VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sellapperumage Shaw
1004 N. Roosevelt Street
Falls church, VA 22046
(703) 447-6917

Current Inspector: Margaret Allworth (703) 209-3521

Inspection Date: June 2, 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 8VAC20-820 THE LICENSE. 8VAC20-770 Background Checks

Comments:

A renewal inspection was initiated on 6/2/2022 and concluded on 6/2/2022.There were a total of 4 children ( 17 points) observed with 2 caregivers present. The children were engaged in the following: toy play and napping. A total of 3 child records and 2 caregiver/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 contact me if you have any questions at Margaret.allworth@doe.virginia.gov or 703-209-3521.

Violations:

Standard #:	8VAC20-770-40-D-4-a
Description:	Based on provider interview, the provider did not obtain a sworn statement for a person age 18 years or older before residing in the home. Evidence: The provider stated that household member #1 and #2 did not complete a sworn statement.
Plan of Correction:	Provider had the household members complete the forms today 6/2/2022.
Standard #:	8VAC20-800-800-B
Description:	Based on review of emergency preparedness plan, the provider did not review the emergency plan at least annually and update the plan as needed. The provider did not document in writing each review and update to the emergency plan. Evidence: the posted emergency preparedness plan has not been updated annually. The current date is 12/20/2019.
Plan of Correction:	The provider will review and sign the emergency plan.
Standard #:	8VAC20-800-830-C
Description:	Based on documentation review and provider interview, the home did not maintain documentation of emergency evacuation and shelter-in-place drills. Evidence: The provider stated that she conducted the drills but could not find the documentation of the fire drills and shelter place drills.
Plan of Correction:	Provider will document fire drills and keep on file.
Standard #:	8VAC20-800-60-B
Description:	Based on review of a child's record, a name, address and telephone number of a designated person to contact in case of an emergency if the parent cannot be reached was not given. Evidence: Child #1 first date of attendance 9/7/2021 did not have a second emergency contact name, address, and phone number.
Plan of Correction:	Provider obtained a second emergency contact today.
Standard #:	8VAC20-800-80-C
Description:	Based on a review of children records, the provider did not document in the child's record the date viewed and person who viewed the identity and age of a child. Evidence: Child #1 date of first attendance 9/7/2021 does not have documentation of the date the proof of birth was viewed and the person who viewed it.
Plan of Correction:	Provider will sign and date the proof of identity form.
Standard #:	8VAC20-800-90-C
Description:	Based on a review of children's records, the family day home did not obtain documentation of additional immunizations for a child who is not exempt from the immunization requirements. Evidence: Child #1 date of first attendance 9/7/2021 did not have an updated immunization record within six months of attendance. The current immunization form was dated 7/30/2021.
Plan of Correction:	Provider will ask the parent for an updated immunization record.
Standard #:	8VAC20-800-180-A
Description:	Based on staff record review and provider interview, the provider did not obtain for each caregiver and adult household member a current Report of Tuberculosis Screening form,every two years from the date of the first screening. Evidence: Household member #1 and Household member #2 does not have documentation of a current tuberculosis screening. The provider stated that she did not ask the roommates to obtain a tuberculosis screening.
Plan of Correction:	Provider will ask household members to get their TB screening.
Standard #:	8VAC20-800-500-E
Description:	Based on observation, the playground sandbox was uncovered while not in use. Evidence: The playground sandbox was observed with wet sand and uncovered.
Plan of Correction:	The provider will keep the sandbox covered.