VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Guidepost Montessori at Fairfax
3909 Oak St
Fairfax, VA 22030
(703) 934-0920

Current Inspector: Sarah Marbert (703) 479-4678

Inspection Date: March 12, 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 (8VAC20-770) 20 Access to minor?s records 22.1 Background Checks Code, Carbon Monoxide 63.2 Child Abuse & Neglect

Technical Assistance:

Discussed with Head of School: Injury report form (model form will be sent) Injury prevention plan (sample plan provided)

Comments:

An unannounced renewal inspection was conducted today, There were 8 children present with 2 staff. 6 staff records and 2 child records were reviewed. Children were observed serving themselves snack, playing with toys, working independently with blocks and cards and playing on the playground. See the Violation Notice for non-compliances cited today. Due to staff availability, you will have until close of business on 3/13/24 to send me the requested documentation. If you have questions regarding this inspection, you may contact me at (703) 479-4678 or at Sarah.Marbert@doe.virginia.gov LI was present today from 3:10 PM - 6:00PM. Please submit your plan of correction within 5 business days in order for it to be included on the website.

Violations:

Standard #:	22.1-289.035-B-4
Description:	Repeat Violation Systemic Deficiency Based on a review of records, one staff record did not contain documentation of an out of state background checks for residences outside of Virginia in the past 5 years, in the required time frames. Evidence: 1. Staff A's record had no documentation of a completed Child Abuse and Neglect search within 45 days of employment for two residences outside of Virginia in the past 5 years. 2. Staff A's record had no documentation of a completed Criminal History search for one residence outside of the state of Virginia in the past 5 years, prior to employment. (Date of Hire: 03/27/23)
Plan of Correction:	Background checks are underway. Updated onboarding checklist is in place.
Standard #:	8VAC20-770-60-C-2
Description:	Repeat Violation Based on a review of staff records, the center failed to discontinue employment of staff when Central Registry Search (CRS) results were not obtained within 30 days of employment. Evidence: 1. Staff C's record contained no CRS results. (Date of Hire (DOH): 4/4/23) 2. Staff E's record contained no CRS results. (DOH:11/28/23)
Plan of Correction:	New CRS searches have been completed. Staff E's results on file; awaiting Staff C's results.
Standard #:	8VAC20-780-130-A
Description:	Based on a review of records, one child record did not contain documentation of immunizations,before the first date of attendance. Evidence: Child #1's record did not contain an immunization record. (First date of attendance: 2/1/24)
Plan of Correction:	Request for documentation has been made.
Standard #:	8VAC20-780-140-A
Description:	Based on a review of records, one child record did not contain documentation of a completed physical within 30 days of enrollment. Evidence: Child 1's record contained no completed physical, (First day of attendance: 2/1/24)
Plan of Correction:	Request for documentation has been made.
Standard #:	8VAC20-780-160-C
Description:	Based on a review of records, one staff record did not contain documentation of a follow up tuberculosis screening at least every two years. Evidence: Staff F's record contained documentation of a tuberculosis screening result that was dated 10/8/21 (expired)
Plan of Correction:	Staff F has been notified to update this record.
Standard #:	8VAC20-780-40-I
Description:	Based on staff statement and a review of available documentation, the center has not developed a written injury prevention plan. Evidence: No plan could be located during the inspection.
Plan of Correction:	Plan will be developed and reviewed.
Standard #:	8VAC20-780-60-A
Description:	Repeat Violation Based on a review of records, one child record did not contain all required in formation. Evidence: 1 of 2 records reviewed was incomplete. Missing information included: 1. No documentation of having viewed proof of birth within 7 days of enrollment. 2. A complete second emergency contact's information. (First date of attendance: 2/1/24)
Plan of Correction:	Child records reviewed. Missing documentation will be requested and added to files.
Standard #:	8VAC20-780-70
Description:	Repeat Violation Systemic Deficiency Based on a review of records, one staff record did not contain documentation of all required components. Evidence: Staff E's record did not contain documentation of two references obtained prior to employment. The references available for review were not dated.
Plan of Correction:	Second reference has been obtained. Dated will be added to all new employee reference records.
Standard #:	8VAC20-780-80-A
Description:	Based on a review of the attendance sheet, the center did not maintain a written record of daily attendance documenting the arrival and departure of each child as it occurred. Evidence: The attendance sheet for the Children's House room showed 9 children present. There were 8 children in the room.
Plan of Correction:	An updated process has been put in place for documenting this inclusive attendance situation.
Standard #:	8VAC20-780-240-A
Description:	Repeat Violation Based on a review of records, one staff record did not contain documentation of completion for the required 10 hour Pre-Service course within 90 days of employment, Evidence: Staff C's record did not contain documentation of completion of the required course. (Date of Hire: 4/4/23)
Plan of Correction:	Training was completed at time of hire. Certificate has been added to Staff C's file.
Standard #:	8VAC20-780-420-E-3
Description:	Repeat Violation: Based on a review of records, one child record was not updated annually. Evidence: Child 2's record was dated 2/24/22.
Plan of Correction:	Annual records review will be conducted.
Standard #:	8VAC20-780-510-B
Description:	Based on Staff statement and a review of medication log, medication was not administered according to written authorization. Evidence: Child 2's authorization for an Over-The-Counter (OTC) medication stated to administer the medication at 11:30 and 3:30 daily. Medication was not administered on 3/12/24. A new medication authorization was not completed when the times for administering the medication changed to "as needed".
Plan of Correction:	Staff followed verbal directions from parent at drop off, and had parent complete an updated for the next day.
Standard #:	8VAC20-780-550-E
Description:	Based on a review of available documentation, Shelter-in-place (SIP) drills were not practiced a minimum of twice a year. Evidence: There was no record of 2 SIP drills being conducted in 2023.
Plan of Correction:	Drill logs will be consolidated and updated.
Standard #:	8VAC20-780-550-G
Description:	Based on a review of documentation, no record was maintained of emergency evacuation drills being practiced monthly. Evidence: There was no documentation of emergency evacuation drills having been practiced for September, October and November in 2023.
Plan of Correction:	Drill logs will be consolidated and updated.
Standard #:	8VAC20-780-550-P
Description:	Repeat Violation Based on a review of injury reports, all required information was not documented. Evidence: 6 injury reports were reviewed. Missing information included: 1. Time/Date/Method of parent notification. (6 of 6 reports) 2. A parent and staff signature, or 2 staff signatures (2 of 6 reports) 3. Child's complete name (3 of 6 reports)
Plan of Correction:	New/corrected forms are in use. Staff will review procedure for completing correctly. Updated process for signatures in place.