Pure at Heart Childcare Center, Phase 2

8VAC20-780-150-B

“Immunization records are required to be signed and dated by a physician, his designee, or an official of the local health department. The immunization record for child #5 was not signed.”

Rule 8VAC20-780-150-B.

Hazardous substances such as cleaning materials shall be kept in a locked place using a safe locking method that prevents access by children.

“In the infant room bathroom was an unlocked cabinet with disinfectant spray, cleaner, and air fresher with the warning labels, “keep out of reach of children”.”

Rule 8VAC20-780-280-B.

8VAC20-780-270-A

“Repeat Violation Areas and equipment of the center, inside and outside, shall be maintained in a clean, safe and operable condition. There was one ceiling tile above a crib that was not secure and protruding from the ceiling. .”

Rule 8VAC20-780-270-A.

8VAC20-790-600-B

“The vendor shall ensure staff who work directly with children shall have completed within the first 90 days of employment Virginia Preservice Training for Child Care Staff. Staff #4 completed the Virginia Preservice Training more than 1 month after it was due.”

Rule 8VAC20-790-600-B.

8VAC20-770-40-D-6

“A facility must not accept a required central registry ( CRC ) finding from an applicant, licensee, registrant, or other person required to obtain background checks that is dated more than 90 days prior to the date of employment, volunteering, residing in the home. Staff #4’s TCRC is dated 11 months prior to hire.”

Rule 8VAC20-770-40-D-6.

8VAC20-780-270-A

Rule 8VAC20-780-270-A.

8VAC20-780-280-B

“Repeat Violation Hazardous substances must be in a locked place that prevents access by children. In Room #1 sanitizing spray, hand sanitizer and disinfectant wipes were observed stored on shelves in an unlocked manner and were out of reach of children.”

Rule 8VAC20-780-280-B.

8VAC20-780-40-J

“The center is required to update at least annually the injury prevention procedures based on documentation of injuries and a review of the activities and services. The most recent injury plan was dated 2023.”

Rule 8VAC20-780-40-J.

8VAC20-780-500-A

Rule 8VAC20-780-500-A.

8VAC20-780-500-B

“Repeat Violation The diapering surface shall be cleaned with soap and at least room temperature water and sanitized after each use. Staff #1 did not clean the diaper changing surface. “Cleaned” means treated in such a way to reduce the amount of filth through the use of water with soap or detergent or the use of an abrasive cleaner on inanimate surfaces.”

Rule 8VAC20-780-500-B.

8VAC20-780-570-A

“Repeat Violation When a child is placed in a highchair, the protective belt shall be fastened securely. One child was observed sitting in a chair at the feeding table and the protective strap was not used”

Rule 8VAC20-780-570-A.

8VAC20-780-70

Rule 8VAC20-780-70.

8VAC20-780-330-B

“Playground equipment with moving parts or climbing apparatus must have appropriate fall zones that encompass sufficient area to include the child’s trajectory in the event of a fall. Where playground equipment is provided, resilient surfacing shall comply with minimum safety standards and shall be under equipment with moving parts or climbing apparatus. The resilient surfacing for merry-go-cycle measured 1 ? inches or less and a minimum of 6 inches is required.”

Rule 8VAC20-780-330-B. From a complaint.

8VAC20-780-340-F

“Children under 10 years of age shall always be within actual sight and sound supervision of staff. On11/7/2024,3 infants were observed left unsupervised when Staff #1, in the infant room went into the restroom to change another child’s diaper.”

Rule 8VAC20-780-340-F. From a complaint.

8VAC20-780-500-A

“(Repeat Violation) Staff hands and children’s hands shall be washed with soap and running water after toileting, or any contact with blood, feces or urine. On 11/21/2024 Staff # 2 changed a child’s diaper and did not wash their hands or the child’s hands with soap and water.”

Rule 8VAC20-780-500-A. From a complaint.

8VAC20-780-500-B

“The diapering surface shall be a nonabsorbent surface for diapering or changing and shall be cleaned with soap and at least room temperature water and sanitized after each use. On 11/21/2024 the diaper pad in the toddler room had a tear (less than 1/2 inch) and therefore it was no longer nonabsorbent. Staff #2 was observed changing a diaper in the toddler room and cleaned the diaper changing surface but did not sanitize the surface.”

