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Thanh-Tam Nguyen
3221 Patrick Henry Drive
Falls church, VA 22044
(571) 282-4234

Current Inspector: Stacy Doyle (571) 835-0386

Inspection Date: April 4, 2023

Complaint Related: No

Areas Reviewed:
8VAC20-800 Household Members
8VAC20-800 Physical Health of Caregivers and Household members
8VAC20-800 Physical Equipment and Environment
8VAC20-770 Background Checks
22.1 Background Checks Code

Technical Assistance:
Discussed the requirements for household members including the TB Test or screening and the background checks.

Comments:
An unannounced focused inspection was conducted from 12:45pm to 1:10pm. At the time of entrance, there were no children were in care. The physical space was inspected and the new household members record was reviewed. Areas of non-compliance are identified in the violation notice. Please contact me if you have any questions at Stacy.Doyle@doe.virginia.gov or 571-835-0386.

Violations:
Standard #: 8VAC20-770-40-D-4-a
Description: Based on interview of a household member's records and observation, the provider did not have a completed sworn statement for each household member prior to residing in the home.
Evidence:
1. Household Member #1 moved in April 1, 2023 and the provider did not have a completed Sworn Statement prior to them moving in. The Household Member filled it out during the inspection on 4/04/2023.

Plan of Correction: I just learned that the household member must have filled the Sworn Statement form out before they moved in. I will do it in the future.

Standard #: 8VAC20-800-170-A
Description: Based on review of records, the provider did not obtain from each adult household member
a current report of Tuberculosis Screening form published by the Virginia Department of Health or a form consistent with it documenting the absence of tuberculosis in a communicable form..
Evidence:
1. Household Member #1 (Moved in 4/01/2023) did not have a Tuberculosis screening form on file with the provider.

Plan of Correction: My mistake. I thought I have 30 days to complete. I will do it in the future.

Disclaimer:

A compliance history is in no way a rating for a facility.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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