Nichole Hickman

Areas and furnishings of the family day home, inside and outside, shall be maintained in a clean, safe, and operable condition.

“A crib that was occupied by a child had a broken wheel and was unstable.”

Rule 8VAC20-800-240-A.

The provider shall ensure that the total number of children receiving care at any one time does not exceed the maximum licensed capacity of the home.

“There were 12 children in care. The maximum licensed capacity of the home is 11.”

Rule 8VAC20-800-40-A.

No soft bedding of any kind shall be used under or around infants including, but not limited to, pillows, quilts, comforters, sheepskins, or stuffed toys.

“Child #2, 3 months old, was asleep in a bassinette, laying on top of a ‘Boppy” pillow with a blanket up against the infant’s face.”

Rule 8VAC20-800-530-F.

The provider shall ensure that a caregiver does not exceed 16 points by using a point system to determine if an additional caregiver is needed.

“Upon arrival to the home Caregiver #2 was alone with 12 children. The point total was 27. The provider left Caregiver #2 alone with 12 children to run an errand. There were 3 children under the age of 6 months, 1 toddler, 4 children between the ages of 3 and 4, and 4 children between the ages of 5 and 6. Four of the children have a documented developmental disability. The provider arrived approximately 20 minutes after the start of the inspection.”

Rule 8VAC20-800-570-A.

The following acts are forbidden: enclosure in a small, confined space or any space that the child cannot freely exit himself.

“Three preschool age children were observed confined in cribs, and one preschool child and three school age children with special needs were observed confined in high chairs. The children were watching television.”

Rule 8VAC20-800-640-2.

Caregivers who work directly with children shall complete the department’s health and safety update course annually.

“Caregiver #2 last completed the department’s health and safety update course on 08/27/24. The training was overdue by over five months.”

Rule 8VAC20-790-250-F.

(Repeat Violation / Systemic Deficiency) The provider shall obtain documentation of a physical examination prior to a child’s attendance or within 30 days after the first day of attendance.

“There was no physical examination on file for Child #9, who has been in attendance for over eight months.”

Rule 8VAC20-800-100-A.

A tuberculosis (TB) screening is required every two years from the last screening.

“An updated TB screening for Caregiver #2 was not completed and was overdue by eight months.”

Rule 8VAC20-800-180-A.

(Repeat Violation) The provider shall obtain documentation that each child has been adequately immunized prior to the child’s attendance.

“There was no documentation of immunizations for Child #9, who has been in attendance for over eight months.”

Rule 8VAC20-800-90-A.

The center is required to have employees undergo a background check every five years.

“The most recent national criminal history check for caregiver #1 was overdue by over 3 weeks. The most recent central registry check for caregiver #1 was overdue by over 2 weeks.”

Rule 22.1-289.035-A.

**Repeat Violation** The provider shall obtain documentation of a physical examination prior to a child’s attendance or within 30 days after the first day of attendance.

“There was no physical exam record available for child #1, who had been in care for over 3 years. There was no physical exam record available for child #9, who had been in care for over 3 months.”

Rule 8VAC20-800-100-A.

Prior to attendance, documentation of immunizations is to be obtained for each child.

“There was no documentation of immunizations for child #9, who was in care during the inspection and had been in care for over 3 months.”

Rule 8VAC20-800-90-A.

The provider shall obtain documentation of a physical examination prior to a child’s attendance or within 30 days after the first day of attendance.

“There were no physical exam records available for Child #1, #3, and #5, who had been in care between 23 months to four months.”

Rule 8VAC20-800-100-A.

Current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in-person competency demonstration.

“Provider #1 and Caregiver #1 did not have CPR certification with an in-person competency demonstration.”

Rule 8VAC20-790-250-D-1.

Trampolines shall not be used during the hours children are in care.

“A trampoline was set up in one of the rooms that was used for children in care.”

Rule 8VAC20-800-500-F.

The provider shall ensure that a caregiver does not exceed 16 points by using the following point system: Children from birth through 15 months of age count as four points each; Children from 16 months through 23 months of age count as three points each; Children from two through four years of age count as two points each.

“The provider had 9 children present, totaling 21 points when the inspector arrived to conduct a monitoring inspection. The youngest child in care was 4 months old. At approximately 12:35 PM an additional caregiver arrived.”

Rule 8VAC20-800-570-A.

Before a child may attend the family day home, the provider shall obtain documentation that the child has been adequately immunized according to the requirements of ? 32.1-46 A of the Code of Virginia and applicable State Board of Health regulations.

“The record for child #4 did not have immunizations prior to enrollment.”

Rule 8VAC20-800-90-A.

