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Ms. Audrey Stafford
10245 Sunset Lane
Unionville, VA 22567
(540) 854-5262

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

Inspection Date: Aug. 13, 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 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 children's records, records for residents, and playground equipment. The risk assessments for violations were provided. We talked about the wading pool use that is for grandchildren only. The pool must be empty when children are in care. Today, it was stored upside down. Please make sure rain water is removed promptly. Suggestions were made for the playground surface materials.

Comments:
Thank you for your assistance during the unannounced monitoring inspection conducted from 12:45 PM to 4:50 PM. Today, there were seven children and one resident child in care (seventeen points) with two caregivers. I viewed staffing, supervision, interactions with children, activities, daily routines, snack, equipment, diapering procedures, four records for children, five caregiver/resident records, two pet records, training, emergency supplies and drill records, indoor and outdoor areas. The children have enjoyed outdoor play activities during the pleasant summer weather. Regularly planned learning activities have been provided. Let me know if you need any assistance. 540/430-9259

Violations:
Standard #: 22VAC40-111-100-A
Description: Based on a review of four records for children, and an interview with the provider, there was not a physical examination report obtained within thirty days of attendance for child 1 (Repeat violation.). Evidence: Child 1 began attending on June 29, 2015 and there was not any medical information obtained for the files.

Plan of Correction: The provider will talk to the parent during pick-up time and arrange to obtain a copy of the physical examination report. The provider will track the need for records at the time children enroll and make sure the reports are obtained within the first month of attendance.

Standard #: 22VAC40-111-60-B
Description: Based on a review of four records for children, and an interview with the provider, there was incomplete written information for child 1. Evidence: The provider indicated that registration forms were not received for child 1, including authorization for emergency medical care. There was some written information with the files on a food program form and a sibling's record.

Plan of Correction: The provider will request and obtain the written emergency medical authorization and have the parent complete the regular registration information for child 1. In the future, the provider will require the forms by the first date of attendance.

Standard #: 22VAC40-111-80-B
Description: Based on a review of four records for children, and an interview with the provider, the age and identity of child 1 was not verified within the first seven business days of attendance (Repeat violation.). Evidence: There was not documentation of the viewing of a birth record or a copy of a birth record in the file. The first date of attendance was June 29, 2015.

Plan of Correction: The provider will speak with the parent during pick-up time and arrange to view a birth hospital letter or certificate. The provider will make sure new parents are required to show proof of age and identity with a birth record within the first seven days of attendance.

Standard #: 22VAC40-111-90-A
Description: Based on a review of four records for children, and an interview with the provider, there was not an immunization record obtained for child 1 by the first date of attendance. Evidence: The first date of attendance was documented as June 29, 2015. The provider indicated that she was aware that the child has had immunizations and the parent did not provide the requested record.

Plan of Correction: The provider will talk with the parent during pick-up and obtain a copy of the immunization report for child 1. In the future, the provider will communicate with parents of new children about the need for the immunization record by the first date of attendance.

Standard #: 22VAC40-111-170-A
Description: Based on a review of five records for caregivers and residents, and an interview with the provider, there was not a current TB screening and statement obtained for resident 5 who moved back into the home at the end of June. Evidence: The provider indicated that there were new family residents. Resident 5 was observed in the home after returning from work.

Plan of Correction: The provider will arrange to obtain a TB statement from resident 5. In the future, the provider will arrange to obtain all required records for adults living in the home.

Standard #: 22VAC40-111-500-C
Description: Based on observation of the outdoor play equipment, and measurements in the use zones, the perimeter of some of the equipment was less than six feet from obstacles and other equipment. Evidence: The two orange Little Tikes slide ladders, with a height of twenty inches, were positioned one foot and two feet from the fence. The airplan teeter-totter had seats which were two feet six inches from a play house. The blue slide with a height of sixteen inches was two feet from the Little Tikes composite structure and a toy box. The exit area of the pink slide of the composite structure, with a height of twenty-nine inches, was three feet from the outbuilding wall.

Plan of Correction: The provider started moving equipment to areas six feet from obstacles and other equipment. The provider will arrange for family members to assist with the movement of equipment away from obstacles. The play house will be moved away from play equipment. The provider will make sure the children play on equipment that is always six feet away from other equipment or structures so they can't fall against anything.

Standard #: 22VAC40-191-40-D-1-c
Description: Based on interviews with the provider, and observations in the home, and a review of five caregiver/resident records, there was not a sworn statement and background checks in the file for resident 5. Evidence: The provider indicated family members who moved back into the home at the end of June. Also, the former records were in storage or discarded and were over three years old. There was not a current sworn statement or affirmation, criminal history record and central registry check completed by the end of July.

Plan of Correction: The provider will arrange for resident 5 to complete a sworn statement this date. The request forms will be sent to the agencies in Richmond and the provider will obtain both background checks for the records. In the future, the provider will make sure all required background checks are maintained for all residents of the home.

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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