VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Lilly Grace LLC
1908 West Club Lane
Richmond, VA 23226
(804) 282-4482

Current Inspector: Sharon Curlee (804) 840-8312

Inspection Date: March 12, 2020

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. 22VAC40-191 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:

None

Comments:

An unannounced monitoring inspection was conducted on March 12, 2020 from approximately 2:30 PM to 5:50 PM to determine the facility's compliance with licensing standards. The staff to child ratios were observed as follows: Infants 3:11, and Toddlers 2:12. Lunch today consisted of cheese quesadilla, green beans, peaches, and milk. All areas used for child care were inspected. The facility has age appropriate materials and supplies. The following required information was posted; the License, most recent inspection notice, emergency numbers, evacuation map/procedures, menu, daily schedules, and various parent information. The first aid kits and non-medical emergency supplies were inspected and found complete. The inspector interacted with staff and children in care. Five staff records and five children's records were reviewed. Medications were reviewed along with authorizations. Staff on site have current First Aid, CPR, MAT, and DHO training. The most recent evacuation drill was documented on 3/10/2020. The most recent shelter-in-place drill was documented on 1/9/20. Health inspection 5/16/19. Fire inspection 7/1/19. If you have any questions, please contact the licensing inspector at 804-662-9092.

Violations:

Standard #:	22VAC40-185-130-B
Description:	Based on a review of 5 children?s records, the center did not obtain documentation of additional immunizations once every six months for children under the age of two years. Evidence: 1. The record for Child #1, who turned two years old in March 2020, indicated an immunization last updated 12/14/18. The immunization record should have been updated by 6/14/19. 2. The record for Child #2, who will turn two years old in April 2020, indicated an immunization last updated on 4/24/19. The immunization record should have been updated by 10/24/19.
Plan of Correction:	Administration will ensure that immunization records are updated every six months for children under two years old.
Standard #:	22VAC40-185-160-A
Description:	Based on a review of five staff records, the center did not ensure that one record contained documentation of a tuberculosis screening, which is required no later than 21 days after employment. Evidence: The licensing inspector observed the record for Staff #1 (hire date 8/27/19) contained a tuberculosis screening dated 9/23/19.
Plan of Correction:	Administration will ensure that staff submit a tuberculosis screening no more than 21 days from their hire date.
Standard #:	22VAC40-185-160-C
Description:	Based on a review of five staff records, the center did not ensure that two staff records contained documentation of an updated tuberculosis screening which is required at least every two years. Evidence: 1. The record for Staff #3 showed a record of last having a tuberculosis screening on 5/25/17. 2. The record for Staff #4 showed a record of last having a tuberculosis screening on 6/25/17.
Plan of Correction:	Administration will ensure that staff update tuberculosis screenings at least every two years.
Standard #:	22VAC40-185-280-B
Description:	Based on observation, the center did not ensure all hazardous substances were kept in a locked place. Evidence: 1. In the toddler bathroom the licensing inspector observed a can of disinfectant on the toilet tank. 2. A bottle of spray disinfectant and two cans of powdered cleaning products were observed in the lower, unlocked cabinet in the toddler bathroom. 3. In an unlocked closet in the toddler bathroom, 2 containers of an ice melt product were observed. The labels on the ice melt products had warnings listed to include ?keep out of the reach of children? and ?harmful if swallowed.?
Plan of Correction:	Corrected on site.
Standard #:	22VAC40-185-450-C
Description:	Based on staff interviews, the center did not ensure that crib sheets shall be clean and washed daily. Evidence: During interviews with the licensing inspector, staff and administration reported that crib sheets are sent home each Friday to be washed by parents, and returned clean on Monday. Both staff and administration report the crib sheets are washed once per week.
Plan of Correction:	Administration will update policies and procedures, and notify parents of the need to provide clean crib sheets daily.
Standard #:	22VAC40-185-510-C
Description:	Based on interviews and a review of the center?s written policies and procedures, the center did not ensure that the center?s procedures for administering medication shall include the required information. Evidence: 1. Administration reported the center?s written medication policy is located in the center?s ?Parent Handbook.? 2. The licensing inspector observed the medication policy located in the parent handbook did not include procedures that ensure that non-prescription medication shall be consistent with the manufacturer?s instructions for age, duration, and dosage. 3. The medication policy did not include the duration of the parent?s authorization for medication, provided that it shall expire or be renewed after ten work days. It did not dictate that long-term prescription drug use and over-the-counter medications may be allowed with written authorization from the child?s physician and parent. 4. The center?s medication policy did not include methods to prevent the use of outdated medication.
Plan of Correction:	Administration will ensure the written medication policies are updated to include all required information.
Standard #:	22VAC40-185-510-N
Description:	Based on a review of medication, the center did not ensure that when an authorization for medication expires, the parent must renew the authorization or the medication must be picked up by the parent within 14 days. Medications that are not picked up by the parent within 14 days shall be disposed of by the center. Evidence: 1. The licensing inspector observed that he authorization for medication at the center belonging to Child #1 expired on 2/12/20. 2. The authorization for medication belonging to Child #3 expired on 1/29/20. 3. The authorization for medication belonging to Child #4 expired on 10/23/19. 4. The authorization for medication belonging to Child #5 expired on 10/16/19. 5. The authorization for medication belonging the Child #6 expired on 10/4/19.
Plan of Correction:	Administration will ensure the medications and authorizations are corrected and procedures will be updated.
Standard #:	22VAC40-185-520-A
Description:	Based on review of medication, the center did not ensure that all nonprescription drugs shall be used in accordance with the manufacturer?s recommendations. Nonprescription drugs shall not be kept or used beyond the expiration date of the product. Evidence: 1. The licensing inspector observed the medication for Child #4 had an expiration date of January 2020. 2. Child #6 was administered 2.5ml of a medication on 10/2/19. The product label dosage instructions state when children are under two years old, ?ask a doctor.? There was no dosage information from the child?s doctor available.
Plan of Correction:	Administration will ensure that nonprescription medications not kept beyond their expiration date, and are administered according to the manufacturer?s recommendations unless documentation is received from the child?s physician.
Standard #:	22VAC40-191-60-B
Description:	Based on a review of five staff records, the center did not ensure that one record contained a complete sworn statement prior to employment. Evidence: The record for Staff #1 indicated a hire date of 8/27/19 and a sworn statement dated 8/28/19.
Plan of Correction:	Administration will ensure that staff complete a sworn statement no later than their first day of employment.