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Dina Revollo
6526 Roosevelt Street
Falls church, VA 22043
(703) 241-3827

Current Inspector: Anansa Archer-Hicks (703) 268-3295

Inspection Date: Sept. 30, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
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.
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.

Technical Assistance:
**Discussed with the provider that she needed to ensure that she obtained the required paperwork for staff within the established guidelines, even it staff are still on probation or in the midst of a trial run. The day of their first day working as a caregiver is their first day of employment; therefore, all requirements for staff must be maintained/obtained at that time.

Comments:
An unannounced monitoring inspection was conducted today. There were12 children (30 points) directly supervised by 3 staff. The home, 1 staff record, 2 children?s records, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. Children were observed playing freely. Diapering 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 (keesha.minor@dss.virginia.gov) (703)479-4680

Violations:
Standard #: 22VAC40-111-120-B
Description: Based on review, the provider failed to ensure that assistants' records contained the required 2 reference checks prior to employment. Evidence: Reviewed 1 staff record and found that Staff 1 did not have documentation of 2 reference checks being completed prior to the first day of employment.

Plan of Correction: I will request the staff member in question to turn in two reference checks to satisfy the requirement. In the future, I will be more diligent in ensuring that the two reference checks are turned in prior to employment.

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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