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Gita Kumar
5642 Powers Lane
Centreville, VA 20120
(703) 266-0223

Current Inspector: Nancy Radcliffe

Inspection Date: Oct. 14, 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 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.

Comments:
An unannounced monitoring inspection was conducted today from12:35pm-1:30pm. There were 10 children(25 points) directly supervised by 2 staff. The home, 2 staff records, 3 children?s records, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. Children were observed playing freely. Areas of non-compliance are identified in the Violation Notice. If you have any questions regarding this inspection, please contact the Licensing Inspector, Erika Gibson: erika.gibson@dss.virginia.gov 703-479-4686

Violations:
Standard #: 22VAC40-111-60-B
Description: Based on record review, all three children's records reviewed were incomplete. Evidence: 1. The parent's signed acknowledgement of the receipt of the Information for Parents form, Liability Insurance Declaration, Policy for the Administration of Medication form, and the Emergency Preparedness and Response Plan were not observed for Child 1, Child 2 and Child 3. 2. The doctor's information, the street address for the emergency contacts, the medical insurance information, and the medical insurance policy number were not observed documented for Child 2. 3. An annual update of the child's emergency information was not observed documented for Child 3.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-111-90-A
Description: Based on record review, before a child's attendance, the provider did not obtain documentation that the child had been adequately immunized. Evidence: Documentation of an immunization report was not observed for Child 3, who enrolled March 3, 2014.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-191-40-D-1-c
Description: Based on record review, the provider did not obtain documentation of a sworn statement or affirmation every three years from the date of last sworn statement for a caregiver. Evidence: The sworn statement or affirmation observed for Caregiver B was last completed on August 11, 2012.

Plan of Correction: Not available online. Contact Inspector for more information.

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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