8VAC20-780-550-O · Based on staff interview and record review, the center did not notify parents of known injury by the end of the day of the incident.

Evidence: 1. Child # 1 sustained an injury on 7/18/24 at 9:30 am. 2. Child # 1's parent was not notified of the injury until 7/19/24 at 8:30 am. 3. The serious injury report submitted by the center listed the same dates and times for the injury and notification of the injury. 4. Staff # 1 stated that the center had a system in place to let the parent know to see staff at the end of the day. The parent did not see that notice and staff did not notify the parent on 7/18/24 of the injury.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

8VAC20-780-80-B-2 · Based on record review, the center did not inform the department's representative as soon as practicable, but not to exceed two business days, of any injury to a child that occurs while the child is under the supervision of the center and requires outside medical attention.

Evidence: 1. On 9/1/22 a child in care sustained injuries on the playground. Child # 1's was seen by a physician. 2. The department received notification of this incident requiring outside medical attention on 9/9/22.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

8VAC20-780-60-A-8 · Based on records review, the center did not obtain a written allergy action plan 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 for each child.

Evidence: 1. Child # 1's record indicated that he had a diagnosed allergy to eggs. 2. The center did not obtain a written allergy action plan for Child # 1.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

22VAC40-185-240-D-1 · Based on staff interview and records review, medication was administered to a child without the center staff having satisfactorily completed a training program for this purpose approved by the Board of Nursing.

Evidence: 1. Child # 1has a prescribed emergency medication (insulin) on site to be administered on an as needed basis. 2. The medication log showed: a. 2 units of the insulin were administered on 9/17/21 at 5:15 pm; b. 2 units of the insulin were administered on 9/21/21 at 5:07 pm; and c. Staff # 1 signed off on the medication log as having administered the medication on both these dates. 3. Staff # 2 stated that Staff # 1 did not administer the medication, but supervised Child # 1 while the child self administered the medication. 4. On 9/17/21 and 9/21/21 and at the times of administration, there were no staff members on site with the required emergency medication administration training related to Child # 1's medical need. 5. There was no documentation from the physician or parent in Child # 1's record that permitted the child to self administer the medication.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.