VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Meadowbrook Child Development Ctr
555 Winchester Street
Warrenton, VA 20186
(540) 349-4354

Current Inspector: Angela Dudek (804) 629-8167

Inspection Date: Aug. 24, 2023

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. 8VAC20-770 Background Checks 20 Access to minor?s records 22.1 Background Checks Code, Carbon Monoxide

Technical Assistance:

Provided consultation on the following: 8VAC20-780-70 All staff need to have 2 positive references on file.

Comments:

An unannounced monitoring inspection was initiated on 08/24/2023 from 1:00pm to 1:35pm as the result of a self-reported incident of children ages 19 months through age 2 years old ingesting adult Acetaminophen 650mg and an Antacid at the center during playground time on 8/23/23. Documentation was reviewed, the outdoor playground area was observed and interview with the director was conducted onsite. Staff and parent interviews were conducted offsite. There were 4 violations cited related to the incident and 3 violations cited that were unrelated to the incident. An exit interview was completed on 9/29/23 with the Director to review the findings. Areas of non-compliance are identified in the Violation Notice. Please complete the columns for "Plan of Correction" and "Date to be Corrected" for each violation cited on the Violation Notice, and then return a signed and dated copy to the licensing office by 5pm on 10/6/23. Please email me at angela.dudek@doe.virginia.gov with any questions.

Violations:

