VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Barrow Center
790 Irisburg Road
Axton, VA 24054
(276) 806-2797

Current Inspector: Rebecca Forestier (540) 309-2835

Inspection Date: Feb. 27, 2024

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 22.1 BACKGROUND CHECKS, CODE, CARBON MONOXIDE

Comments:

An unannounced focused monitoring inspection, resulting from an Intensive Plan of Correction, was conducted on 02/27/2024. There were 12 children, ages 5 months- 4 years, and 5 staff members present during the inspection. The inspector reviewed compliance in the areas of administration, staff qualifications and training, staffing and supervision, special care provisions and emergencies and nutrition. A total of 5 children?s records, 5 staff records, and 13 medications were reviewed. The inspector arrived to the center at 10:30 am and departed at 1:00 pm. Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the provider.

Violations:

Standard #:	8VAC20-780-240-B
Description:	REPEAT VIOLATION Based on record review, the center failed to ensure that staff shall complete orientation training prior to the staff member working alone with children and no later than sever days of the date of assuming job responsibilities. Evidence: The record for Staff 3 contained a documented hire date of 09/29/2023; the record for Staff 3 did not contain documentation that Staff 3 has completed orientation training. Staff 3 was observed working during the 02/27/2024 inspection.
Plan of Correction:	The Program Director will oversee providing this training and ensuring that they have successfully completed it. Her assistant will check with the program director to be sure that these orientations are being fulfilled.
Standard #:	8VAC20-780-355-A-2
Description:	Based on observation and staff interviews, the center failed to ensure that for a therapeutic child day program, in each grouping of children of preschool age or younger when there are children present that are diagnosed as having an intellectual disability with a significant subaverage intellectual functioning and deficits in adaptive behavior, or with physical and sensory disabilities, or with autism, there shall be one staff member to four children. Evidence: There were 9 children and 2 staff members observed in the large classroom. Staff 2 stated that the youngest child in the group was 2 years old. Staff 2 stated that Child 5 and Child 7 were autistic. Three staff would be required for this group of children.
Plan of Correction:	The center will provide the correct number of staff in each room. If we do not have the correct staff-to-child ratio there, we will either call someone else in or send the children home. We will also have people on call to come in in case staff gets sick or has an emergency. The program director will oversee the schedule and be sure that every room is covered correctly and that we have our ?as-needed? staff on call. The directors assistant will go back behind Jessica and be sure that her numbers are correct per room.
Standard #:	8VAC20-780-430-L
Description:	Based on observations and staff interviews, the center failed to ensure that infant walkers shall not be used. Evidence: There were two infant walkers observed in the infant class. Staff 6 verified that the walkers were used by children enrolled at the center.
Plan of Correction:	All walkers have been removed from the room. The program director will ensure that there are no walkers in any classrooms unless they get approved for them. The directors assistant will go behind the director regularly and ensure that there are no walkers in any of the rooms.
Standard #:	8VAC20-780-500-A
Description:	Based on observations, the center failed to ensure that children?s hands shall be washed with soap and running water or disposable wipes before and after eating meals or snacks; and that staff shall wash their hands with soap and running water after any contact with body fluids. Evidence: 1. The children in the large classroom were observed during lunch. The children were observed immediately returning to their regular activities upon the completion of lunch. The children did not wash their hands with soap and running water or disposable wipes after eating a meal. 2. Staff 2 was observed wiping a child?s nose. Staff 2 did not wash their hands after contact with body fluids.
Plan of Correction:	The center will ensure that every child is washing their hands with disposable wipes before and after meals. The staff will also wash their hands with soap and water any time they encounter bodily fluid or are dealing with bodily fluid. The directors assistant will check that hands are getting washed before and after every meal/snack and will ensure that the center has wipes for this purpose. She will also check with the staff and be sure that they are washing their hands with soap and water when encountering bodily fluids/dealing with bodily fluids. The program director will ensure that her assistant is doing this regularly.
Standard #:	8VAC20-780-500-B
Description:	Based on observations, the center failed to ensure that the diapering surface shall be nonabsorbent. Evidence: The diapering surface in the infant room had multiple tears in the surface exposing the absorbent foam padding. The diapering surface was observed being used during the inspection.
Plan of Correction:	The center will ensure that the changing table is non-absorbent by replacing the changing table and ensuring that the new one does not have any holes or tears in it. The Program Director will ensure that a new changing table replaces the old one. The directors assistant will check that the new changing table, as well as others, do not have tears/holes in them regularly.
Standard #:	8VAC20-780-510-G
Description:	Based on observations and staff interviews, the center failed to ensure that medication shall be labeled with the child?s name, the name of the medication, the dosage amount, and the time or times to be given. Evidence: 1. Medication 2, located inside of Child 6?s diaper bag, was not labeled with the child?s name. Staff 6 verified that Medication 2 belonged to Child 6. 2. Medication 3, located inside of Child 6?s diaper bag, was not labeled with the child?s name. Staff 6 verified that Medication 3 belonged to Child 6.
Plan of Correction:	All medications will be labeled with children?s names and the staff will suggest to the parents that they have different bags. (One for daycare specifically). That way staff can ensure that the child only has what he/she needs for the day and can ensure that there is no extra medication in the child?s bag that staff is unaware of. The program director will ensure that she is checking children?s bags for medications daily and being sure that it is labeled correctly. She will also suggest to the parents that they keep a separate daycare bag to avoid confusion. The directors assistant will also double-check all bags to be sure no extra medication has been added to any.
Standard #:	8VAC20-780-520-A
Description:	Based on document and medication review, the center failed to ensure that all prescription drugs shall be used in accordance with the manufacturer?s recommendations. Evidence: The manufacturer?s instruction for Medication 2 states the following, ?if your child is under the age of 2 years of age, be sure to ask your doctor?. The dosage amount for Medication 2, when used for children under 2 years states, ?ask a doctor?. The medication authorization form for Medication 2 did not include dosage instructions from a physician. The medication administration log contained documentation that 2.5 ml of Medication 2 had been administered to Child 6 (age 7 mo.) on the following dates: 01/25/2024, 01/29/2024, 01/30/2024, 02/07/2024, 02/08/2024, 02/23/2024.
Plan of Correction:	The center will ensure that ALL medication consent forms for children under the age of two have a doctor?s consent section where the doctor can confirm the dosage the child should receive and can sign the form. The program director will ensure that she goes in and adds a place for a physician to sign and will not allow any child under the age of two to take the medication until everything is confirmed by the child?s physician. The directors assistant will go back over the director and double-check that this is done before the medication is administrated.
Standard #:	8VAC20-780-560-M
Description:	Based on observations, the center failed to ensure that no child shall be allowed to drink or eat while walking around. Evidence: Multiple children in the large room were observed walking around the room while drinking from sippy cups. One child was observed walking around the room eating from a bag of cookies.
Plan of Correction:	The center will ensure that all cups are to stay in the kitchen or put away in a cabinet unless it is snack or lunchtime. The cups will also remain labeled and dated to ensure there will be no confusion. If a child is thirsty, the staff will let the child drink and then take their cup and put it away. The program director will check in on classrooms daily to be sure that the staff is appropriately storing children?s cups and ensuring that they are not always out and accessible to every child. The program director will ensure that Julie is doing this and will follow up with her about it regularly.