Rule 8VAC20-780-500-B. From a complaint.

8VAC20-780-560-F

“When centers choose to provide meals or snacks, they shall follow the most recent, age-appropriate nutritional requirements of the Child and Adult Care Food Program of the United States Department of Agriculture (USDA). USDA indicates children ages 1-2 shall have 4 fluid ounces of milk for lunch. On 11/21/2024 the center served during lunch approximately 2 fluid ounces to the children in the toddler room (ages 16 months to age 2).”

Rule 8VAC20-780-560-F. From a complaint.

22.1-289.035-A

“Repeat Violation Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a search of the central registry check (SCR). Evidence: Staff #6?s was not updated as the most recent SCR is dated 2-18-2019.”

Rule 22.1-289.035-A.

Based on observation, the licensee did not ensure areas and equipment of the center inside was maintained in a clean, safe and operable condition.

“Evidence In the infant room, next to a crib there was approximately a 2 inch by 2 inch area of peeling plaster type substance. Infant was observed sleeping in the crib.”

Rule 8VAC20-780-270-A.

Based on observation, electrical outlets shall have protective covers that are of a size that cannot be swallowed by children.

“Evidence: Ther were 4 uncapped outlets observed in the infant room.”

Rule 8VAC20-780-290-A-3.

Repeat Violation Based on observation and staff interviews, the licensee did not ensure children’s and staff hands shall be washed with soap and running water as required.

“Evidence: Infant staff was observed during a diaper change and did not ensure the infants hands were washed with soap and running water after toileting/diapering.”

Rule 8VAC20-780-500-A.

8VAC20-780-500-B

“Repeat Violation Based on observation and staff interviews, the licensee did not ensure the diaper pad/ surface was cleaned after each use. Evidence: Center staff was observed conducting a diaper change and the diaper surface was not cleaned with a soap and water solution after changing the diaper.”

Rule 8VAC20-780-500-B.

Based on observation, when occupied by a child, high chairs were not used according to the manufacturer’s instructions and a safety strap was not used and securely fastened.

“Evidence: Two infants were observed seated in a high chair without using the high chair safety strap.”

Rule 8VAC20-780-570-A.

Repeat Violation Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.

“Evidence: Two out of two of the classrooms did not have attendance list as required. 1.In the infant room 7 infants were observed and only 5 were listed on the attendance. The last two children in the infant room arrived at 8:19am and 8:30am and the attendance list was not updated until 10:08am. 2. In the toddler room 3 children were observed and only two were on the attendance list. The third child arrived at 8:54am and the attendance list was not updated until 10:08am”

Rule 8VAC20-780-80-A.

Based on a record review and staff interviews, the vendor did not ensure staff shall complete annually the departments health and safety course.

“Evidence: The most recent course for Staff #4 is dated 2-10-23 and Staff #5?s is dated 3-7-23.”

Rule 8VAC20-790-600-F.

Based on observation and staff interviews, the licensee did not ensure the license and any other documents required by the Superintendent were posted in a conspicuous place on the licensed premises.

“Evidence: The most recent inspection results were dated 11-16-2023 were not posted in a conspicuous place.”

Rule 22.1-289.011-F.

Based on record review and staff interviews, the licensee did not ensure all staff shall undergo a background check every five years to include a sworn statement, criminal records check ( CRC ) and search of the central registry check (SCR).

“Evidence: Staff #3?s most recent CRC is dated 1-25-2019 and the SCR is dated 2-18-2019. Both background checks were not updated every 5 years a required”

Rule 22.1-289.035-A.

Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center.

“Evidence: The record for Child #3, (first date of attendance 5-6-2024) did not include documentation of required immunization.”

Rule 8VAC20-780-130-A.

Repeat Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department

“Evidence: The physical and immunization documents for Child #5 did not include a physician or designated individual’s signature”

Rule 8VAC20-780-150-B.

Based on record review and staff interviews, the licensee did not ensure that each staff member had obtained at least every two years from the date of the initial screening or testing, the results of a follow- up tuberculosis screening.

“Evidence: The records for Staff #3 did not include updated TB screening as the most recent screening was dated 1-17-2021.”

