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Magaly Paz-Quiroga
4000 19th Street
Arlington, VA 22204
(703) 553-0170

Current Inspector: Stephanie Salvatori (571) 389-0980

Inspection Date: April 9, 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 Physical Environment and Equipment
22VAC40-111 Medication Administration
22VAC40-111 Emergencies
22VAC40-111 Nutrition
63.2 General Provisions.
63.2 Facilities and Programs..
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/renewal inspection was conducted today from 11:35am-1:00pm. There were 7 children (22 points) directly supervised by 3 staff. The home, 1 staff record, 4 children?s records, 1 household member?s records, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. Children were observed finishing up lunch, playing freely, preparing for nap and napping. Hand washing procedures were also observed. There was an abundant supply of books, toys, and materials for the children. The home was clean and organized. Areas of non-compliance are identified in this report. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to me within 10 calendar days from today. If you have any questions regarding this inspection, please contact the Licensing Inspector. Keesha Minor ( (703)479-4680

Standard #: 22VAC40-111-800-B
Description: Based on review, the provider failed to document in writing that the emergency preparedness plan is reviewed at least annually and updated as needed. Evidence: Reviewed the provider's emergency preparedness plan and found that it was last updated on 11/1/2013.

Plan of Correction: Corrected

Standard #: 22VAC40-111-60-B
Description: Based on review, the provider failed to ensure that all children's records contained the required information. Evidence: 1) Reviewed 4 children's records and found that CH2 did not have telephone numbers for both emergency contacts. 2) Reviewed 4 children's records and found that CH1 did not have documentation of a medical insurance policy number. 3) Reviewed 4 children's records and found that CH2 did not have documentation that the provider had verified the child's original documentation of proof of identity. 4) Reviewed 4 children's files and found that CH1 had blank forms for liability insurance and the provider's medication policy. Neither of the forms were filled out, notifying the parents of whether or not the provider has liability insurance or what the provider's medication policy is.

Plan of Correction: #1 has been corrected on 4/9/15 #2 has been corrected on 4/9/15 #3 has been corrected on 4/10/15 #4 has been corrected on 4/10/15

Standard #: 22VAC40-111-80-A
Description: Based on review, the provider failed to obtain from the parent(s) documentation of the child's proof of identity. Evidence: Reviewed 4 children's records and and identified through the provider's interview that CH1 had not yet provided the provider with documentation of the child's proof of identity.

Plan of Correction: Parents are waiting for birth certificate in the mail. As soon as possible.

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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