VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Mrs. Joan Green
710 Halifax Street
Emporia, VA 23847
(434) 348-0799

Current Inspector: Rene Old (757) 404-1784

Inspection Date: March 17, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-111 Administration 22VAC40-111 Personnel 22VAC40-111 Household Members 22VAC40-111 Physical Health of Caregivers and Household Members 22VAC40-111 Caregiver Training 22VAC40-111 Physical Environment and Equipment 22VAC40-111 Care of Children 22VAC40-111 Preventing the Spread of Disease 22VAC40-111 Medication Administration 22VAC40-111 Emergencies 22VAC40-111 Nutrition 22VAC40-80 THE LICENSE. 22VAC40-191 Background Checks for Child Welfare Agencies 22.1 Background Checks Code; carbon monoxide detectors

Technical Assistance:

The following was discussed and reviewed with the provider: *Follow manufacturer label for ages and weight of children when using high chairs; *Standard 600 - Daily activities for infants and toddler; *Standard 610 - Use of television shall be limited to not more than a total of two hours per day; *Standard Standard 510.C - Occupied cribs and cots and beds shall be at lease 12 inches from each other; *Standard 380 - The home shall provide each child with adequate space to allow free movement and active play indoors; *Additional gauze pads are needed for the first aid kit; *A carbon monoxide detector is now required in all licensed FDH's.

Comments:

An unannounced renewal inspection was conducted on 03/24/2022 from 11:25 am - 1:20 pm. At the time of entrance there were 12 children in care with 3 caregivers. One resident child was also in care. The ages of the children counted for a total of 35 points. Children were observed watching television and napping in infant swings. One diaper change was reviewed. The inspector reviewed records for four caregivers, one household member and 12 children. Violations were observed in the following areas of the FDH standards: Administration, Environment and Equipment, Preventing the Spread of Disease and Background Checks. These violations are listed on the violation notice and were discussed with the provider at the exit interview.

Violations:

Standard #:	8VAC20-770-40-D-1-c
Description:	Based on record review and interview, the provider failed to ensure that any person living in the family day home who is required to have a search of central registry shall obtain an updated central registry check before three years since the dates of the most recent central registry finding. 1. The most recent central registry search for household member 1 was conducted on 12/08/2016. a. The provider confirmed that an updated central registry check had not been obtained for household member 1.
Plan of Correction:	An updated central registry check was requested on 03/18/2022.
Standard #:	8VAC20-800-100-A
Description:	Based on record review and interview, the provider failed to obtain documentation of a physical examination by or under the direction of a physician prior to a child's attendance or within 30 days after the first day of attendance. Evidence: 1. Child 2, child 3 and child 4,enrollment date 01/19/2022, lacked documentation of a physical exam 2. The provider confirmed that a documented physical exam was not on file for these children.
Plan of Correction:	The provider stated that she thought that the signed "well child check-up" prescription note on file for all three of these children would suffice for a physical exam. The parent of these children will be asked to obtain a physical exam documenting all of the required elements.
Standard #:	8VAC20-800-90-C
Description:	Based on record review and interview, the provider failed to obtain documentation of additional immunizations once every six months for children under the age of two years. Evidence: 1. The most recent immunizations on file for child 1, age 21 months, were conducted on 07/21/2020. a. Child 1 was in care during the inspection and has an enrollment date of 11/23/2020. 2. The most recent immunizations on file for child 4 , age 18 months, were conducted on 09/02/2020. a. Child 4 was in care during the inspection and has an enrollment date of 01/19/2022.
Plan of Correction:	The provider stated at the conclusion of the inspection that documentation of updated immunizations will be requested.
Standard #:	8VAC20-800-240-A
Description:	Based on observation, the provider failed to ensure that furnishings of the family day home, shall be maintained in a safe, and operable condition. Evidence: 1. One crib , (color white) , was missing an attachment bolt between the end and side panel/railing attachment. The result was a loose unsecured end panel. 2. A second crib, (color brown), had a thick piece of cardboard attached to one side of the railing using duck tape. This is a safety hazard as cribs are not to be modified in any way as changes can comprise the integrity of the crib. Additionally, the duck tape and cardboard are unsafe to children if they were to chew or mouth on them.
Plan of Correction:	The provider has stated that the white crib has been repaired and that the brown crib has been discarded.
Standard #:	8VAC20-800-530-B
Description:	Based on observation, the provider failed to ensure that cribs when being used by infants shall have a tight-fitting bottom cover. Evidence: The crib sheet placed on the brown crib was loose and had two holes in the sheet.
Plan of Correction:	The provider stated that a new crib sheet will be placed on the crib - that is tight fitting.
Standard #:	8VAC20-800-530-G
Description:	Based on observation and interview, the provider failed to ensure that children under two years of age shall not use pillows. 1. A pillow was observed inside of a mesh sided portable play pen that identified for use by child 3 during awake play time. a. Child 3 is 6 months of age.
Plan of Correction:	The provider stated that the pillow will be removed immediately.
Standard #:	8VAC20-800-540-A
Description:	Based on observation, the provider failed to ensure high chairs shall be used according to the manufacturer's instructions and when occupied by a child, a safety strap shall be used and securely fastened. Evidence: 1. Four children, ranging in age from 18 months - 2 years , were observed sitting in high chairs without the safety strap engaged. 2. The manufacture label affixed to the high chairs states: :Warning: Prevent serious injury or death from falls or sliding out. Always secure child with the restraining system ...the tray is not designed to hold the child in the chair."
Plan of Correction:	The safety strap was engaged during the inspection. Going forward - the safety strap will be used at all times.
Standard #:	8VAC20-800-680-A
Description:	Based on observation, the provider failed to ensure that caregivers shall wash their hands with liquid soap and warm running water after diapering. Evidence: 1. Caregiver 1 failed to wash her hands with soap and water after changing the diaper of child 3 at 11:41 am. a. After completion of the diaper change caregiver 1 was observed placing child 1 in an infant swing and then walking to the back of the home to retrieve emergency supplies for the provider.
Plan of Correction:	The provider stated that all caregivers will be retrained on appropriate hand washing procedures.
Standard #:	8VAC20-800-680-B
Description:	Based on observation, the provider failed to ensure that children's hands are washed with liquid soap and warm running water after diapering. Evidence: 1. Caregiver 1 failed to wash child 3's hands with soap and warm running water after completion of a diaper change at 11:41am. a. After completion of the diaper change, caregiver 1 immediately placed child 3 into an infant swing.
Plan of Correction:	The provider stated that all caregivers will be retrained on correct handwashing procedures for children.
Standard #:	8VAC20-800-690-D
Description:	Based on observation, the provider failed to ensure that the diapering surface shall be cleaned and sanitized after each use. Evidence: The provider failed to clean and sanitize the diapering surface after changing a diaper at 11:41am.
Plan of Correction:	The provider stated all caregivers will be retrained on correct cleaning and sanitizing procedures for the diaper changing area.