Standard #:	8VAC20-780-130-A
Description:	Based on review of 6 child records, the provider did not obtain documentation of updated immunizations once every six months for children under the age of two years. Evidence: 1)The record for Child #1 (2 years old) did not contain documentation of updated immunizations, the most recent immunizations on file were dated 11/29/21 when the child was 4 months old 2) The record for Child #4 (2 years old) did not contain documentation of updated, the most recent immunizations on file were dated 4/28/21 when the child was 7 months old. 3) The record for Child #6 (2 years old) did not contain documentation of updated immunizations, the most recent immunizations on file were dated 6/16/22 when the child was 17 months old.
Plan of Correction:	Center requested updated student immunization records from parents and student files have been updated as of October 1, 2023. The Center is implementing a system whereby the required annual student/employee medical record updates are reviewed by supervisory staff quarterly to ensure completion/compliance and to send out reminders, if necessary. Supervisory staff will be briefed on the protocol by October 15, 2023.
Standard #:	8VAC20-780-160-C
Description:	Based on review of 4 staff records, the center did not obtain documentation of a negative tuberculosis (TB) test or screening for staff every 2 years from the date of the initial screening or testing. Evidence: The record for Staff #1 did not have documentation of a negative TB test or screening within 2 years of the last TB test. The most recent TB test on file was dated 11/21/2017.
Plan of Correction:	1) Staff 1 obtained a TB test on 9/6/23 and the test was read on 9/8/23; however, Staff 1 is no longer employed with the Center. 2) Center requested updated student immunization records from parent and student file have been updated as of October 1, 2023. The Center is implementing a system whereby the required annual student/employee medical record updates are reviewed by supervisory staff quarterly to ensure completion/compliance and to send out reminders, if necessary. Supervisory staff will be briefed on the protocol by October 15, 2023.
Standard #:	8VAC20-780-280-H
Description:	Based on staff interviews, the center failed to ensure that cosmetics, medications, or other harmful agents were not stored in areas, purses or pockets that are accessible to children. Evidence: A bottle of Acetaminophen (650mg) and a bottle of Antacid were stored in Staff #2?s backpack and left in an area accessible to children. The children ages 19 months to 2 years old accessed the backpack and spilled the medications in the playground mulch where they were able to pick up the medications and possibly ingest some of the pills.
Plan of Correction:	1)Staff 1 was terminated by the Center for use of a cell phone for personal reasons during work hours and during the supervision of children, where the noncompliance was one of the precipitating factors in the incident self-reported by the Center to Poison Control immediately, Child Protective Services (The center was informed that the incident did not warrant further investigation) and the parents of the children involved in the incident. Staff 2 was placed on a 2 week unpaid leave status for leaving her backpack that contained medication on the playground, precipitating the incident, and required to review medication safety protocol prior to return to work. Upon return to work, management conducted a re-entry interview to ensure Staff 2 is clear on medication safety protocol and Center policy on storage of personal items during work hours (All staff are current on all required training and continuing education hours, including a playground safety class that is required every year). Center safety protocol was modified immediately to reflect that employee's personal items, including medication, must be left in their locked vehicles in the Center parking lot or in a locked area in the center, when necessary; emergency medication must be kept in a locked area of the Center. The Center will also post a prominent reminder notice to all employees in the Center regarding the safety protocol for medication, storage of personal items during work hours and the use of cell phones by employees for personal use during work hours. The notice will be posted no later than October 15, 2023. In the future, the Center will also conduct a post- incident staff meeting to review the incident and any violations of protocol and discuss any further center and/or staff remediation necessary. The protocol was put in place on October 1, 2023. Additionally, as of October 2, 2023, the Center has adopted a staff supervision policy whereby a supervising staff will monitor all staff members in their duties at least once every one to two hours to ensure compliance with child supervision and safety regulations.
Standard #:	8VAC20-780-340-A
Description:	Based on interviews, the center failed to ensure the care, protection and guidance of all children in care. Evidence: 1)On 8/23/23 at approximately 4:30pm, Staff #1 and Staff #2 were on the Toddler playground with Child #1, Child #2, Child #3, Child #4, Child #5 and Child #6. Staff #2 had brought their unlocked backpack to the playground which contained a bottle of Acetaminophen 650mg and a bottle of Antacid. The backpack was not locked up and was placed on the ground in an area where the children were playing. 2)The center failed to ensure the care and protection of the children in care when it was discovered that the 2 medications from the backpack had spilled on the ground and the pills were mixed in with the rubber mulch inside the playhouses. Children were trying to pick up the pills and eat them. One of the children had powder from the pills around their mouth and 5 of the pills recovered were wet and had bite marks. The backpack was located approximately 10 feet from where it had been stored and it was unzipped. 3) The center was unable to account for 3-7 of the Acetaminophen pills and 1-2 of the Antacid pills. The children (ages 19 months through age 2) who were present on the playground possibly ingested some of the medication. 4)The center failed to provide parents with complete information during the notification process. Staff stated that there were 2 medications (Acetaminophen 650mg and an Antacid) that spilled on the Toddler playground where Child #1, Child #2, Child #3, Child #4, Child #5, and Child #6 had been playing and they were unable to determine if the medication had spilled before or after Staff #2 took Child #6 inside. Only 5 of the 6 children?s parent were notified that their child may have ingested the Acetaminophen in error. Only 1 of the 6 children?s parent were notified that their child may have ingested the Antacid in error. Without this notification, parents were not aware of the possibility of ingestion of these medications and therefore not able to look for signs of reaction in their children.
Plan of Correction:	1)Staff 1 was terminated by the Center for use of a cell phone for personal reasons during work hours and during the supervision of children, where the noncompliance was one of the precipitating factors in the incident self-reported by the Center to Poison Control immediately, Child Protective Services (The center was informed that the incident did not warrant further investigation) and the parents of the children involved in the incident. Staff 2 was placed on a 2 week unpaid leave status for leaving her backpack that contained medication on the playground, precipitating the incident, and required to review medication safety protocol prior to return to work. Upon return to work, management conducted a re-entry interview to ensure Staff 2 is clear on medication safety protocol and Center policy on storage of personal items during work hours (All staff are current on all required training and continuing education hours, including a playground safety class that is required every year). Center safety protocol was modified immediately to reflect that employee's personal items, including medication, must be left in their locked vehicles in the Center parking lot or in a locked area in the center, when necessary; emergency medication must be kept in a locked area of the Center. The Center will also post a prominent reminder notice to all employees in the Center regarding the safety protocol for medication, storage of personal items during work hours and the use of cell phones by employees for personal use during work hours. The notice will be posted no later than October 15, 2023. In the future, the Center will also conduct a post- incident staff meeting to review the incident and any violations of protocol and discuss any further center and/or staff remediation necessary. The protocol was put in place on October 1, 2023. 