Children shall not be allowed to eat or drink while walking, running, playing, lying down, or riding in vehicles.

“Child A was laying in his crib, drinking from a bottle.”

Rule 8VAC20-800-900-B.

(Repeat Violation) Based on a review of five children’s records and interviews, the provider did not ensure one child’s record contained the required information.

“Evidence: The record of Child #1, enrolled on 06/11/24, did not contain a second emergency contact. During interview, Caregiver #1 acknowledged the record was missing a second emergency contact. Each child’s record shall contain the name, address and telephone number of two designated persons to contact in case of an emergency if the parent cannot be reached.”

Rule 8VAC20-800-60-B.

Based on a review of three caregivers’ records and interview, the vendor did not ensure one caregiver completed the Virginia Preservice Training for Child Care Staff sponsored by the Department of Education within the first 90 days of employment.

“Evidence: The certificate of training of the Virginia Preservice Training in the record of Caregiver #3, employed on 10/10/23, had a completion date of 01/20/24. During interview, Caregiver #1 acknowledged the training was completed more than 90 days after employment.”

Rule 8VAC20-790-250-B.

Based on a review of three caregivers’ records and interviews, the provider did not obtain the satisfactory results of a national fingerprint-based criminal record search for one caregiver prior to employment.

“Evidence: The national fingerprint-based criminal record search in the record of Caregiver #3, employed on 10/10/23, was completed on 10/18/23. During interview, Caregiver #1 confirmed the fingerprint-based criminal record search for Caregiver #3 was not received prior to employment.”

Rule 22.1-289.035-B-2.

(Repeat Violation) Based on a review of five children’s records and interviews, the provider did not obtain documentation of a physical examination by or under the direction of a physician for two children prior to the children’s attendance or within 30 days after the first day of attendance.

“Evidence: The record of Child #4, date of attendance 04/04/23, and the record of Child #5, date of attendance 04/04/23, did not contain documentation of a physical examination. During interview, Caregiver #1 confirmed Child #4 and Child #5 do not have documentation of a physical examination on file.”

Rule 8VAC20-800-100-A.

(Repeat Violation) Based on a review of five children’s records and interview, the provider did not ensure four children’s records contained the required information.

Rule 8VAC20-800-60-B.

Based on a review of five children’s records and interview, the provider did not obtain documentation that two children had been adequately immunized according to the requirements of ? 32.1-46 A of the Code of Virginia and applicable State Board of Health regulations before the children attended the family day home.

“Evidence: 1. The immunizations in the record of Child #4, date of attendance 04/04/23, were dated 04/05/23. 2. The immunizations in the record of Child #5, date of attendance 04/04/23, were dated 04/05/23. 3. During interview, Caregiver #1 acknowledged the immunizations for Child #4 and Child #5 were obtained after they attended the family day home.”

Rule 8VAC20-800-90-A.

Based on a review of two caregivers? records and interview, the provider accepted a required central registry finding from a caregiver that was dated more than 90 days prior to the date of employment.

“Evidence: 1) The central registry finding in the record of Caregiver #2, employed on 04/01/23, was completed on 08/02/22. 2) During interview, the Provider reported a new central registry was not requested for Caregiver #2 at the time of employment. A facility must not accept a required criminal history record report or a central registry 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.”

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

Based on a review of five children’s records and interview, the provider did not obtain documentation of a physical examination by or under the direction of a physician for one child prior to the child’s attendance or within 30 days after the first day of attendance.

“Evidence: 1) The record of Child #5, enrolled on 03/07/23, contained a physical examination that was completed on 05/08/23. 2) During interview, the Provider confirmed the physical examination was not provided within the required timeframe.”

Rule 8VAC20-800-100-A.

Based on a review of two caregivers? records and interview, the provider did not obtain from one caregiver a Report of Tuberculosis (TB) Screening within the required timeframe.

Rule 8VAC20-800-170-A.

Based on observations and interview, the provider did not ensure that portable wading pools without integral filter systems shall when not in use during the family day homes? hours of operation, be emptied, sanitized, and stored in a position to keep them clean and dry.

“Evidence: 1) During the inspection of the outdoor play area, the inspector observed a portable wading pool in the middle of the yard. The pool contained water, leaves, and dirt. 2) During interview, the Provider reported the pool is not used by the children enrolled and stated she was unaware it had to be emptied, sanitized, and stored away while the children were in care.”

Rule 8VAC20-800-260-C.

Based on observation, the provider did not ensure potentially harmful substances, materials and supplies such as, but not limited to, cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children.