Rule 8VAC20-780-160-C.

Repeat Based on observation, staff interview and record review, the licensee did not ensure to follow the required ratio of 1 staff for every 4 infants in care.

“Evidence: At 1:10 PM In the infant room 9 children, youngest age 4 months were observed with only 2 staff. The ratio of 1 staff to every 4 children was not followed.”

Rule 8VAC20-780-350-B-1.

Based on observation and staff interview, the licensee did not ensure cots/mats used by children other than infants during the designated rest period shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges.

“Evidence: Three children out of seven were observed sleeping without a second cover (top or bottom).”

Rule 8VAC20-780-450-A.

Repeat Based on observation and staff interviews, the licensee did not ensure the requirements for diapering were followed.

“Evidence: 1.The diaper pad/ surface was not sanitized after each use as sanitized is defined as sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes. Staff #4 was observed conducting a diaper changes, and the diaper pad was wiped with disinfectant wipes and was not sprayed with a disinfectant solution as required. 2. The diaper pad in the toddler room had small tears and therefore it was no longer nonabsorbent.”

Rule 8VAC20-780-500-B.

Based on observation and staff interviews, the licensee did not ensure if diaper ointment or cream is used, it shall be in original container and labeled with the child’s name and stored in a place inaccessible to children

“Evidence: Three containers of diaper cream were observed and were not labeled with the children’s names and were stored in a drawer below the handwashing sink and accessible to children”

Rule 8VAC20-780-520-C.

Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of monthly emergency evacuation drills.

“Evidence: Center owner confirmed they did not have documentation of November and December 2023 evacuation drills.”

Rule 8VAC20-780-550-D.

Based on staff interviews and review of documentation, the licensee did not ensure to maintain documentation of lockdown procedures practiced at least annually.

“Evidence: Center Owner confirmed they did not have documentation of a 2023 lockdown drill.”

Rule 8VAC20-780-550-F.

Based on observation and staff interviews, the licensee did not ensure to follow the recent, age-appropriate nutritional requirements of the Child and Adult Care Food Program of the United States Department of Agriculture (USDA) when they choose to provide meals and snacks.

“Evidence: The menu posted was for the week of April 29, 2024”

Rule 8VAC20-780-560-F.

Repeat Based on documentation review and provider interview the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.

“Evidence: Two out of two of the classrooms did not have attendance list as required; 1.At approximately 1:10 PM, 9 infants were observed in the infant room and only 8 were on the attendance list 2. There was not an attendance list for the toddler room and 7 children were observed”

Rule 8VAC20-780-80-A.

Based on record review and provider interview, the licensee did not ensure the physical examination and dates of immunizations shall include the signature of a physician, his designee, or an official of a local health department

“Evidence: The immunization and physical documents for Child #5 did not include a physician or designated individual’s signature.”

Rule 8VAC20-780-150-B.

Repeat Violation Based on observation, the licensee did not ensure hazardous substances shall be kept in a locked place using a safe locking method that prevents access by children.

“Evidence: In the infant room there were containers of hazardous substances, a spray disinfectant and bottle of hand sanitizer were stored on a shelf in an unlocked manner. These items were labeled “keep out of reach of children” and at least one other statement “caution”, “flammable” and “warning”.”

Rule 8VAC20-780-280-B.

Based on observation, staff interview and record review, the licensee did not ensure to follow the required staff-to-child ratio for children birth to 16 months is 1:4.

“Evidence: On 11-15-2023, in the infant room, from approximately 2:15 PM until 2:25 PM, there were 9 infants with 2 staff.”

Rule 8VAC20-780-350-B-1.

Based on observation and staff interviews, the license did not ensure that cribs, cots, rest mats, and beds shall be identified for use by a specific child.

“Evidence: Child #4 was observed sleeping in a crib that was not labeled for his individual use.”

Rule 8VAC20-780-440-B.

Repeat Violation Based on observation and staff interviews, the licensee did not ensure children’s and staff hands shall be washed with soap and running water or disposable wipes when required.

Rule 8VAC20-780-500-A.

Repeat Violation Based on observation and staff interviews, the licensee did not ensure the required procedures for diapering were followed.

Rule 8VAC20-780-500-B.

