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Nuria Ibrahim
10625 West Drive
Fairfax, VA 22030
(703) 927-6170

Current Inspector: Margaret Allworth (703) 209-3521

Inspection Date: Aug. 18, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Household Members
22VAC40-111 Physical Health of Caregivers and Household Members
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
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

Technical Assistance:
Model forms given to provider: Emergency preparedness plan, Provisions of the Emergency preparedness plan, Information for parents, Child Enrollment form, Decision to administer medication. I do not have a copy of the Liability insurance disclosure form. Please down load one from the DSS web site at:

An announced Initial inspection was conducted today. By the end of the inspection, there are 4 children present (8 points) with one adult. 3adult and 2 children's files were reviewed. See violation notice from missing information. I recommend that you sign up for recall alerts from Consumer Product Safety Commission. ( If you have any questions regarding this inspection, please contact me at 703-479-4678. Two children are within 7 days of enrollment for viewing Proof of Birth documentation, and with in 30 for having a completed physical on file. Please begin using the DSS model forms immediately as the OFC forms do not contain all required information. I Will notify OFC that your license has been submitted for approval, as you will need to relinquish your permit. LI was present today form 9:25 AM - 10:50 AM

Standard #: 22VAC40-111-770
Description: There is no weather band radio available.

Plan of Correction: I will purchase a radio.

Standard #: 22VAC40-111-800-A
Description: There is no written emergency preparedness plan available for review.

Plan of Correction: I will complete the model form.

Standard #: 22VAC40-111-60-B
Description: Based upon a review of files, children's files are incomplete. Evidence: 2 of 2 files reviewed were missing: Parent's work information, Emergency contact information. (Children 1,2)

Plan of Correction: I will ask the parent to complete the DSS model form that contains all the required information.

Standard #: 22VAC40-111-70-A
Description: Based upon review of files, children's files doe no contain documentation of policies having been provided in writing prior to attendance. Evidence: 2 of 2 files did not contain documentation of having received all required information on the Information for Parents model form. Missing information includes but is not limited to: DSS web site, Custodial rights statement, termination policy, policy for the administration of medication, provisions of the emergency Preparedness plan, liability insurance disclosure. (Children 1,2)

Plan of Correction: I will complete the model DSS forms and have the parent sign the forms. They will be placed in the files.

Standard #: 22VAC40-111-90-C
Description: Based upon a review of immunization records, children's records are incomplete. Evidence: Children 1 and 2 do not have immunization records on file, prior to the first day of attendance.

Plan of Correction: I will ask the parent to provide the records.

Standard #: 22VAC40-111-240-B
Description: Based upon direct observation, one mattress in use has been recalled. Evidence: A mattress from IKEA (VYSSA) is in the crib and has been used. It must be removed from use immediately.

Plan of Correction: I will have a new mattress purchased today. I was not aware of the recall.

Standard #: 22VAC40-191-40-D-4-a
Description: Based upon a review of files, one adult file is incomplete. Evidence: Adult B does not have a signed Sworn Disclosure Statement (SDS) form on file. It is completed; however, it is not signed.

Plan of Correction: I will have him sign the form today.


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.

Virginia Quality is a voluntary quality rating and improvement system for early care and education facilities serving children ages birth through pre-K. Eligible child care facilities must be fully licensed, licensed exempt and a VDSS subsidy vendor, or a voluntary registered day home and a VDSS subsidy vendor. Only programs enrolled in Virginia Quality will display a rating. Virginia Quality contact information for your region is available at the following link Regional Contacts.


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