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Roina Mustafa
7702 Tanner Robert Court
Springfield, VA 22153
(703) 569-4084

Current Inspector: Anansa Archer-Hicks (703) 268-3295

Inspection Date: April 27, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
22VAC40-111 Household Members
22VAC40-111 Physical Health of Caregivers and Household Members
22VAC40-111 Caregiver Training
22VAC40-111 Physical Environment and Equipment
22VAC40-111 Care of Children
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Medication Administration
22VAC40-111 Emergencies
22VAC40-111 Nutrition
22VAC40-111 Transportation
22VAC40-111 Nighttime Care
63.2 General Provisions.
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies
54.1-3408 Provider must be MAT certified to administer prescription medication.

An unannounced monitoring inspection was conducted today. Observed 6 children (20 points) directly supervised by 2 caregivers. Ratio and supervision were in compliance. A sample of 4 children's records, 2 caregiver records, and 3 household member records were reviewed. The physical plant, emergency supplies and procedures were also reviewed. No medications were reported to be on site. The provider has current CPR and First Aid certifications. The children were engaged in various activities, to include: free play, infant care, and feeding. Areas of non-compliance are identified in this report. The exit interview was conducted with the provider. Inspection conducted 10:20am-11:30pm. Please submit your plan of correction within 10 calendar days of receipt. If you have any questions regarding today's inspection, please contact Ana Dally at (703) 577-0270 or

Standard #: 22VAC40-111-800-A
Description: Based upon interview, the family day home did not have a written emergency preparedness and response plan. Evidence: Upon Licensing Inspector request, the provider stated that she could not locate the family day home written emergency preparedness and response plan.

Plan of Correction: Original plan posted was missplaced. Will write a new plan. [sic]

Standard #: 22VAC40-111-50-C
Description: Based upon observations made and documentation reviewed, children's records were not kept confidentially. Evidence: Confidential information was posted on the bulletin board and readily viewable by the public and parents. Identifying information about staff and children referenced on the Supplemental Information portion of the December 4, 2014 inspection report was posted. The report states, "Information found on the Supplemental Information page is confidential and this document is not to be posted in the facility".

Plan of Correction: Removed! It was posted under the initial documents.

Standard #: 22VAC40-111-60-B
Description: Based upon documentation reviewed, children's records were incomplete. Evidence: Two of the four children's records reviewed did not contain documentation of viewing the proof of the child's age and identity (Child A and B).

Plan of Correction: Proof of child's age was virewed. Signed in front of inspecter. [sic]

Standard #: 22VAC40-111-180-A
Description: Based upon documentation reviewed, an adult household member did not obtained a current report of tuberculosis screening (TB) form within two years from the last test/screening. Evidence: Household member #1 did not have a current TB test/screening on file. Last TB test/screening was dated 02/01/2013, past two years from the date of the first screening.

Plan of Correction: Will obtain.

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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