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Bon Secours - St. Francis Medical Center
13901 St. Francis Boulevard
Midlothian, VA 23114
(804) 594-4990

Current Inspector: LaTasha Smith (804) 588-2362

Inspection Date: March 2, 2022

Complaint Related: No

Areas Reviewed:
8VAC20-780 ADMINISTRATION.
8VAC20-780 STAFF QUALIFICATIONS AND TRAINING.
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.

Comments:
This inspection was conducted by licensing staff using an alternate remote protocol, including telephone contacts, documents review, and interviews.

A monitoring inspection was initiated on March 2, 2022 and concluded on March 3, 2022. The director was contacted by telephone and a virtual inspection was conducted. There were 70 children present, ranging in ages from 7 months to 5 years, with 13 staff supervising. The inspector reviewed compliance in the areas of administration, staffing and supervision, programming, medication, special care and emergencies and nutrition. A total of 4 child records and 4 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.

Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to me within 5 business days from today. Please specify how the deficient practice will be or has been corrected. Your plan of correction should contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measures. Please do not use staff names; list staff by positions only.

Violations:
Standard #: 8VAC20-780-140-B
Description: Based on a review of children records on March 3, 2022, the center did not ensure a physical exam that was completed prior to a child's first date of attendance was not dated within 3 months prior to attendance for a child that 16 months old at the time of enrollment.
Evidence: Child #2 was 16 months of age on their first date of enrollment on 11/12/21 and documentation of the physical exam was dated 7/22/21.

Plan of Correction: Prior to the child's start date, we will be sure that the physical examination is within the required timeframe for the age of the child.

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. To find programs participating in Virginia Quality, click here.

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