Main Street Day Care Center, Inc.

“REPEAT VIOLATION Based on a review of records and interview, the facility did not have a written care plan for each child with a diagnosed food allergy to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: The record for child #9 whose record contained documentation of an allergy to peanuts, did not contain a written care plan with instructions from child #1’s physician in case of a reaction. The center confirmed that the allergy was documented in the child’s record, but that a care plan was not present at the center for child #1.”

“*** REPEAT VIOLATION*** Based on a review of records and interview, the facility did not have a written care plan for each child with a diagnosed food allergy to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: The record for child #9 whose record contained documentation of an allergy to peanuts, did not contain a written care plan with instructions from child #9’s physician in case of a reaction. The center confirmed that the allergy was documented in the child’s record, but that a care plan was not present at the center for child #9. The same documentation was missing from child #9’s record when it was reviewed on 5/24/2023.”

“Evidence: The authorization form for child A’s over-the-counter Cold and Cough medication was completed by the parent for a duration of 2/4/2023 through 2/24/2023. The authorization form for child B’s over-the-counter Acetaminophen was completed by the parent for a duration of 1/21/2022 through 1/2024. The authorization form for child C’s two over-the-counter medications: Acetaminophen and teething gel, was completed by the parent for a duration of 5/11/2023 through 9/2023. Each of these over-the-counter authorization forms cover a duration of more than 10 days and do not include written authorization from the children’s physician.”

“Based on a review of records and interview, the facility did not have a written care plan for each child with a diagnosed food allergy to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction. Evidence: The record for child #3 whose record contained documentation of an allergy to peanuts, did not contain a written care plan with instructions from child #3’s physician on case of a reaction. The center confirmed that the allergy was documented in the child’s record, but that a care plan was not present at the center for child #3.”

“Evidence: The licensee self-reported to licensing that a parent was concerned that her toddler (child #1)Incurred marks on his face while in care. The parent noticed two small oval red marks, one on each of the child’s cheeks, when she arrived during nap time to take her child home. The child’s parent inquired about the marks with the two staff present in the classroom. However, these staff had just arrived in the classroom to relieve the morning staff whose shift ended and had not been informed of the marks or how they were incurred. The parent then voiced her concern about the red marks on her child’s cheeks with the program director who confirmed the presence of the marks but stated that she was not aware of how or when they appeared, and said she would speak to the morning staff to get more information. The child’s parent was not provided with any written report documenting the presence of the red marks on her child’s cheeks on that day nor later. When the licensing inspector asked to view documentation of the minor injury which left marks on the child’s cheeks, the program director was unable to demonstrate that a report had been written.”

“Evidence: Ten staff records were reviewed. The record for staff #1 whose date of hire was documented as 9/1/2022, contained the results of a federal criminal records review which was dated 9/8/2022 (after the initial date of employment). The record for staff #2 whose date of hire was documented as 4/20/2022, contained the results of a federal criminal records review which was dated 4/21/2022 (after the The record for staff #6 whose date of hire was documented as 1/3/2023, contained the results of a federal criminal records review which was dated 1/10/2023 (after the initial date of employment). initial date of employment). The administrative staff who maintains staff records confirmed this documentation during the inspection.”

“Based on a review of records and interview, the licensee was unable to demonstrate that each corporate board member submitted results of a federal criminal records review. Evidence: Four corporate officer / agent records were reviewed as part of the renewal application review. There was no documentation to demonstrate that a Federal Criminal Record Check had been conducted for officer #1 and officer #3 who were listed as current officers of the corporation on the renewal application dated 1/11/2023. The Program Director was unable to confirm that this background check had been conducted or provide this documentation during the inspection.”

“Based on a review of records and interview, the licensee was unable to demonstrate that each corporate board member submitted results of a Search of the Central Registry. Evidence: Four corporate officer / agent records were reviewed as part of the renewal application review. There was no documentation to demonstrate that a Search of the Central Registry had been conducted for officer #1, officer #2 and officer #3 who were listed as current officers of the corporation on the renewal application dated 1/11/2023. The Program Director was unable to confirm that these background checks had been conducted or provide this documentation during the inspection.”

“REPEAT VIOLATION Based on a review of records and interview, the licensee was unable to demonstrate that two or more references as to character and reputation as well as competency were checked before each staff member’s employment or volunteering. Evidence: Ten staff records were reviewed during the Renewal inspection. There was no documentation in staff #6’s record to demonstrate that two or more references as to character and reputation as well as competency were checked before employment. There was only documentation of one reference check documented in staff #4’s record. The Program Director was unable to confirm that these reference checks had been conducted or provide documentation of these reference checks during the inspection.”

