleeping infant, and interviews with staff, there was an infant who was unable to roll over from prone position (on stomach) to supine position (on back) that was placed in her crib on her stomach for sleep. Evidence: The licensing inspector asked about the age of child 1 that was seen sleeping on her stomach at 12:05 PM. A caregiver indicated that the infant was eight weeks old. However, according to the record of child 1 she was three months old. When asked about the current sleep period, staff member 1 said child 1 had been placed on her stomach in the crib and asleep since her parent dropped off child 1 at 7:50 AM. The child was described as sleeping much of the day for long periods. When questioned about child 1's sleep position, staff member 1 indicated child 1 has been placed on her stomach for sleep because the parent told her that is how child 1 sleeps.

Plan of Correction: An administrative staff person immediately moved the child to her back. The administrative staff will instruct infant staff to always place children on their backs in their crib for sleep. Administrative staff will instruct staff to inform them immediately if a parent requests a procedure, such as a sleep practice, which is contrary to the way staff received training and is a known safety practice and requirement. Administrative staff will monitor safe sleep practices for young infants.

Standard #: 22VAC40-185-370-5
Description: Based on observation of the play spaces and routines for infants, and an interview with staff, the center failed to ensure that infants who cannot turn themselves over and are awake, shall be placed on their stomachs a total of 30 minutes each day to facilitate upper body strength and to address misshapen head concerns. Evidence: During a review of the infant daily sheets around 12:00 noon, the section for recording the tummy time was undocumented for child 1 who was age three months and it was confirmed with staff that child 1 could not roll from her stomach to her back. Staff member 1 indicated that child 1 did not like tummy time and did not confirm a regular routine for providing awake time on the stomach for infants who do not roll over. After the requirement for tummy time was discussed with staff member 1 and 6, the inspector returned to the infant room during the afternoon when she was told by staff member 6 that child 1 had started tummy time for an unspecified amount of time. However, infant 1 was seen awake in an infant seat and there was not any documentation on the daily record. At 3:20 PM, the inspector viewed the daily sheet and there was not any documentation of the tummy time. At least thirty minutes of tummy time was not provided on December 4, 2018 for child 1.

Plan of Correction: The administrative staff will train the infant staff on ways to provide tummy time during the day and documenting each time an infant spends time awake on their stomach. Administrative staff will make sure infant tummy time is attempted each day with infants who cannot turn themselves over and the times will be documented in the daily record.

Standard #: 22VAC40-185-420-E-1
Description: Based on a review of the infant daily records, and interviews with staff, the daily record for an infant, who could not roll over by herself, did not include the amount of time spent awake and on her stomach (prone). Evidence: During a review of the infant daily sheets around 12:00 noon, the section for recording the tummy time was undocumented for child 1 who was age three months and it was confirmed with staff that child 1 could not roll from her stomach to her back. After the requirement for tummy time was discussed with staff member 1 and 6, the inspector returned to the infant room during the afternoon when she was told by staff member 6 that child 1 had started tummy time for an unspecified amount of time, however, there still was not any documentation on the daily record.

Plan of Correction: The program director and administrative staff will make sure staff who care for infants understand the requirement for tummy time and that it is offered during periods of awake time so that young infants have at least thirty minutes total each day of attendance.

Standard #: 22VAC40-185-500-A
Description: Based on observation of diapering procedures, and an interview with staff, hand washing procedures were not followed after diaper changes. Evidence: After a diaper change and the disposal of diapers, wipes and disposable gloves soon after twelve noon in the younger infant room, staff member 1 was seen carrying the infant to the far end of the room, taking out two bottles of formula from the refrigerator, and started to heat a bowl of water in the microwave. When questioned about hand washing after the diaper change, staff member 1replied she did not wash hands because she wore gloves.

Plan of Correction: The administrative staff will instruct staff to always wash hands after each diaper change, including when disposable gloves have been worn. The administrative staff will conduct regular observations of diapering procedures, especially by newly assigned staff, so that staff can be trained as needed in hand washing procedures to prevent the spread of illness.

