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Ms. Mozhdeh Monjezi
1658 Old Brook Road
Charlottesville, VA 22901
(434) 409-6465

Current Inspector: Diann S. Reed (540) 280-0742

Inspection Date: June 8, 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
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
63.2 General Provisions.
63.2 Child Abuse and Neglect
63.2 Licensure and Registration Procedures
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.

Technical Assistance:
We discussed the requirements for caregiver's records and children's medical records. The risk assessment for a violation was provided. We talked about making sure the children are consistently re-directed away from the gate and electric panel area during outdoor play.

Comments:
Thank you for your assistance during today's unannounced renewal inspection conducted from 11:45 AM to 4:00 PM. Today, there were twelve children in care (thirty-seven points) with three caregivers. I viewed staffing, supervision, interactions with children, daily routines, equipment, posted information, five records for children, five records for caregivers/residents, caregiver training, emergency supplies and drill records, meals/snacks, diapering procedures, indoor and outdoor areas. The children have enjoyed a variety of age appropriate toys and activities. They enjoyed outdoor play during today's comfortable temperatures. The caregivers were observed responding to individual needs for food, comfort and care. Recommendation for issuance of a renewed license will be made after receipt of the final zoning approval. Feel free to contact me with any questions. 540/430-9259

Violations:
Standard #: 22VAC40-111-100-A
Description: Based on a review of five records for children, and an interview with the provider, there was not a physical examination record in the file for child 2. Evidence: There was a blank health department form for the physical examination report. There were only immunization records in the file.

Plan of Correction: The provider will contact a parent by text message and request the physical examination record for child 2. The physical examination record will be obtained for the child's file. The provider will continue to review all records for children at the time of enrollment and make sure the physical examination report is obtained in addition to the immunization dates.

Standard #: 22VAC40-111-120-B
Description: Based on a review of five records for caregivers/residents, and an interview with the provider, there was required information missing from the records of caregiver 2, 4 and 5. (Repeat Violation) Evidence: There was not any documented orientation training, dates of employment and position titles, background information regarding education and programmatic experience with the caregiver's records.

Plan of Correction: The provider took out model forms from the record storage area and began writing information regarding the orientation training that was completed for each assistant. The information regarding dates of hire, positions, education, and experience will be written on the staff information sheets for assistant caregivers.

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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