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Children of America (Winchester), LLC
631 West Jubal Early Drive
Winchester, VA 22601
(540) 667-7003

Current Inspector: Diann S. Reed (540) 280-0742

Inspection Date: April 23, 2019 , April 25, 2019 , April 30, 2019 , May 3, 2019 , June 3, 2019 and June 17, 2019

Complaint Related: Yes

Areas Reviewed:
22VAC40-185 ADMINISTRATION.
22VAC40-185 STAFF QUALIFICATIONS AND TRAINING.
22VAC40-185 STAFFING AND SUPERVISION.
22VAC40-185 SPECIAL CARE PROVISIONS AND EMERGENCIES.
22VAC40-191 Background Checks (22VAC40-191)

Technical Assistance:
A supplemental page was provided.

Comments:
The licensing inspector conducted an unannounced complaint inspection on 04/23/2019, 04/25/2019, 04/30/2019, 05/03/2019, 06/03/2019, and 06/17/2019. The inspection was in response to a complaint that was received in the Valley Licensing Office on 04/22/2019. The on-site portion of the inspection was conducted on 04/25/2019 from 10:00a.m. to 12:15pm. On this date, there were 68 children present and in the care of 17 staff members. There were a total of 133 children enrolled in the center. Five staff members and one parent were interviewed. The records of one staff member and one child were reviewed. The allegations were regarding Part VII of the licensing standards. The violations of the licensing standards were noted on the violation notice and the risk ratings associated with the violations were noted on the supplemental page. An exit interview was conducted on 06/27/2019.The preponderance of the evidence gathered during the investigation did support the allegations and the complaint disposition was, therefore, "Valid." Please complete and submit your ?Plan of Correction? for each violation cited on the violation notice to the licensing inspector within five calendar days of receipt. If you have any questions, please contact your licensing inspector, Diann Reed, at (540) 280-0742.

Violations:
Standard #: 22VAC40-185-340-A
Complaint related: No
Description: Based on interviews with one adult and five staff, review of a prescription medication label and a medication administration log, the center failed to ensure the care and protection of one child when administering medication. Evidence: 1. At 12:03p.m. on 04/19/2019, Staff #3 administered five times the prescribed dose of a medication to Child A. The prescription label on the bottle read, ?Take ? (one-half) tablet by mouth at noon.? At morning drop-off, Parent #1 reported there were five ? tablets in the bottle. At approximately noon and prior to administering the medication, Staff #3 asked Staff #2 why the medication pieces were so tiny and Staff #2 looked in the bottle and stated, ?Mom had already broken them up.? Staff #3 assumed that meant that Mom had broken them up so it would be easier for Child A to swallow. Staff #3 administered all of the medication in the bottle to Child A. 2. Staff #2 stated, ?I should have used more words. (Staff #3) did not understand.? Staff #2 stated, ?I knew he should have only had one piece, but I did not communicate it.? 3. Staff #1 and Staff #3 reported they were unaware of the medication error until Child A was picked up for the day. 4. According to Poison Control possible symptoms of an overdose for this medication include rapid heart rate, irritability, agitation, altered mental status, and seizures.

Plan of Correction: Staff has been retrained on licensing standards and COA policies for administering medication and will always follow that policy making sure that the correct child is given the correct medication and correct dosage by the correct route at the correct time.

Standard #: 22VAC40-185-510-A
Complaint related: No
Description: Based on interviews with one adult and five staff, review of the center?s policies and procedures for medication management, and verification from staff, the center failed to follow the center?s policy regarding medication administration when administering medication to one child. Evidence: 1. In paragraph 4 of the center?s written Health Policy 1.7 ? Medication Management it states, ?If the medication is a controlled substance the pills must be counted in front of the parent to ensure agreement of quantity received. This number is also recorded on the log.? In paragraph 5 of the same policy it states, ?The child receiving the medication is taken from their classroom and brought to the Director?s office. This allows the child privacy.? 2. On 04/19/2019, Parent #1 brought to the center a prescription bottle of a controlled substance medication to be administered to Child A. Staff #2 took the bottle of prescription medication from Parent #1 and placed it in the locked medication box. The center?s medication management policy was not followed when Staff #2 did not count the number of pills contained in the bottle in front of Parent #1 and did not record the number of pills on the medication log. 3. Parent #1 reported that Staff #2 took the bottle, did not look in it, and locked it in the box. 4. Staff #2 stated, ?I did not open the bottle.? 5. At approximately noon on 04/19/2019, Staff #3 entered Classroom A and administered the medication to Child A. The center?s medication management policy was not followed when Staff #3 did not take Child A from Classroom A to the Director?s office to administer the medication. 6. Staff #3 reported that she took the bottle of medication to Classroom A and she asked Child A to come over to the sink. She gave Child A a cup of water and administered the medication to him. 7. Staff #4 reported he saw Staff #3 administer the medication to Child A in the classroom.

Plan of Correction: When a parent is dropping off narcotic medication a member of the administration will witness the parent count and verify the number of pills. The parent and staff member will sign log verifying the child?s name, name of medication, and the number of tablets or capsules. All narcotic medications will be given in the Director?s office.

Standard #: 22VAC40-185-510-G
Complaint related: No
Description: Based on interviews with one adult and five staff, review of a prescription medication label and a medication administration log, the center failed to administer a drug to one child in accordance with the prescriber?s instructions pertaining to dosage. Evidence: 1. On 04/19/2019, Parent #1 entered the center with Child A and a prescription bottle of medicine. The prescription label on the bottle read, ?Take ? (one-half) tablet by mouth at noon.? At approximately noon, Staff #3 opened the bottle and saw ?five tiny pieces of pills.? Staff #3 administered all of the medication in the bottle to Child A. Child A was administered approximately five times the prescribed dose of medication. 2. Parent #1 reported that she told Staff #2 that she had already cut the pills in half and there were five ? tablets in the bottle. 3. Staff #2 reported that Parent #1 said, ?He (Child A) only gets a half so I have broken them up.? Staff #2 stated, ?I did not open the bottle. I assumed there were many in there but she did not tell my there were five doses.? 4. When Staff #3 opened the bottle to begin medication administration, she stated there were ?five tiny pieces? and asked Staff #2 why the pieces were so tiny. Staff #2 looked in the bottle and stated, ?Mom had already broken them up.? Staff #2 reported, ?They were all jagged. They were pieces but all different sizes. Some looked like a half-moon and some not.? 5. Staff #3 reported, ?It never registered that Mom would bring five doses for one day. There was nothing to judge what ? tablet or one tablet looked like and I thought the five tiny pieces added up to ? tablet.? Parent #1 stated that even if the pieces were cut unevenly and were jagged, one could not combine all five pieces to make one complete tablet.

Plan of Correction: MAT trained staff member will ensure that the correct child is given the correct medication and correct dosage at the correct time and by the correct route.

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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