“Evidence: During the inspection of the home, the inspector observed bottles of cleaning agents throughout the home. The children were observed waking up from nap time and the cleaning agents were within their reach. On the deck where the children walk by to access the outdoor play area, the inspector observed a bottle of pesticide. There was nothing preventing the children from accessing the bottle of pesticide.”

Rule 8VAC20-800-280.

Based on observation and interview, the provider did not ensure children under two years of age and children over two years of age who are not developmentally ready to climb or descend stairs without supervision shall not have access to stairs.

“Evidence: 1) During the inspection of the outdoor play area, the inspector observed the staircase that goes from the deck to the front yard where the children play did not have a protective barrier to prevent access by children. 2) During interview, the Provider confirmed the children use the staircase to go outside and play. She confirmed there is no protective barrier that would prevent access by children under two years of age. There were seven children under two years of age present at the time of the inspection.”

Rule 8VAC20-800-430-A.

Based on observation and interview, the provider did not ensure one child was provided with an individual crib, cot, rest mat, or bed for resting or napping.

Rule 8VAC20-800-510-A.

Based on observation and interview, the provider did not ensure cribs when being used by infants shall have a tight-fitting bottom cover.

“Evidence: 1) The inspector observed three occupied cribs that did not have a tight-fitting bottom cover. 2) During interview, the Provider acknowledged she did not have bottom covers for the cribs.”

Rule 8VAC20-800-530-B.

Based on observation, the provider did not ensure soft bedding of any kind shall be used under or around infants including, but not limited to, pillows, quilts, comforters, sheepskins, or stuffed toys.

“Evidence: The inspector observed a boppy pillow in a crib occupied by Child #5 (7-month-old).”

Rule 8VAC20-800-530-F.

Based on observation and interview, the provider did not ensure infant walkers shall not be used.

“Evidence: 1) The inspector observed two infant walkers in the area where children receive care. 2) During interview, Caregiver #2 reported the infant walkers are used by the children in care.”

Rule 8VAC20-800-540-B.

Based on observation and interview, the provider did not ensure that when play pens were used, they were not used as a designated sleeping area and that they did not contain any pillows or filled comforters.

“Evidence: 1) During the inspection, Child #10 (16-months-old) and Child #11 (10-months-old) were observed sleeping in play pens. Child #11 was observed sleeping on a boppy pillow in the play pen. 2) During interview, the Provider confirmed the play pens were the designated sleeping areas for Child #10 and Child #11.”

Rule 8VAC20-800-550.

Based on a review of documentation and observation, the provider did not ensure that each caregiver did not exceed 16 points.

Rule 8VAC20-800-570-A.

Based on a review of five children’s records and interview, the provider did not ensure two children’s records contained the required information.

“Evidence: 1) The record of Child #2, enrolled on 02/01/23, did not contain proof of the child’s age and identity. 2) The record of Child #4, enrolled on 02/13/23, did not contain the name, address, and telephone number of a second emergency contact. The record did not contain proof of the child’s age and identity. 3) During interview, the Provider confirmed the information was not on file for Child #2 and for Child #4.”

Rule 8VAC20-800-60-B.

Based on observation and interview, the provider did not ensure medication, except for those prescriptions designated otherwise by a written physician’s order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place using a safe locking method that prevents access by children.

“Evidence: 1) During the inspection of the family day home, the inspector observed non-prescription medication in the area where first aid supplies are kept. The drawers were not locked and there was nothing preventing access by children. 2) On the kitchen countertop, the inspector observed non-prescription medication in a bowl. The Provider reported the medications were household medications and did not belong to any of the children in care. The medications were not locked and there was nothing preventing access by children.”

Rule 8VAC20-800-730-D.

Based on observation and interview, the provider did not ensure that when food is brought from home, the food containers shall be clearly labeled in a way that identifies the owner.

“Evidence: 1) During the inspection, the inspector observed several lunch boxes that belonged to the children in care. The lunch boxes were not labeled. 2) During interview, the Provider reported the children bring food from home and acknowledged that not all the lunch boxes are labeled in a way that identifies the owner.”

Rule 8VAC20-800-890.

Based on observation, the provider did not ensure infant bottles were labeled with the child’s full name and the date, if more than one infant is in care.

“Evidence: 1) The infant bottles observed were not labeled with children’s names or the date. There were four infants present at the time of the inspection. 2) During interview, the Provider acknowledged the bottles were not labeled as required.”

Rule 8VAC20-800-960-E.

Based on the review of two children’s records, two records did not contain 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: The records for Child #1 (first day of attendance 11/17/2020) and Child #2 (first day of attendance 12/28/2020) did not contain documentation of a physical exam by or under the direction of a physician.”

Rule 8VAC20-800-100-A.