VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Jasbleidy Cruz Pava
14707 Saint Germain Dr
Centreville, VA 20121
(571) 641-0932

Current Inspector: Sarah Marbert (703) 479-4678

Inspection Date: May 10, 2022

Complaint Related: No

Areas Reviewed:

8VAC20-800 Administration 8VAC20-800 Personnel 8VAC20-800 Household Members 8VAC20-800 Physical Health of Caregivers and Household Members 8VAC20-800 Caregiver Training 8VAC20-800 Physical Equipment and Environment 8VAC20-800 Care of Children 8VAC20-800 Preventing the Spread of Disease 8VAC20-800 Medication Administration 8VAC20-800 Emergencies 8VAC20-800 Nutrition 8VAC20-770 Background Checks 22.1 Background Checks Code, Carbon Monoxide

Technical Assistance:

Discussed with Provider: Child file requirements, Staff file requirements, Emergency drill record, caregiver reference form, current Sworn Disclosure statement form. Model forms provided.

Comments:

An in-person monitoring inspection was conducted today. There are 7 children present (18 points) with 2 caregivers. 2 caregiver, 2 household member, and 3 child records were reviewed. See Violation Notice for missing items. First aid supplies, emergency evacuation drills, emergency supplies, bathroom supplies age and stage appropriate toys and games are all in compliance. The inspection will be typed off site. LI was present today from 8:45 AM - 10:15AM. Additional time was spent with provider in the afternoon reviewing file components and model forms. If you have any questions regarding this inspection, please contact me at 703-479-4678 or at sarah.marbert@doe.virginia.gov.

Violations:

Standard #:	22.1-289.035-A
Description:	Based on a review of records, caregiver and household member records do not contain documentation of repeated Central Registry Searches (CPS) being conducted within the allowable 5 year time frame. Evidence: Caregiver A: CPS search is dated 8/4/16 (expired) Household Member 1: CPS search is dated 9/13/16 (expired) Household member 2: CPS search is date 9/7/16 (expired)
Plan of Correction:	I will send the form for all us at the family.
Standard #:	8VAC20-770-60-C-2
Description:	Based on a review of records, one caregiver record does not contain documentation of a completed Central Registry Search (CPS) with in 30 days of employment. Evidence: Caregiver B (Date of employment: February 2022) does not have a completed CPS search on file as of today's date.
Plan of Correction:	Search was mailed to Richmond in March, but it has not been returned yet. I will call the Office of Background Investigations (OBI) to follow up on the form.
Standard #:	8VAC20-800-100-A
Description:	Based on a review pf records. one child record did not contain documentation of a completed physical within 30 days of enrollment. Evidence: 1 of 3 records reviewed did not contain a physical. (Child 1: Date of enrollment: 7/17/19)
Plan of Correction:	I will ask the parent to bring a physical.
Standard #:	8VAC20-800-120-B
Description:	Based on a review of caregiver records, one record did not contain documentation of all required information. Evidence: One record did not contain documentation of: Emergency contact, education, programmatic experience, two references. (Caregiver B)
Plan of Correction:	The staff will be done today.
Standard #:	8VAC20-800-60-B
Description:	Based on a review of records, one child record did not contain documentation of all required information. Evidence: 1 of 3 records reviewed did not contain Father's employment information. (Child 2)
Plan of Correction:	I will ask the parent to fill out the form.
Standard #:	8VAC20-800-70-A
Description:	Based on review of records, child records do not include written documentation of acknowledgment of all required policies and procedures. Evidence: 3 records reviewed. *2 of 3 records did not include documentation of the decision to administer medication. (Child 1, 2) * 1 of 3 records did not contain documentation of the relocation address for the Provisions of the emergency preparedness plan. (Child 2)
Plan of Correction:	The parents will update the forms by 5/30/22
Standard #:	8VAC20-800-180-A
Description:	Based on a review of records, one Household member record does not contain documentation of a subsequent TB screening within 2 years. Evidence: 1 of 3 records reviewed did not contain documentation of a repeated TB screening result within the allowable 2 year time frame. The results on file are dated 1/14/2019 (expired) HHM1
Plan of Correction:	He will be done soon.
Standard #:	8VAC20-800-200-B
Description:	Based on a review of records, one caregiver record does not contain documentation of orientation within the first week of employment. Evidence: There is no documentation of orientation available for review for Caregiver B (Date of Employment 2/22).
Plan of Correction:	Staff will be done today.
Standard #:	8VAC20-800-690-E
Description:	Based on observation, there is no foot operated diaper disposal system in use. Evidence: LI observed 2 diapers being changed during today's inspection. Neither diaper was placed into a foot operated diaper disposal system.
Plan of Correction:	I will buy a new one by today.