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(Under the authority of Executive Order 51, the Commissioner of Department of Social Services is waiving regulation 22VAC40-665-40.N which references the period of time for a redetermination of eligibility for the subsidy program. )

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Behshid Nazeri
18429 Mill Run Ct.
Leesburg, VA 20176
(703) 989-8826

Current Inspector: Mary J. Wizbicki (703) 479-4707

Inspection Date: April 20, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Physical Environment and Equipment
22VAC40-111 Care of Children
22VAC40-111 Medication Administration

Technical Assistance:
Model forms given to the provider for medication administration authorization.

An unannounced monitoring inspection was conducted today. There are 5 children present (15 points) with 2 adults. 3 children's files were reviewed. See violation notice for missing information. There are 8 cribs assembled and ready for use. Four have manufacture dated of 01/2015, 4 have manufacture dates of 1/2014. First aid supplies are in compliance. If you have any questions regarding this inspection, please contact me at 703-479-4678 LI was present today from 12:10 PM - 1:30 PM

Standard #: 22VAC40-111-700-B
Description: Based upon a review of medication, one medication present does not have an authorization available. Evidence: There is no authorization available for Child C's Epi-pen.

Plan of Correction: I will have the parent complete an authorization form.

Standard #: 22VAC40-111-830-C
Description: There is no record of monthly emergency escape drills having been practiced.

Plan of Correction: I have practiced the drills. I will record the drills from now on.

Standard #: 22VAC40-111-60-A
Description: Based upon a review of files, one child's file is incomplete. Evidence: Child A does not have a parent signature and date on the child enrollment form

Plan of Correction: I will ask the parent to sign and date the enrollment form.

Standard #: 22VAC40-111-70-A
Description: Based upon a review of files, one child's file is missing documentation of policies and procedures for medication. Evidence: Child B does not have documentation of receipt of the Policy for the Administration of Medication.

Plan of Correction: I will give the policy to the parent for their signature.

Standard #: 22VAC40-111-240-A
Description: Based upon direct observation, a shelving unit in the day care area is not maintained in a safe manner. Evidence: During today's inspection at approximately 12:18 PM, the shelf unit tipped over onto a child when she pulled multiple storage bins out.

Plan of Correction: The shelf unit will be secured to the wall.

Standard #: 22VAC40-80-120-E-2
Description: The most recent Violation notice is not posted.

Plan of Correction: I will post today's paperwork.

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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