Based on observation and staff interviews, the licensee did not ensure when a child is placed in a highchair, the protective belt shall be fastened securely.

“Evidence: Child #2 was observed sitting in a feeding table and the protective strap was not used”

Rule 8VAC20-780-570-A.

Based on observation and provider interviews, the licensee did not ensure that prepared infant formula shall be refrigerated, dated and labeled with the child’s name.

“Evidence: The bottle for Child #6 was not dated as required”

Rule 8VAC20-780-570-E.

Based on documentation review and staff interviews, the licensee did not ensure that for each group of children, the center shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.

“Evidence: The attendance sheet for Infant Room was not accurate, it did not include Child #1 who was observed in care.”

Rule 8VAC20-780-80-A.

Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in- person competency demonstration.

“Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of CPR certification.”

Rule 8VAC20-790-600-D-1.

Based on record review and staff interviews, the vendor did not ensure staff completed who work directly with children shall have obtained within 90 days of the date of hire a current certification in first aid appropriate to the ages of children in care.

“Evidence: The record for Staff #3 (date of hire 8-3-2022) did not include documentation of First Aid certification.”

Rule 8VAC20-790-600-D-2.

Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child’s attendance; or within 30 days after the first day of attendance.

“Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical”

Rule 8VAC20-780-140-A.

Based on staff record records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care.

“Evidence: Staff # 3 (hire date 8-3-2022) did not have documentation of CPR / First Aid orientation”

Rule 8VAC20-780-240-E.

Based on documentation review and staff interviews, the licensee did not ensure to obtain an annual fire inspection report from the appropriate fire official having jurisdiction.

“Evidence: The most recent copy of the fire inspection available for review was dated 1-20-2022.”

Rule 8VAC20-780-260-A.

Based on observation and staff interviews, the licensee did not ensure hazardous substances such as cleaning materials, insecticides, and pesticides shall be kept in a locked place using a safe locking method that prevents access by children.

“Evidence: Hazardous chemicals were observed in the toddler room and were stored in an unlocked manner. 1) A container of room deodorizer and a container of disinfectant were observed in a wooden cubby underneath the box of toys. 2) A container of disinfectant was observed on the hooks where `s belongings are placed. These items are hazardous chemicals, and they were labeled “keep out of reach of children” and at least one other statement “caution”, “flammable” and “warning”.”

Rule 8VAC20-780-280-B.

Based on staff record review, observation and staff interviews, the licensee did not ensure that there shall be in each grouping of children at least one staff member who meets the qualifications of a program leader or program director.

“Evidence: Staff #4, was the designated program leader for the toddler room and was the only staff supervising 5 toddlers during the inspection. Center owner documented in Staff #4?s record that they were promoted to program leader as of 6-20-2021. Center owner indicated they may have gotten rid of the training documents when the records were cleaned out.”

Rule 8VAC20-780-340-D.

Based on observation and staff interviews, the licensee did not ensure to wash their hands and did not ensure that children’s hands shall be washed with soap and running water after toileting and any contact with blood, feces, or urine.

“Evidence: Staff #2 was observed conducting a diaper change for child #6 and the staff did not ensure child #6 had washed their hands after diapering.”

Rule 8VAC20-780-500-A.

Based on observation and staff interviews, the licensee did not ensure the diapering surface was cleaned with soap and at least room temperature water and sanitized after each use.

“Evidence: Staff #2 was observed conducting a diaper change and the diaper pad was not sanitized after. Staff #2 sprayed the diaper pad with a soap and water solution and then wiped it down. The diaper pad was not sanitized as it is required to be sprayed with a disinfectant /sanitizing solution and allowed to air dry or wiped down after two minutes.”

Rule 8VAC20-780-500-B.

8VAC20-790-600-F

“Based on a review of 5 staff records and staff interviews, the vendor did not ensure staff completed who work directly with children shall have completed the departments health and safety update course. Evidence: The record for Staff #2 and Staff #4 did not include the required annual 3 hour health and safety update course. The most recent Health and Safety course available for review for Staff #2 was dated 3-1-2020 and for Staff #4 it was dated 11-13-2019.”

Rule 8VAC20-790-600-F.