2)See plan of Correction at paragraph 1. 3)See Plan of Correction at paragraph I. The Center was unable to account for one (1) Tylenol tablet and the ages of the children on the playground who were present during the incident were 20 months to 3 years. 4)Child #6 was not outside at the time of the incident and had been taken into the Center for a diaper change where the parent of ChiId #6 was present. Parent of child #6 was not formally notified of the incident, as the parent was present at the Center during the incident. The Center is in the process of developing a Checklist for notification to parents on the occurrence of a reportable incident at the Center. The Checklist will be complete for utilization by Center staff no later than October 15, 2023.
Standard #:	8VAC20-780-340-F
Description:	Based on staff interviews, the center failed to ensure that children under 10 years of age always be within actual sight and sound supervision of staff. Evidence: On 8/23/23, 6 children (ages 19 months-2 years old) were playing on the Toddler playground. Staff stated that there was a backpack containing 2 adult medications on the playground. The children carried the backpack approximately 10 feet from where it had been stored. The backpack was unzipped and two medications were removed by the children, spilled in the mulch inside the playhouses, and possibly ingested by multiple children before any staff saw what had occurred or before the staff intervened to stop the children.
Plan of Correction:	1)Staff 1 was terminated by the Center for use of a cell phone for personal reasons during work hours and during the supervision of children, where the noncompliance was one of the precipitating factors in the incident self-reported by the Center to Poison Control immediately, Child Protective Services (The center was informed that the incident did not warrant further investigation) and the parents of the children involved in the incident. Staff 2 was placed on a 2 week unpaid leave status for leaving her backpack that contained medication on the playground, precipitating the incident, and required to review medication safety protocol prior to return to work. Upon return to work, management conducted a re-entry interview to ensure Staff 2 is clear on medication safety protocol and Center policy on storage of personal items during work hours (All staff are current on all required training and continuing education hours, including a playground safety class that is required every year). Center safety protocol was modified immediately to reflect that employee's personal items, including medication, must be left in their locked vehicles in the Center parking lot or in a locked area in the center, when necessary; emergency medication must be kept in a locked area of the Center. The Center will also post a prominent reminder notice to all employees in the Center regarding the safety protocol for medication, storage of personal items during work hours and the use of cell phones by employees for personal use during work hours. The notice will be posted no later than October 15, 2023. In the future, the Center will also conduct a post- incident staff meeting to review the incident and any violations of protocol and discuss any further center and/or staff remediation necessary. The protocol was put in place on October 1, 2023. Additionally, as of October 1, 2023, the Center has adopted a staff supervision policy whereby a supervising staff will monitor all staff members in their duties at least once every one to two hours to ensure compliance with child supervision and safety regulations. 2)Prior to the incident there were two (2) staff supervising 6 children (ranging in age from 20 months to 3 years), supervision within the student/teacher ratio requirement of l teacher to every 5 children for children under 2 and I teacher for every 8 children for children 2 and older. At the time of the incident one staff member left the playground to change the diaper of one of the children, leaving 5 children on the playground ranging in age from 20 months to 3 years with one staff, where staffing still met the mandatory ratio requirements. At the time of the incident, the children were within sight and sound of the supervising staff member; however, the staff member was distracted while on a cell phone for personal use.
Standard #:	8VAC20-780-420-E-3
Description:	Based on review of 6 child records, the center did not ensure annually that parent confirmation of the required information in the child record is up to date. Evidence: The files for Child #1, Child #2, Child #4 and Child #6 did not have documentation that the parent had confirmed the updated record annually. The last update for Child #1 was 8/20/21, the last updated for Child #2 was 8/1/22, the last update for Child #4 was 1/10/21, and the last update for Child #6 was 6/16/22.
Plan of Correction:	1)Records have been updated for Child 1, Child 2, Child 4, and Child 6. 2) Center requested updated student immunization records from parents and student files have been updated as of October 1, 2023. The Center is implementing a system whereby the required annual student/employee medical record updates are reviewed by supervisory staff quarterly to ensure completion/compliance and to send out reminders, if necessary. Supervisory staff will be briefed on the protocol by October 15, 2023.
Standard #:	8VAC20-780-510-L
Description:	Based on observation, the center failed to ensure that medication be kept in a locked place using a safe locking method that prevents access by children. Evidence: On the Toddler playground there were 2 staff medications (Acetaminophen 650mg and an Antacid) that were not stored in a locked place preventing access by children.
Plan of Correction:	1)Staff 1 was terminated by the Center for use of a cell phone for personal reasons during work hours and during the supervision of children, where the noncompliance was one of the precipitating factors in the incident self-reported by the Center to Poison Control immediately, Child Protective Services (The center was informed that the incident did not warrant further investigation) and the parents of the children involved in the incident. Staff 2 was placed on a 2 week unpaid leave status for leaving her backpack that contained medication on the playground, precipitating the incident, and required to review medication safety protocol prior to return to work. Upon return to work, management conducted a re-entry interview to ensure Staff 2 is clear on medication safety protocol and Center policy on storage of personal items during work hours (All staff are current on all required training and continuing education hours, including a playground safety class that is required every year). Center safety protocol was modified immediately to reflect that employee's personal items, including medication, must be left in their locked vehicles in the Center parking lot or in a locked area in the center, when necessary; emergency medication must be kept in a locked area of the Center. The Center will also post a prominent reminder notice to all employees in the Center regarding the safety protocol for medication, storage of personal items during work hours and the use of cell phones by employees for personal use during work hours. The notice will be posted no later than October 15, 2023. In the future, the Center will also conduct a post- incident staff meeting to review the incident and any violations of protocol and discuss any further center and/or staff remediation necessary. The protocol was put in place on October 1, 2023. 2)The center has re-checked (Locked areas are checked for proper operation on a daily basis.) all locks on all designated locked areas for proper lock operation and a safe locking method that prevents access by children as of October 1, 2023.