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(Under the authority of Executive Order 51, the Commissioner of Department of Social Services is waiving regulation 22VAC40-665-40.N which references the period of time for a redetermination of eligibility for the subsidy program. )

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Hiromi Waite
715 Fall Place
Herndon, VA 20170
(703) 371-4529

Current Inspector: Karen Dickens (571) 423-6978

Inspection Date: Oct. 6, 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
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.

An unannounced monitoring inspection was conducted today from 10:10am- 11:15 am. There were 8 children (16 points) directly supervised by the provider .The home, provider records, 4 children's records, 1 household member's records, evacuation drills, emergency supplies, and policies were inspected. Medications and authorizations were also inspected today. Children were observed playing "kitty" and searching for each other with flashlights. One by one children worked with the provider practicing Japanese characters and engaged in conversation. 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. If you have any questions regarding this inspection, please contact the Licensing Inspector 703 479 4746.

Standard #: 22VAC40-111-730-A
Description: Based upon observation, medication for a child was not kept in a locked place, inaccessible to children in care. Evidence: The provider showed the inspector that a child's epi-pen was kept in the child's backpack in the cubbies by the front door and was transported to and from school each day in attendance.

Plan of Correction: The provider will lock medication while the child is in care each day. Inspector suggested a self locking device so that the medication could remain in the backpack.

Standard #: 22VAC40-111-60-B
Description: Based upon review of records, required information was found to be incomplete or missing. Evidence: Child A's record did not state students first date of attendance Child B's record did not have an complete information for emergency contact #2. Child C's record contained a health form, however, the first page of the health form was blank and needs to be completed by a parent.

Plan of Correction: Provider will have parents complete required information.

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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