8VAC20-780-130-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center. Evidence: The records for Child #2, (first date of attendance 11-7-2022) did not include documentation of required immunizations.”

Rule 8VAC20-780-130-A.

8VAC20-780-140-A

“Based on record review and staff interviews, the licensee did not ensure to obtain documentation that each child has received a physical examination by or under the direction of a physician, before the child’s attendance; or within 30 days after the first day of attendance. Evidence: The record for Child #5, (first date of attendance 9-20-2021) did not include documentation of a physical.”

Rule 8VAC20-780-140-A.

8VAC20-780-160-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure that each staff member shall submit documentation of a negative tuberculosis screening and the documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician’s designee, or an official of the local health department. Evidence: The record for Staff #5 did not include documentation of a TB screenings/ test conducted. Staff #5 was observed working during the inspection.”

Rule 8VAC20-780-160-A.

8VAC20-780-240-C

Rule 8VAC20-780-240-C.

8VAC20-780-240-E

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure each staff member had obtained within 30 days of the first day of employment, training in first aid and cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Evidence: Staff # 4 (hire date 1-28-2022) did not have documentation of CPR / First Aid orientation”

Rule 8VAC20-780-240-E.

8VAC20-780-245-A

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure staff completed 16 hours of annual training. Evidence: The record for Staff #2 only included 1 ? hours of annual training (March 2021 to March 2022)”

Rule 8VAC20-780-245-A.

8VAC20-780-270-A

Rule 8VAC20-780-270-A.

8VAC20-780-280-B

Rule 8VAC20-780-280-B.

8VAC20-780-340-D

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure in each grouping of children there is at least one staff member who meets the qualifications of a program leader or program director. Evidence: Staff #4, the designated lead teacher does not have documentation indicating they meet the qualifications of program leader. Staff #4 was the only staff observed supervising 3 toddlers during the inspection. Center Director confirmed there was not documentation available for review during the inspection.”

Rule 8VAC20-780-340-D.

8VAC20-780-40-K

“Based on review of center documentation and staff interviews, the licensee did not ensure the center shall develop written procedures for abusive head trauma. Evidence: Center Director, Staff #5 confirmed there was not a policy available for review related to head trauma.”

Rule 8VAC20-780-40-K.

8VAC20-780-440-B

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats shall be identified for use by a specific child. Evidence: Child #4 and Child #5 were observed in cribs that were not identified for use by them. Child #4 was in crib that was not labeled for his use and Child #5 was in a crib that was labeled with another child’s name (Child #6).”

Rule 8VAC20-780-440-B.

8VAC20-780-450-A

“Based on observation and staff interviews, the licensee did not ensure cribs, cots and mats used by children other than infants during the designated rest period or during evening and overnight care shall have linens consisting of a top cover and a bottom cover or a one-piece covering which is open on three edges. Cribs when being used by infants shall have a bottom cover. Evidence: Child #5 was observed in a crib without a bottom cover.”

Rule 8VAC20-780-450-A.

8VAC20-780-530-A

“Based on review of 5 staff records and staff interviews, the licensee did not ensure there was at least one staff in each classroom or area where children are present had obtained a current certification in cardiopulmonary resuscitation (CPR) and First Aid as appropriate to the age of the children in care Evidence: In the toddler classroom Staff #4 was the only staff observed supervising 3 toddlers during the inspection and they have not obtained CPR or First Aid certification.”

Rule 8VAC20-780-530-A.

8VAC20-780-70

“Based on a review of 5 staff records and staff interviews, the licensee did not ensure the staff records were kept for each staff person with all required information. Evidence: Staff #2, designated as a lead teacher (program leader) does not have documentation to demonstrate they possesses the education and certification required by the job position. Center Director confirmed there was not documentation available.”

Rule 8VAC20-780-70.

Based on review of 2 staff records and staff interviews, the licensee did not ensure tuberculosis (TB) documentation shall have been completed within the last 30 calendar days of the date of employment and be signed by a physician, physician’s designee, or an official of the local health department.

“Evidence: The record for staff #2 did not include TB screening dated within 30 day of employment. TB screening was dated 6-17-2021 and date of employment 1-18-2022.”

Rule 8VAC20-780-160-A-2.