VIRGINIA DEPARTMENT OF SOCIAL SERVICES

LaShawnda Gunn
8646 Placid Lake Court
Bristow, VA 20136
(703) 853-0494

Current Inspector: Morgan Bryson (540) 270-0057

Inspection Date: Aug. 10, 2021 and Aug. 11, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-111 Administration 22VAC40-111 Personnel 22VAC40-111 Household Members 22VAC40-111 Care of Children 22VAC40-111 Preventing the Spread of Disease 22VAC40-111 Medication Administration 22VAC40-111 Emergencies

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol, including telephone contacts, document review, interviews, and a virtual tour of the program. A non-mandated monitoring inspection was initiated on 8/10/2021 and concluded on 8/11/2021. The provider was contacted by telephone and a virtual inspection was conducted. There were 4 children present, ranging in ages from 12 months to 5 years with one staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, medication, special care and emergencies. A total of 3 child records, 1 staff record, and 3 household member records were reviewed. Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the program. Please complete the columns for "Plan of Correction" and "Date to be Corrected" for each violation cited on the Violation Notice, and then return a signed and dated copy to the licensing office by 4pm on 8/18/2021. Please email me at morgan.bryson@doe.virginia.gov with any questions.

Violations:

Standard #:	22VAC40-111-100-A
Description:	Based on record review, the provider did not obtain documentation of a physical examination prior to a child's attendance or within 30 days after the first day of attendance. Evidence: Child #1 (Start Date: 6/23/2021) did not have a physical examination on file.
Plan of Correction:	Child #1 physical examination will be updated in file on 8/16/21.
Standard #:	22VAC40-111-60-B
Description:	Based on record review, the provider did not ensure children's records contain all required information. Evidence: Child #2's file did not contain written authorization for emergency medical care. Child #2 and Child #3's files were missing the medical insurance policy number.
Plan of Correction:	Child #2 File has been updated with all required forms and medical insurance policy number with signature. Child #3 File has been updated with all forms and ins. policy number.
Standard #:	22VAC40-111-70-A
Description:	Based on record review and interview, the provider did not provide parents required information in writing by children's first day of attendance. Evidence: Child #1, Child #2 and Child #3 did not have the provisions of the family day home's emergency preparedness and response plan or the liability insurance declaration signed by the parents.
Plan of Correction:	Child #1, 2, and 3 File has been updated with emergency preparedness and response plan and liability insurance declaration with parent signature.