“Evidence: Photographic documentation, showing a door hinge / mount on the stall of a restroom used by children in care was provided to the licensing inspector in response to inquiry regarding a child who was injured while in care. The door mount hardware was a thick metal hinge which protruded approximately 1.5 inches from the bottom edge of the stall door frame. The metal hinge had an open slot where the stall door’s hardware would be inserted. However, there was no longer a door mounted on the hinge and instead, a curtain had been hung to provide privacy in the stall. Staff interviews revealed that on 3/23/2022 a three year old child fell and hit her head on the door hinge resulting in a cut above her brow that required outside medical care.”

“Evidence: It was confirmed through interviews and documentation that a 3 year old child was running to the restroom when she fell and sustained a cut above her brow. During an interview on 10/11/2022, staff #1 stated that on 3/23/2022 three or four children were permitted to walk to the restroom located down the hallway from the classroom suite. Staff #1 stated that she intended to supervise the children in the restroom from the door of the classroom suite. An injury report completed by staff #1 and dated 3/23/2022 revealed that Staff #1 was standing at the door to the classroom suite when she `asked [child #1 (3 years old)] to walk and [child #1] turned around laughing and ran?. The report revealed that another child (child #2) was screaming from the classroom inside of the suite and staff #1 ?left from the door and helped [child #2]?That’s when I heard a scream from the hallway? The injury report documents that staff #1 saw that child #1 was in staff #2?s arms. Child #1 had fallen inside of the restroom and sustained a cut above her brow. Staff #1 confirmed in the interview that she ran back to the classroom to pour a cup of milk for child #2 when she ?heard child #1 hollering? in the hallway. Staff #1 established that her co-teacher (staff #2), who was returning from the cafeteria, saw child #1 before she did. During an interview on 10/11/2022, Staff #2 stated she was coming down the hallway toward the restrooms from the opposite end of the hallway from the classroom when she saw child #1 standing in the middle of the hallway. Staff #2 said that she ran to child #1, picked her up, and saw that she was bleeding. Staff #2 confirmed that she did not see any other staff in sight at the time that she discovered child #1 standing in the hallway. During the inspection on 10/11/2022, the inspector stood at the classroom door, which is located inside of a suite of classrooms on the same hallway as the restroom. From inside of the suite where the classroom is located, the inspector was not able to see out into the hallway or down to the restroom which is located approximately 24 feet down the hallway from the entry to the suite.”

“Evidence: An interview with staff #1 revealed that staff #1 was working alone in her classroom with a group of three year old children when staff #1 walked three or four children to the doorway of the suite where the classroom is located, leaving another three or four children alone in the classroom. Staff #1stated that she intended to stand in the doorway of the suite where she could view both the classroom and the door to the restroom where the children were headed. However, she said that one child in the classroom called to her saying that he did not get milk with his snack ?so [she] ran back to the classroom to get milk and gave it? to the child. The four children, advancing toward the restroom at the time, were not in staff #1?s sight or sound supervision when she returned to the classroom to assist the other child. Furthermore, once the three or four children reached the restroom staff #1 was not able to view the restroom door to ensure that anyone who was not staff or a person allowed to pick up a child did not enter the restroom.”

“Evidence: It was established through interviews that on 3/23/2022, three or four children, three years of age, were permitted to use a restroom located down the hall from their classroom suite and that they were not in direct sight and sound supervision of staff while still in transit and after reaching the restroom. Staff #1 confirmed that she was observing a group of three year old children in route to the restroom from the doorway of the classroom suite when she returned to the classroom to assist another child. Staff #2 stated that she came down the hallway from the end opposite to the classroom and saw child #1 standing in the hallway. Staff #2 confirmed that there were no other staff in sight at that time. The written injury prevention plan for the center, viewed on site on 10/11/2022, says ?The staff will always walk to the bathroom with each child or group of children and stay within sight and sound. Once all of the bathroom breaks are done and all children are accounted for you may return to the room with the children.? Staff #5 confirmed that the written injury plan was last updated in June of 2022. Staff #1 did not comply with the center’s own injury prevention plan when she allowed children to go to the restroom outside of staff sight and sound supervision on 3/23/2022 and a child was injured while running into the restroom.”

“Evidence: An incident report reviewed by the licensing inspector on 9/15/2022 documented an injury to a child in care at the center that occurred on 3/23/2022. Interviews with staff confirmed that a three year old child (child #1) fell and hit her head on the hinge of the bathroom stall resulting in a cut above child #1?s eyebrow. Interviews with staff #3 and staff #5 confirmed that child #1 was transported from the center by ambulance to a medical facility for treatment of the cut. The licensing inspector became aware of the injury from a source outside of the center on 9/8/2022. The center had not informed the department or the department’s representative of this injury at that time.”

“Based on a review of records and interview, the licensee does not have a central registry finding for every staff member within 30 days of their employment or volunteer service. Evidence: Four staff records were reviewed. The record for staff #4, whose date of employment was 5/20/2019, did not contain the results of a Virginia Search of the Central Registry. The record contained a response letter from the agency stating that the request form contained an error and needed to be resubmitted, but no results of the Search. The program director confirmed that the results were not present in the record at the time of inspection.”