Standard #: 22VAC40-185-500-B
Description: Based on observation of diapering procedures for three groups of children, and interviews with staff, used diapers, disposable wipes and gloves were not disposed of as required in the younger infant room. The diapering surface was not cleaned and sanitized as required after diaper changes in the younger infant room and at the toddler diapering area. Evidence: During the late morning, after changing the diaper of an infant, staff member 1 was seen hand lifting the diaper disposal container to discard wipes. The container was located under the diapering table and on a shelf. The hinge for the foot pedal was in view. When questioned about the foot pedal, the staff member turned the container around and then repositioned the lid that was on backwards. Separate cleaning solution and sanitizing solution were not seen in use as required on the diapering surface after the diaper change by staff 1. After changing the diaper of a toddler when nap time was over, staff member 7 was seen spraying the cleaning solution followed immediately with the spraying of a sanitizing bleach solution on the diapering mat. Staff member 7 then wiped the mat which had two solutions on it. The sanitizing solution was not left on the diapering mat, separate from soap solution, for at least two minutes.

Plan of Correction: The administrative staff will instruct the staff in procedures to change diapers and prevent the spread of illness, including the consistent use of the foot pedal so that the container is not opened by lifting the lid by hand. Also, the administrative staff will instruct the staff in the use of first using and wiping a cleaning solution followed by use of the sanitizing solution which needs to stay on the diapering mat for at least two minutes if not left to air dry. New staff will be trained in all diapering practices and will be observed periodically to ensure that they understand the required procedures.

Standard #: 22VAC40-185-560-F
Description: Based on observation of the afternoon snack time for toddlers through school age children, and interviews with staff, the center failed to follow the most recent, age-appropriate nutritional requirements of a recognized authority such as the Child and Adult Care Food Program of the United States Department of Agriculture (USDA). Evidence: The toddler group, two year old group and the combined group of three through eight year old children, were seen eating animal crackers and drinking water. When asked about any other food component offering, staff member 5 said they would normally have served juice, but, so many of the children had colds. The staff member supervising the preschool through school age group said that no one brought juice and she could not leave the room to obtain it.

Plan of Correction: An administrative staff person immediately obtained apple juice to offer to all of the children for snack. The administrative staff will only change planned menu items when a nutrition component is replaced so that two food components are offered for snack. The administrative staff will obtain and refer to a copy of the U.S.D.A. food requirement chart for amounts and nutrition component requirements for meals and snacks. The administrative staff will make sure all staff who prepare and serve snack are trained in nutrition requirements.

Standard #: 22VAC40-191-60-C-2
Description: Based on a review of seven records for staff, and interviews with administrative staff, the central registry finding for one staff member was not obtained as required within thirty days of initial employment. Evidence: Staff member 1 began work on July 3, 2018 and there was not a Virginia Central Registry clearance in the staff record. There was not any documentation of when the request was sent to the agency in Richmond. An administrative staff member indicated that Richmond had been contacted to inquire about the results of the request. However, there was not any documentation of the follow-up efforts to contact the agency.

Plan of Correction: The program director contacted the Virginia Department of Social Services in Richmond after the inspection to obtain a copy of the findings when the search was completed. The program director will document all communication when inquiring about the requested background check. The program director or administrative staff will inform the licensing inspector of the attempts to obtain the background check and send a copy of the background check when it is received by email. In the future, the program director and administrative staff will use a system for tracking background check requests and document in each staff file when requests and inquiries are made. The central registry findings will be obtained within thirty days of hire.

Standard #: 63.2(17)-1720.1-B-3
Description: Based on a review of seven records for staff, and interviews with administrative staff, the center failed to obtain a copy of the results of the child abuse registry, or any equivalent registry, from the state that one staff member indicated living in during the past five years. Evidence: Staff member 4 began employment on July 3, 2018 and indicated she resided in another state during the past five years on the Sworn Statement or Affirmation. There was not a child abuse registry finding in the record. Administrative staff indicated that they did not have it for the record. The request was to be submitted within 30 days after initial employment, and the facility was to follow up no later than forty-five days after the request was made if the results were not obtained. There was not any documentation in the staff record regarding when a request was sent.

Plan of Correction: The program director or administrative staff will make sure the Adam Walsh Child Abuse Registry directions are used to obtain a copy of the out-of-state child abuse registry check. The findings will be obtained, viewed and kept in the staff file. Also, the licensing inspector will be told when the request was made and will be provided a copy of the finding. The administrative staff will always follow the directions for obtaining the out-of-state registry findings and will request the information from another state within the first week of hire for new staff.

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.

Virginia Quality is a voluntary quality rating and improvement system for early care and education facilities serving children ages birth through pre-K. Eligible child care facilities must be fully licensed, licensed exempt and a VDSS subsidy vendor, or a voluntary registered day home and a VDSS subsidy vendor. Only programs enrolled in Virginia Quality will display a rating. Virginia Quality contact information for your region is available at the following link Regional Contacts.

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