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Malcolm Cole Child Care Center
839 Estes Street
Charlottesville, VA 22903
(434) 924-2907

Current Inspector: Amy Tomblin (804) 629-3923

Inspection Date: Sept. 14, 2022

Complaint Related: No

Areas Reviewed:
8VAC20-780 Administration.
8VAC20-780 Staff Qualifications and Training.
8VAC20-780 Physical Plant.
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.
8VAC20-820 HEARINGS PROCEDURES.
8VAC20-770 Background Checks (8VAC20-770)
20 Access to minor?s records
22.1 Background Checks Code, Carbon Monoxide
63.2 Child Abuse & Neglect

Comments:
Thank you for your time and assistance with the unannounced renewal inspection conducted on September 14, 2022. The on-site inspection was from 3 p.m. to 6:10 p.m. On this date, there were 89 children present in 11 classrooms and in the care of 17 staff members. A self-reported incident of sight and sound supervision was received on July 26, 2022. The investigation of that incident began on August 25, 2022 and was completed during this renewal inspection. The exceptions to compliance were noted on the violation notice and the risks ratings were noted on the supplemental page. There were eight staff members' records and eight children's records reviewed. The medication and medication paperwork were reviewed for two children. All interactions between children and staff were age appropriate and positive. Some items that were reviewed and observed included: required posted information, injury reports, documentation of evacuation, shelter-in-place, and lockdown drills, emergency supplies, first aid kit, warm water temperature, resilient surfacing, outdoor play, circle time, centers and art activities, infant feeding, diaper changing procedures, hand washing and bathroom procedures, transitions, nap time, and snack. This inspection report was amended on November 7, 2022 to reflect a change in evidence to add the date of the incident.

Please complete the plan of correction and date to be corrected sections for each violation cited on the violation notice and return it to me within 5 calendar days from today. You should 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 preventive measure(s).

Please contact your licensing inspector, Chrystal King, if you have questions concerning this inspection, the licensing standards, and/or if I may be of assistance to you at 804-297-4469.

Violations:
Standard #: 22.1-289.035-A
Description: Based on record review, program failed to ensure that Aall applicants for employment, employees, applicants to serve as volunteers, and volunteers shall undergo a background check in accordance with subsection B prior to employment or beginning to serve as a volunteer and every five years thereafter.

Evidence:

1. The only sworn disclosure statement for Staff #3, hired on 5/22/2017, was dated 8/2/2017.
2. The only central registry results for Staff #3, hired on 5/22/2017, were dated 6/5/2017.
3. The most recent sworn disclosure statement for Staff #6, hired on 3/10/2008, was dated 8/8/2017.
4. The most recent sworn disclosure statement for Staff #8, hired on 8/15/2005, was dated 3/26/2017.

Plan of Correction: Updated sworn disclosure statements were completed for all staff that same day. The statements are in each staff?s file. Sworn disclosure statements will be monitored proactively to ensure renewal prior to every five years.

Standard #: 8VAC20-780-340-F
Description: Based on interviews, program failed to ensure that children under 10 years of age always shall be within actual sight and sound supervision of staff.

Evidence:

1. During interview with Staff #3 on 8/25/2022, Staff #3 stated she entered the 2A classroom at 8:09am on 7/26/2022 and sat with a few children while Staff #9 continued changing diapers. Upon calling the last child for diapering, Child #9, both staff determined that he was not in the classroom. Staff #3 found Child #9, whining slightly, in the foyer between the playground and the hallway, and was returned to classroom. Child #9 received his diaper change at 8:18 am, per their system. Child #9 was not in sight and sound supervision for approximately 12 minutes.
2. During interview with Staff #9 on 8/25/2022, Staff #9 stated that she and another teacher were on the playground with 14 children on 7/26/2022. As they exited the playground, they each took 7 children. Staff #9 completed a face to name check when entering the foyer from the playground, and again when exiting the foyer. When she arrived to the classroom, she still had 7 children, but only realized Child #9 was no longer in her care when she called his name to change his diaper.
3. The program?s transition tracking policy states:
Teachers are required to:
- know the names and the number of children in their care at all times;
-use the We Care Transition Tracking Sheet to account for the children in their care;
-conduct a Face to Name Roll Call whenever a transition through a door or gate occurs,
followed by a Head Count. The Face to Name Roll Call consists of calling each child by name and physically looking at the child to confirm that he/she is present. The Head Count is a simple count which is recorded on the sheet;
4. During interview with Staff #9 on 8/25/2022, Staff #9 completed two face to name roll calls on 7/26/2022, though transitioned through three doors.

Plan of Correction: Immediately upon receiving the report from Staff #3 that Child A was left unattended, both Staff #3 and #9 were placed on administrative leave and written statements about the supervision lapse were obtained from staff, in accordance with our procedures. A self-report was made to licensing and CPS. That same day, the parents of Child #9 were notified about the situation. The Center cooperated with state licensing and CPS, as well as the parents. Staff #9 has resigned. Staff #3 remains on administrative leave, pending the outcome of the licensing and CPS investigations. Child A remains enrolled in the
Center.

Ongoing Corrective Action Steps
All staff have been retrained on Supervision and Transition Tracking and proper
handwashing procedures and expections. A copy of the signed policies are in each staff member?s file. Ongoing unannounced observations of transitions are conducted by center administrators.

Conclusion:
The Center values our relationship with the Office of Child Care Health & Safety and is committeed to meeting all licensing requirements and operating the highest quality program. The Center took immediate and effective steps to respond to this violation notice, correct any deficiencies, and to develop a plan for the future designed to prevent further occurrences. It is our goal to meet and exceed licensing requirements at all times.

Standard #: 8VAC20-780-500-A
Description: Based on observation, program failed to ensure that children?s hands are washed with soap and running water after toileting and any contact with blood, feces, or urine and eating meals or snacks.

Evidence:

On 9/14/2022, Staff #10 was observed changing the diapers of three children in Toddler B classroom. None of the children?s hands were washed after having their diaper changed. Each child then sat down to eat their afternoon snack.

Plan of Correction: All staff in the Toddler B classroom have been re-trained on our hand washing policy and a signed copy of the policy has been placed in each staff member?s file. Center administrators conduct random observations to ensure both staff and children are routinely washing their hands after all bathroom and diaper changing events. Our hand washing policy will be reviewed on a regular basis at staff meetings and for all new hires.

Standard #: 8VAC20-780-510-L
Description: Based on observation, program failed to ensure that medication was kept in a locked place using a safe locking method that prevents access by children.

Evidence:

On 9/14/2022, while reviewing medication and authorization paperwork for Child 1M in Toddler B classroom, medication was stored in a bag that was not locked.

Plan of Correction: The broken medication bag was immediately replaced with a new bag with a properly functioning lock. Medication bags will be checked monthly to ensure proper functionality.

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.

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